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That burning sensation in his chest had to be heartburn. And the pain in his left shoulder — it had to have just been the effects of shoulder surgery, Richard Kief told himself.
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He thought about heart disease, but dismissed it. Kief, who is 64, is extremely fit. He’d ride his bicycle 50 to 60 miles at a time, beating his friends up steep mountain trails.
Now Kief realizes he’s a living example of a cardiologist’s worst nightmare, a middle-aged man who avoids doctor visits and explains away his symptoms. An astute colleague who insisted on an immediate exam likely saved his life, Kief says.
“I am the poster child of what not to do and yet I still had a good outcome, thank God,” says Kief.
It all started soon after Kief and his family moved from Pennsylvania to Washington D.C. a few years ago.
“For about 15 months I wasn’t feeling quite right,” Kief told NBC News. “When I would really notice it was when I would work out.”
Like so many men, he decided to tough it out.
“I was getting acid reflux in my stomach, my chest. I had never had acid reflux but I thought this must be what this burning sensation is in my chest. At first I could just ride through it,” Kief said.
“That’s when my left shoulder started to hurt.”
That’s a classic warning sign of heart disease, but Kief had undergone reconstructive surgery on his shoulder. “I thought it was just the old surgery,” Kief said.
Kief hadn’t been in for a physical in years.
Two incidents made him think really hard about what might be going on. But it still wasn’t enough to make him look for a new primary care doctor in his new town.
“I was on vacation and I was riding with some fellows that I know. They wanted to ride in the mountains,” he said. Usually, Kief was the strongest climber.
“But I could not keep up with them,” he said. “They had to wait for me at the top of every climb. I couldn’t figure out why I couldn’t make the bike move.”
Then another friend invited Kief to a birthday party bike ride. “I barely hung on with them for 10 miles,’ he said.
Kief realizes he should have thought harder about what was going on. He works at a hospital in Washington, D.C. as a philanthropy officer. He’d been taking drugs to lower his cholesterol. And his father died of heart disease.
But an extreme fitness buff might be forgiven for thinking he was doing just what he should be doing to reduce his risk of heart disease. And again, like so many men, he didn’t mention any of this to his wife.
“I rationalized my symptoms,” Kief admits. “I’ve always been in good shape. I thought I was dealing with my problems by staying in shape.”
Finally, he was worried enough —not to go see a doctor — but to mention his symptoms to a colleague who happened to be one.
“I had a meeting with the head of the heart institute, and at the end I said, ‘You got two minutes?’” Kief said.
He described his symptoms to Dr. Stuart Seides, executive director for MedStar Heart & Vascular Institute at MedStar Washington Hospital Center.
“He said, ‘I have had this funny sensation in my chest when I am out bicycling. Sometimes I stop and sometimes I can just keep going and kind of work through it’,” Seides said.
“I said, ‘Hold on a second here’. The short of it is I always pay attention, particularly when a person in middle life or beyond has chest discomfort and that discomfort is related to exertion.”
Seides whisked Kief in for heart tests. Because Kief was so fit, he aced the cardiac stress test. But Seides remained suspicious.
A cardiac catheterization test finally showed what the problem was. This test involves threading a tube into a blood vessel near the heart to inject dye, and then x-raying the area. “They found I had some major blockages — 90 percent in one area,” Kief said.
The cardiology team didn’t even give Kief time to think. “They said, ‘We are going to admit you right now,’” Kief said.
“The next morning I had a triple bypass.”
Heart disease is the No. 1 killer in the United States, and for many men, the very first symptom is a heart attack, and in many cases the very first symptom is a heart attack that kills.
“Men ignore their symptoms,” Seides said. “About 50 percent of men, their chief complaint is ‘My wife made me come’,” he added.
But wives who press their husbands to see a doctor can save lives. Studies show married men are far more likely to get regular checkups and live longer than single men.
“Part of it is the notion that men don’t like to show weakness,” Seides said. “They have this idea that whatever is wrong, you need to push through it or power through it.”
That’s just what Kief was doing.
“One has to wonder if he didn’t happen to be sitting across from a cardiologist in the course of a business meeting and have an opportunity, how long it would have taken him to actually seek medical attention,” Seides said.
“One of the takeaways is that exercise, fitness, good living, good behavior is not a talisman that can protect you from heart disease.”
Kief agrees. “All you have to do is look at all the mistakes I made,” he said. “I didn’t listen to my body,” he added.
“Do it for your family. Do it for yourself.”