Everyone should have a brother-in-law like this man. Not only is he my brother-in-law but we are best friends. We both love outdoors activities and he is holding a redfish we caught in the waters of Beaufort County SC. I just have to tell you about one of our most memorable adventures. We were out on a cold winter night gigging flounder, As we poled the small boat around the corner, we saw something I have never heard described. There was a sound like horses running in the water and there were about 20 bottle-nosed dolphins that had herded a school of mullet and redfish up against the bank of the creek. 15 of the dolphins were racing back and forth and herding the fish. 5 dolphins were in the school feeding on the fish. The dolphins took turns herding and feeding. I have the greatest respect for that animal. Dan and I got in the middle of the school and gigged a few redfish, which was legal in those days.
Dan is a great man-a man’s man. There is no one I admire more. He was an all-conference lineman in college football. He was a football coach and teacher in his professional life. You may have read the book The Water is Wide by Pat Conroy which became a movie named Conrack. It told the story of Conroy’s work educating poor, isolated black children on Daufuskie Island. For some time, Dan drove a large Boston Whaler outboard over to the island to bring those kids back and forth to Hilton Head to go to school. THAT is the kind of man he is. I have never heard of him telling a lie. If he agrees to do something, you can count on it. You don’t need a contract with him. A handshake will do. He is a person of great integrity.
Yesterday he called me about a health problem. He had a CT scan of the chest 3 months ago. They found a small round spot on his lung. This happens so frequently these spots are called incidentalomas and they usually don’t amount to much. They did another CT a few days ago to be sure the spot had not grown. On that scan they noticed he had calcium in his arteries and they recommended a stress test. Dan called to see if they are on the right track.
They are not. Dan has no symptoms. His watch tells him he recently walked 9500 steps in one day. He has a small farming operation. He regularly does heavy work with no chest pain or shortness of breath. He is very fit for his age. He regularly stresses his heart and he has no symptoms. 14 years ago, when he was in his mid 50s he had a coronary calcium score that was over 200. He had documented heart artery disease and a high risk of a heart attack back then. A younger brother died of diabetic chronic kidney disease. He had high blood pressure and a fasting sugar over one hundred. He is prediabetic. As soon as we saw the high calcium score, he started on optimal medical therapy immediately. He takes an ACE inhibitor or an ARB for blood pressure, a high intensity statin, metformin for prediabetes, and an aspirin. Even if his stress test was abnormal, he should not have a cath, or stent. That sequence has a 2% chance of serious medical complications and it adds nothing to preventing a heart attack in this man. He has lost weight. He is very faithful about his medicines and lifestyle measures. He has done very well with very little expense. He has also avoided becoming diabetic and developing chronic kidney disease. Dan and I will continue to enjoy each other’s company and have adventures.
Then there is the issue of cost. Up to half the stress tests performed in the US are inappropriate. 30% of all care is low value like the stress test in patients without symptoms. The average price of a nuclear stress test is $3800. The estimated cost of a heart cath is $9500. Heart artery stent placement costs $11000 to $41,000. These procedures are very expensive. As you have seen, everyone with a suspicion of heart disease gets these tests, but very few get optimal medical therapy—the treatment they really need. For the 2% with serious health complications from these procedures, it gets a lot more expensive.
I have spent a year and a quarter writing about just this issue. I have told the story of my neighbor Jean Now you know Dan’s story. This is a very common problem. I am sure some of your family and friends have the same issue. Spread the word. Protect yourself, your friends, and your family. Protect yourself from medical bankruptcy. Let’s work together to implement the new science, new systems, and new technology that can give us better heart care at lower cost. Thanks Dan, for letting me tell your story.
Dan is a Lowcountry legend. So unselfish and such a great heart! Great story.
Great story! He sounds like a great guy too!