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my old man suffered a heart attack this morning while walking :-(

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my old man suffered a heart attack this morning while walking :-(

Old 03-06-06, 09:39 PM
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mac
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my old man suffered a heart attack this morning while walking :-(

My old man suffered his 1st heart attack this morning at age 65. He was going for his morning walk and 10 minutes into it felt chest pains. Had to turn around and walk 10 minutes back home. By the time he got back, he was in more pain and called 911. They rushed him to the hospital, took an angiogram of his heart, did an angioplasty to install a stent, then took another angiogram. What a big difference from 99% coronary arterial blockage to now.

Okay, here's my rant. WTF is up with our medical care system? He's been going for annual physicals, seen cardiologists, is not overweight but even a little underweight, doesn't smoke, only drinks a little wine, blood pressure is okay, cholesterol is okay, but not one doctor has ever said to get a preventive angiogram. 99% blockage just doesn't happen overnight - or can it? How come none of these doctors, even the cardiologist, detected 50-60-70-80- or 90% blockage? Year after year, the doctors kept telling my old man that he's fine, don't worry, you're not going to get a heart attack. WTF? How can health care costs be so high, yet these doctors do nothing that costs money for preventative medicine? Sure, telling the patient to exercise more, don't smoke, lose weight, etc. is "preventative" but doesn't cost a damn cent. Getting an annual angiogram (and whatever other tests to screen for whatever other diseases are out there) is not mentioned. Had my old man had these done years earlier, he could have had angiopasty & a stent and prevented a heart attack.
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Old 03-06-06, 10:09 PM
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Least hes still here bro, I feel ya, my dads heart is failing. Hes 61 and thinks he 20. Yet, he insists hes OK. Hes been through the ringer and now on meds but its scary.
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Old 03-06-06, 10:10 PM
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Man sorry to hear about your Dad. I can't say anything about why they couldn't just do an angiogram. I should research a bit more.

Best wishes to your Dad for a full recovery.
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Old 03-06-06, 10:12 PM
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They look for risk factors, and it sounds like your father didn't have any. Putting aside the prohibitive cost of screening for everything possible, I've read articles saying that that sort of testing leads to excessive anxiety and "treatment" for things that would have been better left alone.

What a frightening experience. Be glad he survived and they found the problem! A generation ago they most likely wouldn't have been known or been able to treat it properly! I hope he has a complete and speedy recovery and many many more vital years.
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Old 03-06-06, 10:28 PM
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Having been through this several years ago I think I can answer your question. First, very few people get an annual angiogram. Beside being rather costly, the procedure itself has a high risk of mortality associated with it (something like 2%). So its only given to patients that are showing specific signs of coronary blockage, such as angina. Most people that require an angioplasty have some signs of a problem whether it be mild angina, shortness of breath, et.al. Unfortunately, your dad is one of those that didn't show any signs.
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Old 03-06-06, 10:29 PM
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I'm sorry to hear about your father. I hope he gets well quickly.


Originally Posted by mac
Okay, here's my rant. WTF is up with our medical care system? He's been going for annual physicals, seen cardiologists, is not overweight but even a little underweight, doesn't smoke, only drinks a little wine, blood pressure is okay, cholesterol is okay, but not one doctor has ever said to get a preventive angiogram.
Because in this patient population preventative angiograms will introduces more problems than it fixes.



Originally Posted by mac
99% blockage just doesn't happen overnight - or can it?
It absolutely can.



Originally Posted by mac
Getting an annual angiogram (and whatever other tests to screen for whatever other diseases are out there) is not mentioned.
That's because there aren't any such tests.



Originally Posted by mac
Had my old man had these done years earlier, he could have had angiopasty & a stent and prevented a heart attack.
That's not how it works. Coronary catherizations is not without risks. No cardiologist will ethically do an angiogram just because. Furthermore no one will pony up several thousand dollars yearly on the off chance there is something to stent as the insurance companies will be sure not to pay for a procedure that will cause more harm than good.

I think you have a misconception about what coronary angiograms and stenting entails, specifically the risks, cost (both monetary and resources). If your father found an unethical primary care physician, cardiologist, and radiologist, I suppose they would except $5,000 cash yearly per person to find 0.01% more coronary disease.

I realize you are venting, but one can have a normal EKG, stress ECHO, walk home and die from a heart attack. That's the nature of those particular tests. Hell, one can have an angiogram not requiring angioplasty and die the next die of a plaque ruptire.
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Old 03-06-06, 10:43 PM
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Hey guys, thanks for the well wishes. No, I didn't know what angiograms & stenting entails, nor that these things can happen just like that. I thought there would at least be signs as the artery is clogged more and more over the years (like a slowly clogged up bathtub, shower, or sink) and that annual physicals would pick up on it.
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Old 03-06-06, 10:45 PM
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Sorry to hear about your dad, Mac. My dad had a stroke about the same age.

One of the problems with our private health care "system" is that preventive care just doesn't make economic sense for them. Remember, we do have public health in this country -- Medicare -- starting for most folks at age 65. The private health care "system" is concerned only with keeping the customers alive, at the lowest possible cost, until they can pass them on to Uncle Sam.

Looks like they timed it just right with your dad.

I hope he makes a full recovery, Mac. I know it's corny, but love him while he's still here.
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Old 03-06-06, 10:55 PM
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Originally Posted by mac
99% blockage just doesn't happen overnight - or can it? How come none of these doctors, even the cardiologist, detected 50-60-70-80- or 90% blockage? Year after year, the doctors kept telling my old man that he's fine, don't worry, you're not going to get a heart attack. WTF? How can health care costs be so high, yet these doctors do nothing that costs money for preventative medicine? Sure, telling the patient to exercise more, don't smoke, lose weight, etc. is "preventative" but doesn't cost a damn cent. Getting an annual angiogram (and whatever other tests to screen for whatever other diseases are out there) is not mentioned. Had my old man had these done years earlier, he could have had angiopasty & a stent and prevented a heart attack.
sorry to hear about your dad. the blockage can happen in a matter of seconds a couple different ways...well mainly one. if an unstable, fibrous capped atheroma ruptures...bam, near instant occlusion.

we don't just do preventative cardiac catheterizations. they are too costly. at his age, hadn't he had TM stress tests? or a nuclear medicine stress test? what did these show?? please don't be mad at the docs...it is more of a system failure. if those stress tests all appeared normal, they wouldn't suggest an investigative cath. i think they are about 5-6K just to see....then intervention, such as a stent with your father, is a good 10-12K. i believe...not totally sure on those prices.

incidently, preventative coronary screening is here now. they have amazing CT imaging that shows cath like detail with no dangers of the invasiveness of caths. inquire about these new CT imaging machines. many places don't have them yet. if an invasive cardiologist suspects reversible blockage, they would prefer to go staight to the cath lab to fix the problem and be done with it. however, for someone like your dad where there is no suspicion, CT imaging would have been perfect. look into it. i know it is a little different than your standard CT imaging machines.

awesome stuff!

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Old 03-06-06, 11:49 PM
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It is ludacris to blame the doctors or the system for this. Doing "preventitive" caths or even "screening" stress tests have not been consistently shown to give us any information unless the patient has risk factors and a high pre test probability. The CT images are just a new toy and no good studies are out. The reason our health care costs are so high is not because the docs are pocketing the money, but because our patients and their families have grown to expect that at all costs things be done, especially toward end of life issues.

The most dangerous plaques are the around 50% blockages which they usually don't stent. These are the soft ones that rupture and go to 99%. Plus a cath could have killed the patient. I have been called to over a dozen coronary dissections in my short career and many had bad outcomes. There is a great deal of morbidity and mortality from these procedures which is why they are reserved for patients who have gone through the proper channel and can benefit greatly.

We cannot know everything about a patient. If all appears well with the tools we can safely and cost effectively use, then we go with that. Bad things just happen.

I am very glad your father is doing ok.
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Old 03-07-06, 12:18 AM
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Glad to hear your dad's ok. He'll be up be back on his feet in no time.
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Old 03-07-06, 12:43 AM
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The good thing is, he was saved. With aftercare, his life is starting over again. How wonderful!!!!

My brother-in-law at age 43 wasn't so lucky. And it was Thanksgiving.

Go and enjoy your dad's new life with him. I'm sure he will be seeing things differently now. It will feel so good, and everyone will be fulfilled. What a fresh new second chance at life!!!
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Old 03-07-06, 01:10 AM
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Originally Posted by JasonS
It is ludacris to blame the doctors or the system for this. Doing "preventitive" caths or even "screening" stress tests have not been consistently shown to give us any information unless the patient has risk factors and a high pre test probability. The CT images are just a new toy and no good studies are out. The reason our health care costs are so high is not because the docs are pocketing the money, but because our patients and their families have grown to expect that at all costs things be done, especially toward end of life issues.

The most dangerous plaques are the around 50% blockages which they usually don't stent. These are the soft ones that rupture and go to 99%. Plus a cath could have killed the patient. I have been called to over a dozen coronary dissections in my short career and many had bad outcomes. There is a great deal of morbidity and mortality from these procedures which is why they are reserved for patients who have gone through the proper channel and can benefit greatly.

We cannot know everything about a patient. If all appears well with the tools we can safely and cost effectively use, then we go with that. Bad things just happen.

I am very glad your father is doing ok.
I don't want to hijack this thread, but the main reasons our health care costs are so high are:
  • Administration
  • Profit
These costs are the main reasons public health makes more economic sense than our current "system." Administration refers to the jumble of paperwork: insurance premiums, insurance claims, billing, et cet. In this day and age, it also includes advertising and marketing for insurance companies, hospitals, HMOs, doctors... In a single-payer system, administration typically accounts for about 10% of the overall cost. In our "system," administration accounts for a whopping 30%. Of course, a public system also eliminates profit from the equation.

It's even worse when you consider the prescription drug industry, where the costs of marketing and advertising equal the costs of research and development. Guess who pays all these costs, and for their ever-increasing profits? You, me and all the other taxpayers.

We pay about twice as much for health care as most industrialized European countries, we're not as healthy and we don't live as long. Why? Because we are terrified of "socialized medicine?" Ridiculous.

Personally, I'd rather pay Uncle Sam if it's going to cost me less and make me healthier.

As for preventive measures in the case of Mac's dad, I wasn't referring to tests or other expensive procedures, I was referring to simple measures, such as lifestyle counseling. Encouraging and facilitating healthy eating, proper exercise, stress management, et cet. Not-for-profit, lifetime care systems (public health, in other words), typically include such programs, as it makes good economic sense for them to do so. Our "system" doesn't usually include stuff like that, because the savings don't really start to kick in until the patient reaches retirement age -- at which point the patient is the government's problem anyway.
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Old 03-07-06, 07:12 PM
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mac, I had a heart attack and got stents more than 5 years ago. I didn't know it at the time, but in some ways it was the best thing that could have happened to me!

It got me on track with my health and eventually got me to riding a bike again. I hope your dad ends up having a similar experience.

BTW, very recently they have developed new multi-channel MRI machines. These show great promise for imaging the coronary arteries in a safe and non-invsive manner. Hopefully, these will be widely available in a very short time. As others mentioned, angiograms are too risky to be used for routine screening of the coronary arteries.
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Old 03-07-06, 07:53 PM
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Mac glad to hear your dad is doing ok.
My brother (58yo) had a stent put in 3 months ago, healthy as a horse
and just had a burning sensation that wouldn't go away, 85% blockage.
My mother had a stent put in less than a month ago, similiar situation
had mild discomfort and bam, she's in hospital getting a stent.

in any event glad all worked out ok.

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Old 03-07-06, 08:32 PM
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Ouch, hope he turns out ok.
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Old 03-07-06, 08:54 PM
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Originally Posted by mac
...Okay, here's my rant. WTF is up with our medical care system? He's been going for annual physicals, seen cardiologists, is not overweight but even a little underweight, doesn't smoke, only drinks a little wine, blood pressure is okay, cholesterol is okay, but not one doctor has ever said to get a preventive angiogram.
I understand your frustration, and I'm glad that they were able to treat your dad in time. The idea of losing a family member can be very frightening.

As far as the case you described above... Imagine 100 patients with the same risk factors you just described. Now imagine a doctor telling them to have a screening test for a condition for which they're showing no symptoms. The majority of the patients would probably ignore the advice or accuse the doctor of ordering unnecessary tests to jack up his pay check. Sadly, the typical mentality among both doctors and patients is geared more towards reacting to problems once they occur, rather than preventing them from happening.

I hope your dad has a speedy recovery and is back on his feet in no time.
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Old 03-09-06, 07:19 AM
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Originally Posted by mac
My old man suffered his 1st heart attack this morning at age 65. He was going for his morning walk and 10 minutes into it felt chest pains. Had to turn around and walk 10 minutes back home. By the time he got back, he was in more pain and called 911. They rushed him to the hospital, took an angiogram of his heart, did an angioplasty to install a stent, then took another angiogram. What a big difference from 99% coronary arterial blockage to now.
Mac
Glad he is ok. Damn 65 that's close I'm 62. I wouldn't want some of those invasive tests done. I know there is some risk to the angioplasty and I thought there was with the angiogram. I don't know if there are other ways to check for blockage.

One of the Va. State game wardens had to have a triple bypass and he was ~40 and in (we all thought) real good shape. This happened right after he a "complete" physical and was told he was in great shape.
Far be it from me to support the medical profession, but I think some of this just happens - at least the seemed to get him fixed up fine. Good luck to him.

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Old 03-09-06, 09:49 AM
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Originally Posted by JasonS
It is ludacris to blame the doctors or the system for this. Doing "preventitive" caths or even "screening" stress tests have not been consistently shown to give us any information unless the patient has risk factors and a high pre test probability. The CT images are just a new toy and no good studies are out. The reason our health care costs are so high is not because the docs are pocketing the money, but because our patients and their families have grown to expect that at all costs things be done, especially toward end of life issues.

The most dangerous plaques are the around 50% blockages which they usually don't stent. These are the soft ones that rupture and go to 99%. Plus a cath could have killed the patient. I have been called to over a dozen coronary dissections in my short career and many had bad outcomes. There is a great deal of morbidity and mortality from these procedures which is why they are reserved for patients who have gone through the proper channel and can benefit greatly.

We cannot know everything about a patient. If all appears well with the tools we can safely and cost effectively use, then we go with that. Bad things just happen.

I am very glad your father is doing ok.
are you a doctor? we were told in class the new CT imaging was incredibly good. no?
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Old 03-09-06, 10:01 AM
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Originally Posted by budster
As for preventive measures in the case of Mac's dad, I wasn't referring to tests or other expensive procedures, I was referring to simple measures, such as lifestyle counseling. Encouraging and facilitating healthy eating, proper exercise, stress management, et cet.
Did you not read mac's original post? His dad was out for a WALK when this happened. How can you assume that he had not been practicing a healthy lifestyle when this happened? (On the other hand, how can I assume he had?)

Glad Mac's dad got the care he needed post-incident and is on the mend.
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Old 03-09-06, 10:07 AM
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Originally Posted by JasonS
The CT images are just a new toy and no good studies are out. .
i dont quite know what you mean.

A CT scan is an Imaging device, it SHOWS a problem, it doesnt suggest where a problem might be. I dont know why you would need studies on their effectiveness when its obvious where a problem might be by looking at a picture.

New? they've been around for 30 odd years... Is that new?
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Old 03-09-06, 01:08 PM
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Anything that involves bombarding our body with radioactive waves or whatever they call them now imho is not healthy for the body.

Here's the way technology goes
something new is created
People praise and lavish it
later on the negative side effects come out
Products that are touted as being "safer" then prior versions are created
cycle repeats self .

Until for the most part x-rays are considered 'harmless' in the 'grand scheme' of things.

Still not safe enough for my blood and I avoid them unless in dire need of them.

I think we are at least half a century away from truly understanding and controlling how the body works.
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Old 03-09-06, 01:14 PM
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Originally Posted by TexasGuy
Until for the most part x-rays are considered 'harmless' in the 'grand scheme' of things.
Still not safe enough for my blood and I avoid them unless in dire need of them.

I think we are at least half a century away from truly understanding and controlling how the body works.
i think i read somewhere that CT scans have 200 times the radiation that X-rays do, ive had 1 CT scan, tons of x-rays.

unfortunatlyi think we are a lot more than 50 years away.
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Old 03-09-06, 04:34 PM
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Hey guys, thanks for the well wishes. I just brought my dad home from the hospital and he's sleeping. The nurses said he's going to be okay, although there is some heart damage. My neighbor is a year older than my dad and he had a heart attack two decades ago, yet he's still active and does handyman work around the community. He said my dad is now starting his 2nd life. I think someone else posted that as well. That's a nice way to look at it. Does that now mean double the taxes?


Originally Posted by JasonS
The reason our health care costs are so high is not because the docs are pocketing the money, but because our patients and their families have grown to expect that at all costs things be done, especially toward end of life issues.
We have it in all of our wills that a family member(s) can make the decision to pull the plug if that person really has no chance of living. And my dad has said several times that when his time comes, he wants to go peacefully, not be prolonged with machines and wires and tubes, etc. Personally, I think it's more dignified that way. A similar scenario happened to my friend's father last summer and he had to make that decision.
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Old 03-09-06, 10:24 PM
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Glad to hear your dad's doing well. Hopefully he'll be up and around soon and back to his normal self.
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