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Joanie Simpson woke early one morning with a terrible backache. Her chest started hurting when she turned over.
Within 20 minutes, she was at a local emergency room. Soon she was being airlifted to a hospital in Houston, where physicians were preparing to receive a patient exhibiting the classic signs of a heart attack.
But tests at Memorial Hermann Heart & Vascular Institute - Texas Medical Center revealed something very different.
Doctors instead diagnosed Simpson with Takotsubo cardiomyopathy, a condition with symptoms that mimic heart attacks. It usually occurs following an emotional event such as the loss of a spouse or child. That link has given the illness its more colloquial name: broken-heart syndrome.
In Simpson's case, the event that she says tipped her over the edge was the recent death of her beloved Yorkshire terrier, Meha.
"I was close to inconsolable," she said. "I really took it really, really hard."
Simpson's 2016 experience is described this week in the New England Journal of Medicine — not because of the dog's role, according to one of her doctors, Abhishek Maiti, but because hers was a "very concise, elegant case" of a fascinating condition that research has established as quite real and sometimes fatal.
Although not the first published case linking broken-heart syndrome to stress over a pet's death, it underscores something many animal owners take as a given: that grieving for sick or deceased pets can be as gutting as grieving for humans.
A growing body of research supports this notion, which was echoed in a recent study that found pet owners with chronically ill animals have higher levels of "caregiver burden", stress and anxiety.
It's the flip side of evidence that links pets to health and happiness, which gets more attention. Not that people who have lost beloved animals are likely to be surprised.
Simpson certainly wasn't shocked. At the time of what she calls her "episode," she'd been having a rough stretch: Her son was facing back surgery. Her son-in-law had lost his job. A property sale was proving to be complicated and lengthy. Meanwhile, 9-year-old Meha was suffering from congestive heart failure.

The dog was like a daughter, Simpson said. She adored jumping into the swimming pool, and when Simpson and her husband grilled on Friday nights, Meha was given her own hamburger.
"The kids were grown and out of the house, so she was our little girl," said Simpson, a 62-year-old retiree who previously worked in medical transcription.
But Meha started having more bad days. By May of last year, she was ill enough that Simpson made an appointment to have her euthanized. When the day came, the dog seemed fine, and Simpson canceled the appointment. Meha died the next day, and not peacefully.
"It was such a horrendous thing to have to witness," recalled Simpson. "When you're already kind of upset about other things, it's like a brick on a scale. I mean, everything just weighs on you."
After the helicopter carrying Simpson landed on the roof of Memorial Hermann, she was rushed to the cardiac catheterisation lab. Cardiologist Abhijeet Dhoble quickly threaded a thin tube into a blood vessel in Simpson's groin and up to her heart.
The team expected X-rays to show blocked arteries, said Maiti, then an internal medicine resident. They didn't.
"The artery was crystal clear. It was pristine," he said. Another artery was, too. Further tests indicated this was a case of Takotsubo cardiomyopathy, which is most common in postmenopausal women.
A study published in the New England Journal of Medicine in 2005 is among those that confirmed that a flood of stress hormones may be able to "stun" the heart to produce spasms in otherwise healthy people.
Once medications stabilised Simpson, the physicians talked to her about the stress in her life, and they told her about broken-heart syndrome. It "made complete sense", Simpson said. She was sent home after two days, and though she still takes two heart medications, she is doing fine.
Simpson, who now lives about two hours northwest of San Antonio in the town of Camp Woods, only has a cat named Buster these days. She hasn't yet made the right connection with a dog, though she's sure it will happen.
She is the kind of person who takes "things more to heart than a lot of people," she said, and she figures this tendency means her heart will break again, though maybe not so literally.
And it will be worth it, Simpson said.
"It is heartbreaking. It is traumatic. It is all of the above," Simpson said. "But you know what? They give so much love and companionship that I'll do it again. I will continue to have pets. That's not going to stop me."
2017 © The Washington Post
This article was originally published by The Washington Post.

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1.Belmond Grand Hibernian

The Belmond Grand Hibernian brings a "shimmering world of indulgence" to the Irish countryside. Its cushy observation cars offer pristine views from Dublin to Cork or Belfast.

For the 2016 season, full six-night "Grand Tour of Ireland" journeys are scheduled to run Tuesday-to-Monday, as these would consist of both the south-westerly "Legends and Loughs" and northerly "Taste of Ireland" segments with a change-over for some passengers in Dublin on the Saturday of each week.











2. TranzAlpine

In New Zealand, the TranzAlpine lets riders take in the epic vistas and awe-inspiring plains between Christchurch and Greymouth. It covers 139 miles in just under five hours.

It  was introduced on 22 November 1987 to replace the conventional Christchurch-Greymouth express trains and became one of the New Zealand Railways Corporation's 'new' tourist oriented passenger services utilising refurbished rolling stock. Accompanying this new-look train were a new-look livery and rebranding.










 3. Old Orient Express

The century-old Orient Express transports riders to the golden age of rail travel, with its four-course dinners and black-tie glamour. It runs from London to Venice in two days.

The route and rolling stock of the Orient Express changed many times. Several routes in the past concurrently used the Orient Express name, or slight variations. Although the original Orient Express was simply a normal international railway service, the name became synonymous with intrigue and luxury travel.







4.The Ghan

The Ghan takes riders through the fiery red center of Australia, offering access to the dramatic scenery and indigenous sites that are off-limits by other modes of transit.

Construction of what was then known as the Port Augusta to Government Gums Railway began in 1878 when Premier of South Australia William Jervois broke ground at Port Augusta. The 1,070 mm (3 ft 6 in) line reached Hawker in June 1880, Beltana in July 1881, Marree in January 1884 and Oodnadatta in January 1891.








5.Trans-Siberian

The Trans-Siberian Railway offers a 14-day excursion through Russia, from Vladivostok to Moscow, that passes by endless grasslands and Lake Baikal, the deepest lake on Earth.

It was built between 1891 and 1916 under the supervision of Russian government ministers personally appointed by Tsar Alexander III and his son, the Tsarevich Nicholas (later Tsar Nicholas II). Even before it had been completed, it attracted travellers who wrote of their adventures.










6.Shongololo Express

Passage aboard Africa's best affordable railway, the Shongololo Express,It proposes two different itineraries of a duration of about fifteen days. One that crosses the most beautiful cities of South Africa from Johannesburg to Cape Town via Port Elizabeth , the other crosses six African countries ( Zimbabwe , Zambia , Botswana , Mozambique , South Africa and Swaziland ) with among others as a highlight, the passage over Victoria Falls and the Zambezi River .








7.Tren alas Nubes

The Train to the Clouds follows zig-zag tracks across the rugged Andes on its way from Salta, Argentina, to the Chilean border. It's one of the highest train rides in the world.

The route was designed by American engineer Richard Maury, (who later died in Salta) and after whom one of the stations has been named. The complete railway was inaugurated on 20 February 1948, following numerous delays and complications and a 2-year period where work was paralyzed









8.Glacier Express

The Glacier Express connects two major mountain resorts in the Swiss Alps, giving riders a whirlwind tour of Switzerland's snowy peaks, mountain meadows, and storybook villages.

The trip on the Glacier Express is a 7½ hour railway journey across 291 bridges, through 91 tunnels and across the Oberalp Pass on the highest point at 2,033 m (6,670 ft) in altitude. The entire line is metre gauge (narrow gauge railway), and large portions of it use a rack-and-pinion system both for ascending steep grades and to control the descent of the train on the back side of those grades.













 9.Royal Rajasthan on Wheels

Royal Rajasthan on Wheels is a luxury resort aboard a train — complete with a spa — that takes riders past India's temples, forts, and Taj Mahal on a seven-night passage.

The 14 luxury cabins housed within the Royal Rajasthan on Wheels have been named after some erstwhile royal palace of Rajasthan. Categorized into Deluxe and Super Deluxe saloons, these cabins come equipped with amenities such as Wi-Fi internet, Satellite TV, Channel music system and Individual temperature control.Deluxe saloons have three cabins Ruby.








10.VIA Rail Canada

Passengers of the Canadian spend three days watching golden prairie fields, rugged lake country, and picturesque towns pass by their dome cars from Toronto to Vancouver.

Yearly passenger levels on Canada's passenger trains peaked at 60 million during World War II. Following the war the growth of air travel and the personal automobile caused significant loss of mode share for Canada's passenger train operators.










11.California Zephyr

There's no better way to see the heartland of America than the California Zephyr, a railway that climbs the Rockies and the Sierra Nevada before descending to the Pacific Coast.

During year 2016, the California Zephyr carried more than 410,000 passengers, an increase of 10.8% on 2015. The train had a total revenue of $51.4m in 2016 The California Zephyr is part of Amtrak's long distance national network and partial funding for it is provided by the federal government.










12.Belgrade–Bar railway

The Belgrade to Bar railway takes passengers over 435 bridges and through 254 tunnels from Serbia's capital to the shores of the Adriatic in Montenegro, in about 10 hours.


The decision to build the railway connection between Belgrade and Bar was made in 1952, as a national project of the SFRY. However, the construction was passed to the constituent Republics, SR Serbia and SR Montenegro, to build on their own.







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