Saturday, August 12, 2017

Heart Disease and You

Medical history made yesterday when a doctor discovered a heart inside a lawyer!

I'm happy to report that I emerged from my heart catheterization virtually unscathed.  The good news is I didn't need a stent or serious heart surgery.  The bad news is I do have some very mild build up in my arteries and will probably have to be on statins for the rest of my life.

The funny thing is, living on retirement island, when I mentioned I was having this procedure done, nearly everyone I knew recounted how they had the similar or same procedure done in the past or even more extensive procedures.  It seems that everybody I know is on statins at the very least, has been through one or more stress tests, perhaps a heart catheterization, and some have had open heart surgery, pacemakers, and built-in defibrillators just like former Vice President Dick Cheney.

Heart disease isn't some far-off possibility for most of us, but rather a foregone conclusion, if you live long enough.  As I noted in earlier posting, it is a function of diet and exercise, but also heredity.  If heart disease runs in your family, you have a very good chance of getting it.

And as I noted in earlier posting, poor Jim Fixx, the jogging Guru, died of heart disease even after he tried to turn his life around through jogging, exercise, and eating right.  Unfortunately, he failed to address the third leg of the heart disease triangle, that is family history - and visiting a cardiologist and having your heart tested.

Of course, in Jim Fixx's day, the procedures and drugs available were far more primitive. Today, health care has advanced considerably.  When I was a kid, open heart surgery was something that was basically experimental and only for people in very dire conditions. Today, is fairly common and chances are you know somebody who has had a heart bypass operation. This may seem like humdrum commonplace practice, but it wasn't so long ago that this was considered experimental surgery.

There are other less invasive procedures also available such as the heart catheterization I had today. During the catheterization process, they can actually show you a picture of your heart (shown above) and determine whether any of the major blood vessels are clogged. During the procedure they can actually insert a stent without having to perform a second procedure or having to operate.  The stent can then expand the blood vessel and improve the functioning of the heart.

Again, it was not too long ago that these procedures were basically experimental, yet they are commonplace today.

Similarly, statins are the miracle drug for curing heart disease.  I am always very skeptical of miracle drugs, is it seems that every five years, a new miracle drug comes out that everybody claims is the cure-all for everything.  And then like clockwork five years later, bunch of class-action lawyers file suit against the company selling the drug, because people have had horrific side effects from these drugs.

I think it is good to be skeptical of the pill approach to life.  However it appears these statins can prolong the lives of many people and improve their life experience as well.

There are many things I took away from this procedure.  First, hospitals, like doctors and insurance companies, operate in this netherworld between paperwork and computerization.  Our local hospital is pretty efficiently run, with everything on the computer. When I check in, they have all my information from documents scanned in into their system including who my next of kin is, and who has my authorized medical power of attorney.  It is very efficient.

But they also have reams of paper documents for me to sign which were kept in a binder with my name on it, which I found kind of antiquated.  I presume all these documents are leader scanned in.  And it is probably we lawyers who are to blame for all of this unnecessary paperwork. I'm not sure why somebody couldn't sign on some sort of pad device instead of a photocopy of a document.

Yet other things were highly automated,including use of bar codes to keep track of patients and other types of computerized records. And of course, the actual procedure was highly technical and automated, producing real-time pictures of my heart and even providing printouts and videos.  There were more flat screens in the operating room than on the back wall of a Wal-Mart.

But it still seems like a lot has to be done to bring the medical practice into the 21st century.  One thing I find very odd is that I can go online and track down the entire history of my automobile from the first day was registered to any accidents it  has been in for over 20 years.  However my medical records are scattered among various hospitals and doctors across the country, often in paper form, and often I'm not given copies of these.

I have huge binders with copies of receipts for every nut and bolt I've ever put on my car, as well as every oil change and every document related to its purchase and operation. With regard to my personal medical records, I only have a few years worth of hastily scribbled notes.

Why we can't have a national database of medical records for individuals is beyond me - and it was one of the goals of the Obamacare system.  It would really be nice to have copies of my MRI scans of my neck for example, should that ever give me trouble in the future.  Similarly, it would be nice to have an electronic version of my heart scan for future reference by subsequent doctors if necessary.

The second observation I took away from the experience, while waiting for about two and a half hours in the recovery room, was that there are an awful lot of sick people in this world who have bigger problems than I do.

Because of size and space requirements, private rooms are very rarely used anymore in hospitals. Rather we lay in wheeled gurneys that are separated by curtains that are pulled between patients.  While this may provide visual privacy, you can hear everything that is going on, and often the conversations you here are quite interesting.

In the room next to me was a "woman" having breast implants, although her voice was awfully low and gravely to be that of a female.  The conversation between her and the nurse centered on the drugs that she would be taking as well as the drugs she already was on.  I lost track of the laundry list of drugs, but they included both Percocet and Ambien which I thought would make for an interesting cocktail.  Not only that, but the patient seemed to express a keen familiarity with many of the drugs including powerful antibiotics that were being prescribed.  This sounded an awful like a person who spent a lot of time at hospitals and a lot of time taking various drugs.

Well I was relieved that my heart problems were relatively minor, there were other people leaving the area in their gurneys who look positively grim-faced.  Some were facing open heart surgery, others were having stents installed or needed other types of long-term care.  Again, it was quite interesting to hear the laundry list of prescription medications and procedures that many people had.  Some people are very, very sick in this world.  I think others also like to take pills.

The third observation would be that well I am somewhat overweight, I positively look like Twiggy compared to some of the people in the waiting room in the cardio lab.  We have a saying here in Georgia that there is fat, really fat, and then there's Georgia fat.  And there are people there who weighed over 300 lb and were barely over 5 ft tall. I can only wonder how their knees and hips survive, much less their hearts. It must be painful every waking day.

What is even more amazing, but yet not all that uncommon, was how many of the nurses were overweight.  I noticed this before when I went to pick up a friend of mine who is recovering from open-heart surgery (again, this is frighteningly common where I live) and noticed that most of the nurses in the cardio rehab ward could stand to lose 50 to 75 pounds each.

I don't know if this is part of our general epidemic of obesity in this country, or a function of the job. While nurses spend a lot of time on their feet and do a lot of active physical work, they also spent a lot of time behind desks and chairs which is sedentary behavior and is not good for your physique.  Being a Patent Attorney is even worse.   Perhaps also the long hours lead to casual eating, which often means poor eating habits.  Mark went down to the hospital cafeteria to get a cup of coffee while he was waiting for my procedure to be done, and he said he was shocked to see that the cafeteria food was probably the least healthy in the world.  There was a pizza bar, fried chicken bar, and a french fry display that was 4 ft long.  I kidded him that they would have a bowl filled of statins at the end of the line much like they have mints in most restaurants.

Hi Everybody!  Hi Doctor Nick!

As for the procedure itself, it was remarkably brief.  The video above illustrates how the procedure is done, apparently narrated by Dr. Nick Riviera from The Simpsons.  It took about an hour and a half to two hours just to prepare for the procedure, having an IV inserted, confirming my identity, signing off on various release forms, and also undressing and laying on the gurney.

The procedure itself took barely 15 minutes, once I was prepared and in the room and ready for the Doctor.  Once we had the relatively good news, there was another two to three hours of waiting in the recovery room, mostly because they had pierced my artery in my arm to do the procedure, and I would have to wait until that healed up enough to go home so I didn't bleed to death.  Also they had to make sure the calmative they gave to me had worn off enough so I didn't stumble down the steps of the hospital and sue them.  All told the time in the hospital was about a little over five hours while the procedure itself took about 15 minutes.

I haven't gotten the bill for this yet, however I feel it'll probably max out my deductible for the year. The medical technology we have in this country is amazing, but it is not cheap.  Just a simple outpatient procedure like this involves a concentrated a concerted effort on the part of about a dozen nurses, two technicians, the doctor, patient assistant, and even hospital volunteers. It was orchestrated very well and very efficiently I thought.  However I could also see that it wasn't going to be cheap. An awful lot of stuff gets thrown away by necessity during these medical procedures.

I am fortunate enough that I don't have to worry too much about paying the co-pay on my insurance. Others are less fortunate. And yet many people seem to come up with the money for medical procedures.  When I was kibitzing on the conversation with the shemale next door having her breast implants, the nurse confessed that she had implants done 30 years ago, which started leaking later on - which can be a total nightmare. What was odd was the nurse confessed that she went to the plastic surgeon's office and paged through a magazine of sample breasts she could select from.  she said she felt like she was a kid in a candy store, wondering what her insurance company would pay for or what she could afford. S he noted that she had to pay for her breast implants out of her own pocket which I imagine was probably a very expensive procedure for someone in her income range.  And sadly a procedure that went horribly wrong for her.  She noted that she would never advise anybody to have breast implants ever, after her experience. The way she put it was, they sound like a lot of fun when you're in your twenties, but 30 years later, and after four breast-fed children, it's a whole different deal.

I'm not sure what the point of this is other than I'm doing well and the other thing I realized from this experience is I want to stay the hell out of hospitals as much as I can. Even for a relatively mild procedure like this (where they jam some sort of tube up your artery and into your heart) the level anxiety is pretty high.

Changes in diet and exercise are definitely in order.