Heart attack: is it a clogged pipe or a popped pimple?

by Carolyn Thomas      @HeartSisters

decisionsWhen my little sister Bev was booked to have her tonsils removed at age six, our family doctor declared that I must have mine out at the same time – not because there was anything at all wrong with them, but because I was already 12 years old and, for some inexplicable reason, I still had my tonsils intact!  (Back then, kids with tonsils were apparently an endangered species. As New York ear/nose/throat specialist Dr. Steven Park described the historical take on tonsils: “In the 50s to 70s, it was a given that if you had tonsils, they were removed.”)

On our designated procedure date, Bev and I were admitted to the pediatric ward at St. Catharines’ Hotel Dieu Hospital together.  I remember this experience vividly because the archaic rule at the Hotel Dieu back then was that all pediatric patients had to wear diapers overnight.  DIAPERS! As a humiliated almost-teenager, I pleaded with my mother to convince the ward nurses that I most certainly did NOT need to wear diapers at my mature age! But rules were rules, and I somehow managed to survive both an unwarranted surgical procedure and its associated diaper humiliation.

It turns out I wasn’t the only person questioning the wisdom of taking out a perfectly fine pair of tonsils based on flimsy if any medical evidence.  Decades later, many researchers – including in this U.K. study published in the journal Archives of Disease in Childhood (1) – blamed not only the physicians who recommended the routine surgical removal of tonsils (and often adenoid glands at the same time) to treat childhood sore throat, but also “parental enthusiasm” as the factors influencing an entire generation of higher-than-necessary rates of surgery.

“Despite the enthusiasm with which tonsillectomy is offered and sought, there is little evidence of efficacy.”

I like this tonsil analogy to illustrate how medical attitudes, no matter how pervasive, can indeed change over time as our physicians rethink the status quo in order to embrace evidence-based medicine.

In other words, just because we’ve been doing this for a long time, is there any evidence that it’s actually what needs to be done? 
Continue reading “Heart attack: is it a clogged pipe or a popped pimple?”

Deprescribing: fewer drugs, better health outcomes?

by Carolyn Thomas    @HeartSisters

We all know about prescribing. It’s what our docs do when they pull out the prescription pad so we can start or keep taking a specific drug for a specific medical reason.

But have you heard about deprescribing?

Basically, deprescribing happens when a health care professional decides to taper or stop recommending one or more prescription drugs for any given patient. The practice is aimed at minimizing what’s known as polypharmacy (that’s when adult patients are taking multiple medications at the same time) while at the same time improving patient outcomes.

What’s the problem with polypharmacy? Plenty, as it turns out.
Continue reading “Deprescribing: fewer drugs, better health outcomes?”

The Sitting-Rising Test: what’s your score?

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by Carolyn Thomas    @HeartSisters

Back when I was a run leader at the Y Marathon Running Clinic, we’d have an overflow crop of eager new participants at our first Sunday morning run of each New Year. Some even told me that this was finally going to be the year in which they quit smoking, lost 30 pounds, and ran a marathon! “Pick one!” was my pragmatic response to such announcements . . .     Continue reading “The Sitting-Rising Test: what’s your score?”

Size matters – but not in coronary artery blockages

by Carolyn Thomas      @HeartSisters

It’s not about your cholesterol numbers, and it’s not even about big fat blockages clogging up your coronary arteries. Did you know that inflammation is likely the culprit in most heart attacks? As cardiologist Dr. John Mandrola neatly describes it:

“Heart disease is about inflammation.  The same mechanisms that cause the throat to swell from an infection, the skin to redden after an insect bite, and a scar to form after a cut are what cause heart problems.”

Studies continue to show demonstrable links between heart disease and other inflammatory conditions.
Continue reading “Size matters – but not in coronary artery blockages”

Women and statins: evidence-based medicine or wishful thinking?

by Carolyn Thomas    @HeartSisters

Are you:

A.  a healthy woman who’s never had any issues with your heart, but . . .

B you know heart disease is the #1 killer of women, so . . .

C.  you’re wondering what you can do to help prevent B from happening to you?

Warding off a first heart attack is what physicians call “primary prevention”. It’s also what respected cardiologists representing both the American Heart Association and the American College of Cardiology are now telling us can be effectively accomplished by taking one of the cholesterol-lowering drugs known as statins.

But it turns out that many other equally-respected cardiologists don’t believe that taking a powerful drug every day for the rest of your natural life for a disease you don’t even have is appropriate for primary prevention – particularly in womenContinue reading “Women and statins: evidence-based medicine or wishful thinking?”

Dr. John Mandrola: “AFib is your body talking to you”

by Carolyn Thomas  @HeartSisters

If you or somebody you care about has been diagnosed with Atrial Fibrillation (AF),  you likely already know this about the diagnosis: it’s an irregular heart rhythm affecting the heart’s upper chambers (the right and left atria) – and it’s also the most common heart-related reason for hospital admission. As Kentucky cardiologist Dr. John Mandrola likes to describe the disorder:

“AF is both a disease and a consequence of actions. It’s your body talking to you.”

Dr. John is a bike racer and one of my favourite writers in cardiology. As my heart sister Jaynie Martz once sized up his writing: “concise, charming, compassionately light, adult-to-adult, uber-digestible with nary a whiff of condescension or pomposity.” Amen, Jaynie.  His particular cardiac specialty is electrophysiology, the diagnosis and treatment of heart rhythm disorders. Here’s his overall take on the diagnosis of atrial fibrillation, as delivered to a Utah conference of his fellow electrophysiologists recently: Continue reading “Dr. John Mandrola: “AFib is your body talking to you””