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Chest Pain/Blocked Arteries, Transradial Heart Catheterization

Joe Carroll 620

Documented: May 2012

After law school, West Chester native Joseph Carroll devoted the next 36 years of his life to law enforcement in Chester County, including 10 years as District Attorney. In 2011 - a month before his retirement - Mr. Carroll had a short stay in The Chester County Hospital. In a 2012 interview with Synapse magazine, he shares the impact of this life-changing event.

It's Ash Wednesday -- the first day of the holy season of Lent -- a time of reflection and remembrance that life on Earth is finite. It's also a perfect day. The bare trees are a reminder it's February, but the breeze carries hints of spring. Even amidst the mild winter of 2011-2012, this day is a warm surprise.

A year ago, Joe Carroll would have been long on the job by 11:30 am and may not have noticed a delightful day unfolding. His work as District Attorney was all consuming, allowing precious little time for anything else. Today, he is relaxing at home, with time to spare for an interview.

Joe is well accustomed to interviews about crime cases and their investigation, but today the case being discussed is more personal. The would-be victim is Joe himself, and the assailant is a heart attack waiting in the wings. The villain was disarmed December 7, 2011 during a cardiac catheterization procedure at The Chester County Hospital. Joe was lucky, and he knows it. He seems happy to tell his story, which begins with some historical context -- and a prop.

"I found a visual aid," he says, as he reaches for a small bronze plaque on the windowsill behind where he is seated at his dining room table.

"Now that I'm retired, I go through every drawer," he explains. He finds things long forgotten, some to keep and others to toss. The plaque is a keeper. It's from a Philadelphia Marathon he ran in 1978, when the event was known as the Provident Bank Philadelphia Marathon. He placed 46th in the race.

"Forty-sixth doesn't sound that great," he admits. But, 46 out of 15,000+ runners is nothing to sneer at. He continues his story.

"I've always been a runner," he says.

It is clear that running is an important thread in Joe's life, and that athletic competition has long been a source of motivation and energy. He's been hooked on fitness since he was young. Even the 24/7 demands of his job as chief law enforcement officer of the county could not crush his exercise habit.

"I've always enjoyed sports," says Joe. "I ran in high school, in college and after college. I also played a lot of basketball and was a pretty good swimmer," he says. His love of athletics continued after law school, but his responsibilities at the District Attorney's office and at home, where he and his wife were raising twins, meant less time for sports.

"The easiest one to continue was running," he says. "You don't need to get a gang of people together. You just put on your shoes, step out the door, and go."

Joe continued to run over the years and to compete in races, including a second marathon in 2004. He prefers 10K and half marathon races to 26.2-milers and estimates that he's competed in at least 150 half marathons, although none in the last few years. For a number of reasons, his running dropped off from 2008 through early 2011. In late summer 2011, he decided to get back into it.

"I started to try to run a little harder and more regularly," says Joe, "but I was getting intense pain in my chest. It would come on quickly, within the first half mile or so." The pain forced him to slow down or walk for a while before picking up the pace again. He chalked it up to being out of shape. "I just figured, OK, I'm 62. This is what happens when you're older."

Over the next few months he kept at it, but the pain persisted. "My times were getting faster," he says, "but the pain was still coming on early, and it was scaring me."

About the same time he picked up running again, tragedy struck during the 2011 Philadelphia Marathon. Two men -- one 21 and the other 40 -- died running the race, both from apparent heart attacks. The news was a wake-up call for Joe. He recalls thinking, "If I were younger, I would just run through this pain. That's what I used to do. But that's probably a bad idea now." He decided to have it checked out.

On December 6, Joe saw his family physician, Brandt Loev, DO, at West Chester Family Practice. Because Joe had been athletic most of his life, Dr. Loev immediately recognized Joe's symptoms as a change for him. Dr. Loev was able to get Joe an appointment later that day with interventional cardiologist Joseph Lewis, MD, who is a partner at Chester County Cardiology Associates.

"Dr. Lewis happens to be a runner too," says Joe, "so we immediately hit it off." When evaluating Joe's symptoms, Dr. Lewis delved into specifics about his running -- What were his best times? What times was he doing now? How did he feel while running? How did his symptoms now compare to the pain he would get when he was younger?

Understanding the unique situation that Joe was in -- he had new and worsening chest symptoms while he was running but he was still able to run -- Dr. Lewis was concerned that Joe might "pass" a cardiac stress test because of his athleticism. He recommended not doing a stress test but, instead, doing a cardiac catheterization the following morning. He felt something was going on in Joe's heart that needed to be checked out sooner rather than later. Joe agreed.

During the remainder of the appointment, Dr. Lewis reviewed the procedure with Joe. He explained that he would ideally insert the catheter in an artery in Joe's wrist rather than through an artery in his groin, because this would allow for less bleeding and a quicker recovery. He also reviewed problems that might be found in Joe's heart and what options he would have in treating them.

Joe remembers Dr. Lewis saying it was possible he wouldn't find a problem, but he suspected that he would.

Dr. Lewis' suspicion was confirmed. The next morning, he discovered two significantly blocked arteries to Joe's heart -- one 99% blocked and the other 90%, as Joe recalls. Dr. Lewis was able to open the arteries and place a stent in each of them to ensure continued blood flow to Joe's heart. The entire procedure took less than two hours.

"Both arteries were very amenable to fixing with stents," says Dr. Lewis. "We fixed the first one through the wrist, and it went well. We were then able to proceed with the second one." An echocardiogram to look for evidence of damage to the heart muscle showed that there was none.

As is standard procedure at the Hospital when cardiac catheterization leads to interventions to restore coronary blood flow, Joe spent the night at The Chester County Hospital and went home the next day. Monitoring for any post-procedure complications or bleeding problems is important, even though these are highly uncommon events.

"The wound on my wrist healed very quickly, and I had no negative after effects whatsoever," says Joe. What he did experience, however, was a dramatic transformation. It was as if the odometer on his heart had been reset.

"Within an hour after the procedure, I felt like I had more energy than I've had in years," he says. "I also realized how much residual discomfort I had been feeling in my chest even at rest. Suddenly, it was gone."

His resting heart rate also dropped to what it was decades earlier. (He admits that, being a bit of fitness geek, he's compulsive about checking his pulse.) "I know what my pulse should be, and it's usually in the high 40s," says Joe. "But, it had been drifting up and had gotten to about 80 before I saw Dr. Lewis." After the procedure, his resting heart rate was back to 45.

As soon he was cleared to return to exercise, Joe went out and did some easy running and felt fabulous, as if 10 years had been taken off his body. "It's unbelievable," he remarks. "It's so great to have the energy back and the ability to do things physically that I couldn't do years ago."

Because the problem came on gradually and he didn't know what to expect with age, Joe thought it was normal, that it was simply getting harder to run as time went by. "I didn't realize I had a problem, that I wasn't just getting older," he says.

Joe wasn't thinking about heart disease, even though he has a strong family history of it. "I thought my physical activity was protecting me somewhat, and perhaps it was," he says. "It helped me discover I had a problem before I had a heart attack. And, maybe it's why I was able to bounce back within hours. Overall, my heart muscle was in good shape. It was just the blockages causing trouble."

The dramatic improvement in Joe's energy and endurance could not have come at a better time. At just seven weeks into retirement, he has just begun the next chapter of his life.

So what's on his agenda now?

Certainly not sitting on the couch. Joe admits being hardwired for public service, a trait his parents strongly influenced. He says, "My parents always preached the idea that you don't measure your success in dollars. You measure it in what you've been able to do for people."

At the moment, Joe is focusing on family, volunteer work, and some personal projects. He's on the Board of Directors for the Crime Victims Center of Chester County and the United Way of Chester County -- two agencies doing important work he wants to support.

Joe says that in addition to getting regular exercise, he is taking a cholesterol medicine and trying to improve his diet. He jokes that he probably still eats too much pizza but he'll find out soon how he's doing. "I had a blood test, and I continue to see Dr. Lewis to get the results," he says.

And what were the results? Dramatic improvement, says Joe. He reports that his "bad" cholesterol has dropped from 175 to 98 and his "good" cholesterol has jumped from 35 to 50.

He's back to exercising virtually every day and has no limits on his activity, no chest pain, and no shortness of breath. Of course, he's keeping track of his pulse rates and running times. Resting pulse rates are where he wants them to be, and running times continue to improve.

And, one final note: he says that as much as he has enjoyed his brief introduction to retirement, he's going back to practicing law in the Chester County office of a Philadelphia law firm. Joe says the decision to begin working again so soon is a direct result of how good he feels following his heart procedure.

He says, "I have much more energy and even feel more mentally alert. Now, I have energy to burn, and I'm looking forward to it."

By Debra Dreger

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