Cath lab energy costs

22. April 2009 William Davis (6)
In honor of Earth Day, I thought I'd highlight the unexpectedly high carbon costs of activities in hospitals, specifically the cardiac catheterization laboratory.

A patient enters the cath lab. The groin is shaved using a plastic disposable razor, the site cleaned with a plastic sponge, then the site draped with an 8 ft by 5 ft composite paper and plastic material (to replace the old-fashioned, reusable cloth drapes). A multitude of plastic supplies are loaded onto the utility table, including plastic sheaths to insert into the femoral artery (which comes equipped with a plastic inner cannula and plastic stopcock), a multi-stopcock manifold that allows selective entry or removal of fluids through the sheath, a plastic syringe to inject x-ray dye, plastic tubing to connect all the devices (total of about 5 feet), and multiple plastic catheters (3 for a standard diagnostic catheterization, more if unusual arterial anatomy is encountered).

All these various pieces come packed in elaborate plastic (polyethylene terephthalate or other polymers) containers, which also come encased in cardboard packaging.

Should angioplasty, stenting, or similar procedure be undertaken, then more catheters are required, such as the plastic "guide" catheters that contain a larger internal lumen to allow passage of angioplasty equipment. An additional quantity of tubing is added to the manifold and stopcock apparatus, as well as a plastic Tuohy-Borst valve to permit rapid entry and exit of various devices into the sheath.

Several new packages of cardboard and plastic are opened which contain the angioplasty balloon, packaging which is usually about 4 feet in length. The stent likewise comes packaged in an 18-inch or so long package with its own elaborate cardboard and plastic housing.

At the conclusion of the procedure, another cardboard/plastic package is opened, this one containing the closure device consisting of several pieces of plastic tubes and tabs.

If the procedure is complicated, the number of catheters and devices used can quickly multiply several-fold.

By the conclusion of the procedure, there are usually two large, industrial-sized trash bins packed full of cardboard, plastic packaging, and discarded tubing and catheters. The trash is so plentiful that it is emptied following each and every procedure. None of it is recycled, given the contamination with human body fluids.

That's just one procedure. The amount of trash generated by these procedures is staggering, much of it plastic. I don't know how much of the U.S.'s annual plastic trash burden of 62 billion pounds (source: EPA) originates from the the cath lab, but I suspect it is a big number in total.

So if you are truly interested in reducing your carbon footprint and doing your part to be "green," avoid a trip (or many) to the cath lab.
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Comments (6) -

  • Anonymous

    4/23/2009 8:05:00 AM |

    Dr. Davis,
    Isn't a catheter used for an angiogram?  I thought an angiogram is a necessity before surgery for an aortic abdominal aneurysm?  What are the other alternatives if catheters make so much rubbish?  Just wondering since my mother is considering having surgery for her AAA and needs to have an angiogram first.
    Thanks,
    Josephine Keliipio
    Hawaii

  • Anonymous

    4/23/2009 2:19:00 PM |

    Dr. Davis doesn't answer questions posted to his blog any longer. He announced this some time ago.

    I think the point of his little story about being green is to avoid having to have such a procedure done in the first place. I don't believe he is suggesting that you ask the Hospital to recycle all the left over rubbish from such a procedure. At the rate of pay of those people, they'd probably have to charge you a couple of hundred dollars to sort everything out that could be recycled..  Frown

    I am only a lay person but I believe there is no alternative (less rubbish producing that is) to the procedure your Mom needs done. Don't worry about the trash and focus on your Mom's outcome instead.

    Good luck with your Mom's procedure.

  • Anonymous

    4/23/2009 5:10:00 PM |

    Catheter angiogram is no longer needed to demonstrate arteries, especially arterial anatomy in the abdomen, extremities,head and neck, including, carotids and intracerebral arteries, arteries in the arm or legs. There is now, an alternative, non-invasive. This consist of CT, CTA, or even better, without radiation an MRI,MRA. The only indication for catheter angiogram is if there is plan for angioplasty, or placement of a stent.
    No one or nobody should be subjected, to a catheter angiogram, in this day and age.
    I hope this helps.

  • Jonathan Selwood

    4/23/2009 5:55:00 PM |

    Dr. Davis,

    Much obliged for the post.  It provides me with a wonderful counter to claims that a grain-based diet has less of an environmental impact.

    Wheat=Heart Disease=Medical Waste

    jonathan

  • Anonymous

    4/24/2009 9:41:00 AM |

    Anonymous #2,
    Thanks for your comment about angiograms. I am still learning about this procedure and am glad to know that there may be other alternatives. My mom had no plans for a stent or an angioplasty but it seems that angiograms are the standard for elderly patients electing to fix AAAs. Anyway, lots of questions to ask the cardiologist when we see him again in a few weeks. Josephine

  • jean

    4/25/2009 5:53:00 PM |

    Mmmm...stay out of the surgical ICU also, if you can help it. We generated on average 3-4 large cans of waste per room (14) per shift (12hr) per day. Efforts to separate out recyclables were futile. And let's not even get into hand washing. This was in 2000. I hope things have improved.

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At-home blood tests

At-home blood tests

2. May 2009 William Davis (6)
Our at-home blood tests are proving a hit.

So far, vitamin D is the number one most popular test, no surprise.

Second--to my surprise--is DHEA. I would have predicted it would have been thyroid testing.

Our male and female hormone panels are also proving popular.

I've personally been using the thyroid and vitamin D testing to monitor my levels. I increased my Armour thyroid based on a low free T3 value, while my vitamin D was perfect at 77 ng/ml on 8000 units vitamin D3 (cholecalciferol) per day.

The process of performing the blood spots is straightforward. The finger pricks are virtually painless using the automatic spring-loaded finger stick devices:





The number of blots to make depends on how many tests you'd like. Just a vitamin D test requires 2 blots. If 6 or more tests are ordered at a time, then all 12 blots should be made. (Two spring-loaded lancets are provided in each kit.)





If you are interested in any of our at-home blood tests, go here.

Our own Heart Hawk has posted an editorial on about blood spot testing on Health Central:

Simple, affordable home blood testing is a real game-changer in the arena of informed, self-directed healthcare. For the first time broad access to home blood testing, on a scale similar to that enjoyed by persons who routinely test their blood sugar, is available to virtually everyone and it removes doctors as the gatekeepers of these tests. Even private insurance companies and Medicare are beginning to understand the potential for improving healthcare and decreasing costs and are slowly beginning to expand coverage of home blood testing much as they do for diabetics or persons taking anti-coagulants.
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Comments (6) -

  • Anna

    5/2/2009 4:22:00 PM |

    I'm curious about the requirement that California  residents must have a doctor's prescription when sending in the test kit.  I'm a CA resident and I've done home testing a few times with other labs and I never needed an order or Rx from my doctor.  

    Why do these tests have that CA requirement?  I think that policy might need to be reviewed.

    New York State, though, does prohibit home test kits, which really stinks, IMO.  I don't even think one can home test even with a doctor's OK.    I don't know how the state thinks that is protecting their residents.  I had to relay-mail my dad's www.grassrootshealth.net Vit D study test kit to him in NYS to get around this silly prohibition.

  • Big B

    5/3/2009 4:23:00 AM |

    Nice informative blog

    try Heart Health

  • Nick

    5/3/2009 9:25:00 PM |

    I love the idea of at-home blood tests and your April 12 post on self-directed health.  Certainly, websites such as this one, Blood Sugar 101, Whole Health Source, Hyperlipid and Dr Eades blog make it easier to begin to take charge of one's own health (a prediabetes FBS brought me to this world and I am now low-carb and grain free as a result).

    My first experience with a home test was via Grassroots Health's vitamin D test.  One of the things that made it simple and worth doing was all the information on Vitamin D at the usual blogs, including the Vitamin D Council.  I was able to start supplementing immediately once I saw my level.

    But I find that things get more complicated when one tries to interpret the results of the various blood tests offered via TYP.

    For example, I saw an ND who gave me an at home saliva test and an OGTT.  I knew I was prediabetic, but was told I was hypothyroid (very low cortisol), insulin resistant, hypoglycemic and that my serotonin, GABA, and dopamine were very low and nor-epinephrine was too high.  My hsCRP was below 3, but not .5.  Oh, yeah, and something about adrenal fatigue, which I'm not even sure exists.

    I did not follow the advice of the ND because I found so much conflicting information.  My hope is that the Heart Scan Blog will offer much more information about how to interpret the results of the blood tests and what course of action is recommended given various results.

  • PRIDE MAFIA

    5/4/2009 12:28:00 AM |

    I thought that the only testosterone test that mattered was the "free" bio available testosterone level test, which is a saliva test? A man can have "normal" serum T level but none of it is being used which the "free" T test can show

  • Anonymous

    11/22/2009 5:46:39 AM |

    ...please where can I buy a unicorn?

  • buy jeans

    11/3/2010 3:02:55 PM |

    New York State, though, does prohibit home test kits, which really stinks, IMO. I don't even think one can home test even with a doctor's OK. I don't know how the state thinks that is protecting their residents. I had to relay-mail my dad's www.grassrootshealth.net Vit D study test kit to him in NYS to get around this silly prohibition.

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