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5520965 tn?1506012640

Dealing with the emotional side of a TAA and chronic angina

I have a question; how does one deal with the varying emotions of having both a Thoracic Aortic Aneurysm and chronic angina pain?

I've been on 60mg isosorbide mononitrate now for more than a month, and I keep also a prescription for nitrostat.  After the initial adjustment from 30mg to 60mg daily, the angina quieted down for a few weeks, but since about 2 weeks ago has returned, and I have had days where I've had to take 1 or 2 nitro tabs, an hour or two apart in the afternoon/early evening for pain relief.

I contacted my current cardiologist about this change asking him what were his thoughts.  He's decided that, despite this and my history, there's no need for medication adjustments or a follow-up visit.

Pain like this, esp in the area of my heart, is a life quality issue for me as it does depress me, and frustrate me.  Further frustrating is my doctor's lack of will or whatever to do anything further.

So, to deal with the frustration of dealing with this, and a doctor who has no apparent incentive to do anything, and almost seems that he's not taking me seriously, any suggestions?

It almost feels like I'll have to go to the ER just for having some chronic angina pain that the nitro will damp down, so that he'll take me seriously enough to do something... should I be doing that?  It's never been accompanied by arm, neck or jaw pain - so it doesn't feel like a classic heart attack.

Kind of at a loss...

~Dave
2 Responses
Avatar universal
You mentioned, in another post, that you were thinking of seeking an out-of-network referral to Stanford.  I think it might be time to pursue that.  I think that if you were getting what seemed to you to be adequate care, that your anxiety would be greatly alleviated.  I notice, in looking over your previous posts, that a prevalent theme is anxiety about your lack of access to expert care.  Pulmonary artery aneurysms are pretty rare, so it would not be unusual to have to travel to a distant center or to go outside a given insurance network to find a doctor who can give you a trustworthy opinion.  Even a thoracic aortic aneurysm, which you also have, is not an everyday encounter in most cardiologists' practice.  That you are having chest pain raises the ante.

I notice that a doctor on the Expert Forum recommended that you see a specialist in arteropathy.  I don't think that's a recognized medical specialty, in and of itself, but there are a few cardiologists and cardiovascular surgeons who have spent their careers pursuing an interest in what amounts to the same thing.  If you were to be seen at a thoracic aortic aneurysm clinic, such as the one at Stanford, I think that would fit the bill.  That is probably where you are going to find the best doctors in northern California for your condition.  

If you have trouble getting approval for an out-of-network consultation, you might see if you can get a nationally-recognized expert to do a record review of your case and make recommendations.  I believe some places charge for that, and some don't, but even if you have to pay, it should be less than you would have to pay out-of-pocket to go and be seen without insurance coverage.  An expert doctor who reviewed your records would be able to give an opinion that should either put your mind at ease or give you some good support for the out-of-network request.    

I think it is normal to be anxious in your situation.  You have two thoracic aneurysms and now chest pain, and the doctors are doing nothing more than medicating you for the chest pain.  From what you have posted, there has been no consideration given (except by the online CCF doctor) to investigating the underlying cause of your condition.  I would have a lot of the same questions, concerns and feelings in this situation that you do.  In fact, I have been in a similar situation, and I had to go to Houston TX to get expert care.  There are really only a very limited number of doctors in the US who treat thoracic aneurysms on a daily basis, and I think you would be greatly helped by consulting one of them.

Other than securing the very best medical care for yourself, the methods of managing anxiety in this situation are the usual ones.  There's medication, there's meditation/mindfulness, and there's cognitive-behavioral therapy.  There's exercise, but you have to be careful about that and make sure you don't go beyond what's medically safe.  

5520965 tn?1506012640
It's been a while since I checked in here, but I wanted to thank you and let you know that I have taken some of your advice, and have also worked out a decent drpatient relationship with my new cardiologist.  I am going in for a full MRI cardiac work-up on Monday, and I will admit I am worried about the findings, but they will be what they are, and I realize worrying won't help me in the slightest.  Can't help it though.

As far as stress reduction, I've taken an active role in that and making more use of my vacation time for enjoyment than I had been.  I've also taken up tai-chi as a meditation which is helping.  
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