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December 11, 2008
Exam helps save Neenah doctor's life
Tom Rued knew to act fast after eye problem led to heart diagnosis
By Michael King
Post-Crescent staff writer
NEENAH — When Neenah optometrist Tom Rued had a brief blind spot in his vision a few years ago, he asked his colleague to perform an eye exam.
Today, Rued is convinced the exam, and the heart defect it ultimately revealed, helped save his life from one of the deadliest conditions known to the medical community.
On May 27, Rued and his wife, Julie, had just settled in at their Neenah home for a late dinner of Chinese takeout food after an exciting day watching their daughter's soccer game and their son qualify for the state golf tournament with his Neenah Rocket teammates.
After a few bites, his throat suddenly began to swell as if he were having some reaction. Chest pains followed soon and Rued, 49, told Julie she needed to drive him to Theda Clark Medical Center immediately.
En route to the hospital, Rued said the throat problem went away but the chest pains became more severe. It was then he realized "I had a much bigger problem" than a reaction to food.
The Iola native knew that time was of the essence because the eye exam nearly 10 years earlier led to the discovery of a bicuspid aortic valve. He did not know it at the time, but the congenital defect put him at greater risk of a aortic dissection or aneurysm, cardiac events with a significantly higher death rate than a heart attack.
Time critical to survival
While Rued's symptoms were virtually identical to a heart attack, inside his chest, his ascending aorta — the major artery leaving the heart — had swelled to six times its normal size.
As Julie drove him to the hospital, the throbbing chest pain worsened and he urged her to run red lights when there was no cross traffic.
From Theda Clark, he was airlifted to University Hospital in Madison.
"When I got to Madison, they said I had less than a half-hour to live," Rued said. "So every couple of minutes made a big difference."
Rued, an avid musky fisherman and outdoorsman, figures if he had been at his northern Wisconsin cottage when stricken, he would not have survived. It simply would have taken him too long to get to the expert medical care he needed.
"These are the scary ones for ER doctors or surgeons because they know they don't have a lot of time to prepare," Rued said.
High mortality rate
"This is a very, very high risk surgery," said Dr. Lucian Lozonschi, cardiac surgeon at UW Hospitals and Clinics, Madison.
Rued's "dissection was ready to rupture," he said. "The fact that he got there very early and still alive was great. Half of the people (with dissections) don't make it to the hospital. They don't even have time to call anybody."
In the case of a heart attack, there are ways to restart the heart if it stops beating. There is no such luxury with dissections.
"We've had patients rupture on the operating table as we were making the incisions," Lozonschi said. "You can lose a patient right in front of your eyes."
Besides the fatal risk of rupture, the surgery itself has "quite a significant mortality rate," said Lozonschi, who performed the eight-hour surgery.
Most elective open-heart surgeries have a 2 percent to 4 percent mortality rate but Lozonschi said repairing a dissection to an ascending aorta has a 10 percent to 30 percent mortality rate.
"This is the highest mortality of any known disease in the human body where timing is extremely important," he said.
Greater awareness
The medical profession has learned a lot since the tragic 2003 death of comic actor John Ritter, who died of an undetected aortic dissection.
"The big problem with these (aortic dissections) is they don't get diagnosed immediately," said vascular surgeon Dr. Matthew Mell, assistant professor of surgery, UW Hospitals and Clinics.
In Ritter's case, Mell said there "apparently was a delay in diagnosis and it took a while for him to get to the operating room and he died."
Dissections are a difficult diagnosis but the medical profession is getting better, and much better equipped, to pinpoint them. "These (emergency room) scans used to take an hour," Mell said. "Now, it's 30 seconds or a minute. That's really helped in making timely diagnosis.
"If a dissection ruptures in that location (ascending aorta), it's a fatal event," Mell said. "You can lose all your blood in a very fast time."
Rued had annual or bi-annual ultrasound scans of his heart valve over the past decade but no problems had surfaced. While he did not know anything about aortic dissections, Rued believes his insistence in telling emergency room personnel about his heart valve defect helped accelerate the diagnosis.
"There's a lot more awareness now and a lot they attribute to John Ritter's death," Julie Rued said. "It's like every minute counts."
To prepare Rued for the complex surgery, doctors cooled his body temperature down to 80 degrees and used drugs to shut down his brain and circulation.
Lozonschi surgically implanted a mechanical heart valve "made out of carbon covered with titanium" while his ascending aorta was replaced with a woven graft of synthetic material.
Exam found heart defect
"It all started with an eye exam," Rued said. While at his Neenah office one day, he "noticed a little missing area in my side vision" and asked colleague Dr. Wes Meyers to dilate his eyes and take a look. "He noticed there was an infarct and a small plaque in one of the peripheral vessels of my retina," Rued said. "That's got to come from somewhere. A larger plaque going into the brain is what a stroke is."
Since the microscopic piece of plaque found its way into Rued's optic artery, he wanted to know if he had a plaque problem clogging either his carotid artery or heart. Subsequent tests revealed the bicuspid valve defect.
"The dissection I had was very rare but the bicuspid valve is not nearly as rare," Rued said. "Some people live and die and never have an issue with them." But, he later learned, it is the second leading cause of dissection, behind only uncontrolled high blood pressure.
New appreciation for life
A classic Type-A personality, Rued has never been "a sit still with my feet up and watch TV type of guy" so the recuperation period was a definite challenge. He had to stop some of his favorite activities — fishing, golfing and bike riding — for a couple of months to allow his sternum to heal.
He will have to be on blood thinners for the rest of his life to prevent the artificial valve from clogging. "It's a small price to pay for being alive," he said.
By this fall, he was back doing virtually every thing but with a new perspective.
"It made me realize how fragile life really is," said Rued. "It's certainly made me thank God every single day that I'm here."
Additional Facts
At a glance
Aortic dissection: A life-threatening condition in which there is bleeding into and along the wall of the aorta, the major artery leaving the heart. A Type A dissection of the ascending aorta leaving the heart requires surgery before the aorta ruptures. Type B dissections begin in the descending part of the aorta toward the abdomen. Less than half of patients with a ruptured aorta survive. About 10,000 Americans annually are stricken with aortic dissections. Alternative name: aortic aneurysm – dissecting.
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