WSJ.com - Medical Ignorance Contributes to Toll = From Aortic Illness

From: Subject: WSJ.com - Medical Ignorance Contributes to Toll From Aortic Illness Date: Mon, 3 Nov 2003 22:29:40 -0800 MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_000_0055_01C3A259.F87F0990"; type="text/html" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2800.1165 This is a multi-part message in MIME format. ------=_NextPart_000_0055_01C3A259.F87F0990 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://online.wsj.com/article_print/0,,SB106789437888762200,00.html WSJ.com - Medical Ignorance Contributes to Toll = From Aortic Illness



November = 4, 2003

PAGE=20 ONE

MORE ON = ANEURYSMS

=95 Page One: Aneurysm=20 Tests Could Save A Lot of Lives, if=20 Performed¹
01/13/03

=95 Your Health: = Fears=20 Mount Over Dangers of Hoisting Heavy=20 Weights²
03/13/03

=95 Your Health: = A=20 Simple, Seldom-Used Test Can Detect Lethal=20 Aneurysms³
06/10/03

=95 Personal = Journal: Ordering=20 an Autopsy Could Save Your=20 Life⁴
06/03/03

ONE MAN'S TALE

Read Kevin Helliker's personal = accounts=20 of being diagnosed with an aortic aneurysm:

=95 Personal Health=20 Quarterly: A=20 Time Bomb Near My = Heart⁵
04/22/03

=95 Personal Health=20 Quarterly: Denying=20 Death No More⁶
10/21/03

=95 For more health = coverage, visit=20 the Online Journal's Health Industry = Edition at=20 wsj.com/health⁷ and receive daily Health=20 e-mails⁸.

Medical = Ignorance
Contributes=20 to Toll
From Aortic Illness

Many=20 Doctors Don't Realize
Aneurysms Are Treatable;
A Paucity of=20 Specialists

By = KEVIN=20 HELLIKER and THOMAS M. BURTON
Staff = Reporters=20 of THE WALL STREET JOURNAL

After aortic aneurysms struck her ex-husband and = his=20 brother, Debra McMillan learned that the often-fatal condition can = be=20 hereditary. So last autumn, when pain suddenly ripped through the = chest of=20 her 19-year-old son, she rushed him to an emergency room in Omaha, = Neb.,=20 and told the doctor about the family's medical history.

But she says the ER doctor at Nebraska Methodist = Hospital=20 dismissed her talk of aneurysms, which are bulges that can lead to = lethal=20 ruptures in the aorta, the body's largest artery. Instead, the = doctor=20 diagnosed Ms. McMillan's son, Tyler Kahle, with a minor lung = infection and=20 sent him home, she says. In following days, the young man and his = mother=20 visited their family physician and returned to Nebraska Methodist. = During=20 each visit, she asked whether her son's continuing chest pain = could be=20 connected to the family history of aneurysms. Each doctor answered = no --=20 but without ever examining Mr. Kahle's aorta, she says.

Eight days after his symptoms began, the young = man died of=20 a ruptured aorta. Ms. McMillan has filed a malpractice suit = against=20 Nebraska Methodist in state court in Douglas County, Neb. The = hospital has=20 denied any liability, saying it provided adequate care.

The Kahle case illustrates a deadly discrepancy = between the=20 available medical knowledge about aortic aneurysms and the = ignorance of=20 many front-line physicians. The discrepancy contributes to what = may be=20 thousands of unnecessary deaths each year.

A common misconception among physicians is that = aortic=20 disease is rare, when in fact it kills an estimated 25,000 = Americans a=20 year. That is a larger toll than that of AIDS and most kinds of = cancer.=20 Another misconception is that little can be done about aortic = aneurysms.=20 The reality is that improvements in diagnostic-scanning methods = introduced=20 since the 1980s, and greater experience with aortic surgery, have = vastly=20 enhanced the ability to detect and repair aneurysms.

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Behind these misconceptions is an anomaly in the = medical=20 profession's structure: There is no medical specialty devoted to = treating=20 or educating others about the aorta.

Aortic disease "falls squarely between about four = different=20 specialties," says Eric Isselbacher, a cardiologist at Harvard = Medical=20 School. "There's an education gap among physicians about aortic = disease,=20 and this gap isn't small. It's huge."

=20

The depth of medical unfamiliarity with this = illness became=20 clear in September, following the sudden death of Hollywood star = John=20 Ritter, 54. He suffered an aortic dissection, a tear in the = weakened wall=20 of an aneurysm. Although dissection kills quickly by disrupting = blood flow=20 to major organs, the aneurysm that typically causes this event = takes years=20 to grow, during which time it can be detected and removed. Yet in = media=20 interviews after Mr. Ritter's death, doctor after doctor described = dissection as rare and undetectable.

Such comments disheartened aortic experts. "I've = been=20 distressed by the series of physicians getting on the screen and = calling=20 this kind of death unpreventable," says Dianna Milewicz, director = of=20 medical genetics at the University of Texas Health Sciences Center = in=20 Houston. "The message should have been that John Ritter's children = should=20 be screened for this," adds John Elefteriades, chief of = cardiovascular=20 surgery at Yale-New Haven Medical Center. It hasn't been disclosed = whether=20 Mr. Ritter ever was checked for aortic problems.

Despite the diagnostic and surgical = breakthroughs, recent=20 academic studies suggest that there has been little or no = improvement in a=20 longstanding misdiagnosis rate of about 35% for aortic = dissections,=20 compared with about 5% for heart attack. Even with rupturing = abdominal=20 aortic aneurysms -- a variety that tends to strike a highly = identifiable=20 group, men over 60 with a history of smoking and arteriosclerosis = --=20 studies have found a misdiagnosis rate of about 30%. The = in-hospital=20 mortality rate from aortic dissection hasn't declined in = decades.

"No physician can diagnose a condition he never = thinks=20 about," observes Michael DeBakey, an inventor of aortic=20 aneurysm-replacement surgery in the 1950s and, at 95, still on = staff at=20 Methodist Hospital of Houston.

Medical News

This isn't the first time doctors have been slow = to absorb=20 news of medical advances. Hungarian physician Ignac Semmelweis = discovered=20 in 1847 that merely by washing their hands, physicians could avoid = spreading infection. But medical leaders resisted his teachings, = and=20 hand-washing didn't gain wide acceptance for years. In the 1840s,=20 rudimentary communication slowed the spread of knowledge. Today, = many=20 physicians complain they are so swamped by information -- from = journals,=20 drug and device companies, and continuing-education courses -- = that they=20 can't absorb all of the latest news.

=20

In the case of aortic disease, this problem is = heightened=20 by the lack of blood-vessel specialists dedicated to getting out = the word=20 about aneurysms. Every other significant body part -- brain, = heart, lungs,=20 bones and so on -- boasts its own specialty association. = Fifteen-thousand=20 podiatrists in the U.S. focus on feet.

The aorta is the River Nile of blood vessels. It = rises from=20 the heart nearly to the neck, then descends through the chest and = abdomen,=20 carrying blood for every organ and limb. But only about 300 = nonsurgical=20 doctors in the U.S. specialize in blood vessels. Cardiologists are = responsible for the cardiovascular system, and typically are very=20 knowledgeable about the tiny coronary arteries that channel blood = from the=20 aorta back into the heart. But their training leaves many of them = in the=20 dark about aortic disease.

A small corps of aortic experts from various = specialties=20 are beginning to focus more attention on aneurysms. But there is a = long=20 way to go, especially in medical schools, where the experts say = aortic=20 problems typically receive inadequate study.

During eight years as a medical student and = resident at=20 West Virginia University, obstetrician Devin Ciliberti says he = rarely=20 heard any mention of aortic illness. "If it ever came up, it was = like,=20 'This goes at the bottom of your list' " of possible = diagnoses, says=20 the physician, who finished his residency in 2001. In particular, = research=20 suggesting that pregnancy heightens the risk of dissection never = came up,=20 Dr. Ciliberti adds.

This all became relevant when 25-year-old Julie = Neal Lee=20 came to The Women's Hospital of Greensboro, N.C., last November. = She was=20 37 weeks pregnant and in extreme distress, but clearly not in = labor, Dr.=20 Ciliberti says. He says he ordered tests for kidney stones, a=20 pregnancy-related high-blood-pressure condition called = pre-eclampsia and=20 anything else he could think of. All proved negative. Hours = passed, and=20 the young woman was frantic with pain.

Finally, Dr. Ciliberti ordered a = computerized-tomography,=20 or CT, scan of Ms. Lee. "Even then, I wasn't thinking about aortic = dissection," he says. The scan, taken more than seven hours after = she=20 arrived, showed an aortic dissection. Dr. Ciliberti performed an = emergency=20 Caesarean, saving the baby. But Ms. Lee died after aortic-repair = surgery=20 by another doctor.

Her parents, Harold and Robin Lee, say they blame = Dr.=20 Ciliberti for failing to diagnose the problem sooner, but they = haven't=20 gone to court. Dr. Ciliberti says, "I don't think a quicker = diagnosis=20 would have saved her, but I don't know for sure." He attended Ms. = Lee's=20 wake and funeral and says he has spent much of the past year = learning=20 about aortic dissection. Women's Hospital declines to comment.

Driving Progress

Specialists drive most medical progress, = educating=20 generalists and promoting prevention. Twenty years ago, few = Americans had=20 heard of prostate cancer, but urologists have spurred screening = and=20 awareness campaigns, and U.S. deaths from that disease fell 21% = between=20 1990 to 2000.

With no comparable campaign, unfamiliarity with = aneurysms=20 prevails in many emergency rooms and physicians' offices. Michael = Giusti,=20 44, entered the ER at Methodist Medical Center in Peoria, Ill., = one night=20 in June 1998, complaining of chest pain and asking whether his = aorta=20 should be scanned, says his wife, Kathy Schwindenhammer, who = accompanied=20 him. For 13 years, he had been undergoing scans to monitor an = aortic=20 aneurysm that previously hadn't caused any symptoms and only now = was=20 approaching a dangerous size, she says. In the ER, two residents = picked up=20 a textbook and began flipping pages before concurring with the = primary=20 physician on duty that a scan wasn't needed, she says.

In fact, aortic experts say that any person with = an=20 aneurysm who experiences significant chest pain ought to have a = scan done.=20 But the doctors at Methodist Medical diagnosed Mr. Giusti with a = pulled=20 chest muscle and sent him home, his wife says. He died there that = day of=20 an aortic dissection.

The hospital has denied any negligence. But in = 2002 it=20 agreed to pay Ms. Schwindenhammer $850,000 to settle a suit she = had filed,=20 Illinois state-court records show.

MISSING THE SIGNS

The high death rate from aortic = disease=20 is partly due to physicians' unfamiliarity with the = symptoms,=20 the groups that face high risks, and available = diagnostic and=20 surgical procedures.

Julie=20 Neal Lee, 25, died November 2002, = Greensboro, N.C.:=20 Pregnancy is a huge risk factor for women with = aortic=20 disease. But her obstetrician says his medical = training=20 barely touched on the = condition.

Eric=20 Eshleman, 28, died September 2000, Atlanta: = He=20 entered the ER with sudden back pain. His lanky=20 appearance signaled he might have Marfan's, a = condition=20 that makes the aorta prone to = dissect.

Twenty years ago, diagnosing aneurysms was = extremely=20 difficult, and surgery to repair the condition had a high = mortality rate.=20 The fatalism that surrounded the ailment -- which can stretch a = vessel=20 normally the diameter of a garden hose to that of a soda can -- = was=20 captured by a comment a century ago by medical pioneer William = Osler:=20 "There is no condition more conducive to clinical humility than = aneurysm=20 of the aorta."

Today, this shouldn't be true. Aortic aneurysms = don't show=20 up well on X-rays. But the advent of high-tech scans -- such as = CT;=20 abdominal ultrasound; magnetic-resonance imaging, or MRI; and=20 echocardiogram -- have made aneurysms relatively easy to catch. = (The scans=20 cost from $40 to $2,000, depending on the aneurysm's location.) = Medical=20 geneticists have identified high-risk groups in whom the condition = ought=20 to be suspected. And with experience, surgeons have improved to = roughly=20 90% the success rate of replacing damaged sections of aorta with = Dacron=20 hose.

One obstacle to disseminating information on the = aorta is=20 corporate profit. Medical-device and drug companies, which are = playing an=20 increasingly large role in shaping continuing-education seminars, = tend to=20 focus on products they sell, such as coronary stents, which are = used to=20 prop open clogged coronary arteries. Industry hasn't developed a=20 comparable product for repairing aneurysms that is inexpensive or=20 effective enough to replace most surgery. For cardiologists trying = to keep=20 up with their field, "pharmaceutical and device development for = the=20 coronary arteries is where the money and glamour are," says = Harvard's Dr.=20 Isselbacher.

Some heart doctors don't even realize that action = can be=20 taken. When an echocardiogram -- a scan of the heart and = surrounding=20 vessels -- found a large aneurysm in the chest of Donald Kehe four = years=20 ago, his cardiologist in Las Vegas called a private meeting with = Mr.=20 Kehe's wife. "He took my hands in his hands, looked me in the eyes = and=20 said there was no hope -- that Donald should tell his loved ones = goodbye,"=20 says Rowena Kehe.

Sandy=20 Morris, 13, died July 1998, Columbus, Ohio: = When her=20 parents took her to the ER with severe chest = pain, they=20 knew enough to request a high-tech scan. But the = hospital didn't scan her aorta; four hours = later, she=20 died.

Daniel Slaughter, = 37, died May=20 2001, Indianapolis: He entered the hospital with = symptoms of dissection and a classic = consequence: blood=20 in the sac around his heart. Yet he went = undiagnosed for=20 a week.

After a friend pointed Mr. Kehe, then 69, toward=20 Cedars-Sinai Medical Center in Los Angeles, Sharo Raissi, that = hospital's=20 top cardiovascular surgeon, removed the aneurysm. A few months = later,=20 instead of telling his family goodbye, Mr. Kehe treated them to a = Hawaiian=20 vacation. Mr. Kehe, now 71, is alive and well today.

Classic Symptom

In some aneurysm cases, the knowledge gap is = especially=20 clear because multiple cardiac doctors miss danger signs. Daniel=20 Slaughter, a 37-year-old father of four, entered Methodist = Hospital of=20 Indianapolis in May 2001, experiencing chest pain radiating into = his neck.=20 That is a typical symptom of aortic dissection. He was bleeding = into the=20 sac around the heart, a common consequence of aortic dissection. = And an=20 echocardiogram found that his aorta was 50% larger than normal, = according=20 to a hospital report.

Yet the cardiologist who signed the = echocardiogram report=20 noted in it that the heart and aorta looked normal. A second = cardiologist=20 and a cardiac surgeon never looked at the echocardiogram, = according to=20 subsequent written statements they made in administrative = proceedings. A=20 week after entering Methodist, Mr. Slaughter died. After learning = in the=20 autopsy room that the cause of death was aortic dissection, the = cardiac=20 surgeon called Mr. Slaughter's widow. "He said, 'This probably = won't help=20 you now, but I could have saved him,' " says Paige Slaughter. = She has=20 named the hospital and three doctors in a proceeding that Indiana = requires=20 before the filing of a malpractice suit. Methodist Hospital denies = any=20 negligence.

Dr. Elefteriades, the top aortic surgeon at = Yale-New Haven,=20 and Craig Miller, his counterpart at Stanford Medical Center, say = they are=20 each asked about twice a month by lawyers for plaintiffs and = defendants to=20 review cases alleging malpractice related to aortic disease. In = only about=20 half are the doctors' or hospitals' actions legally defensible, = say the=20 doctors, who are paid for their opinions but typically don't = testify in=20 court. Both physicians say that doctors' performance in = heart-attack cases=20 they review is defensible far more often.

Banding Together

At some hospitals, including Massachusetts = General in=20 Boston, cardiologists, surgeons and other physicians are banding = together=20 to form aortic centers that draw on a range of specialties. In = June, the=20 American Heart Association published in its journal, Circulation, = an=20 article on heredity and aortic aneurysms. Still, AHA President = Augustus=20 Grant says, "I don't think aortic dissection is analyzed with the=20 frequency it should be" at cardiac conferences.

Aortic disease generally strikes two types of = victims. The=20 first are men typified by James Whitehead, a University of = Arkansas=20 professor who at 67 had a long history of smoking and high blood = pressure.=20 This August, he experienced sudden, intense pressure in his chest, = radiating into his jaw. At Washington Regional Medical Center in=20 Fayetteville, Ark., he tested negative for a heart attack but = remained=20 stricken by pain so intense that morphine failed to numb it, his = family=20 says. Eight hours after his arrival, doctors did the CT scan that = revealed=20 he had an aortic dissection, and by then, it was too late, his = family=20 says. He died before reaching the operating room. Washington = Regional=20 declines to comment.

The second type of aneurysm victims are young, = fit people=20 cursed with a genetic predisposition for aortic problems. Most = people in=20 this category don't know they have an aneurysm, although family = history=20 can provide a clue.

So can body type. Aortic experts say that = especially tall,=20 lanky people entering an emergency room suffering sudden and = intense chest=20 or back pain ought to be considered possible aneurysm victims. = People with=20 strikingly long limbs may have Marfan's syndrome, a = connective-tissue=20 disorder, and Marfan's sufferers statistically have a=20 much-greater-than-average risk of dissection.

Eric Eshleman, 28 years old, 6-foot-8 and 190 = pounds,=20 entered Atlanta's Northside Hospital in September 2000 suffering = sudden,=20 severe back pain. His wife, Britt Eshleman, says it was the first = time she=20 had ever seen him cry. Neglecting to scan his aorta, the hospital=20 prescribed painkillers and sent him home, his wife says. Seven = days later,=20 he died of an aortic dissection. The county autopsy report = describes him=20 as "marfanoid appearing."

Ms. Eshleman has sued Northside for malpractice = in state=20 court in Fulton County, Ga., alleging that based on her husband's = body=20 type, among other factors, the hospital should have tested more=20 aggressively for aortic dissection. The hospital says the suit "is = without=20 merit."

The seriousness of aortic dissection is lost on = many=20 doctors. Sandy Morris, 13, arrived in July 1998 in the emergency = room at=20 Ohio's Columbus Children's Hospital, complaining of intense chest = pains.=20 Her parents knew their daughter had Marfan's, and they say they = knew the=20 pain might indicate an aortic dissection. They even knew enough to = request=20 an echocardiogram. But doctors failed to do one, testing Sandy = instead for=20 heart attack, the Morrises say. That test came back negative, = because=20 Sandy was having an aortic dissection, the parents say. Court = records show=20 that doctors scheduled an MRI scan but for the following morning, = about=20 eight hours after Sandy had arrived at 11 p.m. She didn't live = that long.=20 "Why don't they do something, Daddy?" were the last words Andrew = Morris=20 says he heard his daughter speak.

Children's Hospital has settled a malpractice = suit filed by=20 the parents in state court in Columbus on terms that weren't = disclosed.=20 The hospital declines to discuss the case. In 2000, Children's = Hospital=20 and the Ohio State University Medical Center, which share faculty, = opened=20 a Cardiovascular Connective Tissue Disorders Clinic. That unit = serves=20 patients with Marfan's and others who have a genetic = predisposition to=20 develop aortic disease.

Extreme Pain

Aortic dissection is one of few conditions that = causes pain=20 so severe it often isn't relieved by morphine, experts say. Even = so, after=20 doctors rule out heart attack, they sometimes neglect to test = patients=20 experiencing this level of chest or back pain for aortic = problems.

Christopher Cole, 39, a manufacturing executive = in Elyria,=20 Ohio, once broke his leg in six places in an amateur motorcycle = race. His=20 foot ended up pointing backward, he says. On another occasion, the = South=20 Africa native was hit by shrapnel while serving in that country's = military=20 in the 1980s. The pain from his aortic dissection 14 months ago = was far=20 worse than from either of those injuries, he says. "When my heart = would=20 beat, it felt as if my skin was tearing," he says.

But it took doctors an alarmingly long time to = conclude=20 that anything was wrong with his aorta. When he arrived at Elyria = Memorial=20 Hospital, near Cleveland, in August 2002, doctors and nurses ran = various=20 tests, but not a scan that would have shown the dissection, he = says. Mr.=20 Cole stayed overnight at the hospital, and the next morning a = cardiologist=20 told him they couldn't find anything wrong and he could go home. = Mr. Cole=20 did, but his pain grew worse. It took two more visits to the ER = the next=20 day before doctors finally gave him a CT scan. When that showed a=20 dissection, he was flown immediately by helicopter to the = Cleveland=20 Clinic. Lars G. Svensson, the clinic's chief aortic surgeon, = performed=20 successful emergency surgery.

Dr. Svensson says Mr. Cole probably wouldn't have = survived=20 more than another two hours without it. The surgeon estimates that = every=20 second or third aneurysm case he gets was originally misdiagnosed. = An=20 Elyria Hospital spokesman declines to comment.

Aortic dissection and rupture are fatal far more = often than=20 heart attack. As a result, some doctors are aggressive about = testing for=20 aortic disease. When Howard Carney entered St. Luke's Hospital in = Kansas=20 City, Mo., last year, complaining of sudden, intense chest pain, = Dr. Lance=20 Waldo immediately ordered a CT scan that showed an aortic = dissection. Mr.=20 Carney, 36, underwent emergency surgery and today is fine. "I'm = paid to be=20 a pessimist," says Dr. Waldo.

Not every case of aortic rupture or dissection = can be=20 diagnosed. Composer Jonathan Larson died of an aortic dissection = in 1996=20 after two New York City hospitals misdiagnosed him. The = 35-year-old's=20 death drew widespread attention because it came after the final = dress=20 rehearsal of his show "Rent," the rock opera that went on to huge = success.=20 Yet Diane Sixsmith, one of the physicians charged by New York = state=20 medical authorities with investigating the case, concluded no = negligence=20 occurred. Mr. Larson had complained only of flu-like symptoms, and = it=20 would have been a huge leap to guess that he had a disintegrating = aorta,=20 says Dr. Sixsmith, chairman of emergency medicine at New York = Hospital=20 Queens Medical Center and a leader in efforts to educate = physicians about=20 aortic disease.

Pregnant Patient

Many aortic dissections and ruptures involve = aneurysms that=20 doctors spot but fail to treat. An echocardiogram picked up Lori = Irving's=20 aortic aneurysm in 1998, her mother, Patty Irving, says. But her=20 cardiologist, who was employed by Kaiser Permanente, said nothing = about=20 it, the mother adds. The younger Ms. Irving, a psychology = professor at=20 Washington State University in Vancouver, Wash., was then 35. In = mid-2000,=20 she became pregnant. Aortic experts say that any woman of = child-bearing=20 age who has an aneurysm should be warned that pregnancy severely = compounds=20 the dangers. "We'd never have gotten pregnant if we'd known about = the risk=20 factor," says Mike Morgan, Lori's husband.

When intense chest pain sent Ms. Irving to the = emergency=20 room at Southwest Medical Center, a Kaiser Permanente hospital in=20 Vancouver, during the last month of her pregnancy in April of = 2001, she=20 had no way of knowing the cause. Doctors didn't take an = echocardiogram,=20 her mother says. They diagnosed the 38-year-old patient with = indigestion=20 and sent her home, her mother says. That same day, Lori Irving and = the=20 unborn baby died.

Kaiser declines to comment, citing a settlement = and=20 confidentiality agreement with Lori Irving's husband.

Father and Son

Some physicians hope that the story of Tyler = Kahle's family=20 could help educate the profession about the dangers of aneurysms. = An=20 article scheduled to appear in the winter issue of the Annals of = Emergency=20 Medicine describes the failure of three sets of medical personnel = in Omaha=20 to scan the aorta of Mr. Kahle, the 19-year-old whose mother = rushed him to=20 the emergency room and told doctors about the family's medical = history.=20 "Scanning him very likely would have saved his life," says Dr. = Milewicz,=20 the University of Texas genetics expert who co-wrote the journal=20 article.

In August 2001, about a year before Tyler's = death, his=20 uncle, Tom Kahle, had entered St. Luke's Hospital in Cedar Rapids, = Iowa,=20 complaining of chest pain. He told doctors about his family's = history of=20 aneurysm, relatives say. But the hospital discharged him without = scanning=20 his aorta, the relatives add. Two days later, Tom Kahle, 37, died = of an=20 aortic dissection. His family has filed a negligence suit against = St.=20 Luke's in state court in Linn County, Iowa. The hospital has = denied any=20 liability.

Terry Kahle, Tom's brother and Tyler's father, = survived a=20 dissection in 1998. After attending Tyler's funeral in Omaha last = year,=20 Terry Kahle returned to his home in Atlanta with his older son, = Marcus,=20 23. Almost immediately, Marcus started complaining of chest pains. = "I=20 figured it was the power of suggestion, but I wasn't taking any = chances,"=20 the father says.

Rushing his son to the emergency room at St. = Joseph's=20 Hospital in Atlanta, Mr. Kahle says he requested a scan of the = young man's=20 aorta -- only to be told that aortic disease didn't strike people = that=20 young. Mr. Kahle, an auto technician who says he had never stood = up to a=20 doctor before, did so then.

"There were tears in my eyes," he says. "I said, = 'Listen, I=20 just buried my 19-year-old son last week, and I buried my brother = last=20 year -- both of them aortic aneurysms. We're not leaving here = until you=20 scan my son.' "

After getting scanned, Marcus Kahle underwent = emergency=20 surgery to repair an aortic aneurysm. Today, he is alive and well = in=20 Atlanta.

Write to Kevin Helliker at kevin.helliker@wsj.com^{9=20
and Thomas M. Burton at tom.burton@wsj.com¹⁰ =}

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