Yesterday, I posted a thread linked to an article in The Atlantic. I have myself received care not based on the best evidence. My own health history is indicative of high cardiovascular risk. First, I am 74 years old. Age is the greatest risk for coronary artery disease. I have a history of high blood pressure (160/100), prediabetes (fasting sugar 107), and low good cholesterol. Even so, I have been extremely faithful with optimal medical treatment for 15 years. My pressure now is 120/70, my last glucose was 85, and my last LDL cholesterol was 55. I was exercising regularly. I was doing high repetition progressive weight training with 12 sets of an assortment of exercises. I could do 15 arm curls with 90 pounds of weight. I could do 15 leg presses with 240 pounds of weight. I had no chest pain, shortness or breath, or heart rhythm problems with these exercises. So, I had no heart symptoms related to heavy exertion and the risk of threatening heart artery disease is therefore low. My father developed atrial fibrillation (a fib) in his 20s. He was seriously wounded and had malaria during the war. It was probably related to one of those things. He lived to be 84. My mother developed atrial fibrillation in her late 80s and she lived to age 94.
My own atrial fibrillation (a fib) began 30 years ago in the aftermath of a bout with large cell lymphoma and chemotherapy. Part of my treatment included doxorubicin and my atrial fibrillation began shortly after that. This medication kills the cancer but it injures healthy cells in the heart. Doxorubicin is so toxic that it is nicknamed “the red death” or “the red devil.” I started having short bouts of a fib while I still had my treatment access catheter in just under my collarbone to deliver my chemotherapy. For the next 28 years I had bouts of irregular heartbeat indicative of atrial fibrillation lasting 5 minutes every six months. About 10 years ago I had a coronary calcium score of zero which is indicative of minimal heart artery disease and better than the average person my age. Since that calcium score, I continued to use optimal medical treatment consistent which is highly effective at slowing the progression of heart artery disease.
Then my atrial fibrillation became more frequent and longer lasting. The episodes increased to once or twice a week and lasted twice as long. I knew that my a fib is most likely due to my doxorubicin chemotherapy. This medication creates a storm of oxidative particles that activates the biology that causes most cardiovascular disease. That biology causes scar formation and makes the atrial chambers larger. Once those genes are activated, they stay activate. Blocking these oxidative particles with optimal medical therapy (OMT) had kept my a fib intermittent and stable for 30 years. There is evidence that components of OMT reduces a fib recurrences and hospitalizations. I was on very low doses of losartan (25mg daily) and eplerenone (12.5). I wanted to double the dose of those medications to see if that would help. I went to a cardiologist and related my history and what I would like to do.
Even though my intermittent a fib had been present for 30 years both before and after a calcium score of zero indicating very low risk of a heart attack, and with no exertional symptoms, the cardiologist recommended a stress test. I knew it was not necessary and I still went along with it. Then the stress test was suggestive of an abnormality, and he said I needed a cath. The cath showed one 20% blockage at the end of one of the arteries which had no impact on my a fib. It did nothing to change my treatment. I have never found any evidence that opening my artery would make a fib less frequent. I am really embarrassed that I went along with it. We finally got around to doubling my losartan and eplerenone and I have not had an episode of a fib since. Those medicines work by reducing atrial size and blocking formation of scar tissue.
I know this science very well and I still got talked into a stress test which led to a heart cath. New guidelines no longer call for stress tests even in patients with heart artery disease and stable chest pain. In my case, I simply needed intensified OMT, and I am embarrassed that I went along with the recommendation. I know it is even harder for laymen to resist inappropriate treatment. Guidelines now recommend OMT first in stable heart artery disease. This a very common problem and the leading cause of death in the United States. Our system needs a renewed focus on training primary care health professionals in to be better advocates for best practice and OMT.
As a layperson and former medical social worker, I find this information very helpful. It's very timely, too, as my 50 year old son just told me he has to wear a heart monitor for two weeks due to fainting spells that have become more frequent. Other than recently diagnosed Crohn's disease managed by diet and weight loss, he has always been quite healthy and is training to run a full marathon in the fall. But a mother worries!
This is a rebuttal letter written by a brave primary care physician who decided to be our customer and use MCG Technology to help his patients. It is devastating, to say the least, to the corrupt Lousiana BCBS AIM Cardiologist:
https://www.linkedin.com/posts/joseph-shen-md-b01760106_mcgshines-activity-6803669314730766336-Q-0c