With 750 animals to care for on his 480-acre dairy farm in Oklahoma, David Boyer, 62, is used to being active. But heart troubles began slowing him down in 1994, the year he suffered a heart attack without knowing it or having any dramatic symptoms.
“I went some time without seeking medical attention,” he says. “My wife, LaNell, is a registered nurse and expressed her concerns about me to a doctor at work. He called and asked me to stop by the hospital so he could do an EKG. I did that, and it ended up I had suffered a heart attack. Some damage had already been done.”
From 1994 to 1999, he simply made lifestyle changes and took medicine for his symptoms. Then gradually, he started experiencing additional symptoms consistent with heart disease, with his main problem being a lack of energy. “Before my heart attack, I did a lot of physical work,” he notes. “I used to fill about 20 five-gallon buckets of feed at a time and go at it fast,” he says. “Then when the heart problems started, I got progressively slower at approaching physical tasks.”
Between 1999 and 2004, David had five stents inserted in arteries to keep them open, and in February, 2009, he underwent triple bypass surgery. All was well for about a year. Then David started feeling weak and developed chest pain that was unrelieved by nitroglycerin. In November of 2010 an arteriogram (an imaging test using X-rays and dyes to view the arteries) revealed that one of his grafted arteries had become blocked.
David had checked in with his cardiologist in Ft. Smith, Arkansas, which is about an hour’s drive from the Boyer’s home in Webbers Falls, Okla. The physician said that stents could possibly help open up the blockages in David’s arteries, but that he was not willing to risk compromising David’s kidneys, which have been impaired as a result of chronic glomerulonephritis (a kidney disease), which was diagnosed in 1972.
“I have a history of high potassium and kidney disease,” David explains. “The area that the doctor thought needed to be stented was in a difficult spot, and he anticipated that I’d need an increased amount of dye, since the procedure could be lengthy. As a result, my kidneys could possibly be compromised.
“The doctor felt the risks were greater than the benefits, and he placed me on medication to treat the chest pain,” David adds. “But I was not satisfied with the medication regimen because it didn’t relieve my symptoms.”
So David went searching for other options. “I was familiar with Cleveland Clinic because my niece’s husband had complex surgery there to replace his aorta,” he says. “I happened to click on Cleveland Clinic’s website and noticed a link to an online medical second opinion program called MyConsult.”
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 respected referral institutions. The secure, online program provides remote medical second opinions from Cleveland Clinic specialists for more than 1,200 life-threatening and life-altering diagnoses.
“I’m not very proficient with computers; so my wife filled in all the online forms for me and sent in my medical records,” David notes. “The economics of receiving a medical second opinion online was a big factor. For one thing, I could’ve gone all the way to Cleveland just to be told that my local doctor was absolutely right. Then I would have spent a lot of money – plus the days gone from the farm – to learn nothing more than I already knew.
“With the online medical second opinion I was able to make an informed decision without having to leave home,” he explains. “The online consultation also gave me time to think about having procedures and to talk it over with LaNell and my local doctors before making a decision.”
Keeping channels open
The Cleveland Clinic expert who provided David’s opinion was Russell Raymond, DO, FACC, FSCAI, an interventional cardiologist who specializes in high-risk coronary interventions, such as stenting, angioplasty and atherectomy. His recommendations for David included:
1. Trying a nitroglycerin patch
2. Changing blood pressure medications
3. Using an electro-stimulation device to shunt blood up the legs toward the heart
4. Placing stents in the area of the heart that was causing David the most trouble
“Dr. Raymond really impressed me,” he adds. “His recommendations were made in a way that I could clearly understand and make the choice, and he didn’t push me one way or the other. He said he’d certainly be happy to schedule an appointment for me in Cleveland. He was inviting and not intimidating.”
David decided to travel to Cleveland Clinic – with LaNell at his side – to have an on-site consultation. Meanwhile, his daughter managed the farm, where modern machines milk 250 dairy cows and where 250 beef cows and 250 sheep graze the fields.
“While waiting for my appointment with Dr. Raymond for two weeks, I tried making the medication changes and didn’t get any results,” he notes. “Dr. Raymond was detailed in explaining how he’d protect my kidneys during the procedure.
David’s angioplasty and stent placement at Cleveland Clinic was a success. “It was a pretty risky procedure,” he says. “After I returned home, I met with my cardiologist in Ft. Smith. He said he was glad I had it done, but that he wouldn’t have taken that level of risk. Ultimately, deciding to have the cardiac intervention was my choice, and I respect my local doctor for his decision and his support of my decision.
“Cleveland Clinic is a great place,” he adds. ““I’m well now. After my bypass surgery in 2009, I had a really good year. I’m getting close to that.”
David is also getting close to his dreams of continuing farming for more years to come. Once he fully recuperates, he should be back into action alongside his daughter and the employees who work the farm.
“I don’t hunt or fish and am not too interested in sports,” he says. “My only outside interest is being involved in church activities. So I don’t want to quit farming. My wife and I started this farm in 1978 when our daughter was 1 and our son was 8. We have five grandchildren, and three of our grandsons live here. They’re lots of fun and bring us lots of joy.”