Though ancient for social media, I thought this week-old but bizarre defibrillator story might be worth a mention.

From the South Florida news feeds, Implanted defibrillator killed Gateway man after wife’s heart stopped.

Here’s the skinny: In October, an 80 year-old woman—with an internal defibrillator– and her 85 year-old husband of 60 years were enjoying themselves in a South Florida hot tub. Something dramatic happened, as they were both found dead the same day.

It took nearly four months for the medical examiner to release the outrageous findings that the woman’s defibrillator electrocuted her husband. Shockingly, the ME released this misleading statement: (remember the rule—no information is better than bad information.)

“Although (implanted defibrillators) are life-saving devices, the public should be made aware of the hazards associated with these devices so proper safety measures can be taken by those in contact with affected patients,” Wheaton said in the statement.

Oh, the many ways to spin this story.

First, it’s well-known and accepted that ICDs confer risk to the patient who has the device. But let’s debunk the myth that an internal defibrillator could harm anyone else. ICD shocks are delivered internally and any person in contact with a patient getting shocked would merely feel muscle contractions, even if they were in water.

Second, in this case, the husband did not have an ICD, so there would be no record of his rhythm at the time of death.

Third, although I am no forensic expert, an external electrical event that would have affected both seems far more likely.

Finally, another way one could look back at this event is with a very wide-angle, big picture life camera. In this lens, the tragedy might look slightly less tragic. (Caveat first: no one advocates for accidental deaths and we all hope to live forever.)

But…How about this view? An elderly couple married for sixty years die together, suddenly, under a Florida sky and after a full life. Their final inning did not involve chemo, nursing homes, dementia, diapers and time away from each other.

Ooh, Death is hard to write about.

JMM

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Way too much.

Do you like common sense?

Are you inflamed by the unintended consequences of well-meaning policies?

Read this young ER-doctor’s view on the medical and dollar costs of measures aimed at eliminating medical errors.

This is real, folks.

JMM

Very nice work, Dr. Graham Walker

 

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I am very excited. Nervous too. The ante has been upped.

240,000 members
- 60,000 cardiologists
- 38,000 other physicians
- 66,000 Health care professionals.

That’s the TheHeart.org: a website where one can find the latest developments in cardiology and cardiovascular research, including heartwire news and commentary by some of the world’s top cardiologists.

It’s a real honor to join this very prominent and respected team.

My new blog on TheHeart.org has the cheeky name, Trials and Fibrillations.

My task is to speak about heart rhythm matters in the real world of private practice. As the THO’s audience includes mostly medical folks, my language will be slightly more technical and the topics clinical.

Like big races, steep climbs and gnarly mountain-bike trails are, the greater the risk, the more the reward. The challenge of writing before this many smart people feels the same. I’m just a regular doctor, and surely less than a regular word guy.

But this is the thing about bike racers and heart docs: doers as we are, we tend to treat apprehension with healthy doses of effort. We try. “Don’t want bad outcomes?…Don’t do anything,” I was once told by a respected surgeon after telling him of a less than ideal procedural outcome.

In my first post, I ask what we are doing with AF ablation. Does the bigness of the hammer fit the size of the nail?

AF ablation: What are we doing?

Special thanks to Shelley Wood and Steven Rourke from heartwire for giving me this great chance.

JMM

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“I felt amazing…It was one of those days on a bike you dream of.”

There’s one thing about cyclists; we like to recall memorable performances. It’s as if retelling—and I say re-telling because any good performance has no doubt been told at least once—jolts our feel-good centers. I bet it’s the same chemicals that get released when someone writes “good post.

Another reason such shows of force are retold: because ‘good legs’ are so mysterious. They couldn’t hurt me today. What gives? Was it the bee pollen? The blue, not red, sports drink? My new coach? The new bike? No…it’s never the bike.

Now…we know what brings bad legs. Competing stress in life, not enough sleep and too much pizza and beer are common leg-sappers. Under-training and over-training are often cited as well.

But what of the dose of training?

How much causes the staleness of over-training and how little can be called under-training? And for that matter, what’s the right mix of intensity, distance and rest? Does the mind play a role? Recent research suggests the brain adds more watts than once thought. And to complicate the good-legs equation further, everyone knows humans respond differently to training.

Shoot, it would be tough to be a coach.

Recent research on the right dose of exercise only adds to the cloudiness of training formulas. As chronicled nicely by Gretchen Reynolds in the NYTimes today, High-Intensity Interval Training (HIIT) looks to be tinkering with cycling dogma. The same horse-hockey that says cyclists must wear knee-warmers to protect our synovial capsules from cold weather has held that getting fit in the early season means slogging around for hours at conversation pace. They call it building a base. I call it boring, and BS. All of it. Non-evidence-based dogma in cycling is just as shaky as non-evidence-based stuff in Medicine.

It turns out that “lacerating” HIIT sessions seem to produce equal or better results than standard endurance training sessions. I have read (some of) the raw data from the physiology journals; the results are eye-opening.

First: The definition of HIIT: The original studies on HIIT called for subjects to do half-hour sessions with 4-6 30-second sprint efforts interspersed with 4 minutes easy. Here in Louisville, such efforts are called ‘pukers.’ As most people, including athletes, can’t tolerate pukers, the researchers modified the HIIT protocol to rotating 60 sec of  intense (but not lacerating) effort with 60 sec easy.

Second: The Results: Though preliminary and small, many studies from multiple centers have shown that subjects that do just 3 short HIIT sessions per week (90 minutes of total exercise) perform as well, or better than those who exercise up to 80% longer but at lesser intensity.

Third: HIIT appears useful in a wide range of patients: It’s not just cyclists that improve time-trial performance; diabetics achieve better sugar control; cardiac patients (post-stent and bypass) improve arterial function and quality of life scores and obese patients boost metabolism and lose fat.

Fourth: The believability of HIIT’s effect is bolstered by real biology. HIIT looks to have easily demonstrated effects at the cellular level. It greatly boosts a ‘master-regulator’ (PGC-1) of mitochondria growth. Having more PGC-1 is a good thing; as PGC-1 also improves muscle oxygen uptake, anti-oxidant defense, sugar uptake, resistance to age-related atrophy and yes, it even fosters anti-inflammatory pathways. At the muscle level, athletes will be happy to know HIIT helps muscles burn fat, use glycogen more efficiently and produce less lactate.

I have led with the good stuff. There are limitations on this research. The studies involve small numbers of subjects, who are often healthy and motivated. Also, the duration of HIIT sessions studied is weeks, not months or years. It’s therefore way too early to make far-reaching claims.

But that said, I can’t help but wonder why I feel so good on the road after doing only 30-60 minute trainer sessions all winter. Every year, the same thing happens: short intense sessions on the indoor bike seem to translate to having ‘good legs’ out there on the road.

Of course, the implications of HIIT reach farther than just toppling cycling dogma—though it’s always cool to see dogma overturned—or explaining why I have good legs each February.

From a public health standpoint, as the richness and modernization of society push us deeper into a health crisis, the discovery that effective exercise requires less of a time commitment is exciting.

Now put down that magazine, turn the fan on high, crank the tunes, prepare the mind and then…sweat!

JMM

Disclaimer:

Please note: Safely starting and maintaining an exercise program is like anything else in life; it’s best accomplished with heaping doses of common sense. Starting slow, warming-up, listening to your body, being mindful of joints and tendons and by all means, consulting with your doctor are just a few examples of such common sense.

References:

Short-term sprint interval versus traditional endurance training: similar initial adaptations in human skeletal muscle and exercise performance JPhysiol 2006

Effects of different interval-training programs on cycling time-trial performance. Med Sci Sports Exerc. 1999 May;31(5):736-41.

How 1-Minute Intervals Can Improve Your Health. NY Times, 2012

Physiological adaptations to low-volume, high-intensity interval training in health and disease. J Physiol. 2012 Jan 30. [Epub ahead of print]–Amazingly complete list of references.

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Grand Rounds: February 14th, 2012–Valentine’s Day version

February 14, 2012 Doctoring

To those who submitted posts, I say thanks. I appreciate that you did. Medical Grand Rounds keeps going because of you, the medical blogger. Your voice, your impressions, your passions and your human stories make our field such a great canvas. Let’s get it started: A Hand of Hearts: I was delighted that one of [...]

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More pieces in the Heart Disease puzzle: Dads and Inflammation

February 10, 2012 inflammation

As if on cue, after my meandering about inflammation on Cycling Wed, the famous British journal, Lancet, publishes a possible landmark study on how certain groups of genes found on the Y-chromosome may increase the risk of heart disease in men. (Think back to biology. The Y- chromosome imparts maleness and is passed from father [...]

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