Question
My husband is a Canadian trucker who regularly runs in the US. He has recently suffered a heart attack and is currently awaiting an angioplasty. Any info regarding medical guidelines for drivers in the US (& Canada for that matter) would be greatly appreciated. Hubby is afraid that he will not be allowed to return to work even though he feels perfectly capable. Thanx in advance:
Flobird
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Flobird,
You will find all of the info you need at our website. Please go to www.Truck.net/abms.
In regards to your hubby's cardiac problem....If he has documentation form his cardiologist that his condition has been compensated or corrected by surgery or medications, he should take that documentation to the physician who will be performing the DOT physical exam.
The physician should qualify him to drive if the condition is controlled or resolved.
Please let me know if you have further questions.
Keeping you safe, healthy, and on the road.
Nurse RedVisit us at
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There is in existence a study documenting successful returns of truckers following an angioplasty. I retrieved it on medline. While the procedure your husband is undergoing is well-established you need a SECONB OPINION. There are some studies suggesting drug treatment for your husband's problems are as successful as surgey. You need to consult a drug-oriented cardiologist and NOT a cardiac surgeon.
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NewYorkTwo,
You are suggesting that the second opinion be from a cardiologist that is drug oriented. How would you go about locating one of those?
If one's condition is from occluded vessels, what medications would they prescribe to treat the cause? How quickly do the medications take affect? It's been my experience that most patients diagnosed with blockages are already in a cardiac emergency. Most are not aware of the condition until they begin showing symptoms. At that point they are in dire need of immediate treatment already. Are medications still the option of choice in your opinion?
By the way, may I ask what your medical background is? You have some very interesting theories on medicine. I would like to discuss more with you. Please e-mail me at this address. Roadmuvva@hotmail.com.
Nurse RedVisit us at
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Well, as you (Nurse Red) know, and most lay people don't when you enter an emergency room (or hospital) there are two spider webs you can get snatched up in. The medical side of the house spider web or the surgical side of the house web. In some hospitals one side or the other is all powerful, and once you are entangled it is goodness-hard to get out. There have been several studies to determine whether emergency revascularization (either angioplasty or bypass surgery) is superior to a strategy of initial stabilization by means of intensive medical therapy, including a recommendation for intraaortic balloon counterpulsation, thrombolytic therapy if feasable, and DELAYED revascularization if clinically warrented. Overall mortality statistics seem to suggest the medical stabilization strategy provides a comparable survival rate. A review of strategies is beyond the scope of this post, but there are significant differences of opinion, even in 1999, over the exact nature of many basic medical syndromes. The best thing you can do for a person with mycocardialo insufficiency, or having an anginal attack, by the way is to have them place crushed ice in their mouth against the upper palate, which activates a vestigal human organ (present and well developed in whales) and triggers the mammalian dive reflex, allowing heart and brain tissue to survive utilizing anaerobic metabolism (metabolism in the absense of oxygen). If I were looking for a physician I would search MEDLINE for a study I liked and call up the physician writing the paper and see if he can suggest someone in my area willing to use the treatment protocol. This can be VERY difficult to do, as Dr. Lorainne Day (a priminent San Francisco physician) found out when she tried to get alternative treatments for a malignancy. In the case of blocked blood vessels there is good evidence these blockages are a result of bacterial infection processes, and the organisms causing these infections (and hence blockages) are surprisingly susceptable to ordinary Pennicillin and tetracycline. The mechanism of action of aspirin in prophalactic treatment is not entirely to "prevent clots", but to REDUCE INFLAMMATION in the vessels leading to the heart, secondary to an immune-system response. Things are changing with the Internet as many more lay people have access to medical information, but in most cases, depending upon the physician you "accidentally" get hooked up with, you end up strapped in the roller coaster and can't get off till the ride ir over.
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Just to qualify my previous post so nobody gets themselves in medical trouble. There are accepted methods of treating anginal pain or any pain suggestive of myocardial insufficiency (Lack of oxygen to heart tissue). I don't disagree with any of them. Nitrogylcerine tablets under the tongue are vasodilators, and open up the vessels. One of the most important things when you have pain suggestive of this condition is DON'T MOVE. Lie down and have someone else summon help. Often problems are the result of SPASM of vessels narrowed by deposits and the trick is not to have heart tissue die while the spasm takes place. Oxygen, of course is helpful. You should not wander four blocks looking for ice. If, however, you are at home and HELP HAS ALREADY BEEN CALLED, and ice is immediately handy, placing a cube in the mouth or crushed ice against the upper pallate is helpful. In hospital emergency rooms patients who have lost blood often crave ice. This is called ice-pica. The physicians have misinterpreted this finding as to have something to do with iron deficiency and the crunchiness of ice. They sent in too many boxtops for the degree. A low hematocrit will induce ice craving but it is the low oxygen level which really triggers it. Activation of mammalian dive is the reason there have been cases where people have remained underwater for hours and been resuscitated without brain damage. The sensor is on the upper palate of the mouth. Most likely activation of this sensor dumps a peptide into the bloodstream. It works for the whales.
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Thank you very much for your helpful posts. I'm glad to report that my husband is home and recuperating nicely from his angioplasty. (A procedure which was deemed necessary due to a 90-95% blockage of the posterior circumflex artery) Thankfully, the MDs at the University of Ottawa Heart Institute feel that there is no damage to the heart muscle itself. However, it is still worrisome that a diagnosis of Coronary Artery Disease (quite advanced) has been made. My husband, by the way, is 47 yrs old. Hopefully the angioplasty and stent insertion will do the trick for now. He is also on medications to reduce the workload on his heart, namely Metoprolol. The addition of Lipidil Micronized for his elevated cholesterol level may help some along with the fact that he has quit smoking and is religiously following his low-fat diet. The Doc says he may be able to return to work sometime after the end of the year.
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Flobird,
So glad to hear that things have gone well for you and your hubby. The important thing is that he has been treated and is on the road to recovery. Please check back often and keep us posted on his progress.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at
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That's great. These are very safe well-established procedures. The most risk is surving the operation and getting out of the operating theatre and that's behind you. Your husband will be good as new. He should be on three grams of vitamin C a day for at least six months. Use the powder you can mix with his food. Eventually you MAY be able to get off the heart medications. Weight control is going to be another issue. Those extra pounds really increase the heart workload. Mild regular exercise as soon as your physician says it's O.K. and keep at it regularly. I have no doubt he will be able to fully function without any handicap. The fact he has no damage to the heart muscle or death of tissue is very encouraging. Sounds like your doctors did a GOOD job of getting to things in time. Normally, after procedures like this, when healed, you can resume life just like before as long as there is no death of tissue. Even when there is tissue death you can often resume a fairly normal life with appropriate medical intervention and care. Good luck.
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Just a little update. My hubby is still at home and getting quite bored with it. He is also becoming depressed thinking that he may not be allowed to return to work. He had an exercise ECG last week which showed that there are still some blockages to be dealt with. Although the MD in Ottawa told him that, I think he was hoping that he was wrong. Oh, well. He has an appointment in Ottawa on the 29th of October when the doc will tell us what he has decided to do with the rest of the blockages. Until then, I guess I'll just have to try to keep him occupied and hope for the best. Thanx for listening.
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It could take him all the time he has left recuperating to read all the messages here on the RT .... turn him loose on us!
Monty
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You can't be sure they are blockages. Exercise ECG's (or EKG's) are merely electricat indications. In fact it is possible to have a reasonably good ECG in a heart that has completely stopped pumping blood (Electromechanical dissociation). Generally the physician looks for a segment called the ST segment and looks for depression. An ocassional cause for such depression during an exercise ECG is spasm of the vessel. There is no way really to determine if the vessel is undergoing a spasm or the blockage is internal (reduced diameter of the lumen by fatty blockages). Spasms can be CONDITIONED, just like Pavlov's dog. Normally sublingual nitroglycerine (under the tongue) vasodilates the vessels and permits normal blood flow. There are many truckers working who carry nitroglycerine pills. A stress ECG is exactly what it says. It STRESSES the cardiovascular system. You are not going to be running while driving a truck. In point of fact, your husband probably knows how he feels better than the physician. Get a second opinion. The important thing is if begins to drive again and experiences signs of cardiac oxygen starvation (numbness of the left arm, chin or substernal chest pain) he stop immediately and pull to the side of the road. Seek a second or even a third medical opinion. Incidentally the June 11th issue of New Yorker magazine lists the best cardiac physicians for consult in the United States.
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Excellent explanation, Tom!
I'm really impressed by your medical knowledge.
I used to be a certified EKG Tech in my younger years, and I completely agree with what you have just stated.
Too many people _and_ doctors rely solely on what the ECG machine says, and it's just not definitive enough to tell you much without further tests.
Thanks for your input!
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"The heart is the happiest when it beats for others."
~ Mary ~
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I should explain that the aforementioned blockages were originally identified during a cardiac catheterization (angiogram). The stress test simply confirmed what we have known since that time. The problem is that the area where the blockages are is very difficult to get at; way down in the posterior circumflex artery. Bypass surgery is not an option at this time because they tell us that his arteries are "too small". I must tell you that I am very impressed with the knowledge and compassion exhibited by everyone who has posted a reply. Thanx again.
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NY2,
You are right again! Very grateful to you and Mary for picking up the slack in my absence. You both have a great deal of info to share and I really appreciate all the input.
Flobird, hope things go well, and hubby is back on the road soon.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at