Tom's Medical Information

Hi Everyone,

Below are excerpts from the autopsy and the report we received from Tom's regular doc, who did his physical check up on January 23.

I'm finding that my aversion to legal language is only exceeded by that of medical language. Every organ seems to be 'smooth and glistening'; those words have now a new meaning..

I've included just a bit from the description of Tom's possesions at the time he died. It is so true to him to walk around with kids' gloves etc.. I found another 2 pairs in his backpack, which was on the passenger seat.
We miss him so horribly.

Allright, here it goes..
Love, Susanne.

EXTERNAL EXAMINATION (Partial):
... Hills Bank ATM card, Zurich travel card, AAA card, airline ticket stubs, two children's
"smile face" ID cards (Sara and Eva Branson), multiple receipts and ATM stubs, and 37 dollars
in US currency (20 dollar bill, 10 dollar bill, 5 dollar bill, two singles). Two red child
size gloves are present in the pocket of the black leather jacket and a key ring with ten keys
is in the pants pocket.

CASE SUMMARY:
The cause of death in this case is acute myocardial ischemia due to atherosclerotic coronary
artery disease. Based on the microscopic findings, the most likely mechanism was that of plaque rupture with concomitant occlusion and/or vasospasm of the affected segment of the left
anterior descending coronary artery. Such an acute event can induce severe acute myocardial
ischemia of the left ventricle and interventricular septum, and may also cause fatal dysrhythmia (abnormal contraction of the heart muscle).
There were no other significant contributing factors found at autopsy, and toxicology analysis
of blood, urine, and vitreous showed no evidence of drugs of abuse.

CARDIOVASCULAR SYSTEM:
The heart weighs 500 grams. The epicardial and pericardial surfaces are smooth and glistening.
The pericardial sac is free of significant fluid or adhesions.
The coronary arteries show a variant take-off of the right main, characterized by early branching of the right mainstem coronary artery, with two ostia present at the take-off from the aortic root. A left dominant pattern of vascularization is present. There is mild atherosclerotic plaque in the right main and left mainstem coronaries, with less than 10% stenosis by plaque.
The left anterior descending artery shows a severe complicated atherosclerotic plaque demonstrating severe occlusion greater than 90% of the luminal cross sectional area. This segment is 1.2 cm in length, and is located 3.5 cm distal to its takeoff from the left mainstem artery. There is no other areas of significant occlusion.
The chambers and valves bear the usual size/position relationship and are morphologically normal.
The endocardial surfaces are smooth and glistening.
The valve ring circumferences are as follows: tricuspid 13.0 cm; pulmonic 7.5 cm; mitral 9.5 cm
and aortic valve 7.9 cm. There is no myxomatous degeneration, and there is minimal atherosclerotic
plaque involving the aortic valve cusps. The valves are free of vegetations.

GENITAL SYSTEM:
The prostate is unremarkable, with an exceptionally possible 1.0 cm cyst-like structure near
the apex.

MICROSCOPIC EXAMINATION:
The microscopic examination confirms the gross pathologic findings. Sections through the diseased portion of the LAD shows >90% occlusion by complicated atherosclerosis, with ruture of the intimal atheromatous cap; fresh blood and scant fibrin is present within the cap. There is evidence of previous cap rupture with an area of organizing fibrin. Sections of the myocardium show no light microscopic changes of ischemia, and no fibrosis is noted.


Relate this to his physical check up on January 23, 2006:

CONCLUSION (Partial):
...
The metabolic panel that includes the blood sugar, liver functions, and kidney function tests was
normal except minimal elevations of sodium, chloride, and calcium. Lab error?? Might recheck these in the next 4-6 weeks.

The PSA test can help in the screening for prostate cancer and is normal at 3.93. This result will
serve as good reference point for future comparisons. For your age, a level of 3.93 would seem
high. Compared to past results: None known. Should have urology review. Call to schedule.

The mix of cholesterols with an HDL ratio of 5.0 falls in the borderline higher risk range. The
total and bad (LDL) levels are elevated with the good or HDL level fair at 47. LDL levels under 100 are felt to be ideal and good or HDL levels over 60 are felt to be protective. One might consider medication to lower cholesterols in patients who have a strong family history of heart disease or other significant risk factors.

Long term, continue to watch the diet and get more regular exercise.

CHOLESTEROL REPORT:

Triglycerides - 157
Cholesterol - 236 H (<200)
HDL Cholesterol - 47 (35-65)
VLDL (Calc) 31 (5-40)
LDL (Calc) 158 H (0-129)
CRF (T. Chol/HDL Chol) - 5.0 (Ratio 0.0 - 5.0)