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Now for those of you who are not familiar with what Cardiac Catheterization is, it is a procedure where we (as in the cardiologist/interventional radiologists....I say we cause I'm on their service this month) go through the femoral artery (in the groin, where your leg meets your torso) with a cateter (hollow tube with a wire in it), and up through the Aorta (big artery that comes from your heart), to the heart itself. Once up there, using flouroscopy (like a real-time x-ray) we can look at how the heart and vessels of the heart are filling (or not filling) with blood. It allows us to identify any abnormal filling or movement of the heart, as well as any blockages in the coronary arteries (which cause angina and heart attacks). After we see blockages in the vessels, we can do a couple different things...
a) Balloon Angioplasty - this is where a tiny catheter with a deflated balloon on the end us sent up to the blockage, and then when within the blockage, the balloon is inflated and the plaque buildup is pushed aside against the walls of the vessel, opening it up
b) Coronary Stenting - like the Balloon-thingamajig, but instead we sent a catheter that has a stent (a cylindrical mesh support-thingy that holds open the vessel), and the stent is opened up on the plaque, thereby clearing the blockage.
c) Identify areas that aren't candidates for A or B, but could be candidates for bypass surgery: This is where you take a vessel from another part of the body and attach it in front of and just past the blockage, bypassing the interruption of flow. This is major surgery with very real risks, so don't just think it's an easy fix.
I am currently working with a cardiologist who is a well known genius, and all-round cool guy....I don't know if he started this, but I know him as the-guy-who-wears-a-sport-coat-with-scrubs....complete with elbow patches and everything. It seems like lots of the surgeons/cardiologists are doing this as well. He's awesome to follow around (no, I am not a puppy), and I feel like I should just be scribbling down every enlightening thing he's saying, cause the man is like an encyclopedia of cardiology knowledge....I'm truly in awe.
Today we 'cathed' a couple people, and here are some amazing before and after shots of what can come of such a procedure...
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Before: You will note in the center of the page is a blockage in the LAD (left anterior descending) artery...it's the main artery supplying the left heart, which supplies the left ventricle (the outflow to the body), and is a common place for blockages. If you don't see it, it's in the middle of the picture...the break in the blackness (the blood-flow)...
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After: No more blockage! This lucky patient went from about 98% occlusion, to clean-as-a-whistle!! Not bad, considering that in this particular patient, this was an incidental finding, and there was no previous evidence of this blockage even being there.....lucky barely cuts it, since had this not been fixed, it would have surely led to a heart attack in the very near future.
Now the moral of the story today is this...
Everyone (I'm going to go out on a limb and add "in western culture") begins developing the startings of plaques as a child...not necessarily in the coronary arteries, but this is where the progression heads. Eating fast/fatty foods, smoking, not exercising, being overweight, drinking alcohol, etc can all contribute to this, and as some of the less fortunate patients that we cathed today now know(who had blockages that were beyond repair), you should work on getting these problems fixed before you have a problem.
How can you do this?
Well, I'm going to go ahead and assume (from the 'average' age of my facebook friends/readers) that you are young and you haven't gotten such blockages yet. So here's what to do - put down the burgers and pick up a salad!! For the love of Pete, put on some running shoes and go for a brisk walk (or some other sort of cardiovascular work-out....remember - cardiovascular = heart and vessels!!) Lose weight! Let go of the "I'm big boned," "I'm husky," and the "I'm trying to set an healthy example for the kids of today." Yes, curves are lovely, but when we say it's important to be in shape, keep in mind that 'round' is not the shape we're talking about. Quit smoking, once and for all. Stop drinking like your 18 years old (unless you ARE 18 years old, in which case enjoy for a couple years, then settle down).
One of our patients today was a 72 year-old gentleman who was recently found to have bladder cancer, and his oncologist sent him for a cath so that they could make sure he was safe for the surgery that would help treat his cancer (ie. removing the bladder and cancer completely). His blockages were so severe, that it was decided he was not a candidate for angioplasty, stenting, or even bypass surgery. I watched as Dr. Brilliance-McMastermind told him that the surgery to fix his heart would likely kill him, so his options for cancer treatment were going to be limited to radiation and chemotherapy. The look on this mans face was so sad....he tried to be strong in front of his wife and daughter, and then muttered today's quote of the day...
"I should have quit smoking years ago when they told me to."
Yeah....you should have. The man had smoked 2 packs a day for 55 years....mind-boggling. And preventable. Not to mention that he, his wife, and his daughter were all morbidly obese (BMI of roughly 40-45....that's big), so I'm guessing he wasn't exactly watching his diet. Again, preventable.
The future of medicine is in prevention. Prevent disease by exercising, eating well, and generally taking care of your body, and you can stay healthy (I say can, and not will because the reality of the situation is that not ALL disease is necessarily preventable, but of the top 10 causes of death in the western world, 7 are (usually) preventable (with the exception of the very small proportion of these killers that are caused by messed up genes/DNA) - Chronic Obstructive Pulmonary Disease (smoking), Diabetes (type II - eating crap, not exercising, obesity), Colorectal Cancer (eating crap, obesity, smoking, not exercising), Lung Cancer (smoking), Stroke and Cerebrovascular (brain-vessel) Disease (eating crap, smoking, alcohol, not exercising), Hypertensive Heart Disease (eating crap, smoking, alcohol, obesity, and not exercising), and the number one killer (and reason that we cath people), Ischemic Heart Disease (eating crap, smoking, alcohol, obesity, and not exercising). Pattern recognition much?
So here is the bottom line...
1. Quit Smoking. Cigarettes don't just cause lung cancers, but is linked to so many types of cancer - bladder, cervical, mouth, esophageal, nasal, pharyngeal and laryngeal (throat), stomach, colon, kidney, pancreatic, and even AML (a type of leukemia). Plus you end up smelling disgusting, getting all wrinkly at an early age (these are the 60 year olds who look 90), and getting addicted to a habit that is more addictive than cocaine or heroin.
2. Add more fruits and veggies to your diet, cut down on fatty and high-sugar/high-glycemic-index foods, decrease the amount of red meat in your diet. Remember - you are what you eat...literally. This does not mean you have to say goodbye to all those foods that are delicious (and lets admit, a krispy creme donut in all it's crack-like ways is WAY more delicious than any salad....admit it); the key is moderation.
3. Exercise...this doesn't mean you have to join a gym and pump iron 7 days a week. We recommend 30 minutes of getting your heart-rate up 5 times a week....that could be a brisk walk if you want it to. Hypertension (high blood pressure) is one of those diseases that can actually kill you with it's effects, and studies show that it's incredibly responsive to exercise.
4. Cut down the alcohol. Now I say cut down, because you don't have to quit (believe me...you don't). The risk of all these diseases starts when you have more than 1 drink per day. That does not mean you can have 7 drinks once a week and be fine, but keep the binge drinking to a minimum. Again, if you aren't 18, wake up to yourself and grow up. An occasional night of getting liquored up isn't going to impact your health that much, but if you're doing it even once a month, you may have a problem. A glass of red wine a night has been shown to actually POSITIVELY impact your cardiovascular health; I'm not going to go into how, but this is a practice I will happily follow :-)
5. Lose weight if your BMI is more than 25**. Doing number 2 and number three will help this, and losing weight can help prevent and treat Diabetes, Hypertension, Ischemic Heart Disease, Stroke and Cerebrovascular Disease, and many types of cancer. Plus, you'll feel better, sleep better, look better and improve your self image (hopefully....if that's something that you need). Studies show that obesity doesn't just impact your health, it can impact your relationships, your sex-life, your ability to play with your kids/grand-kids, and even can prevent you from getting a job (some employers discriminate against obese individuals because they fear a decreased productivity, increased risk of sick-days, and the fact that not taking pride in one's body can equal not taking pride in ones work....this practice is not right, but it exists. We've all heard that obesity is the next big epidemic, and believe me it is - nothing is sadder than having to tell the parent of a 5-year-old that they are overweight and need to lose weight....kids should be fit so they can have oreos and chocolate milk! I feel the obesity rant may translate into another post on another day....
Your health is very much in your hands, and believe me when I say that although doctors sympathize with your diseases, we also don't feel that sorry for you when you are doing it to yourself. True story. There's no magic pill, it takes work, both to get there and maintain. Now get off your computer and get your ass in gear!!
**To calculate your BMI, click here. Now keep in mind this is not always accurate, as people with lots of muscle will appear to be overweight. This does not mean that if you calculate to be overweight that you can get away with that gut cause you've been beefing up with the weights. Be realistic.
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