Heart scan gone wrong

Those of you reading the Heart Scan Blog, I hope, have come to appreciate the power in measuring atherosclerotic plaque, the stuff of coronary artery disease, and not relying on indirect potential "risk factors," especially the fictitious LDL cholesterol.

However, like all things, even a great thing like heart scans can be misused. Here's a story of how a heart scan should NOT be used, submitted by a reader.


Dr. Davis,

First of all, let me start out by commending you on all of the work you are doing with your website, blogs, etc. You are truly a breath of fresh air at a time when conventional medicine is no longer making any sense. In the last 3 years or so, I have spent a lot of time using the internet to try and find answers . . . and just about every time, when I find things that make "sense," it coincides which the recommendations you provide. Thank You!!

I am 56 years old, and roughly 5 years ago I bought your book, Track Your Plaque, primarily because I had asked my then Internal Medicine physician about why we weren't more "proactive" about determining the state of our cardiovascular health...since the means to do so existed (scans). He was trying to get me to go on a statin because my cholesterol #'s were a little high and at the time I smoked. Other than that, I was in perfectly good health with no side effects or issues. The following year at my annual physical, we again discussed this and he gave me a few options and I ended up having a calcium score done, which showed some blockage, but again, I never had any pains, sweats, or any other symptoms whatsoever, and I am a very active former athlete. This is when I bought your book to try and set a course of plan that wouldn't just include pharmaceuticals.

At the same time, my father was in his last months of life dealing with prostate cancer and the multiple radiation and chemo treatments, so I was making many trips from my home to be with him . . . a 4 hour drive, and very disruptive to family, as I still have 3 kids at home. At what I thought was going to be my last visit with him, I stopped at the cemetery he had planned on being buried to confirm details and such and then started home.

As I was driving, a symptom hit me which I was unfamiliar with (pretty sure it was an anxiety attack now) and I stopped at a friend's house in Chicago, as I didn't want this to be a heart attack while I was driving. This is when I began thinking about the heart scan and the blockage, and ended up driving back later that night and went right to the ER....not because I had any chest pains, but thought it best to be checked out because I did not want to go before my dad did. I ended up staying the night. In the morning the cardiologist PA [physician's assistant] came in with a copy of my calcium scoring and said it was best to have a heart cath...which I was in total agreement with since it would definitively tell me the current condition of my coronary vessels. As I was getting ready to be wheeled into the cath lab, they approached me with a form that would allow them to treat (stent). This is where I became very uncomfortable, in that I had never even met the cardiologist . . . and I didn't like this. No one ever had asked if I was experiencing pains or anything else . . . but I buckled and signed the form.

Before you knew it, I was awake watching my heart being cathed and the cardiologist angry because they did not have all the right sizes of stents, so he had to use a couple extra and I ended up w/5 total . . . and my life changed forever! In looking back, I can't necessarily argue the need for intervention, but in hindsight, it would have been nice to have tried an alternative method of reversing my plaque, especially since I had never experienced any symptoms and didn't appear to be in any imminent danger.

Upon release from the hospital I was put on a cocktail of drugs that typically follow and I then began to search and research. No one talked to me about lifestyle changes other that smoking....but nothing on diet or other means of cholesterol control, etc....in fact, when I had to pick out my meals in the hospital, they wouldn't let me have cheese....but the rice crispy treat was fine....how stupid! They originally told me the Plavix had to last 6 months....and then 12....and then 2 years....I stayed on it for 1-1/2 years and it was the only thing other than a baby aspirin. I went to another cardiologist out of town and he wanted me back on 5 or 6 medications and said that now I had the stents....I would have to be on these for life.....and he was the expert that talked at several main conferences.....my last trip to him.

Now, fast forward to about 6 months ago: I was participating in a father-son soccer scrimmage and was playing goalie. It was wet out and I couldn't catch very well. So being the competitive person I am, I resorted to using my chest on several of the saves and also took a direct blow to my eye ( I wear glasses) and the eye started swelling up pretty good. We then finished and went inside to have pizza and everyone was concerned about my eye. About 30 minutes later I excused myself as i felt some pretty significant sweats and subsequently a pretty severe pain directly in the middle of my chest....I was having a heart attack! Called 911 and went to hospital (2-1/2 years since original stents) and my local cardiologist removed the blockage that was at the anterior portion of my 1st stent causing the blockage. The huge disappointment to me is that I had taken many steps to improve my overall health. But now that I have foreign bodies in my vessels, the chance of further clotting is something that i will most likely always have to live with.

BU, Michigan



This is an example of how heart scans should NOT be used. They should NEVER be used to justify a procedure, no matter how high the score or where the plaque is located. The "need" for procedures is determined by symptoms (BU's symptoms were hardly representative of heart disease), blood findings, EKG, stress testing, and perhaps CT coronary angiography. "Need" for procedures can never be justified simply on the basis of the presence of plaque by a heart scan calcium score.

Unnecessary procedures like the one BU underwent are not entirely benign, as his experience at the soccer game demonstrated.

Heart scans are truly helpful things. But, like many good things, they are subject to misuse in the hands of the uncaring or greedy.

Comments (9) -

  • jcj - mich

    2/6/2010 6:22:47 PM |

    My father had hardening of the arteries when he was 56 years old. My doctor put me on statins when I turned 50 because of high numbers . I am on a low-carb diet now and I have lost about 10 lbs ( I am only alitte over weight ).  My thought is, shouldn't the doctor consider taking my off the statins for a while to see if my numbers will be fine now ?  I am afraid of having the same problem as my father .

  • pmpctek

    2/6/2010 7:06:32 PM |

    This is an example of how heart scans should NOT be used. They should NEVER be used to justify a procedure, no matter how high the score or where the plaque is located. - Dr. Davis

    This is exactly the reason why my primary care physician says a heart scan is pointless, because the diagnoses of high coronary calcium leads to no accepted procedure/treatment protocol (other than a statin prescription) and may lead to nothing more than anxiety for the patient.  

    If only the AMA/AHA/ACC made Dr. Davis' book, website, and blog mandatory reading.

  • osusana

    2/7/2010 6:06:42 AM |

    Can the K2 vitamin promote clotting and lead to a thrombus?

  • Anonymous

    2/7/2010 5:17:00 PM |

    Reading this blog was eerie for me, as I suffered a similar experience.  I am 56.  2 1/2 years ago an unscrupulous cardiologist put 5 stents in my arteries after a nuclear stress test revealed some impaired blood flow. Subsequent reviews by other cardiologists showed that my arteries were not sufficiently blocked to justify placement of the stents.  I will now likely be on Plavix for the rest of my life but, even more importantly, have an increased risk of future problems because of these stents.  Although I was somewhat knowledgeable about prevention at the time, as a Trackyourplaque member, I did not suspect that there were cardiologists out there in established clinics who were so interested in making money at the risk of others' health.  Dr. Davis' program has helped me gain confidence that I will overcome this.

  • Nigel Kinbrum

    2/8/2010 12:18:45 AM |

    @osusana
    Vitamin K deficiency results in slow/no clotting. Vitamin K sufficiency results in normal clotting.
    Nige.

  • Selena

    2/8/2010 2:09:32 AM |

    I'm wondering if you're against all types of wheat. I found this:

    http://www.quakeroats.com/products/more-products-from-quaker/content/cereals/unprocessed-bran.aspx

    For 35 calories, it has 11g of carbohydrates, 8 of which is fiber...It also has very impressive mineral composition. What do you think?

  • Anonymous

    2/8/2010 2:24:20 PM |

    "No one talked to me about lifestyle changes other that smoking....but nothing on diet or other means of cholesterol control, etc."

    I find it so hard to believe that this person has absolutely no idea about basic food nutrition. With public libraries everywhere, and the internet it is easy to access food nutrition information. Please do not blame doctors for your ignorance about nutrition.

  • garval

    3/1/2010 8:07:24 PM |

    I would appreciate your help with the following: can coronary artery stenosis of between 70-80% be reduced by non invasive means for instance, by a combination of a healthy diet, exercise and medication or is it bypass surgery the only course of action?

  • buy jeans

    11/3/2010 3:04:09 PM |

    This is an example of how heart scans should NOT be used. They should NEVER be used to justify a procedure, no matter how high the score or where the plaque is located. The "need" for procedures is determined by symptoms (BU's symptoms were hardly representative of heart disease), blood findings, EKG, stress testing, and perhaps CT coronary angiography. "Need" for procedures can never be justified simply on the basis of the presence of plaque by a heart scan calcium score.

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Body count

Body count

Imagine the following headline:

War in Iraq a growing success: 20,000 Americans now dead!


If a newspaper ran that headline, we would all be outraged, and rightly so. Deaths in war are a tragedy. They are not something we celebrate.

Then why do we hear hospitals boasting about the number of bypass operations performed every year, number of heart catheterizations performed, number of heart attacks treated?


"_______ Hospital breaks 1000-heart bypass per year milestone"

"We treat more heart attacks than other other hospital in the state!"

"More people come to ________ Hospital than any other in the region!"




I hear this stuff on the radio, on TV, see it in newspapers and magazines, even on highway billboards every single day in Milwaukee.

Heart procedures, like deaths in war, are casualties of health.

They are not successes (though, of course, you can have a "successful" bypass). I see most procedures as a failure of prevention.

Death from heart attack is a failure of prevention. Tim Russert's death was a (unnecessary) failure of prevention. But so are bypass surgery, stents, and the like.

Such is the perverse state of affairs in hospitals and health: They celebrate illness. They glamorize it with ads displaying high-tech equipment, efficient staff in scrubs, "caring and friendly staff." But it is illness they are celebrating. Why? Because it has become a business necessity, a necessary strategy to remain competitive and profitable in the business called "healthcare" that makes money from treating people. The biggest return is from major procedures like bypass operations.

Every success in prevention denies the hospital an $80,000+ opportunity. You'll never hear that advertised.

Comments (7) -

  • baldsue

    6/28/2008 2:27:00 PM |

    After having been through two unnecessary brain surgeries, minor though they were, I find it refreshing to hear that not all  doctors are out to slice into my body.  Thank you!

    And the hospital and surgeon who performed the surgeries on me probably added them to the counts they tout.  Never mind that I consider both surgeries to be unsuccessful.

    I'm living the kind of life that I hope prevents me from ever needing to go under the knife.

  • brian

    6/28/2008 2:52:00 PM |

    This commentary reminded me of the Beth Israel mess and their diabetes prevention program. What a shame!

    http://www.nytimes.com/2006/01/11/nyregion/nyregionspecial5/11diabetes.html

  • Anonymous

    6/28/2008 4:01:00 PM |

    Excellent points. We celebrate sick days every time we get them. 'Health Insurance' companies actually make more money if you are sick - they can charge our employers more and more money each year. What is wrong with this picture?

  • Anna

    6/28/2008 4:51:00 PM |

    I've been thinking a lot about our system of "sickcare" lately.  I have a hard time calling it "healthcare" any more.  I don't see "the system" doing much to support and preserve health, mostly it just looks for signs of illness to treat after illness develops, at least in those with access to the system.  

    Thinking about the national dialog about CVD that has begun since Tim Russert's tragic and shocking passing, I was reminded of a similar situation closer to home.  Late last December my 9 yo son's pediatrician, only 55 yoa, died suddenly and unexpectedly of CVD.  My son and I went to a well attended public memorial service at the beach, where everyone was more or less in shock, from the family and friends, to his co-workers and patients, as well as many now-grown patients.  Of course, this occasion was a celebration of his life, so little was said about his death other than that it was sudden and unexpected.   But I remember thinking, if a doctor can drop dead without warning, despite daily access to a pretty good medical system, what chance do the rest of us have?  

    The more I thought about it, the more I wonder how out of the blue it was, though.  I had noticed during my son's more recent doctor office visits that the good doctor had suddenly aged a bit in the past couple of years, and his tall, lean stature had thickened in the middle in recent years, too, and he appeared a bit stooped.  But it's so easy to attribute that to ordinary aging.
      
    But I've been thinking more about that lately.  I remember being one place ahead of the pediatrician in the cashier line at Trader Joe's about a month or two before the doctor's death, and sneaking a peak in his cart while we chatted in line.  Skimmed milk, high fiber cold breakfast cereal, egg substitute product, soy ice cream substitute, and red wine are the items I remember distinctly, though I think there was also some produce and a package of boneless chicken breasts or something similar (very lean and "nutritionally correct".  I remember thinking, "how unsurprisingly conventional".  

    Thinking back on it now, it isn't so surprising that our pediatrician could die so unexpectedly, because he probably was checked with all the conventional test measures and doing all the conventional "right" lifestyle things (at least his grocery cart indicated that), which don't reveal/improve what is really going on, undetected, in the CV system.  

    The irony is that I had been wrestling with the idea of looking for a new pediatrician for the last year or two -  someone a little less conventional, but not "way out there".  But no one in our insurance plan fit my "ideal", nor was I able to find someone outside our plan that seemed right, either.   So I "coasted" on the decision.    We really did like our doctor as a person, and I appreciated his somewhat laid-back approach to child development and growth.  But my own ideas about what we want/need from medicine has changed a lot since I chose this doctor in the final months of my pregnancy nearly a decade ago.  And after my son developed a UTI and possible kidney infection while camping with some relatives two summers ago, and the conventional treatment of a year of antibiotics were prescribed as a prophylactic measure (without any mention of what that would do to his gut flora) because an imaging test showed a bit of kidney reflux on one side (we suggested monthly urinalysis to ensure sterile urine rather than the antibiotics, which the doctor agreed to), I guess I was at the point where I thought we needed to look for a pediatrician with more of an "outside the conventional box" vision (not exactly "alternative", but one who sees the body and enhancing health more holistically, not simply dysfunctional plumbing and germs to wipe out.  However, this of course, was not how I wanted to go looking for a new pediatrician.  No, I haven't found a new pediatrician yet, so if my son develops anything requiring medical attention, he'll be seen by one of the other partners in "the conventional system" for the time time being.  But I'm keeping my eyes open.

  • Stan

    6/29/2008 11:06:00 AM |

    That is bad news.  Good news is that Nature has a way of imposing a positive feedback through natural selection. The profession will clean itself up over time, through their own medicine. I wonder if Darwin Award can be applied to entire professional group or only to individuals?

    Stan (Heretic)

    Quote:
    "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it." - M. Planck

  • Anonymous

    6/29/2008 12:14:00 PM |

    I enjoy mailing out your blog postings to friends.  some friends are conservative while others are liberal in thought.  From the feed back that I receive it amazes me sometimes at how extreme our nation can be.  The two sides of the political spectrum all to often seem little different than gangs.

    Doing my best to take as many money making opportunities away from hospitals.

  • MedPathGroup

    9/8/2008 1:19:00 AM |

    I definitely agree with you, Healthcare has somehow indeed turned into a business. This is the reason why sometimes I don't anymore feel so compliant when i go visit a doctor and receives a lot of requests to go on various medical procedures. I feel like they are just unnecessary.

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