The recent paper by Dr Aseem Malhotra in JAMA (Journal Of American Medical Association) has caused a stir and I hope he causes a revolution in the entire thought process in healthcare. He says that most of the stenting done for heart patients is not necessary and not required and neither really beneficial.EUREKA !
Its out in the open (refer my earlier post on heart and common sense).In India its been going on for a long time but what do I say? India is just coming out from the joint family and with economy ok most have disposable income and healthcare is becoming fancy.
However, in USA who has been lamenting about the high healthcare costs this is important. Maybe a lot of surgeries are not required because if the totality of the body is taken into account surgeries may not change the outcomes for the patient. With rising costs hospitals can also refrain from such procedures.There is plenty of evidence that many know this -but still it goes on...
http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?pagewanted=all&_r=0
http://www.webmd.com/heart-disease/news/20120227/stents-overused-stable-heart-patients
What is stent implantation ? Lets say that you have diabetes and high cholesterol. This is like "extra" and it starts to accumulate in your heart arteries (coronary artery) or the arteries that supply blood to your heart. Now heart is the blood supplier to the whole body (like a pump) and hence important and it needs enough blood.The result of this accumulation is that the arteries collapse/block/jammed and blood cannot flow through. Angioplasty means with balloon and pressure you mechanically sort of open it.But often it open and collapses back-so a STENT is put-sort of metal mesh-to hold it in place.
This does not work well because there are many issues with this-the body can reject it, you can have allergies to dyes required for procedures, there can be bleeding and rupture.Many times for a single patient multiple stents are advised doubling the risks.There are NO long term benefits in fatal heart attacks, death or emergency operations.
Why are they of no benefit ? Simply because this stage of arteries have happened over a period of time due to high cholesterol levels, stress, emotions, diet, lack of exercise.Have any of these significantly changed ? No, after operation within 48 hrs I am back at work. Great ! back to work, stress, cholesterol-heart block.
So how can we expect things to reverse ? You are just emptying the bucket-close the TAP for good results.
What do we need to do ? Take a wholistic view of person, his needs, his mobility, his stress. If there are multiple blocks and he has severe diabetes, high cholesterol, wants only simple mobility why do this operation.? I had once a patient 73yrs old who was advised 5 stents who was diabetic (controlled) and walked 2kms daily. One of his block was the carotid artery(goes to brain) for which they dont do stenting.
So I told him it was no use cause if carotid is blocked you will die anyways-no point in surgery.He is 80 today without surgery and still walks 2kms.
What happens if stenting is not done ? In most cases the other small arteries of the heart start supplying blood to heart much like we using small lanes when the highway is closed. This is enough for a normal non-hectic life.
Much like heart there are many unwanted surgeries done-hysterectomy(removal of uterus), gall bladder stone removal , bypass surgery, varicose veins surgery.
As I see it surgery is a serious issue and specially the heart. Not from money point of view though thats important as well. Its heart not some plumbing in your kitchen. Heart is tough enough to cope with many things but its important for us to assist it by our behavior. It self heals with time and patience and little help.
Imagine 400,000 non emergency stenting procedures are done in US each year.
There should be addressing the underlying causes, then medication, then evaluation and then surgery if not better with all that was done.Even one-third reduction can save 6billion$.
Alternative therapy like homeopathy does exactly the way it needs to be done.And I am not saying its a miracle. Homeopathy helps heart self heal ! And dirt-cheap !
Its out in the open (refer my earlier post on heart and common sense).In India its been going on for a long time but what do I say? India is just coming out from the joint family and with economy ok most have disposable income and healthcare is becoming fancy.
However, in USA who has been lamenting about the high healthcare costs this is important. Maybe a lot of surgeries are not required because if the totality of the body is taken into account surgeries may not change the outcomes for the patient. With rising costs hospitals can also refrain from such procedures.There is plenty of evidence that many know this -but still it goes on...
http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?pagewanted=all&_r=0
http://www.webmd.com/heart-disease/news/20120227/stents-overused-stable-heart-patients
What is stent implantation ? Lets say that you have diabetes and high cholesterol. This is like "extra" and it starts to accumulate in your heart arteries (coronary artery) or the arteries that supply blood to your heart. Now heart is the blood supplier to the whole body (like a pump) and hence important and it needs enough blood.The result of this accumulation is that the arteries collapse/block/jammed and blood cannot flow through. Angioplasty means with balloon and pressure you mechanically sort of open it.But often it open and collapses back-so a STENT is put-sort of metal mesh-to hold it in place.
This does not work well because there are many issues with this-the body can reject it, you can have allergies to dyes required for procedures, there can be bleeding and rupture.Many times for a single patient multiple stents are advised doubling the risks.There are NO long term benefits in fatal heart attacks, death or emergency operations.
Why are they of no benefit ? Simply because this stage of arteries have happened over a period of time due to high cholesterol levels, stress, emotions, diet, lack of exercise.Have any of these significantly changed ? No, after operation within 48 hrs I am back at work. Great ! back to work, stress, cholesterol-heart block.
So how can we expect things to reverse ? You are just emptying the bucket-close the TAP for good results.
What do we need to do ? Take a wholistic view of person, his needs, his mobility, his stress. If there are multiple blocks and he has severe diabetes, high cholesterol, wants only simple mobility why do this operation.? I had once a patient 73yrs old who was advised 5 stents who was diabetic (controlled) and walked 2kms daily. One of his block was the carotid artery(goes to brain) for which they dont do stenting.
So I told him it was no use cause if carotid is blocked you will die anyways-no point in surgery.He is 80 today without surgery and still walks 2kms.
What happens if stenting is not done ? In most cases the other small arteries of the heart start supplying blood to heart much like we using small lanes when the highway is closed. This is enough for a normal non-hectic life.
Much like heart there are many unwanted surgeries done-hysterectomy(removal of uterus), gall bladder stone removal , bypass surgery, varicose veins surgery.
As I see it surgery is a serious issue and specially the heart. Not from money point of view though thats important as well. Its heart not some plumbing in your kitchen. Heart is tough enough to cope with many things but its important for us to assist it by our behavior. It self heals with time and patience and little help.
Imagine 400,000 non emergency stenting procedures are done in US each year.
There should be addressing the underlying causes, then medication, then evaluation and then surgery if not better with all that was done.Even one-third reduction can save 6billion$.
Alternative therapy like homeopathy does exactly the way it needs to be done.And I am not saying its a miracle. Homeopathy helps heart self heal ! And dirt-cheap !
