OT: Aortic Dissection (What Juwan Avoided)
Please remove from the board if this is too far OT between an amazing Rose Bowl and a chance at a national title, but Jason Torchinsky of The Autopian (formerly of Jalopnik) had an Aortic Dissection, survived (only 3 in 10 patients do) and wrote about it well:
https://www.theautopian.com/what-it-feels-like-to-have-your-aorta-explode-and-almost-die/
Juwan did NOT have a dissection. What the doctors found with Juwan was an aortic aneurysm, a weakening in the tissue that had not yet ruptured. If that aneurysm was not repaired, Juwan would have been at high risk of a dissection in the future. Get your tickers checked!!
January 3rd, 2024 at 10:32 AM ^
I gather The Autopian is the trade journal of those who perform autopsies?
January 3rd, 2024 at 1:54 PM ^
Would make more sense than the auto-enthusiast site it is.
A rather tortured portmanteau of "Automobile" and "Utopia", I believe.
January 3rd, 2024 at 10:39 AM ^
I am not quite 50 and, as some of you are aware, I have been in the hospital because of my ticker, if you will, twice already over the last several years. Please do mind them on occasion. I can attest to this personally.
January 3rd, 2024 at 10:44 AM ^
I'm curious how this is found. I have a family history of heart attacks related to high cholesterol, not structural abnormalities -- something that can ostensibly be controlled by meds and lifestyle changes. The most basic tests for that are blood work, stress test (not routine), and an optional calcium heart scan that most insurance does not cover, though it's not expensive. But it isn't until you have symptoms of distress that docs would do a more extensive work up. Are there signs one might look for before it would become an issue that needs immediate treatment?
January 3rd, 2024 at 10:55 AM ^
Usually found by accident on a CT scan for something else (like a chronic cough or shadow on a chest x-ray). If there is family history of aortic complication, chest CT is the appropriate screening test. CT for calcium scoring will show part of the thoracic aorta.
Aneurysms don't cause any symptoms until they tear. Then it's an emergency.
This is different from heart attacks. Those are due to atherosclerosis (hardening) in coronary arteries (blood supply of heart, itself).
January 3rd, 2024 at 1:18 PM ^
A good friend of mine who was a serious jock and ran five miles every day had an aortic dissection on the way home from a run. He unfortunately did not survive. He was in great shape and in his early 60's.
As someone suggested, for heart disease, at least atherosclerosis, a coronary calcium CT can be very worthwhile. You may need a referral but it is a very quick test. I had one recently and it is non-contrast and can easily be done at lunch hour. If you have a family history if heart disease, it is worth being checked.
Ditto for colonoscopies for at the very least sending the box in for colon cancer. The prep is not a lot of fun but bearable and way easier than surgery/chemo or worse. Don't ask me how I know.
January 3rd, 2024 at 3:22 PM ^
As I mentioned below, my insurance didn’t cover this but it cost me $60. Made me wonder why other CT scans are so much more expensive than this one.
January 3rd, 2024 at 10:57 AM ^
Probably a CT scan but they are also doing more advanced MRI work now. Cardiac Ultrasound can be a good a relatively inexpensive screening. No radiation with ultrasound or MRI. They can be dormant for years and then catastrophic….or remain dormant
You might be out of pocket unless you have noticeable conditions and you may need to just ask for the tests. Ask your doctor obviously but also insist on going somewhere where the equipment is modern.
January 3rd, 2024 at 10:58 AM ^
If anyone in your family has had an aortic aneurysm, then it’s recommended that you get screened - often with a MRI. If you’re a male over 50 with history of smoking, an abdominal ultrasound is recommended for screening for abdominal aortic aneurysms.
Those recommendations are to screen for aortic aneurysms, which are technically different from aortic dissections. There isn’t a recommended strategy for screening for primary prevention of aortic dissections that I’m aware of.
January 3rd, 2024 at 11:29 AM ^
My uncle died from an aortic aneurysm. I was wondering about getting checked myself so thanks for asking. Although seeing that I will probably pay out of pocket I'll put it off. Can't afford to spend money on that now. Yay.
January 3rd, 2024 at 11:32 AM ^
Most insurances will cover it for a family history of aortic aneurysms.
January 3rd, 2024 at 12:03 PM ^
That is correct, and you can do ultrasound studies (echocardiogram for the chest, AAA scan for the abdomen) if you don't want the radiation/IV contrast
January 3rd, 2024 at 11:56 AM ^
With a family history or if you have a connective tissue disorder (ie marfans) you would be followed with routine CT scans. A CT scan can pick up an aneurysm anywhere (there are really three spots: ascending aorta, descending thoracic aorta, and abdominal aorta where they can occur). If you just have an ascending aorta aneurysm you can follow them on echocardiograms (cardiac ultrasound). They are almost always asymptomatic until too late but thankfully far more rare than something like a heart attack.
January 3rd, 2024 at 5:25 PM ^
In one of Phil Martelli's interviews with Sam he implied that Juwan could tell something wasn't right and got checked.
January 3rd, 2024 at 10:52 AM ^
Aneurysms run in my family (grandfather died of one and father has one)
At age 45 I had a calcium score done, aortic MRI, and abdominal aortic ultrasound. I’m perfectly fine but at least now I have baseline for my doctors to reference in the future
that’s about all you can do. we’re all gonna die, no one gets out alive. Just a matter of preventing the most preventable
January 3rd, 2024 at 11:19 AM ^
No aneurysms in the family that i'm aware of, but we have heart conditions.
My grandfather and father had heart attacks at 49 yo. Grandfather's was fatal, father's was not, but the rest of his life involved treatment for heart disease. (fortunately he lived 42 more years and it wasn't his heart that took him out at the ripe age of 91)
Talked to my doc about all this, his reply was "This is why we do bloodwork every year. Your cholesterol numbers have been good and as long as they are, you're in good shape."
January 3rd, 2024 at 10:55 AM ^
Family med doc here: we don't routinely screen for thoracic aortic aneurysms, although if there is a family history or reasons to be concerned, a cardiac echo would pick up most of those.
For abdominal aortic aneurysms, we can sometimes getting a screening test covered depending on risk factors. For $99, it's also the most worthwhile of all of the tests they do with those Life Line Screening events that happen all over the place
January 3rd, 2024 at 11:19 AM ^
Unfortunately, thoracic aortic aneurysms, particularly in the absence of coronary artery disease, are often asymptomatic unless they push against something. Dissections can happen in the absence of an aneurysm. The gravest complication of a large aneurysm is rupture-thoracic aneurysm rupture is usually fatal. The aortic root (ie aortic valve and the beginning of the aorta, aka sinuses of Valsalva) is often involved as well. Replacement of the ascending aorta with a graft is relatively straightforward if the aortic arch is ok, which unfortunately is often not the case.
Sorry for the detail. Juwan is lucky. His tall stature may have generated an echo. There are genetic conditions in tall people (Marfan’s, Loeys-Dietz to a lesser extent) in which people are predisposed to aneurysms, and aortic sizes are routinely assessed. I have no idea if he has that or not-FWIW he does not look Marfanoid to me. I am glad he is well! There are good surgeons at U of M:)
January 3rd, 2024 at 11:30 AM ^
Besides the tests mentioned by others, an echocardiogram is prudent. Combined with a nuclear stress test and a heart CT looking at calcium.
January 3rd, 2024 at 11:58 AM ^
A cardiologist recommended I do a calcium CT scan 6 years ago. I had never heard of it. I had to pay out of pocket but it was $60 -- I think money well spent. I recently asked my primary care doc if I should get another one and she said sure, so I got one at my own expense again. I'm wondering why, since it's relatively cheap, it's not more prevalent or part of routine heart care. Maybe it is and I'm just unaware, but I don't think my doc would've recommended one had I not asked. I have a family history so that's why I did ask.
January 3rd, 2024 at 11:34 AM ^
Of note, Don Canham, the legendary athletic Director of Michigan, who is credited for many of the great achievements of the University of Michigan, died of a ruptured abdominal aortic aneurysm.
January 3rd, 2024 at 11:48 AM ^
GOD BLESS OUR COACH JUWAN HOWARD. And Happy New Year to all Mgobloggers!!! God Bless you all!!!
January 3rd, 2024 at 11:54 AM ^
For my first post, I figured I would make it a worthwhile one. One of the major issues with aortic disease is that it is asymptomatic until it is not and as someone else pointed out, the survival rate of a dissection is poor. The key to this, and for most cardiac disease for that matter, is early detection. Up until recently this really came down to incidental findings on other imaging studies. We spend more time and money in this country screening for colon cancer (with that fun prep) and breast cancer (with lower prevalence) than we do screening for significant cardiac disease via accurate means. Typically you "know your numbers" such as cholesterol and BP but then have to "estimate" your cardiovascular risk. We are now starting to do formal cardiac CT scans (not new tech, just looking at how to use it more effectively) called Coronary CT Angiography. With this you look at the coronary arteries directly for degree of blockage, look at the aorta, and any surrounding structures. Less expensive and more accurate than any stress test on the market. And if you have chest pain/pressure or shortness of breath, insurance covers well typically. Sorry for the long post but I feel like this is something everyone over the age of 50 (or earlier if family history) should have done.
January 3rd, 2024 at 12:50 PM ^
I, too, decided to post because of this topic and it's major impact on my life. Thank you for contributing and for all you do.
Fwiw, the Cardiac MRI with contrast is not as bad as you might think. (N.B. the hospital I go to--Northwestern in Chicago--is extremely modern and cushy) You get to listen to music, you hold your breath a bit, and, if you're not allergic to the contrast, it's painless.
January 3rd, 2024 at 11:54 AM ^
Jamie Dimon, CEO of JP Morgan Chase, also survived a dissecting aortic aneurysm.
January 3rd, 2024 at 12:15 PM ^
I don't have the money to get my ticker checked, or the money to pay to fix it if something is wrong with it. My death is paid for in advance though. I've told me family a while ago if something happens to me to put my corpse in a trashbag, throw me in a dumpster, and go buy themselves something nice with my life insurance.
January 3rd, 2024 at 12:28 PM ^
One thing I did not see posted yet is regarding dilation (enlarging diameter) of the aorta. Not a doctor, but I have been diagnosed with a slight dilation, which is obviously a risk factor for aneurysm/dissection/rupture. It can be measured via CT or ultrasound, and monitored. Once the size becomes a certain level, the risk is high for these issues. Hypertension is the typical cause of dilation.
January 3rd, 2024 at 12:41 PM ^
The term "dilated aorta" and aneurysm are both used interchangeably, there isn't a strict cutoff, but the key is recognizing that not all dilated aortas are created equal. Your dimension typically should be normalized to your age/gender/body habitus (a 5'0" 40 yo F and a 6'6" 70 M would have different tolerances for what is considered "pathologic").
January 3rd, 2024 at 11:39 PM ^
OK, thanks. I assumed an aneurysm was more of a local "bulge" vs a dilation which I thought is more of a constant, more evenly distributed increase in diameter for a longer length, which is what I believe I was diagnosed with.
January 3rd, 2024 at 12:39 PM ^
I, too, had an aortic aneurysm--so did Steve Sarkisian as we saw on Gameday...and Fred Hoiberg. The cause of mine was identical to Sarkisian's: a bicuspid aortic valve that started to calcify/not open all the way. They call that aortic stenosis and it carries symptoms including fatigue, dizziness, etc. If you feel those, definitely go get an Echo of your heart and, if things look bad, a Cardiac MRI.
If you have a heart murmur, be sure to get an Echo regularly. The murmur, in my case, forced me to keep an eye on my heart since I was a child. (Though as an adult, I totally let it slip...not recommended.)
Be safe, all. Go to the doctor. It sucks but it's worth it.
January 3rd, 2024 at 12:50 PM ^
I have my annual physical on Friday so I made sure I threw a few blueberries on my cereal this morning.
January 3rd, 2024 at 12:51 PM ^
You've done all you can, sir. Godspeed.
January 3rd, 2024 at 1:05 PM ^
What's a Juwan?
January 3rd, 2024 at 2:08 PM ^
My uncle had what the doctors described as “a complete, top-to-bottom spontaneous aortic dissection”.
Basically he bled out internally almost instantly at breakfast one morning and was dead before he dropped his spoon.
This became a lot scarier to me personally a couple years later when I was diagnosed with Ehlers-Danlos syndrome, a genetic disorder that affects collagen in different ways depending on which type you have. Having had a bowel perforation myself, my mother having multiple brain aneurysms, and of course my uncle, there was significant concern that I had the Vascular type, which is the type you definitely don’t want.
It was a long month waiting for the genetics to come back, but ultimately I was negative for vascular and they defaulted to the clinical diagnosis of hypermobile type.
I still had to have a heart echo which was normal, but I’ll be monitored for heart conditions for the rest of my life.
January 3rd, 2024 at 6:58 PM ^
His kids need to have their tickers checked/monitored.