Hope? Alexander Cooper wondered if he had any. He sat down heavily in his desk chair and sighed. A clock ticked on the wall. It seemed to be counting seconds off of his life.
Mr. Cooper (not his real name) is a forensic chemist. He works on criminal cases, like the forensic scientists you see on TV. But unlike the stars of "CSI: Crime Scene Investigation," Mr. Cooper is neither slender nor glamorous. He is morbidly obese. He smokes. And he has heart disease.
In September 2006, he went to a hospital in Chicago and had a cardiac catheterization. During a cardiac catheterization, a small thin tube is inserted through the blood vessels into the heart, enabling doctors to perform a number of tests that can tell them how a patient's heart is functioning. Mr. Cooper's heart wasn't functioning well. His coronary arteries were sclerotic, that is, narrowed by the buildup of fatty plaques. His doctors talked about treatments. They ordered blood-pressure lowering medications, and a blood-thinner. They proposed that he allow them to perform another type of catheterization procedure to clear significant blockages in his arteries.
Mr. Cooper was not about to make any quick decisions. As a forensic chemist, he knew that there was more than one way of looking at evidence. A second opinion could change the whole course of a criminal trail. In a capital case, it could mean the difference between life and death. . .
Suddenly, Mr. Cooper knew what had to be done. He stubbed out his cigarette, swiveled around in his chair, and began tapping on the keyboard of his computer. He went online to Cleveland Clinic's MyConsult website. The MyConsult® Online Medical Second Opinion program is a sophisticated, Web-based extension of Cleveland Clinic's 90-plus-year role as one of America's most respected referral institutions. The secure, online program provides second opinions from Cleveland Clinic specialists for more than 1,200 life-threatening and life-changing diagnoses.
Following the MyConsult directions, Mr. Cooper filled out the online questionnaires and had his medical records and test results forwarded to Cleveland Clinic. He had very specific questions for the Cleveland Clinic specialists. He asked what treatment the Cleveland Clinic specialists would recommend; whether he should have interventional or pharmaceutical treatment; and, finally, he wanted to know, "Is there any hope?"
Mr. Cooper's records and tests results were carefully reviewed by Christopher Bajzer, M.D., a top cardiologist in Cleveland Clinic's Heart and Vascular Institute. Dr. Bajzer believed that Mr. Cooper had received thoughtful care in Chicago. But there was reason for concern. From reviewing the records, Dr. Bajzer could see that the patient had every known risk factor for the development and progression of severe atherosclerotic vascular disease.
Mr. Cooper's father and grandfather had both died young of heart disease. He smoked. He was morbidly obese. He had high blood pressure, and significantly elevated LDL cholesterol. Plus, he had type 2 diabetes - an adult-onset condition associated with obesity, poor diet and lack of exercise.
Mr. Cooper's test results showed blockages in the blood vessels that wrapped around the outside of the heart and fed its demanding musculature. The blockages were scattered all around Mr. Cooper's heart. Some of them were awkwardly placed. They would be hard to treat by any interventional method.
Indeed, Mr. Cooper had been treated for coronary artery disease back in 2000. He'd had a blockage cleared and a stent implanted (a stent is a tiny, cylindrical scaffold erected inside a cleared coronary artery to keep it open). Unfortunately, the stented area was starting to block up again, too.
Dr. Bajzer carefully studied each of Mr. Cooper's coronary artery blockages and assessed each one in terms of its potential for treatment. From what he saw, he could not recommend coronary artery bypass. He did not rule out clearing some of the remaining blockages using a catheterization procedure. But he doubted that doing so would have much long-term benefit. In the case of one artery (the already stented one), further treatment might even do harm. The patient had asked about "hope," and Dr. Bajzer found some. The heart's left anterior descending artery was clear. This is a critical artery, so much so that a blockage here is sometimes called "the widow-maker."
There was no sign of valve disease, and Mr. Cooper was not having any chest pain or shortness of breath. But the best news of all was that many of the factors that were contributing to Mr. Cooper's disease were highly modifiable. That is to say, they could be changed through the use of proper medications and aggressive changes in Mr. Cooper's lifestyles and habits.
Dr. Bajzer compiled a detailed report on all that he had seen in Mr. Cooper's medical records and test results. He described to Mr. Cooper the condition and potential for treatment of each of his coronary arteries, and explained what all of the numbers and outcomes of his tests really meant in terms of his condition. He wanted to make sure Mr. Cooper perfectly understood the seriousness of his case. Finally, he gave him the hope he had been asking for. The report was provided to Mr. Cooper through the secure MyConsult online portal.
Mr. Cooper could take immediate steps to affect his condition. He needed to stop smoking, exercise regularly, and make drastic changes in his diet. Further, in his report, Dr. Bajzer recommended that Mr. Cooper ask his doctors about statins. These are drugs that can lower cholesterol and actually reverse the build-up of plaque inside the walls of coronary arteries if taken in large doses. In short: medication and intensive lifestyle changes. This was the hope that Mr. Cooper sought when he asked for a second opinion from Cleveland Clinic.
After completing his second opinion report, Dr. Bajzer gave himself over to his own moment of hope. He hoped that this patient would follow his advice, get statin therapy, and change his lifestyle for the better. He hoped that Mr. Cooper wouldn't follow his father and grandfather into early mortality. He hoped that, thanks to MyConsult, Mr. Cooper would continue to enjoy life, and serve society as a chemist and crime-fighter for a long time to come.