My iPhone vibrated with an urgent message that read: Please call…The INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?” I responded, sounding like an expert: “It’s Ok. Pradaxa thins the blood adequately, it just doesn’t change the […]
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Are ICDs overused?
The medical news of the week nearly shocked me off my bike trainer. It isn’t often that electrophysiology makes the major-network evening news broadcast. The teaser proclaimed…“thousands of heart patients have unnecessary expensive cardiac devices…Should they be removed?” They were talking about ICDs (internal cardiac defibrillators), and were referring to the widely publicized JAMA study […]
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Cycling Wed: Life’s too short to…
My topic for cycling Wednesday changed abruptly this afternoon. It was to be a report on yet another scientific publication (and editorial) about the deleterious cardiac effects of long-term endurance athletics. The paper was published recently in the scientifically-rigorous journal, Circulation. (In fact, I went so far as to spend an hour on the phone with […]
“Did you sign those (three) consents?” “This patient needs a short form; your office letter was done 30 days and one hour ago.” (just over the legal limit) “The insurance ‘people’ in area code (***) denied the stress test.” “Mr Smith’s son, an alternative medicine specialist in California wants a phone call to discuss herbal […]
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Still asking the question…
It is a holiday weekend, the decibels of medicine and bike racing are tuned down low, so I ask myself, “why do I have this blog?” Then, as if on cue, Dr Ves’ tweet about personality traits of bloggers appears. The study said that only openness to new experiences was predictive of being a male […]
“Hey John, I hear there is a new ICD out…without any wires,” came the question in the doctor’s lounge. That’s cool, they are reading the NEJM, I thought. It is true that a very preliminary report on a subcutaneous-only ICD was published in the print version of the NEJM this week. The print version of anything […]
“What do you do for a living?” I ask this of nearly all patients, as inflammation doesn’t just come in processed food wrappers, plastic bottles of carbonated beverages or cartons of tobacco products. Artery irritating, arrhythmia triggering inflammation can also emanate from one’s occupation. Keep your eyes, ears and mind open, and it is striking […]
At the risk of exposing my naivete, or being too much like the geeky student who sits in the front of the classroom, I can’t help but welcome the upcoming policing of cardiac device implants. As recently written by Dr Wes, government policing agencies, the DOJ and RAC folks, are planning to focus on […]
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Shocking revelations…
Defibrillators (ICDs) are in the news today. Few medical treatments are more misunderstood, both by doctors and patients, than the ICD. It was a huge observational study presented today in Denver at the annual HRS (Heart Rhythm Society) meeting. In 88,804 ICD patients from 2500 centers, researchers studied how ICD programming related to inappropriate shocks. They concluded: (translation […]
Do doctors know whether their therapies really work? We are doctors. We know. Don’t we? Wide variations in the application of medical treatments often differ greatly, sometimes solely by adjoining county or state line. This shouldn’t be. That a place of residence, not a clinical scenario, determines one’s treatment, highlights the inherent uncertainty of medicine. […]
Medical prowess has exploded in the past decade. Â The toolbox of therapeutic options has grown so large that often times, the most challenging aspect of patient care is in matching the right tool to the right patient. Â There is no better example than the expanding capability to ablate atrial fibrillation. Now that I can successfully […]