A Treasure Lost – Surgeon, David Wulkan, M.D.

I lost a colleague this week to acute leukemia. He was diagnosed and treated at a world class Center of Excellence but succumbed to the complications of treatment so rapidly that those of us who worked with him daily had little knowledge that he was ill or gone until it was all over.  This 56 year old General and Vascular surgeon shared a February 17th birthday with me, came from a working class urban background and trained in the General Surgery program at the rigorous and demanding University of Miami Jackson Memorial Hospital Program. He completed his residency training several years after I completed my general medical training and then moved up to Boca Raton, Florida to join one of the premier surgical groups in the area.

My wife had the privilege of teaching one of his children at the pre-school level and knew his wife and children. We never broke bread together or visited each other in our respective homes. We didn’t go out socially together either. Despite this, I considered him a friend as I saw him on a daily basis while I made morning and evening rounds at the Boca Raton Community Hospital as we both strove to prevent disease and help others. He was warm, understanding, even-tempered, showed great judgment clinically and great understanding of his patients’ needs and concerns.

Surgeons are often branded as arrogant, cold, and volatile. Dave was like a teddy bear, just a very bright talented competent one.  We shared patients and they all thanked me for finding them such a special physician in their time of need. He educated me when I needed to be educated and he did it in a manner that conveyed the message in a professional and respectful way without making me feel like I should have known that.

I know the kind of hours he put in and the sacrifices his wife and children made with regard to time so that he could care for other persons’ loved ones. That is time one never recaptures.

My community has lost a treasure of a doctor and a wonderful human being. We will miss his kind and affable manner, wisdom and skill. My thoughts and prayers will be with him and his family and with the families of all those other caregivers who make it easier for their loved one to care for and help someone else’s loved one routinely.

I was proud to be Dr. Wulkan’s colleague and will miss him greatly.

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Aspirin Holiday Carries Its Risks

A recent publication in the British Medical Journal looked at the risk of stopping aspirin therapy and taking a drug holiday from it if you are taking aspirin as secondary prevention for heart disease. The study, conducted from 2000 – 2007, looked at almost 40,000 participants aged 50-84 who were taking low dose aspirin (75- 300 mg per day) for secondary prevention of cardiovascular outcomes. They followed the patients for 3.2 years.

Researchers determined that individuals who stopped aspirin for 1-6 months had significantly more myocardial infarctions (heart attacks) and cardiovascular deaths than individuals who continued the aspirin.  Most of the patients who stopped the medication just stopped it on their own for no particular reason.

The study has implications for patients who have known coronary artery disease, have had a heart attack or stent placed or have survived bypass surgery. It says that if you stop the aspirin you increase your risk of having a cardiac event.

As a physician I am always faced with phone calls from patients going for minor dental work and the dentist insists on stopping the aspirin. I have patients going for elective cosmetic procedures who are required to stop their aspirin.  The message must be “is the risk of excessive bleeding from the elective procedure greater than the risk of having a heart attack?”  This is a question you should ask your cardiologist, internist or family physician before stopping the aspirin. You and they will need to ask your dentist or surgeon the same question before you stop the aspirin.

There will be times when you will have no choice but to accept that increased risk to have work done which may be necessary.  By informing your physician of the problem, and discussing it with the surgeon or dentist, we can determine if stopping the aspirin is essential and if there are other measures we can take to prevent a cardiac event.