He had a secret plan: A patient compliance story

Keith Orr thought he would surprise his doctor when he came in for a checkup. His doctor had told him to have a weight loss operation to reduce the amount of food his stomach could hold, worried because Keith weighed 278 pounds, had a very high blood sugar level, putting him at high risk of diabetes, and a strong family history of early death from heart attacks. Indeed, he himself had had a heart attack nine years ago, at age 35.

But Keith had a secret plan. He had been dieting and exercising for four months and lost 45 pounds. He imagined proudly telling the doctor what he had done, sure that his tests would show huge drops in his blood sugar and cholesterol levels. He planned to admit that he had also stopped taking all of his prescription drugs for heart disease since, he thought, he no longer needed them. He had never taken them regularly, so stopping completely wouldn’t matter much, he thought, in light of his improved diet and exercise.

But the surprise was not at all what he expected. A week before his scheduled doctor’s appointment, while at the gym in Boston on February 6, he felt a tightness in his chest—the start of a massive heart attack, with the blockage in an artery that doctors call "the Widow-Maker."

He survived, miraculously, with little or no damage to his heart.

Advice to people on aggressive diets and exercise plans: Discuss them with your doctor first.

Read another of our heart disease stories, or Gina Kolata’s source story in the April 8 issue of The New York Times, "Lessons of Heart Disease, Learned and Ignored."