A Country Doctor Writes:

Jack Frommer has been my patient since last fall. He has high blood pressure and high cholesterol and he had a small heart attack six years ago.

Jack hates to take pills, and that was one of our topics when I first met him. He needed some changes in his regimen, based on his history, lab work and physical exam.

We had a lot of ground to cover in that first visit, but I don’t remember feeling particularly rushed. Other than his blood pressure, his cardiovascular exam was normal. I re-read my notes the other day. His heart sounded regular without murmurs, his neck veins weren’t engorged, his carotid arteries didn’t have bruits, and the pulses at his ankles were good and strong. I remember him pointing out as I listened to his neck that nobody had done that before.

His three-month follow-up was encouraging. His cholesterol had dropped below his target level with the new medication I had prescribed, and his blood pressure was almost normal. I spent some extra time on his smoking and the importance of taking aspirin.

I didn’t do much of an exam that day because it was a brief visit with a lot of numbers to talk about.

At his six-month follow-up all the numbers looked good. We talked about the 3-4 cigarettes he was still smoking. I listened to his lungs and repeated his cardiovascular exam.

Suddenly, there it was: A loud, harsh scraping bruit in the lower portion of his right carotid artery.

An ultrasound suggested a stenosis greater than 80% and an MRA clinched the deal. Within weeks, Jack had surgery to remove the buildup in his neck artery.

In follow-up he and his wife showered me with praise for saving him from a stroke by listening and noticing the abnormal sound in his carotid artery.

I felt humble. I had not heard it the first time I listened.