As with any typical day for a sleep clinic, a patient was referred to me to evaluate her for insomnia. After my extensive evaluation of her, I listened to her carotid arteries and heard bruit. “Bruit” is a noisy blood flow suggestive of narrowing of an artery. I asked her if her carotid artery was known to be narrowed or “clogged up”. She said, “No.” So I urged her to make an appointment with her primary care physician right away for further evaluation. He ordered an ultrasound of the carotid arteries which also suggested that she has carotid artery stenosis (which means narrow blood vessel). An angiogram was performed later, being the ultimate test for the assessment of this condition. The angiogram confirmed the presence of severe Carotid Artery Stenosis. The standard treatment for severe stenosis is surgery.
So this patient who went to see a sleep doctor ended up having carotid surgery. She went ahead with the surgery and afterwards called to thank me for making the diagnosis before she had symptoms or complications from Carotid Artery Stenosis. The initial symptom could have led to a transient ischemic attack or stroke. I have not seen her in a long time because her insomnia did not require further intervention. But her trip to see me saved her from a possible disabling stroke or even death.
I learned a lot from this event. One lesson in particular is that a physician should look out for the health of his or her patient even if it is something unrelated to one’s specialty.