Test Of Scanner Saves A Doctor's Life


















Read the story online at http://www.courant.com/news/health/hc-luckydoc.artsep10,0,7572510.story?coll=hc_features_promo

I personally hate these stories, the ones that turn heart scans into drama by describing how someone had a heart scan, then turned out to have so much coronary plaque that they had to have bypass surgery.

But I point this one out because the story is related in an interesting way. It highlights the utter ignorance that operates in heart disease detection.

The story highlights how a 50-year-old, 5 ft 8, 150 lb slender, exercising neurologist underwent a CT coronary angiogram in a newly installed device in a Hartford, Connecticut hospital (not a heart scan) that detected entirely unsuspected severe and diffuse coronary disease. You know the rest: abnormal stress test, heart catheterization, bypass surgery of the hapless doctor-now-patient, followed by grateful patient saying things like "This machine saved my life."

It probably is true. You've seen these stories before. I've witnessed these sorts of headline-makers for the past decade. I remain surprised that it still happens.

The doctor is not some ignorant, uninformed man who can't even fill out his income tax forms. Yet how does a man like this walk around with life-threatening disease and not know it? Why does it still make headlines?

Anyway, despite all my jawing about heart scans and early heart disease detection, many physicians and the public remain in the stone age of heart disease. Even though this neurologist's story made headlines, the many other people who 1) identified their heart disease earlier with a simple heart scan, then 2) took action to put a stop to it, do not make headlines. But that's the way to go.

Why isn't the rest of the story being told? Why was this man's heart disease uncovered only in its late phases? Hartford, Connecticut is not some backwater. I've been there. It's a major city with large hospitals and a University Medical Center. But a professional with presumed knowledge of health and his doctor(s) allowed this to happen?

In other words, this is not a story of success, but of failure--failure to identify coronary disease years earlier when preventive action would have prevented bypass. But that's not such a compelling headline, is it?

As an aside, I'll bet you that this man has lipoprotein(a), a severe small LDL pattern, and severe deficiency of vitamin D. Correct these and it's unlikely he'll need bypass again. But that's kind of boring, isn't it?

Comments (5) -

  • Mike

    9/11/2007 2:57:00 PM |

    The article didn't mention the doctor's diet, but I'd be willing to bet that it was high-carb/low-fat.

  • Anonymous

    9/11/2007 3:04:00 PM |

    If DR. Wade had done a heart scan instead of the CT angio, what do you suppose his CAC would have been given how serious his condition was at the point of discovery?

    Also, given how the story lays out how quickly his stress test -- no echo described -- revealed EKG abnormalities with very little exertion, it boggles my mind that he would be completely asymptomatic.  Wouldn't he have some symptoms?  Chest discomfort?  I'm amazed he didn't.

  • Dr. Davis

    9/11/2007 8:16:00 PM |

    I agree. It's surprising that no symptoms were present.

    His heart scan score was almost certainly in the thousands.

  • Peter

    9/12/2007 5:29:00 AM |

    Dr Davis,
    I have been reading your Blog for months now and have found it enormously informative.  As I read this post, your use of the words "early detection' stood out.  I would encourage the use of this term because people have a favorable response to it already due to it's use when people are talking or writing about cancer.  CT scans need to get the same "social weight" as mamograms have now.  The battle of ideas is often about how language is used.  "early dectection" is a very powerful phrase.

  • Dr. Davis

    9/12/2007 11:58:00 AM |

    Excellent point. Thanks, Peter.

Loading
Are we done here?

Are we done here?

Les' doctor consulted me because his CT heart scan score had increased 40% from 893 to 1259 over 18 months.

Judging by his appearance, Les was a 59-year old guy trapped somewhere in the 1980s. The only reason he'd undergone two heart scans was from the prompting of his wife, who was quite savvy.

Among the steps we took was to have Les undergo a stress test. I explained to Les and his wife that stress tests are effective tests of coronary blood flow, but not of plaque. Therefore, there was somewhere around a 25-35% likelihood of an abnormality that suggested poor flow in one or more portions of the heart.

Les passed his stress test easily. A bricklayer, Les was accustomed to heavy physical effort. "Are we done here, doc?" Les asked. Les' wife raised her eyebrows but, to her credit, kept quiet. She'd obviously been here before.

I explained to Les that having normal coronary blood flow was just one aspect of the issue.

"But I don't need a stent, right? I don't need a bypass. I already take Vytorin. So I need a cheeseburger once in a while. So what! Who doesn't? What else is there?"

I continued. "Les, with a normal stress test, there's no denying you still have lots of plaque in your heart's arteries. The risk to you is that one of these plaques will 'rupture,' sort of like a little volcano erupting. Of course, it's not lava that flies out, but the internal contents of plaque. When that happens and the contents of plaque get exposed to blood flowing by, a blood clot forms. That's a heart attack.

"With a 40% increase in your score over 18 months, you are, in fact, at substantial risk for such a plaque rupture. Unless you're fond of hospitals and the thought of heart procedures, then we need to address that part of the issue."

So it went. Step by step, with the quiet, strong support of Les' wife, we uncovered 7 additional causes of his heart disease. It wasn't the easiest process for us, but we did manage to educate Les on the simple steps he needed to take to 1) correct the causes of his coronary plaque, 2) how to use foods and stop fanning the flames of his plaque, and 3) how to live with this nasty specter hanging over him.

Now, if we could only transform Les into an optimist . . .

Comments (4) -

  • Anonymous

    7/28/2007 12:15:00 AM |

    I'm curious what those "7 additional causes of his heart disease" were.

  • Dr. Davis

    7/28/2007 1:32:00 PM |

    These refer to the lipoprotein sorts of abnormalities we commonly uncover, e.g., small LDL, IDL, VLDL, deficient vit D, etc.

  • Anonymous

    8/25/2007 2:40:00 AM |

    I am interested in learning what you prescribe for lessening plaque rupture. My score was 1229 and I also easily passed an echocaridogram. I am doing all
    I can to correct the deficiencies from my lippo testing
    but what I fear most is plaque rupture. Currently I am
    taking 2000 mg omega3s and 10mg Mevacor as prevention. I was taking an ACE inhibitor but discontinued 2 weeks ago as my blood pressure has stabilized for the first time in 14 years.
    Any thoughts you may add would be appreciated.
    Regards
    Gene Mc

  • Dr. Davis

    8/25/2007 2:52:00 AM |

    Hi, Gene--

    I'm afraid that our approach is too lengthy to cover in this blog.

    I would invite you to participate in the conversation on the www.trackyourplaque.com website. The entire website is, in fact, devoted to answering your question.

    I will stress to you that, given your current regimen, an increase in heart scan score is virtually guaranteed unless you take appropriate action.

Loading