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Phylicia Rashad Discusses Peripheral Artery Disease

Many members of Phylicia Rashad’s* family have had peripheral artery disease (P.A.D.), strokes, and heart attacks. In a candid interview with me, she describes how her healthy lifestyle (regular exercise, no smoking, and a Mediterranean diet) has helped her to beat the odds and avoid the disease.

Dr. Val: I’m so sorry to hear that 8 of your relatives have suffered stokes or heart attacks. What was that like for you?

Ms. Rashad: All of these relatives of mine had diabetes. At the time of their deaths, P.A.D. was not a recognized condition. It wasn’t regularly diagnosed until the 1990s. I remember my father complaining of his legs cramping a lot. At the time we chalked it up to him being on his feet all day as a dentist, but I wish we had known that it was a sign of something much more serious. Things were different back then – people just accepted that if you had diabetes, you were going to lose toes or limbs. They accepted that as we age, we’d likely have a stroke or a heart attack. No one thought about preventing that from occurring.

Dr. Val: What do you do differently to help insure that you don’t follow in their footsteps?

Ms. Rashad: I eat differently, and have done so for decades. I also get regular exercise. Unfortunately, my hard working family was in the habit of coming home, having dinner and relaxing on the couch after work. This contributed to their diabetes and P.A.D. issues. Interestingly, my relatives who worked on a farm lived into a ripe old age with no chronic disease. Read more »

Peripheral Artery Disease: What You Need To Know

Peripheral Artery (Arterial) Disease (P.A.D.) is an under-recognized and under-diagnosed condition, yet it serves as an important warning sign for those at high risk for stroke and heart attack. Even though we have an inexpensive and non-invasive test for P.A.D. very few people have the test done. I interviewed Dr. Gary Schaer, Director of the Cardiac Cath Lab at Rush University Medical Center in Chicago, about P.A.D. and also spoke with actor Phylicia Rashad about her family’s trials and tribulations with P.A.D. This post is devoted to Dr. Schaer’s insights on the medical aspects of the disease, and the next post focuses on Ms. Rashad’s personal story. 

Dr. Val: To set the stage for our listeners, Dr. Schaer, can you tell us what is peripheral artery disease exactly?

Dr. Schaer: Peripheral Arterial Disease is a condition where the blood vessels (that deliver blood to the legs) become plugged up with a mixture of fat and cholesterol, also known as plaque. This plaque sticks to the blood vessel walls and causes a decrease in oxygen delivery and blood flow to the leg muscles. Patients sometimes experience a burning, aching or tired feeling in their calf muscles (called “claudication”) when the blood supply is diminished. This discomfort is usually made worse by walking but relieved by rest.  It’s a fairly common problem, particularly in people with risk factors (like smoking, diabetes, and high cholesterol) for P.A.D.  It’s important to recognize when a person has P.A.D. because they could be at higher risk for stroke, heart disease, and even death.

Dr. Val: Why do you think so few people know about P.A.D.?

Dr. Schaer: It’s not as “glamorous or exciting” a disease as heart attack or stroke (as portrayed in Hollywood movies). P.A.D. is a chronic disease that is a marker for atherosclerotic plaque – which can lead to heart attacks and strokes.

Dr. Val: How does the average person know they have P.A.D.?

Dr. Schaer: You can get tested. We have a simple, non-invasive test available to diagnose this disease – it’s called the “Ankle Brachial Index.” The test basically compares the blood pressure in the arm with blood pressures in the thigh and ankle.  If there’s a significant drop in the leg blood pressure, then that suggests a blockage of blood flow or P.A.D.

Dr. Val: Who would be a good candidate for the ABI test?

Dr. Schaer: People who have symptoms of P.A.D. (claudication) should definitely be tested. However, keep in mind that about half the patients who have P.A.D. are asymptomatic, so people with risk factors like long-term smoking, age over 65, diabetes, and high cholesterol should consider having the test too. The reason why we do the test is because there are some excellent treatment options that can reduce the risk of heart attack and stroke for people with P.A.D.

Dr. Val: What are the treatment options?

Dr. Schaer: First of all, people with P.A.D. should be on an anti-platelet drug – either Plavix or aspirin. Studies have shown that these drugs substantially reduce the risk of stroke and heart attack (and heart related death) in patients with P.A.D. However, Plavix is more effective than aspirin, though aspirin is cheaper. Secondly, people with P.A.D. must not smoke. Quitting smoking is a top priority. Thirdly, underlying conditions like diabetes, high blood pressure, and high cholesterol must be aggressively managed. And finally, increasing physical activity can also reduce the risk of dangerous complications from the disease.

Dr. Val: What’s the most important thing for Americans to know about P.A.D.?

Dr. Schaer: The most important thing is for Americans at risk for P.A.D. to get tested for it. Anyone over 65 with claudication symptoms or other risk factors like smoking, diabetes, or high cholesterol should get an ABI test from their doctor. If P.A.D. is diagnosed, there are therapies that clearly reduce the risk of having it progress to heart disease, stroke, and even death. Testing could save your life.

*This post was first published at my new blog site – URL pending*

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Grand Rounds Enters Its Fifth Year!

Dear Medblogger Friends – I will be hosting the historic Volume 5, edition 1 of Grand Rounds on September 23rd. Please email your submissions to: valjonesmd -at- gmail -dot- com. There is no theme (I’ll accept all submissions). Please put “Grand Rounds Submission” in the subject line of your email. Please send me your URLs by midnight, Sunday, Sept. 21. Stay tuned for some breaking news… (Blog posting will be light here for a little while).

**ABOUT GRAND ROUNDS**

“Grand Rounds unifies the health blogging community.”

Grand Rounds is a weekly summary of the best health blog posts on the Internet. Each week a different blogger takes turns hosting Grand Rounds, and summarizing the best submissions for the week. The schedule for Grand Rounds is currently available at FromMedskool.com. Both Dr. Val Jones and medical student Colin Son coordinate the schedule and identify appropriate hosts for Grand Rounds. Medscape.com features weekly interviews with new hosts of Grand Rounds, usually written by Mr. Son.

Grand Rounds was originally established by Emergency Medicine physician, Nicholas Genes in September, 2004. His concept was to highlight and capture the best medical blog posts in one place each week. The rotating nature of the hosts for Grand Rounds promotes community awareness of new bloggers, and encourages cross linkage to more content.

Grand Rounds is the oldest and most popular medical blog “carnival” on the Internet. Under the stewardship of Dr. Val Jones and Mr. Colin Son, we anticipate that Grand Rounds will remain a pillar of the health blogging community, enjoyed by healthcare professionals and patients alike.

***

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Remembering 9/11

This reflection is from a previous blog post

When the president of a country dies suddenly, they say that the citizens forever remember where they were, and what they were doing, when they first heard the news.  I’ve heard people discuss their personal circumstances when they received word that President Kennedy was shot.  For some reason, that sort of news is a memory fixative, preserving individual experience along with national tragedy.

For me, 9/11 was one of those events.  I was getting off a night shift rotation at a hospital in lower Manhattan, sitting in morning report, dozing off as usual – my eye lids sticking to dry corneas, my head feeling vaguely gummy, thoughts cluttered with worries about whether or not the incoming shift of residents would remember to perform all the tasks I’d listed for them at sign out.

And as I dozed off, suddenly our chief resident marched up to the front of the room, brushing aside the trembling intern who was presenting a case at the podium at the front of the dingy room.  “How rude of him” I thought hazily, as I shifted in my seat to hear what he had to say.

“Guys, there’s been a big accident.  An airplane just crashed into the World Trade Center.”

Of all the things he could have said, that was the last thing I was expecting.  I shook my head, wondering if I was awake or asleep.

“We don’t know how many casualties to expect, but it could be hundreds.  You need to get ready, and ALL of you report back to the ER in 30 minutes.”

I thought to myself, “surely some Cessna-flying fool fell asleep at the controls, and this is just an exaggeration.”  But worried and exhausted, I went back to my hospital-subsidized studio apartment and turned on the TV as I searched for a fresh pair of scrubs.  All the channels were showing the north tower on fire, and as I was listening to the news commentary and watching the flames, whammo, the second plane hit the south tower.  I stared in disbelief as the “accident” turned into something intentional.  I remembered having dinner at Windows on the World the week before.  I knew what it must have looked like inside the buildings.

I was in shock as I hurried back to the hospital, trying to think of where we kept all our supplies, what sort of injuries I’d be seeing, if there was anything I could stuff in my pockets that could help…

I joined a gathering crowd of white coats at the hospital entrance.  There was a nervous energy, without a particular plan.  We thought maybe that ambulances filled with casualties were going to show up any second.

The chief told me, “Get everybody you can out of the hospital – anyone who’s well enough for discharge home needs to leave. Go prepare beds for the incoming.”

So I went back to my floor, recalling the patients who were lingering mostly because of social dispo issues, and I quickly explained the situation – that we needed their beds and that I was sorry but they had to leave.  They were actually very understanding, made calls to friends and family, and packed their bags to go. 

And hours passed without a single ambulance turning up with injuries.  I could smell burning plastic in the air, and a cloud of soot was hanging over the buildings to the south of us.  We eventually left the ER and sat down in the chairs surrounding a TV in the room where we had gathered for morning report.  We watched the plane hit the Pentagon, the crash in Pennsylvania… I thought it was the beginning of World War 3.

The silence on the streets of New York was deafening.  Huddling inside buildings, people were calling one another via cell phone to see if they were ok.  My friend Cindy called me to say that she had received a call from her close friend who was working as a manager at Windows on the World.  There was a big executive brunch scheduled that morning.  Cindy used to be a manager there too… the woman’s last words were, “the ceiling has just collapsed, what’s the emergency evacuation route? I can’t see in here… please help…”

That night as I reported for my shift in the cardiac ICU, I was informed by the nursing staff that there were no patients to care for, the few that were there yesterday were either discharged or moved to the MICU.  They were shutting down the CICU for the night.  I wasn’t sure what to do… so I went back to my apartment and baked chocolate chip cookies and brought in a warm, gooey plate of them for the nurses.  We ate them together quietly considering the craziness of our circumstance. 

“Dr. Jones, you look like crap” one of them said to me affectionately.  “Why don’t you go home and get some rest.  We’ll page you if there’s an admission.”

So I went home, crawled into my bed with scrubs on, and slept through the entire night without a page.  The disaster had only 2 outcomes – people were either dead, or alive and unharmed – with almost nothing in between.  All we docs could do was mourn… or bake cookies.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Healthcare Reform: How To Expand Patient Choice

Last week I attended a press conference about healthcare reform at the National Press Club. The most interesting of the 4 speakers was Grace-Marie Turner, president of the Galen Institute. In a recent editorial in the Wall Street Journal, Ms. Turner argued that,

The complex problems in our health sector are best cured by a bigger dose of market competition, not more government intervention.

I had the chance to interview Ms. Turner after her lecture.

Dr. Val: You’ve said that “we’ve got to come to a uniquely American solution to our healthcare crisis.” What does that mean?

Ms. Turner: I speak a lot in Europe, and they really believe that we have a permanent underclass of 47 million people who never have access to our healthcare system. They imagine that they’re bleeding in the streets. We know that’s not the case. Everyone has access to healthcare through emergency rooms – but this is an inferior way to access healthcare. People end up getting treatment at the end of an illness rather than the beginning when things could be better treated, and it’s much more expensive. We need to solve the problem of health insurance.

The movement of “consumerism” is something the world is looking to us to figure out. In other countries their concept of “innovation” is adopting diagnostic codes and payment structures for a system of treatment. We’ve had that for over 20 years in America. When we talk about innovations we mean new ways to respond to consumer needs. The fact that we don’t have so many rules and regulations guiding the entire structure of the healthcare experience means that we can innovate. We can create diversity of care options.

Most of the major research-based pharmaceutical innovations occur in America because we don’t have price controls and we don’t have restrictions on access to care. These are unique aspects of the American healthcare system, and even though Europeans criticize us, they’re always looking to learn from us.

Dr. Val: Why are “medical homes” important?

Ms. Turner: In this increasingly complex healthcare system, people need to have a place to go where their care will be coordinated. That may be a physician’s practice, but it can also be an electronic medical home where people have their medical records kept in one place, and where they have access to different specialists that they can use to coordinate their care. The medical home is really a beacon for more accurate, coordinated and more productive use of our healthcare system.

Dr. Val: You mentioned that there is a “workforce crisis” in our healthcare system — that there are not enough primary care phsyicians to meet demands. Yet you also said that If people could buy health insurance across state lines we could solve a lot of the access issues. How can both be true?

Ms. Turner: It’s a chicken and egg problem. We’ve got to increase access to health insurance. We can’t have 45 million people feeling that they’re blocked from predictable access to healthcare. Once you get tens of millions more people into the healthcare system, then you’re going to start to see a lot of pressure to better utilize the resources that are currently in the system. For example, people don’t always have to go to a doctor for something that a mid-level medical professional could provide them.

I predict that more people will begin to purchase high deductible insurance in case of major accidents or catastrophic events – but they’ll want more control over their routine access to the system, including convenient care clinics and complementary and alternative medicine. If we allowed cross-state health insurance purchasing, it would force the system to meet the needs of consumers for more affordable and convenient care.

Dr. Val: You said that increasing access to complementary and alternative medicine is about giving people “more choices.”

Ms. Turner: I’ve heard so many stories about people who were getting their care through their health insurance providers – guided through a predictable pattern of specialist care. And then when they swithched to a health savings account, they could access the system the way they wanted to. So many of our health issues are behavior-related, and it seems that alternative medicine practitioners can have success in helping people modify their behaviors. The more we have top-down regulatory prescription of what the system will pay for or not, the more you eliminate the alternative practices that might be very helpful to people. I’d like to see a lot more pluralism in our healthcare system, and expanding government intervention is not going to help us achieve that goal.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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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

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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

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