Mayor Stephanie C. Rawlings-Blake stepped out of a black SUV shortly after being released from the hospital Thursday afternoon and teetered in stiletto heels toward City Hall.
"I guess I wore the wrong shoes to show I'm back on my feet," she said with a wry grin.
The mayor was hospitalized for eleven hours after she awoke before dawn with chest pains, numbness and dizziness. Doctors performed a battery of tests and determined that the 39-year-old was suffering from gastro-intestinal difficulties, she said.
"I just need to slow down on the caffeine," she said at a brief news conference Thursday afternoon before heading to a meeting with top aides. "And I should be walking around with a bottle of water."
The mayor's husband, Kent Blake, drove her to Sinai Hospital, near their Northwest Baltimore home around 3 a.m. Thursday after she complained that she felt like she could pass out. She was later transferred to the University of Maryland Medical Center for evaluation.
Tests, including an EKG and a stress test, indicated the mayor was in "excellent health" and ruled out serious medical concerns such as a heart attack or a stroke, said Dr. Andrew Pollak, associate director of trauma at the University of Maryland Medical Center.
"Apparently, I'm a rock star on the stress test treadmill," she said.
Despite the pressure that Rawlings-Blake has experienced lately, it did not appear that her illness was stress-related, Pollak said.
"Certainly with somebody who is as exposed to stress as the mayor is, you worry about that type of thing," he said. "But it really doesn't appear to be [stress-related] right now."
Rawlings-Blake was sworn-in as mayor one month ago, following the resignation of Sheila Dixon as part of a plea deal in her criminal case.
On her second day of office, the first of an unprecedented pair of blizzards hit the city. The storms choked the city in more than four feet of snow, shutting offices and snarling traffic for days. The mayor spent long hours in the emergency operations center, toured city streets and supervised the recovery.
The mayor, who is two weeks short of her fortieth birthday, served on the City Council for 15 years and was its president for three years, but her responsibilities as mayor are considerably more taxing. She juggles a schedule of public appearances with time with her family, including her six-year-old daughter.
Rawlings-Blake said she was surprised that she grew ill during a relatively quiet time rather than during the "wild and wacky" schedule she maintained during the snow storms.
She did not take a break from her work yesterday, meeting with top aides, including Chief of Staff Sophie Dagenais and Assistant Deputy Mayor Kaliope Parthemos, from her hospital bed. Her mother, Nina Rawlings, a retired physician, was also by her bedside, aides said.
"She hasn't stopped thinking about her priorities," said Dagenais. "She asked me to brief her on a number of meetings from yesterday."
Top aides made a point of saying that the mayor was not succumbing to stress, which one politicial observor said was important to maintaining her image.
Health issues can cause problems at the polls, said Matthew Crenson, a professor emeritus in political science at the Johns Hopkins University.
"It suggests that you're not fit for the job," he said. "For people who want to challenge her in 2011, this is like blood in the water."
But given the minor nature of her malady, the buzz over Rawlings-Blake's health should blow over quickly, he said. In the meantime, the mayor should "be very visible" to show the public that she is fine, he said.
Rawlings-Blake is slated to read to children at an elementary school this morning and resume her normal work schedule today, including a meeting to review fire department statistics, her spokesman, Ryan O'Doherty, said. O'Doherty declined to give more specific information about the mayor's ailment.
The evening before she grew ill, Rawlings-Blake dined at Corks in Federal Hill with former City Councilman Carl Stokes, who has been nominated to replace the seat vacated by Council President Bernard C. "Jack" Young.
The mayor ordered a pork chop entree and appeared "vibrant" and "upbeat" but very busy, Stokes said. She stepped away from the table for several minutes for a radio interview and left before dessert for another meeting, he said. A tall woman with glowing skin, the mayor played tennis while a student at Western High School, but put on weight after the birth of her daughter. She has lost a significant amount of weight since the summer.
Her father, the renowned statesman Del. Howard P. Rawlings, died in 2003 at age 66 after a lengthy battle with bladder cancer.
Dr. Brian Kahn, a cardiologist at Mercy Medical Center, said patients admitted to the hospital for chest pain and numbness typically receive a battery of tests to determine whether the cause is heart related, gastrointestinal or stemming from an injury that might cause sore chest muscles.
Typically doctors will do an electrocardiogram, to determine if a patient had a heart attack and afterward a stress test, which measures how well the heart works after exercise. The source of chest pain could also be stress to muscles, he said.
"It depends on a patient's history," he said. "They could have been lifting heavy boxes, or perhaps she was in an accident or was out shoveling and she has a tender chest wall."
At the first sign of chest pain, physicians always look for life-threatening heart trouble. But often, doctors and patients alike can mistake chest pain for heart problems when they are actually symptoms of acid reflux disease, said Dr. Harold Tucker, a gastroenterologist and chief of staff at Greater Baltimore Medical Center.
Acid comes up into the esophagus, triggering spasms of the muscles surrounding it, resulting in chest pain that's tough to distinguish from a heart attack, he said.
Studies have found about a third of patients who come to the hospital complaining of cardiac-style chest pain and don't have heart disease, actually have reflux at the source of their pain, he said.
"Reflux is common, and diet and stress may bring on the condition," Tucker said.
Eliminating fatty foods, chocolate and caffeine can help alleviate the problem and the condition responds well to common medications, he said.
Another possibility for patients with chest pain, particularly women, is gallbladder disease, he said. Women who are overweight or who had a spell of rapid weight loss also are more prone to developing gallstones, which often cause upper abdominal pain, as well as chest pain, Tucker said.
Other medical conditions can result in chest pain that can mimic a heart attack, such as a blood clot in the lung, said Dr. Dawn Kershner, a Union Memorial Hospital cardiologist who specializes in women's heart care.
Far less serious, symptoms of dizziness with pain, could be the result of a common stomach virus, she said. "When you get a little nauseous, abdominal pain can stimulate a nerve in the neck that can increase your heart rate and make your blood pressure drop very low," Kershner said. "You can get very dizzy and lightheaded."
Most common of all, stress can take its toll on the body, aggravating heart problems, reflux disease and virtually any medical condition. And anxiety can trigger panic attacks that are often mistaken for cardiac problems. But there's no objective way to measure the effect of stress on a person's health, Kershner said.
Someone with a high stress lifestyle may have many coping skills to deal with it, while another person with small amounts of stress may not manage it well, she said.
Regardless of the severity of the symptoms, the mayor did the right thing by seeking treatment fast, Kershner said. "Too many women stay home and say it's this or that and things get missed and it's too late," she said. "Women have a lot to balance on their plates and are always trying to keep it all together. But she came in and saw a doctor instead of ignoring her symptoms or being stoic and expecting them to go away."
The mayor said she wanted to "set a good example" by not ignoring her symptoms.
"I just know I'd rather be safe than sorry," she said.