My adventure with the health care system began on a very cold day in early March, 2009. I had just completed my first ½ marathon and, although I didn't set a record time, I was happy with the result. After the run, I returned home feeling tired and very hungry. I made myself a bowl of pasta and topped it off with a very generous helping of tomato sauce. At this point, I should say that this was not the smartest move on my part. Although I love tomato sauce, it doesn't love me and usually causes heartburn.

A couple of hours after eating my pasta, I started to feel a familiar burn just below my sternum. However, it felt more intense than it has been on previous occasions and I started to become a little bit concerned. My rational mind knew that I had consumed more tomato sauce than usual and therefore, it was only natural that the heartburn would be more significant. However, my irrational mind started to think that it might be something more serious. At that point, I decided to go to the hospital to get things checked out.

The staff in the Emergency Room were great when I arrived. I gave them all of the background information that they asked for (circumstances that brought me to the ER, my family history of heart disease (my father died of a heart attack at 48; my mother had a heart attack at 57; and my brother had a heart attack at 40)They took care of me very quickly, taking my blood pressure, HR, an electrocardiogram and then a blood test. All my vital signs were normal, and the ER nurse was joking with me, telling me that she'd be able to spring me once the blood work came back.

After a while, the ER nurse came back with a more serious look on her face and said that she was going to have to hook me up to the ECG. She said that the blood work had come back with "some abnormalities.".

An hour or so later, a doctor came to say that the tropinin level in my blood was slightly elevated, which indicated that I might have experienced a cardiac incident. The doctor said that someone from cardiology would be down to see me shortly.

Later that evening, as I waited in ER, the cardiology resident came to see me. She explained about the tropinin level being slightly elevated and that, as a result of my family history, it was consistent with a heart attack. That said, she thought that it might be possible that extreme exercise (like running a half-marathon) to cause the tropinin level to increase but that she would have to check with her boss to confirm that possibility. In the meantime, she took another blood sample from me and told me that she would check back as soon as she could.

In the middle of the night, the resident came back to me to say that her boss had confirmed that it is possible for extreme exercise to cause the tropinin level to increase and that, in fact, my subsequent blood test had shown that the level had already come down. She said that a cardiologist would come by to see me in the early morning to evaluate things further.

Early on the following day, the cardiologist, Dr. X., came to see me. He said that because of my family history, he would like to run a few tests to make sure everything checked out. Therefore, I was admitted to the hospital.

After a delay of one and a half days (a much longer story), I was taken down for a stress test. The technician explained that I was to walk on a treadmill until I reached a targeted heart rate. At that time, the technician would then inject me with a dye and diagnostic imaging would be done. After walking on the treadmill for about 9 ½ to 10 minutes, the technician called for the dye to be injected and then told me to stop walking on the treadmill. The images were then taken and I returned to my room.

The staff on the cardiac ward were joking with me when I returned to my room, and told me that they just had to wait for word from Dr. X so that they could discharge me. Time passed, and in the early evening, Dr. X came to see me in my room. He said that although the stress test showed that I was low risk for an incident, he also said that there was something about the test results that concerned him, and that he thought I might have some blockage in one of my arteries. He also said that he was troubled that I had had to stop walking at the 11 minute mark of the stress test. I told him that the technician told me to stop and that I could have kept going on the treadmill. Dr. X shrugged this off, and told me that he had scheduled me for an angiogram the following day. If the angiogram indicated any blockage, then an angioplasty would be performed at the same time.

In the late afternoon of the following day (day four of my hospital stay), I was wheeled downstairs for my angiogram. It indicated that there was no blockage in any of the arteries, but did show evidence of some myocardial bridging (where one of the arteries in the heart passes through the muscle), the doctor performing the procedure said that Dr. X might prescribe some medication for that. "But I'm fine, right?," I asked the doctor as I was lying on the table. The doctor laughed and said "I'll let Dr. X (the cardiologist) talk to you about that, but things look good to me."

Later that evening, Dr. X. came to my room to explain the results of the angiogram. While my arteries were clear, he explained that they had discovered some myocardial bridging. He said that he was going to prescribe a beta blocker to deal with the bridge. Dr. X. did not tell me the extent of the bridging, or how much of the artery ran through the muscle. He said that I could still exercise - biking and running - but that I shouldn't "overdo it." I asked him to clarify what that meant, and he said to not be "extreme" with my exercise. Since I like to race, I asked him again to clarify what that meant. He finally said that "you've had the bridging all of your life and it hasn't bothered you yet." Still no clear answer.

Dr. X. also said that, on the basis of my family history, he was going to prescribe both Lipitor and Ramipril. In discussing the cholesterol medication with Dr. X, I said that I was kind of surprised since my cholesterol was usually quite low and asked him what my reading was when he checked it. Dr. X said that he didn't know because he hadn't checked my cholesterol level. (When I finally returned home, I checked my most recent blood tests which showed an overall cholesterol was 3.66 and my LDL was 2.09).

When I was finally arrived home after a five-day stay at the hospital, I was quite discouraged. I'm a very active guy, and the thought of having to limit the scope of my activities and to be on medication for the rest of my life left me feeling frustrated. I wanted some answers in order to have a better understanding of what was going on with my health.

It was at this point that I consulted with Rupert Case Management. I provided Dr. Rupert with all of the reports from my hospital stay and he and his team immediately arranged a number of appointments in order to get a more complete picture of my heart health.

After taking a few weeks to recover from the hemmohrage and false aneurysm that occurred at the incision point of the angiogram, I was scheduled to take a stress echocardiogram. The results were conveyed to me within days and showed that everything looked normal.

A matter of days later, I underwent a cardiac MRI. I was pleasantly astonished as to how quickly I was scheduled for the procedure. Once again, the results came back within days and showed that everything was essentially normal.

I was very happy to hear this news, but I was also quite puzzled. The test results had come back normal and yet I was looking a future of being on heart medication for the rest of my life an having to limit my physical activities. I expressed my concern to Dr. Rupert, in that Dr. X had made the situation surrounding my myocardial bridging sound quite grave. Dr. Rupert contacted one of his colleagues in cardiac imaging to discuss the extent of my myocardial bridging.

Dr. Rupert's colleague responded that, in reviewing, my file, there was no evidence to suggest that the bridging was anything to worry about. In fact, he said he felt badly that Dr. X had given me that impression.

In order to put my mind at rest, Dr. Rupert arranged for me to meet with the head of cardiac imaging at Mt. Sinai Hospital to discuss my case. Dr. John Parker sat me down and told me that, after reviewing the images taken over the course of the various tests and procedures that I had undergone, he felt that the bridging was minimal and nothing to worry about. When I asked him about exercise and racing, Dr. Parker laughed and said "go do what you do. Knock yourself to pieces."

At the same time, Dr. Parker concurred with the findings of other medical professionals that Dr. Rupert had consulted that I should not be on any prescribed medication.

I'm now in the process of training for a duathlon (a race involving a 5 km run, followed by a 30km bike ride, followed by a final 5 km run) that will take place in a month. If I hadn't enlisted the help of Rupert Case Management, my life would have been a lot different. I will always be grateful for the excellent work that RCM did on my behalf.

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