A neurosurgeon’s (and heart patient’s) message to the community
Hyannis Neurosurgeon Paul Houle, MD, FAANS, is the first one to admit that his experience with cardiac disease is a cautionary tale. In fact, he says, he is probably lucky to be alive.
He also claims he is fortunate to have been cared for by the cardiac team at Cape Cod Hospital. When Dr. Houle’s latest cardiac event happened early in January, and he needed a cardiac catheterization, he said the thought never crossed his mind to go anywhere else for care.
“I put my money where my mouth was,” he said recently. “(The care) is good enough for me and it’s certainly good for the community.”
Dr. Houle’s journey into the world of cardiac care began about seven years ago. Always an active, fit man who has taken part in many outdoor and indoor sports, as well as intensive workouts all his life, he had just returned from a fishing trip off Venezuela. He got off the plane on a Saturday and drove to New Hampshire to join his family on a ski weekend.
The family returned the next day and Dr. Houle played in his regular men’s hockey league that night. That’s when the heart pain started, and he went to Cape Cod Hospital to have it evaluated.
“There were some findings, but they weren’t sure I needed a catheterization,” he said. He was sent to a Boston hospital for a cardiac MRI stress test (a test that is now done at Cape Cod Hospital through the Cardiac Imaging Program.) “After that, we decided I should get a stent (in a blocked artery) and I was fine.”
Dr. Houle, 55, was then placed under the care of Hyannis Cardiologist Mallory Hatfield, MD, FACC, but admits he was not good about keeping up with regular check-ups, either with her or his primary care physician. And his heart problems caught up with him again.
A Second Bout
Two years ago, he returned from another fishing trip and was in his home gym working out on the elliptical machine when the chest pains started again.
“It just happened that I was establishing with a new primary care physician, and he said, ‘you really should go back and see your cardiologist’” said Dr. Houle. “I hadn’t seen Dr. Hatfield for a couple years.”
He set up an appointment with her for later that week and continued to feel unwell overall. Dr. Houle, who is recognized as an expert in his field and lectures on specialized neurosurgical procedures around the U.S. and even overseas, was scheduled to give a lecture in Florida the day after his appointment with Dr. Hatfield.
The night before he was to meet with her, to dispel any thought in his mind that he was being a “hypochondriac,” he went back on the elliptical machine and very quickly developed classic heart attack symptoms – chest pain, jaw and arm pain, and shortness of breath.
At his appointment with Dr. Hatfield the next day, Dr. Houle told her about the previous night’s episode and he said she looked at him in disbelief that he had not taken it more seriously.
“She told me I needed a CT angiogram of my heart, and I told her I would do it when I got back (from the Florida lecture), and she said, ‘no, you’re going now,’” he said.
“So, the hospital scheduled me for an angiogram. The next thing I know, they pulled the curtain back and a team of cardiac experts was standing there. That’s when I knew something was wrong.”
Quickly taken to the hospital’s Cardiac Catheterization Lab, Dr. Houle had a procedure to address what is known as a ‘widow maker’ – a blockage of the largest artery in the heart, the left anterior descending artery, which supplies about half of the heart muscle’s blood supply.
“They actually found a ruptured plaque with a blood clot, and had they waited, I probably would have died,” Dr. Houle said.
The Latest Episode
But that is not the end of Dr. Houle’s tale. Over the recent Christmas break in December, he and his family went north to ski and he said he felt fine. He continued to work out three or four times a week and worked out on an exercise machine two or three days a week. “So, I’m pretty active. No problems,” he said.
When the family returned home on New Year’s Day, he was anxious to get back on the exercise machine, but when he did, the chest pain returned.
“It was so bad, I actually took nitroglycerin (a medication he had been given in the hospital to stop the pain while waiting for the catheterization two years earlier), which I never do.”
The next day, Dr. Houle was at Cape Cod Hospital and was walking from the intensive care unit to Mugar 6 to check on a patient. “When I do that, I always take the stairs for more exercise,” he said. “But by the time I got up to Mugar 6, I couldn’t breathe and had chest pain.”
Dr. Houle said he completed his patient notes and was still feeling off but wondered again if he was imagining the pain or the severity of it. After walking around the hospital, the chest pain and shortness of breath started again and he went straight to the ER.
The ER and cardiac team jumped into action, as is always the case with patients presenting with chest pain or other heart attack symptoms. Blood tests showed elevated troponins, a type of protein only present in the heart during a heart attack. Dr. Houle underwent another cardiac catheterization.
A cardiac MRI, done at Cape Cod Hospital this time by Cardiac Imaging Specialist Tendoh Timoh, MD, FACC, showed an inflamed area of his heart muscle. He was ultimately diagnosed with acute coronary syndrome, an umbrella term for blockages in the heart.
Dr. Houle’s condition can likely be controlled with strict adherence to his medications and paying more attention to how hard he pushes himself physically. “This means the extreme exercise things I was doing, I shouldn’t be doing. Nor do I need to anymore,” he said.
Two Important Messages to Readers
Dr. Houle said his heart condition was likely caused by “bad genes” and “longstanding untreated hypertension,” which is one of the messages he is eager to share with others: Get regular health check-ups so that high blood pressure or other issues can be caught early and controlled.
“Whenever I broke a bone or had a fishing wound that got infected, and every time I came to the hospital, my blood pressure would be high, and everyone, including myself, just assumed that was because I was in pain. But, in retrospect, I really was hypertensive.”
Dr. Houle believes he had gone nearly a decade with untreated hypertension, leading to the constriction of the small blood vessels in his heart that deliver oxygen to the heart near the end of the vascular system. The treatment is maintaining healthy blood pressure through medication, diet, stress management and a reasonable level of regular exercise. While he has followed a diet that emphasizes plants for some time now, regularly exercises, and has healthy cholesterol levels, Dr. Houle said he had fooled himself into thinking a heart attack could never happen to him.
“They talk about how hypertension is a silent killer. I didn’t go to the doctor, I didn’t pay attention to my health. I was never sick and so never went to my primary care doctor. I thought I was young and then all these thing happened,” he said.
The other message Dr. Houle wants to convey to the community is the trust he had for his caregivers at Cape Cod Hospital throughout his ordeals. After his most recent heart catheterization, he said it occurred to him that he had never even questioned whether he should be treated locally.
“It never crossed my mind to go to Boston, but it crossed my mind later as to why it didn’t cross my mind to go to Boston,” he said. “I have the knowledge and I have the contacts to go anywhere in the world to be treated. If I had insisted on going to Boston they wouldn’t have hesitated to send me. I chose to stay because I trust my colleagues, I trust the system and I knew I would get fantastic care, and I did. The ER staff was absolutely phenomenal, the nurses on North 3 (where he recuperated) were absolutely phenomenal. And, while I don’t remember much about the catheterization, everything worked out perfectly.”
Dr. Houle’s recent experience demonstrated to him how important and valuable the entire team of caregivers is to a good patient outcome. The system insures that while members of the medical staff may come and go, the team will carry on with the same expert care.
“We have in this community really great physicians that we trust. I choose to get my care here,” he said.
