Dear Dr. Roach: My good childhood friend recently passed away from a hemopericardial aortic dissection at the age of 45. He suffered for days and was in and out of the hospital during this period, complaining of abdominal pain with some rectal bleeding. They looked at his gallbladder and appendix and sent him home twice with pain meds. He died in his sleep following his second trip to the emergency room. My question is: Would an EKG show an abnormality in this situation, as no imaging was ever done of the thoracic cavity? Could rectal bleeding have thrown off the doctors? An autopsy determined the cause of death.
Anon.
I am sorry to hear of your friend. Unfortunately, aortic dissection is an emergency that is sometimes hard to diagnose, and even when a diagnosis is made, it has a high mortality rate.
The aorta, the largest blood vessel in the body, comes off the left ventricle and goes all the way down to about your bellybutton, where it divides into the femoral arteries. Like all arteries, it has three layers, and when the innermost layer (the intima) is torn, the blood can propagate along the space, tearing the intima from the middle layer, the media. In most people, there is a sensation of tearing chest or back pain. The pericardium fills with blood about a quarter of the time (that鈥檚 called a hemopericardium).
An EKG is useful in that it can show a lack of evidence for a heart attack, with which dissection is often confused. The diagnosis can be made by CT, MRI or a special echocardiogram done through the esophagus. Unfortunately, if you don鈥檛 think about it, you won鈥檛 find it. I think the rectal bleeding probably did mislead his doctors, as did his young age. Most people with this condition are over 60. It鈥檚 possible your friend had a collagen disease, such as Marfan鈥檚 syndrome, which predisposes a person to this condition. So can inflammation of the blood vessels and some congenital abnormalities.
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Dear Dr. Roach: The last two times my husband consumed nutmeg, he experienced severe stomach pain lasting up to 24 hours. He describes it as a broad ache that prevents him from getting comfortable. This last time, he vomitted. I am wondering if you think it is just coincidence and that he just happens to eat nutmeg before he comes down with a virus, or if there is some nutmeg allergy that can cause these symptoms. His symptoms kicked in about an hour after he consumed the nutmeg in a slice of banana bread, and there was no rash or swelling or anything, just indigestion and stomach pain. The other time it was in oatmeal. He is allergic to nuts and avoids them.
Anon.
Food allergies are highly variable from person to person, and nutmeg allergies are uncommon. Most cases of food allergy have more than just gastrointestinal symptoms like pain and vomitting, such as a rash, and runny eyes or nose.
Unfortunately, I can鈥檛 really say for sure. It could be an allergy to nutmeg, or a reaction to something else. The fact that it happened within an hour of eating suggests that it was something he was eating that he is reacting to, but it doesn鈥檛 necessarily mean an allergy, nor that it is due to nutmeg. I think I would still avoid nutmeg in the future, though.
Nutmeg, by the way, isn鈥檛 a nut, and most people with nut allergies have no trouble with it.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or write him at P.O. Box 536475, Orlando, FL 32853-6475.
