Jay Middleton, a former Harlem Globetrotter, was rushed to the emergency room (ER) at affiliate Methodist Healthcare in San Antonio, Texas after experiencing severe pain and chest pressure. HCA Healthcare physician, Dr. Kim de la Cruz, knew time was of the essence and swiftly performed a complex surgery to repair Jay’s aortic dissection, which ultimately saved his life.
Athletes go their entire career routinely examined for health conditions and injuries. Jay Middleton’s life took an unexpected turn at just 36 years old when the basketball star faced a life-threatening condition.
At 7-foot-4, Jay, or “Stretch” as he is known to many, began playing basketball in grade school. He devoted his college career to playing basketball, attending Central Connecticut State University for two years before transferring to the West Palm Beach, Florida campus of Northwood University for his final two years.
Jay later went on to play for the American exhibition basketball team, The Harlem Globetrotters for the 2011-12 season. Uniquely, their style of play combines athleticism, theater and comedy. The Harlem Globetrotters took Jay all over the world, performing in over 100 countries. Jay recalls the special memories of his career with the Harlem Globetrotters and says, “It was such an interesting and unique experience to have been a part of.” He retired from the famous basketball team after six years and has since made San Antonio, Texas his home base.
In early March 2020, Jay recalls a two-week time span where he noticed some minor changes in his health. “I didn’t feel like myself, I just felt drained,” he recalls. Jay was working on a roof March 13 when he suddenly felt a severe pain jolt through his back and had some chest pressure. He immediately sensed that something was wrong. Attributing his extreme discomfort to dehydration, Jay safely got off the roof and called an ambulance.
Emergency services brought Jay to the Methodist Hospital emergency room where he presented with incredibly high blood pressure. He was given oxygen and medications to manage his pain and reduce his blood pressure. A negative electrocardiogram (EKG) and blood work ruled out a heart attack. However, He was then sent to have a computed tomography (CT) scan to look at his lungs and aorta, which confirmed Jay had an aortic dissection.
His ER physician, Dr. Jennifer Gemmill, knew to call Dr. Kim de la Cruz, aortic surgeon with the Methodist Hospital Aortic Center who rushed to the ER.
“When I first saw Jay, he looked pale and diaphoretic (sweaty). He was mildly short of breath,” commented Dr. de la Cruz. “There was a look on his face that something had gone wrong inside.”
Jay had suffered a Stanford type A/DeBakey type I aortic dissection. This type of dissection occurs when blood travels through the aorta tear and inserts itself in between the inner and outer layers of the aorta, creating a false channel from the root of the aorta on the heart down to the aortic bifurcation in the abdomen.
There was fluid around Jay’s heart caused by blood leaking from the aorta. Had he not sought treatment, his condition could result in a cardiac tamponade, a severe and life-threatening condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle. This places extreme pressure on the heart and prevents the heart’s ventricles from expanding fully and functioning properly. Jay’s leaky aortic valve was causing congestion in the lungs and heart failure. His only chance at survival was emergent surgery.
Dr. de la Cruz contacted Jay’s close friends in town to explain the dire situation he was in and that he required surgery immediately. “There is a 1-2% per hour risk of mortality while waiting to fix an acute aortic dissection,” Dr. de la Cruz stated.
Jay underwent a repair of his aortic dissection. This involves going through the breastbone, then replacing the valve-sparing aortic root. A stent was then placed in his descending thoracic aorta to cover the tear in his proximal descending thoracic aorta. Dr. de la Cruz was able to remove Jay’s dissected aortic aneurysm and reconstruct his aortic root using his valve. Jay’s accessibility to comprehensive aortic care ultimately saved his life.
One of the first questions Dr. de la Cruz asked Jay was whether he had suffered Marfan syndrome, a genetic disorder that affects the body’s connective tissue, usually present in people who are significantly tall and have long limbs and fingers. Marfan syndrome is a mutation, or defect, of the fibrillin 1 gene, which can cause tissues, including the aorta, to be soft and elastic. They tend to form aneurysms that dissect at smaller diameters. Jay mentioned that he had genetic testing performed before and that he tested negative for Marfan syndrome.
“Although Jay is negative for the more common genetic syndromes associated with aortic aneurysms and dissections, he might be in the spectrum of these heritable aortic syndromes, having presented with an aortic aneurysm with dissection younger than 50 years old,” commented Dr. de la Cruz. “There is still a lot we do not know about the genetic basis of aortic diseases, and scientists are working to find out more genes that may be involved in the pathophysiology of this disease process.”
Dr. de la Cruz also noted Jay’s lifestyle may have attributed to his dissection. Jay admits to overworking out and drinking pre-workout drinks. “Too much caffeine in energy drinks may cause the blood pressure to elevate and promote aortic growth which can trigger a dissection. Lifting heavy weights also has the same effect,” de la Cruz noted.
Jay’s surgery was successful and is recovering well. While he has not since returned to the court, he has slowly integrated a healthy lifestyle back into his routine.
“Only time will tell for my basketball future,” Jay said. “My dissection has brought me some limitations, but I don’t take anything for granted anymore. Tomorrow is not promised.”
Remember to not delay necessary medical care during the global pandemic. For life-threatening conditions like a heart or attack or stroke, faster treatment means better outcomes. If you think you or a loved one are having a heart attack or stroke, it is best to not drive yourself to a healthcare facility. Dial 9-1-1 and seek medical attention immediately. Medical professionals can begin life-saving treatment and get you to an emergency room right away.
Nashville-based HCA Healthcare is one of the nation’s leading providers of healthcare services, comprising 186 hospitals and approximately 2,000 sites of care, including surgery centers, freestanding ERs, urgent care centers, and physician clinics, in 21 states and the United Kingdom.