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Cyclocross Exercise Health Care Reform Healthy Living

In the Prime posts for this week — Health Insurance and Obesity

Hi all, I wrote two posts this week for the Courier-Journal’s online health portal, In the Prime. The first was titled, Can an insurance company improve our health? In this post I use the tragic story of a patient who stopped taking an important medicine because of a high copay. Two recent medical studies have […]

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Atrial fibrillation

New Trials and Fibrillations post up: Obesity and Atrial Fibrillation

The old thinking had obesity only indirectly involved with atrial fibrillation. That is, fatness perpetuated AF because the extra weight led to other conditions like high blood pressure, diabetes and sleep disorders. Emerging data paint a gloomier a picture for patients with high body fat composition. It looks like fatness itself has direct and negative […]

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Health Care Reform Healthy Living Nutrition

Obesity: Finding hope in a seemingly hopeless struggle

I like positive thinking. Optimism helps keep inflammation at bay. You can’t be a heart doctor and think problems are hopeless or that bad outcomes will occur. But…I have to tell you, obesity and its flume of chronic diseases makes it tough to stay upbeat. As an office doctor, obesity frustrates; as an internationalist, working […]

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Doctoring Health Care

What I Got Wrong (and Right) about COVID19

In May, I wrote a column about COVID19 that got some attention. My reason for writing was the change in messaging about the strategy of flatten-the-curve. We were first told to flatten-the-curve to prevent overwhelming hospitals. But then the thinking changed to flatten-the-curve to save lives.  I made eight assertions about COVID19. Let’s see how […]

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Exercise General Medicine Health Care Reform Healthy Living

The Case for Opening (some) Pools In COVID19 Pandemic

The COVID crisis has decimated water exercise. Can we rethink pool closures? A significant number of my older patients relied on pools for their fitness. During a pandemic, you can stay active or fit only if you have good legs and joints. Walkers, runners, and cyclists have no problem; they play outside in the Spring […]

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AF ablation Athletic heart Atrial fibrillation

Survey for Athletes with AF

Hey Athletes: My colleague, Professor Rachel Lampert, from Yale, along with the StopAF.org patient group, seek to learn more about how atrial fibrillation (AF) and its treatments affect athletic people. If you are an athlete or if you regularly exercise vigorously, please give the Yale researchers a few moments of your time. Here is the […]

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AF ablation Atrial fibrillation

Musings on the CABANA trial — AF ablation vs Drugs

Last week at the Heart Rhythm Society meeting in Boston, Dr. Douglas Packer from the Mayo Clinic presented results of The Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial. I cannot remember a more consequential HRS (Heart Rhythm Society) meeting. Before and after the presentation, CABANA talk dominated conversations amongst colleagues. I wrote […]

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AF ablation Doctoring General Cardiology ICD/Pacemaker Knowledge

The Nobel in Economics and Medicine?

Once again, the Nobel prize for economics–not science and medicine–has immense influence on the practice of medicine. Every day, in fact. This year, Richard Thaler, a behavioral economist at the University of Chicago, won for his work on human biases and temptations. The famous writer Michael Lewis (Moneyball) has a nice essay on Thaler’s work […]

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Atrial fibrillation Dabigatran/Rivaroxaban/Apixaban Doctoring

How important are short AF episodes?

A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes. Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF). SCAF is AF on a monitor that is often […]

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AF ablation Doctoring General Ablation General Cardiology

AF Ablation is Overused in the US

A colleague recently asked me if atrial fibrillation (AF) ablation was overused. Yes it is. AF ablation has become the wild west of electrophysiology. There is essentially no scrutiny of this invasive, expensive and risky procedure. I also include here the add-on “maze-like” procedures done during heart surgery for other conditions. I believe they too […]

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AF ablation Atrial fibrillation General Ablation Healthy Living

Are women with AF being under-treated with ablation?

This post is an introduction to commentary I made recently over at theHeart.org on Medscape. Gender features in the discussion, but there are lessons for men and women with AF. *** A large study from a group of Stanford researchers made three big observations on AF ablation: Women, compared with men, presented for first AF […]