Just the other day, I saw a 52 year old man in my office for what I thought was a routine prostate issue. I walked in the exam room, introduced myself and immediately knew his prostate was fine. His eye contact was non-existent. He was nervous and his handshake was clammy and brief. I see these patients everyday. Their prostates are just fine. It's their love life that's the issue. ...
Posts tagged Heart
There is a patient attached to that implantable defibrillator
As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going to talk about what your physician looks for when a device is interrogated. Many times this happens in silence or with few words, and some pushes of a button, when done in the office, and when done with remote patient management, is accomplished either automatically or with ...
Treating heart failure on a budget
As a third year medical student, I spent one afternoon each week at a health clinic at a community hospital affiliated with my medical school. This health clinic was focused on primary care for patients with HIV, and many of our patients were poor, homeless, immigrants, or uninsured. Many were also living with their diagnosis in secrecy and had to hide their medications and medical bills from family members.One of ...
Why patients with implantable defibrillators deserve their data
The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009.The objective of Measure 12/15 of Meaningful Use regulations of the HITECH act which refer to electronic health records, states that eligible professionals “provide patients with an electronic copy of their health information (including diagnostic test results, problem lists, medication ...
Meaningful treatments in the battle against coronary disease
I saw a patient in my office this week who had received a stent from one of my partners last month. The man was highly satisfied with his experience—the procedure was tolerable, the recovery short, and the nurses were pretty (he specifically made a point of this, presumably because the post-hospitalization customer surveys don’t include what seemed to him to be the most important feedback metric)—but his wife had a ...
Overcoming tragedy requires a team
When tragedy strikes, one looks for comfort in many places. When traditional resources--relatives, physicians, clergy members--do not completely satisfy, one may reach out for comfort from unexpected places. Increasingly, people turn to online health and wellness support communities.My family’s tragedy occurred when my father suffered a Sudden Cardiac Arrest, or SCA, in 2010. As I watched him lay lifelessly on life-support in that hospital bed, the man who was undoubtedly ...
MKSAP: 67-year-old man with confusion, agitation, and malignant hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 67-year-old man is evaluated in the emergency department for confusion and agitation secondary to malignant hypertension. Initial blood pressure is 230/130 mm Hg, and funduscopic examination reveals papilledema.He is admitted to the intensive care unit, and therapy with nitroprusside by continuous infusion is begun; ...
Creating a practical, uniform policy on vein treatment
The general public, and much of the medical profession, has unfortunately little understanding of the connection between varicose veins and more serious manifestations of chronic venous disease, represented by higher CEAP classes. This is a fact that keeps many with vein disease from obtaining, or even considering, treatment. Fortunately, public education concerning venous disease and its potential complications, including chronic venous insufficiency and deep venous thrombosis, is growing.Organizations such ...
Making tailored health education standard of care
The recently instituted 30-hour-shift work restrictions placed on medical residents have created a need for "dayfloat" services to safeguard potentially unsafe handoffs in patient care and help residents adhere to duty hour limits. The past two weeks I’ve been the dayfloat resident for the cardiology inpatient service. My job is to round with the post-call team, help them get out of the hospital on time, and then take care of their ...
A doctor resolves to cut his heart attack risk
I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of ...
Let’s close the chapter on statin safety
There was important news recently on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.I’d like to tell you about a recently-published landmark study in the Lancet that should quell safety concerns over statin drugs.The punch line after I tell you the study’s ...
MKSAP: 55-year-old man to undergo coronary artery bypass graft surgery
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin ...
Considering cancer and heart disease in opposing ways
The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first.Response to treatment of limited incidence and duration are accepted and deemed beneficial. ...
What patients with heart disease need to learn from cancer patients
Cardiologist Dr. Richard Fogoros has issued this blunt warning to those at risk for developing heart disease: "You need to change your life. If you don’t, you will suffer the consequences – possibly decades earlier than is necessary."In his Heart Health Center column, he observed that most high-risk people end up making only half-hearted efforts to modify their heart attack risk. And he blamed doctors for enabling this ...
Simple tips to improve your blood pressure checks
A recent study confirmed that the doctor’s office may be one of the worst places to determine if your blood pressure is under control. The automatic rise in tension many people experience when they are being scrutinized contributes to artificially high blood pressure readings. Although many times the only way improve one’s blood pressure is through treatment (such as medication, a low salt diet, and weight loss), other times ...
MKSAP: 60-year-old man with type 2 diabetes mellitus and hypertension
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 60-year-old man with type 2 diabetes mellitus and hypertension visits the office to establish medical care. He reports monitoring his blood pressure and blood glucose measurements at home with good results. He had a cholesterol panel checked approximately 5 years ago, at which time ...
Chest pain is where protocol driven medicine breaks down
On the theme of knowing when and when not to follow the diktats of emergency medicine, one of the greatest challenges for a practicing ER doc is chest pain. Missed MI is still the biggest driver of malpractice costs, and last I hear, ER docs still send home something like 2% of patients who are having MI or unstable angina. Not good. So over the last decade we've gotten all ...
Stem cells, surgery free heart valve repair and nutraceuticals advance heart care
The last post in this series discussed new advances in cardiology – the two themes of genetically informed therapy and technical advances. I will continue with three additional themes – regenerative medicine, minimally invasive approaches and prevention.The third of the five themes is regenerative medicine. One major area of investigation is whether stem cells can heal the damaged heart. Perhaps the field is “more glamour than fact” just now ...
Genetically informed therapy and technical innovations in cardiology
I want to give an overview of cardiac care advances – the first two themes are discussed here. I want to thank Dr. Mandeep Mehra, chief of cardiology at the University of Maryland for conceptualizing these themes for me.First is genetically informed therapy. Pharmacogenomics is having an impact in the use of warfarin (Coumadin) and clopidogrel (Plavix). Warfarin dosage can now be titrated in part based on a person’s genomic makeup. In ...
Achieving a 90 minute door-to-balloon time in STEMI patients
At a recent committee meeting, my hospital’s administration announced new quality measures and targets. Striving for top performance, the board of the hospital system set the bar extraordinarily high. The bonuses of senior management are tied to achieving the targets, so the announcement had everyone’s attention.
One target that caught my interest was for achieving a door-to-balloon time of less than 90 minutes in STEMI patients. As an interventional cardiologist who ...
