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Dr A Gupta
Dr A Gupta, Doctor (MD)
Category: Health
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Experience:  MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
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My husband had a heart attack, no damage to the heart ...

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My husband had a heart attack, no damage to the heart muscle, stents were put in. At the same time he had an ulcer start to bleed . They had to take him off or decrease the blood thinners for a couple of days but was put back on medication. He suffered a massive heart attack and died a few days later. They say this is very rare. I am not thinking anything was not handled properly it would just help to understand if a clot formed would it be due to the fact that the ulcer bled. He had been sent home from the hospital with no restrictions.
Submitted: 6 years ago.
Category: Health
Expert:  Dr A Gupta replied 6 years ago.
Hello,
I am sorry to hear about the loss.

A bleeding ulcer will not result in clot formation and is an entirely different issue. If the cause of death was heart attck or MI due to a clot, it would be completely unrelated to the bleeding ulcer. However if the cause of death was cardiac arrest (sudden stopping of the heart), it may result from excessive blood loss from bleeding ulcers. Bleeding ulcers when present with another serious illness like heart attack (stress ulcers) does increase the mortality rate(death rate) significantly.

Also since the blood thinners were resumed after two days and repeat heart attack occured after this modification, the clot formations cannot be implicated to the lack of adequate medication.
Let me know if you have any further queries.

Regards.
Dr. Gupta

Please click "Accept" if you find my comments useful. Let me know if you need further input. Feedback / bonus will be warmly appreciated.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
I was only told at the hospital that he had died.
What happened before the first heart attack did seem to happen again. They were trying to use paddles at home and CPR at the hospital. The coroner said that he didn't feel an autopsy was necessary due to the incident the prior week. Could it be possible that the stents closed? He said he felt weak just before he lost consciousness. He was diabetic but I tested his sugar level, it was okay, he also had high blood pressure.
Expert:  Dr A Gupta replied 6 years ago.
Were you informed of the cause of death as MI or cardiac arrest or heart attack ?
Did he had chest pain during the first attack? Did he had chest pain during second time?
Thanks
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
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Customer: replied 6 years ago.
I wasn't informed. He had chest pain during the first attack, I don't know for sure during the second, just that he told me he felt weak before he passed out.
Expert:  Dr A Gupta replied 6 years ago.
It is possible that he may have had another heart attack due to formation of a blood clot or a thrombus in the arteries distal to the stents. It is not the stents that will block so soon, but the length of arteries in which stents were not placed can get blocked due to a thrombus originating there itself or elsewhere. Stents are placed in the narrowest regions of the arteries most affected by atherosclerosis but does not protect the entire length of the vessals. Also chest pain is not always present during the heart attack in diabetics due to decreased sensations.
Also since we do not have the exact information of the cause of death, it is also possible the cause of death was heavy internal bleeding from stress ulcers resulting in cardiac arrest. I am not surprised that an autopsy was not performed, as his overall medical condition carried a high rate of mortality. Also the feeling of weakness and loss of conciousnes can occur with both of these conditions, but will be the most prominent symptom in internal bleeding.

Regards.
Dr. Gupta
Let me know if you have any further queries.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
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Customer: replied 6 years ago.
Relist: I still need help.
The questions you are answering for me are helping me to cope a bit better. The doctor that
was treating the ulcer said that they would need to wait a month before starting aspirin, which makes sense. He was on Plavix, is it possible that he was more likely to have formed a clot due
to the fact that he wasn't on aspirin?
Expert:  Dr A Gupta replied 6 years ago.
I am glad that my answers are helping you.
Aspirin and plavix act on the platelets differently at the biochemical level, but at the cellular level they both inhibit clot formation by preventing adhesions of platelets. For patients at high risk of recurrent clot formation, both aspirin and plavix are recommended for added protection. So yes, perhaps the aspirin would have decreased the chances of repeat clot formation if that was the case.
Having said that, both heart attack and bleeding ulcers are potentially life threatening conditions. For a health professional, it would have been impossible to predict the chances of occurence of one versus the other. Generally the risk of stomach bleeding is greater with aspirin than with plavix, so it is understandable that it was discontinued. Often there are no set guidelines in these situations and the decision has to made by the physician based on his experience and by comparing overall risks vs the benifits.

Regards.
Dr. Gupta
Any further queries are welcome.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
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Customer: replied 6 years ago.
Relist: I still need help.
My husband was released from the hospital with no restrictions except that he wasn't to return to work until it was approved by his family doctor. Two days before the final heart attack he carried a suitcase full of clothes upstairs, I am worried if this could have caused a clot to
form.
Expert:  Dr A Gupta replied 6 years ago.
Carrying a heavy suitcase upstairs or doing any physical exersion two days before the attack would not be responsible for the clot formation. If anything early mobility after any major illness will help improve the circulation and prevent other vascular conditions like deep vein thrombosis and pulmonary embolism.

However if the attack had occured at the time of exertion, then it would have been implicated as the possible cause. This can happen because sudden rush of blood through the sclerosed arteries can damage the inner layer of artery and trigger a chain reaction reaction resulting in clot formation within minutes of the damage.

Regards.
Dr. Gupta

Let me know of any further queries.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
When my husband began to feel weak before he passed out before what I assume was a massive heart attack he told me that he had checked his blood pressure and it was higher than it had been. His blood sugar was good. Since the coroner felt that an autopsy wasn't necessary due
to the first episode, would it be fairly safe to assume that a clot was the most likely problem. They did say his potassium level was just a little bit low at discharge. When they put the scope down to check the ulcer it seemed to have stopped bleeding, they didn't cauterize it, it was very large though, the size of a silver dollar.
Expert:  Dr A Gupta replied 6 years ago.
This is an important piece of information that his blood pressure was high just before the incident. And this significantly tilts the odds in favour of a heart attack rather than bleeding ulcers as the cause of death. Blood pressure during a heart attack is usually high due to the sympathetic action of adrenaline. On the contrary, fatal bleeding ulcers would cause rapid decline in BP, sometimes so low that it is unrecordable.

A slightly low potassium level will not cause any major problem. However if it drops significantly it can cause fatal arrythmias along with other symptoms like muscle pain, weakness etc. Also cautery is done to control active bleeding or when you can actually see a bleeding blood vessal during endoscopy. If the bleeding has stopped, cautery will not have any added benifit and can actually restart the bleeding.

Regards.
Dr. Gupta

Any further queries are welcome.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
If it is more likely that it was a heart attack is it more likely that he formed a clot or that
he developed arrythmia. He was kept in intensive care for longer after the first heart attack. I believe due to arrythmia.
Expert:  Dr A Gupta replied 6 years ago.
It is difficuilt to predicct without examining the clinical data and lab results at the time of hospitalization. Arrythmia can not only occur due to electrolyte disturbance like low or high potassium levels, but also as a complication of heart attack. Many times patients can get a severe ventricular arrythmia while recovering from a heart attack. The risk of arryhtmia increases if there was extensive damage to the heart especially to the tissue that transmits the electrical signals for the heart beat. Early signs of this damage can be detected during the immediate period after the heart attack with a cardiac monitor. So if he was sent home with limited restrictions, I doubt if he had any extensive damage. Therefore possibility of repeat clot formation cannot be ruled out even though he did not had chest pain. As I said it is difficult to predict without looking at the EKG's and other clinical data.

Regards.
Dr. Gupta
Let me know of any further queries.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
Would high blood pressure or diabetes be more likely to have caused the heart attack. His blood pressure did run high even with medication.
The diabetes seemed to only need about 5mg. medication and diet modification. There is a definate history of heart attack and stroke on
both sides of his family. There has never been a
man on either side live beyond 61 due to heart attack. The doctor did wonder if there might be a
genetic predisposition to clotting. I wonder as I have three sons.
Expert:  Dr A Gupta replied 6 years ago.
Both high blood pressure (hypertension) and diabetes are risk factors for heart attack. For hypertension to be a causative factor it has to be present for many years and be poorly controled with treatment. Uncontrolled hypertension not only causes thickness of arteries but also can cause enlargement of heart. This enlarged heart will now require increased blood supply to funtion properly and is thus more vulnerable to infarction(damage).
Also poorly controled diabetes is a strong risk factor for narrowing of arteries. However if the blood sugar level has been reasonably well controlled with medications or lifestyle modification, it should not cause any problems. Your husband seemed to have mild diabetes and is unlikely to be of major risk factor.

It seems the strongest risk factor in this case was family history. Strongly positive family history is regarded as an independant risk factor for heart attack i.e. regardless of other factors like increased age, diabetes, smoking etc. Family history is considered strongly positive if more than one first degree relative has had similar illness at around about the same age. However if the association is weak, there may be other hidden fators responsible for the heart attack eg. presence of diabetes in all relatives, a particular diet and lifestyle of the family etc. So a family history can be attributed to the illness but it cannot be used to predict the occurance of similar condition in the future generations.

Regards.
Dr. Gupta
Any further queries are welcome.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
Since my husbands potassium level was a bit low when he left the hosptital would there be anything that would have possibly caused it to drop dramatically? He was on Plavix 75mg, Protonix 40mg., Amaryl i mg., Cozaar 10mg., Zocer 20mg., once a day and Metropolof 50mg 2x/day
Expert:  Dr A Gupta replied 6 years ago.
None of these medications will cause any significant drop in potassium level. If anything Cozaar may cause slight increase in potassium level by preventing its excretion from the kidneys but even this effect is not significant. Severe arrythmias when occur not only cause drop in blood pressure, but often can be felt by the patient as rapid heart beating. Also if it were the low potassium that would have triggered the event, other effects of low potassium eg. severe weakness in muscles, fatigue, confusion etc., would have been felt by the patient several hours to days before the attack. Generally level of potassium is well balanced by the body and any changes that occur, do so gradually.

And I appreciate your encouraging feedback and bonuses.
Regards.
Dr. Gupta


Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
You're welcome, this is very important to me right now. Do you know what would have been most responsible for the narrowing of the arteries, he had diabetes for about two years, high blood pressure for 34 years?
Expert:  Dr A Gupta replied 6 years ago.
Diabetes present since two years is not a significant risk factor for MI this severe. Also due to its typical symptoms, diabetes is usually diagnosed early and with treatment the effects of high blood glucose can be prevented.
However high blood pressure for over 30 years is an important risk factor. Hypertension causes thickening of small and medium sized arteries and causes deposition of fibrous materials within their walls. A lot depends on how well and strictly the blood pressure is controlled with medications and other methods. If the treatment has been able to maintain the mean blood pressure below the target level more times than not, then high blood pressure will also not cause any major problems. Many times since a person will not feel any symptoms from high blood pressure, it is easy to go ignore the importance of maintainence of optimum blood pressure and compliance with treatment is poor. This is one of the major reason that blood pressure is major risk factor for heart attack.

Regards.
Dr. Gupta
Let me know of any further queries.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
My husband had eaten Mexican food although it didn't seem too spicy, however his ulcer had begun to bleed about three days before the first heart attack. Could the food have made his ulcer bleed and contributed to the heart attack?
Expert:  Dr A Gupta replied 6 years ago.
Spicy or tropical foods can sometimes cause increased acid production in peolpe not accustomed to these foods. And increased acid production can worsen a pre-existing ulcer. However a sinlge meal alone cannot cause ulcers, although it may cause bleeding in the ulcer already present. However as I mentioned in a previous answer, bleeding ulcers as such will not contribute towards heart attack. But when present together, both these conditions do make things a lot more complicated. Another way of considering their association is by stress and anxiety. Any one of these conditions raise the overall stress and anxiety level of the body and these emotional factors increase the risk of both these conditions.

Regards.
Dr. Gupta
Further queries are welcome.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
One of the arteries that received a stent was very easy to open. The other was the most difficult the doctor had done in the last four years. Also it was mentioned that he might need a bypass somewhere along the way. How do they determine whether to do a stent or a bypass?
Expert:  Family Physician replied 6 years ago.
The other expert is offline, I will be glad to help yo with your question.

The decision to do an angioplasty with stent versus bypass surgery depends on the degree of blockage (how narrow), where along the course of the artery (at the beginning, or further downstream in the artery) and if the blockage is located at or near to a bifurcation (branching) of the artery
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12566
Experience: Emergency Medicine and Family Practice for over 26 years
Family Physician and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
The cardiologist who placed the stents was shocked when he found out my husband had a second heart attact and died. My husband wasn't able to be on aspirin, due to the ulcer but was on 75mg. of Plavix. He told my son that what happened is very rare. I'm just wondering as this just helps me come to terms with things what
would be the approximate percentage of cases that
something like this would happen?
Expert:  Dr A Gupta replied 6 years ago.
Reoccurance of heart attack few days after the stent placement and resulting in death of the patient is quite rare. According to one large study (done in 1998) recognised by Americal Heart Association, the incidence of a major cardiovascular event eg. heart attack, severe arrythmia etc. during first 30 days after the stent procedure range from 2.9% to 4.5% depending on the size of arteries. If the stents were placed in smaller arteries the risk would be greater. However exact data on how many of these events resulted in death of the patient is not available.

Regarding long term outcome , the one year survival free of heart attack after this procedure ranges from 94.7% to 95 %. However in some of these cases (20-25%) a repeat procedure was done due to evidence of restenosis(repeat narrowing) of arteries on the angiogram test.

I don't think there is a study done to assess the risk of heart attack in the immediate post-op period due to lack of aspirin.

Regards.
Dr. Gupta
Let me know of any further queries.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
About ten days before the first heart attack we were in Colorado, my husband experienced symptoms similar to altitude sickness, I was concerened about his heart. When he called his family doctor he scheduled heart tests for the next week but my husband had the first heart attack before the test. The family doctor said he
didn't think it was heart related due the mention
of altitude. I just wondered if the altitude could have triggered the heart attack. His voice
was even weak.
Expert:  Dr A Gupta replied 6 years ago.
If the symtoms were mainly nausea, dizziness, headache etc, they were indeed altitude sickness and would not be realted to heart attack in any way. Also altitude sickness cannot trigger a heart attack or a blood clot. However if he had symptoms of chest pain, shortness of breath, sweating, palpiatations etc. then they could have been related to ischemia of heart. Also if he had done heavy exertion eg. hiking, before the onset of symptoms, then it is more likely to be due to heart rather than altitude.

Regards.
Dr. Gupta
Let me know of any further queries.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
Dr A Gupta and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
How long does it usually take for a clot to develop and then cause a heart attack?
Expert:  Family Physician replied 6 years ago.
The time to develop a clot is minimal. Think of the time it takes to stop bleeding when you cut your finger (a small cut - not a huge gash) - and you have some idea of the time frame.

The atheroscleosis leading up to the "event" takes years - but once the cascade of event leading to clot formation starts - it progresses quickly.
See this link for additional information
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12566
Experience: Emergency Medicine and Family Practice for over 26 years
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Customer: replied 6 years ago.
Relist: I still need help.
My husband came home from the hospital around 11:00 a.m. on Tuesday and had the heart attack on the Thursday around the same time, I just wondered if the clot would have developed during that time frame?
Expert:  Family Physician replied 6 years ago.
YES - it can occur within minutes. People can be perfectly normal, have a normal EKG, even a normal stress test, go home, and hours later have a massive heart attack.
Family Physician, Doctor (MD)
Category: Health
Satisfied Customers: 12566
Experience: Emergency Medicine and Family Practice for over 26 years
Family Physician and 4 other Health Specialists are ready to help you
Customer: replied 6 years ago.
Relist: I still need help.
I'm pretty sure my husband took his heart medications the morning before he had the fatal heart attack but if he had forgotten to take the Plavix, could that have caused a clot to form within a few hours?
Expert:  Family Physician replied 6 years ago.
Missing a single dose of Plavix would likely NOT have caused a heart attack.
Family Physician, Doctor (MD)
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Satisfied Customers: 12566
Experience: Emergency Medicine and Family Practice for over 26 years
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Expert:  Dr A Gupta replied 6 years ago.
Although Plavix as a drug do not remain in the system for more than few hours, its action can last for several days. If Plavix is regularly used for a week or more, it reaches a steady state in the body. And one missed dose would not make a significant difference to its anti-platelet action. Its effect starts to fade away in 4-5 days after discontinuing the medication.

Regards.
Dr A Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 938
Experience: MD Internal Medicine, Internist with over 12 years of urgent care/outpatient experience.
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