DEAR DR. GOTT: My dad has been having chest pain toward the left side in the center for two days. He “thinks” he cracked a rib from coughing or that it’s from sleeping on the couch. I noticed he was breathing like someone with a very tight shirt on – he was breathing very quickly in and out using only the top portion of his lungs. He hasn’t been coughing any more than normal. A few days ago he was sick and missed two days or work which is extremely unlike him to miss even one, let alone two.
To back up, he is 50, overweight, not very physically active, has a poor diet, is a 30-year smoker (I believe up to a half pack a day), has a hiatal hernia long with severe GERD, beginning signs of diverticulosis/litis and likely stomach ulcers. We can’t get him to go to the doctor for anything on his own, not even the recommended check up when you turn 50. Every diagnosis he has was made more than five years ago and I say “likely” stomach ulcers because I’ve heard him say it, sort of, without being able to get a definitive answer whether he THINKS he has an ulcer or whether he’s been DIAGNOSED with an ulcer. He won’t tell me why he was sick a few days ago, only that he was sick so I can’t fill in any blanks.
I’ve cracked ribs so I know his breathing COULD be attributed to that; however, I found it odd that he coughed and didn’t visibly seem to be in any additional pain while coughing. I remember coughing with a cracked rib and having a very different outcome.
Considering his poor health and everything else, could this be signs of angina or, worse, a heart attack? Please help. Do I need to get all paranoid about getting him to the hospital ASAP or should I continue to plug away at just getting him in soon? Should I be worrying about a heart attack? Could it be misinterpreted as a cracked rib?
DEAR READER: Before I get into answering your question, I must say a few things. The first, and most important, is that my medical advice column is NOT to be used in place of proper medical attention or to determine if medical attention is necessary in serious situations such as the one you described.
It took me several weeks to get to your email (which are printed out for my perusal and acceptance or denial as an answer worthy question) and because I try to keep a few months worth of answered questions ready for typing and eventual publication available at any given time, it has taken some time for your letter to actually make it to my column and website. I try to offer helpful suggestions and advice to my readers but am not responsible for the results (positive or negative) of said advice, especially if readers fail to inform their physicians or seek proper medical advice/treatment. That said, let’s get into your father’s abysmal health, stubborn refusal of medical aid, and probably NOT cracked rib.
Your father’s health is pretty awful and his seeming unwillingness to make changes or get help is a perfect recipe for disaster. Given your comments that he is overweight, smokes, has a poor diet, doesn’t exercise, and more leads me to believe that it is highly unlikely that he cracked a rib. Even your statement that it’s unusual for him to miss a day of work, yet he recently missed two, leads me further to believe that something serious occurred recently that left him unable to function normally for a few days. In all likelihood, he had some sort of a cardiac event, probably a heart attack. And, you are correct, had he actually cracked a rib, coughing would almost assuredly be sheer agony causing visible cues of pain to anyone looking on.
Because I don’t know what has happened in the time that has passed between your letter and my answering, my advice to get him to a doctor or hospital immediately is far from possible. I can say, that what SHOULD have been done was to drag your father, willing or not to the nearest hospital for immediate testing.
I will not sugar-coat this; unless your father makes immediate and drastic changes to his lifestyle, including regular medical check ups, he is undoubtedly on a fast track to a short life. If he refuses, that is his choice, but it is selfish of him to force his family to sit by and watch. My advice to you and the rest of your family is to sit him down and have a frank discussion about his poor choices and how it makes you feel watching him hurt himself. After that, you need to step back and let him do was he will. With luck, he will realize how much he his hurting those around him as well as himself and start to make those changes. If that occurs, step back up and help him in any way that he will allow. Start taking an exercise class or walk around the block with him, make an effort to have family dinners full of nutritious meals, and congratulate him for every positive change he makes.
If, on the other hand, he still refuses to take responsibility for his health and lifestyle, there is little that you can do until (or even after) something serious, perhaps even life-threatening, occurs. As painful as it might be, you may have to step back even further so that his eventual decline doesn’t take you down with it. Counseling to work through and deal with the emotions that arise from situations such as this can be especially beneficial.
