Angiograms: often an unnecessary rip-off

An angiogram lets doctors look for blocked blood vessels. Beginning at the groin (sometimes the arm), doctors thread a catheter through the arterial system until it reaches a coronary (heart) artery. Then they squirt in some dye and take a look at an image of the arterial system that shows up on a screen.

If they see blockage they thread a thin wire through the catheter and across the blockage. Over this wire, they pass a second catheter that holds an expandable balloon on the end. They inflate the balloon, which pushes plaque to the side and stretches the artery open. This is called angioplasty. Often, they also insert a wire mesh tube (stent) into the blocked area to hold it open.

If you have a completely blocked artery, these procedures may be life-saving. But angiograms are frequently performed as elective procedures on people with no symptoms of heart problems. According to the American Medical Association, 35% of the procedures are “inappropriate” and another third are questionable. That’s a lot, especially considering that the procedure typically costs around $8000 and angioplasty costs about $30,000. (An efficient “cath lab” in a hospital can perform around twelve diagnostic angiograms in a day—a big money maker.) Moreover, while major complications are not common, the procedure can cause tears in blood vessel walls and major bleeding.

The thing is, there’s no predicting where a heart attack will originate. It could start anywhere where there is plaque, even if the plaque is not obstructing blood flow. (A heart attack occurs when a clot breaks off the plaque and blocks the artery). A study performed in 2011 found that only a third of heart attacks originated in plaques that were blocking at least half of an artery. The remainder began with the rupture of plaques that appeared to be causing no problems. In other words, the partly blocked area visible in an angiogram is no more likely to be the site of a heart attack than any other plaque.

You will be unhappy to learn that, according to Dr. Gregg W. Stone, a cardiologist at Columbia, “Half the people over 65 have blockages.” We just need to get comfortable with that fact. As Dr. Judith Hochman, a cardiologist a NYU Longone says, “People believe that if they have a blockage, they have to fix it mechanically. It seems logical, but in medicine, many things that seem logical are not true.”

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Take two aspirin...

Voltaire said “the art of medicine consists of amusing the patient while nature cures the disease.” Of course I love that idea. Case in point: during World War II, Archibald Cochrane was a prisoner of war in Germany and was in charge of overseeing the health of 20,000 fellow prisoners who suffered from diarrhea, typhoid, diphtheria, and other infections. With no medicine except for aspirin and antacids, he expected hundreds to die. But in his six months at the camp, only four prisoners died, three of whom had been shot by their captors. When he returned to Britain, he began to question many of the standard medical practices—such as bed rest after a heart attack—that were later shown to be ineffective. He was also instrumental in calling for more randomized trials to test the efficacy of medical treatments.

Twenty years ago an organization was named after him: The Cochrane Collaboration.  It's is a global network of scientists and others who study the best evidence from research to determine whether treatments actually work. They have 37,000 contributors from more than 130 countries who work together to produce credible health information free from commercial sponsorship.

You can go to their Web site and look up the results of their studies. For example, I randomly chose “Acupuncture for tension-type headache” and got the following report: “The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with frequent tension-type headache.” To come to this conclusion, they explain, they “reviewed 12 trials with 2349 adults, published up to January 2016.” It's a good site for looking up medical treatments. 

Anyhow, back to letting nature cure the disease. I have what seems like millions of actinic keratosis on my skin—those scaly patches that are supposedly pre-cancerous. Occasionally, I have them “burned” off. Just recently they have started to disappear on their own. It’s called spontaneous regression. Go nature!

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Cortisone injections: a second look

Last October I wrote a post about cortisone injections. I wrote about it because unrelenting pain in my left hip prompted me to see an orthopedic surgeon. I thought I might need a hip replacement. But the pain was from bursitis, not arthritis. The doctor gave me a cortisone shot at the site of the bursitis. When I wrote the post, I was disappointed in the results. After a few weeks, the pain came back—probably because I’d overdone physical activity too soon after the injection. A few weeks after that the pain receded again and now, over two years later, my hip is pain free.

Last May, I had another injection—this time in my right knee. For the past seven or eight months, bending my knee had been painful—although walking didn’t hurt. So I lived with it, but then it kept getting worse. My range of motion kept getting smaller. Not knowing the cause was driving me crazy, so I had an MRI. (My chiropractor said that my lower leg bones were misaligned with my thigh bone, which may be true.) The MRI showed torn cartilage and lots of fluid in and around me knee. So I got another cortisone shot.

The shot was not to dull the pain, but to reduce the inflammation that was causing the fluid build-up, which was the source of the pain. Bending my knee forced the fluid up and down my leg. Cortisone is a powerful anti-inflammatory drug. Supposedly, reducing the inflammation would also cause the fluid to subside, which, apparently it has. My knee is much better.

Those of you who follow my posts know that I resist medical treatments (I don’t have annual checkups, for example). But I do seek medical help if I’ve got a problem. So now I’m all for cortisone shots if needed. But too many injections over a short period of time can cause damage to the tendons, ligaments, and cartilage at the injection site. Also, studies have shown that giving cortisone shots to people with tendinitis, such as tennis elbow, makes them worse off than doing nothing. The shots impede healing and can put you higher risk for continuing damage. It turns out that this type of tendinitis is not from inflammation but from tears in the tendon.

So be careful.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

More reasons not to diet

This post is a follow-up to an earlier one about dieting, which basically says that your body wants to be a certain weight, which is why you regain the weight you lost. Sandra Aamodt, a neuroscientist, tells us the same thing: “The root of the problem [inability to lose weight and keep it off] is not willpower but neuroscience.” When your weight drops below what is normal for your body, your body not only burns fewer calories but also produces more hunger-inducing hormones. When you lose weight, your brain declares a state of starvation emergency and institutes these corrective measures.  “The brain’s weight-regulation system considers your set point to be the correct weight for you, whether or not your doctor agrees.” 

Dieting just makes matters worse. After about five years, 41 percent of dieters gain back more weight than they lose. For example, in a study of 4,000 twins, researchers found that dieters were more likely to gain weight than their non-dieting identical twins. Even worse, studies show that dieters are more likely than non-dieters to become obese over the next one to 15 years. For example, a study of elite athletes who dieted to qualify for their weight classes (boxers and wrestlers) were three times more likely to be obese by age 60 than their peers who competed in other sports.

What’s more, we’ve been taught to believe that being fat can be deadly—that you’ll develop diabetes or heart problems and die an early death. In fact, there’s little evidence that dieting improves health. For example, in a 2013 six-year study of obese and overweight people with diabetes, researchers compared those who dieted with those who didn’t and found that the dieters had a similar number of heart attacks, strokes, and deaths from heart disease as those who didn’t diet. More recently researchers who studied a group of overweight diabetics for 19 years found that intentional weight loss had no effect on mortality. Yet another study showed no relationship between health improvements and amount of weight lost.

Thus based on all the evidence, according to Aamodt, “Dieting is rarely effective, doesn’t reliably improve health, and does more harm than good.” So stop it.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.