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Is The Ironman Triathlon Safe For The Middle-Aged Heart?

Before I even start, let me say this to my triathlete friends…

I really like you all. And…I am sorry for how I feel about your sport’s pinnacle, the Ironman triathlon. But I was poked into writing this post. When asked the question of whether the Ironman is safe for the middle-aged heart, what was I to do? Lie?

Each August, my hometown, Louisville, KY, gets overrun, over-swum and over-ridden with “Iron people.” No, these humans aren’t rust colored, or all that hardened, but they are indeed a determined lot. Triathletes, or iron people if you will, wake up before sunrise to swim, bike or run. Then they eat; some go to work (barely), and then they do the training thing again in the evening. Calling these athletes focused would surely be an understatement.

So it is each summer that I endure the same question: “Dr. Mandrola, did you do the Ironman?”

“No…I just ride bikes.”

But this year was different. Before I could launch into my usual dissertation on how training for Ironman-length triathlons causes excess inflammation, coronary calcium, atrial fibrillation, divorce, etc., etc., another question quickly popped up.

“What did you think of that guy who died during this year’s race?” Read more »

*This blog post was originally published at Dr John M*

Apixaban Finally Showing Superiority Over Warfarin In Clinical Trial

With the publication of “Apixaban versus Warfarin in Patients with Atrial Fibrillation” (the ARISTOTLE trial) in the New England Journal of Medicine, the third drug in a series of medications designed to attack thrombin in the clotting cascade. The study was announced with quite a fanfare in Europe as cardiologists, financial analysts and reporters gushed forth with ‘mega-blockbuster’ praise this past weekend.

And for good reason.

This is the first trial to conclude that Read more »

*This blog post was originally published at Dr. Wes*

Articles Give An In-Depth Analysis Of Multaq

As a patient, you probably see lots of hype-filled reports about various drugs. After a drug is approved, there’s an inevitable blitz of negative publicity which often scares people away from important new solutions that could help them.

There has been so much news lately about Multaq (dronedarone), the drug designed to provide the benefits of amiodarone but with fewer risks. This drug is important to people with afib, especially those with heart disease whose choices are limited, so it’s time to put into context for patients what has transpired in the two years since FDA approval.

These two companion articles provide an in-depth analysis into issues that have been reported about Multaq, including whether it can cause: Read more »

*This blog post was originally published at Atrial Fibrillation Blog*

Sometimes The Best Thing To Do Is Nothing At All

It’s the hardest thing in the world for a doctor to do.

After all, doctors are do-ers. That is how they have managed to achieve their degrees: hard work, discipline, perseverence. Who else would be willing to memorize all those organic chemistry equations long enough to vomit them back on paper? Who else would tolerate long nights and weekends on a constant basis? But they do it because it’s the right thing to do. They do it because someone has to. People don’t get sick nine to five. They get sick at 2 am. And so, by it’s very nature over the years, medical education becomes a sort of natural selection: only the strong survive.

Historically, doctors endure the system because they know that there are rewards for this hard work personally, professionally, socially, and financially. So throughout their training, doctors learn to perfect the art of doing. That’s what people come to expect. Oh my God, doctor, he’s choking: do something! He’s turning blue: do something! But he fainted, doctor! Do something!

One of the best parts of medical school is learning the answers to these mysteries of medicine and how to fix them. In the past, this gave doctors an aura of deity: they could be trusted to fix just about any ailment that befell man. It was awesome. With time, a sense of invincibility and omnipotence set in.

And like flies to a flame, we bought it. Lock. Stock. Barrel.

In fact, Read more »

*This blog post was originally published at Dr. Wes*

New Blood-Thinner Shifts Responsibility To Patients

I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa).

Fellow Kentucky cardiologist, and frequent TheHeart.org contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran.

Dr. Walton-Shirley details the very commonly done procedure of cardioversion (shock) for AF. As she clearly points out, the most important safety feature of shocking AF back to regular rhythm entails adequate blood thinning before and after the procedure. Thin blood prevents the possibility of clots dislodging after restoring normal contraction to the top chambers of the heart (atria).

Herein lies the rub with dabigatran, and the two soon-to-be-approved non-warfarin blood-thinning agents, apixaban and rivaroxaban. In the past, Read more »

*This blog post was originally published at Dr John M*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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