Thomas is 53 years old. He first started coming to the
clinic three years ago. He came with bronchitis; he smokes, and ultimately was
diagnosed with Chronic Obstructive Pulmonary Disease (COPD).
COPD is one of
the most common lung diseases. It makes it difficult to breathe. There are two
main forms of COPD:
- Chronic bronchitis, which involves a
long-term cough with mucus
- Emphysema, which involves destruction
of the lungs over time
Most people with
COPD have a combination of both conditions.
Smoking is the
leading cause of COPD. The more a person smokes, the more likely that person
will develop COPD. Of course, not everyone who smokes will develop COPD.
Thomas was seen fairly
frequently for bouts of acute bronchitis. He would be put on antibiotics and
sent on his way.
About seven
months ago, he began to complain of headaches and some dizziness. We did a
sleep study, thinking that he wasn’t getting enough oxygen at night. His sleep
study showed periods of decreased oxygenation overnight – and it was assumed
this was the cause for his headaches.
The headaches got
worse as did his shortness of breath. A chest x-ray was done which showed
“stable chronic changes consistent with COPD. No acute findings.”
In November he
complained of weight loss, fatigue and a lump on the right side of his neck.
Labs done were normal. The physician seeing him ordered a CT scan of his neck.
The CT scan showed evidence of carotid artery aneurysm, located in the area
where he felt the lump. The recommended follow-up was a MR angiogram in three
months.
Aneurysms happen when the wall of a blood vessel becomes
weakened and starts to dilate. The weakened area can balloon, causing the side
of the vessel to become very thin, and there is a risk that the aneurysm could
rupture, potentially causing serious medical complications. In the case of a
carotid aneurysm, the weakening occurs in one of the two carotid arteries which
run along either side of the neck.
He had the MR angiogram last week. It shows an aneurysm. The
radiologist recommended that he be followed up by a neurosurgeon. Of course,
there are no neurosurgeons in rural, southern Michigan. So, we try to get him
an appointment at one of the major medical centers. But, he is uninsured. He
cannot be seen until we get him qualified for their charity care program.
If the aneurysm ruptures, he may not die. He could have
“stroke-like” symptoms, requiring months, if not years of rehabilitation
services and medical care.
If he had insurance, and had access to healthcare, it is
possible that this could be easily treated – or at least treated – and he could
continue to live a productive life.
The lack of access to healthcare could cost him his life. If
the aneurysm ruptures, it will cost all of us as we provide for his long term
needs.
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