Categories
Cycling Wed Reflection

Cycling Wed: Be wrong Sports Illustrated

Every morning I rest my coat on a chair in a shared office that has this picture on the wall. My son and I were glued to the TV that day.  We cheered loudly and hugged each other after Lance rose up from the pavement and stomped away from his rivals.  (Rivals that have subsequently […]

Categories
Doctoring ICD/Pacemaker

What to do when a chronically ill patient reaches the end of battery life of their cardiac defibrillator…

Years ago at the time of the original cardiac defibrillator implant (ICD), he was a vibrant active man who had suffered from an arrhythmia related to scar from a remote heart attack. Things change.  Life has chapters. It is amazing what can happen to a person during the 5-7 year battery life of an ICD. […]

Categories
AF ablation Atrial fibrillation General Ablation

The challenge of ablating in the human heart…

Some very sad words from the comments section of a previous post on atrial fibrillation… Anonymous said,   Is there anyone out there that has hypertrophic cardiomyopathy and was told to have an ablation? Any problems??? My husband of 45years and I believed that his cardio doctor would not put him in harms way by […]

Categories
Knowledge Reflection

A doctor discovers the political process…

He grabs your hand enthusiastically and looks you in the eye and says in the most convincing tone possible, “nice to meet you Doctor.” So it was at the Lincoln Day dinner given by the Republican Party of Jefferson County, (Louisville) KY.   Staci and I were invited guests of the May’s, friends whom we […]

Categories
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 […]

Categories
Doctoring Health Care Healthy Living Knowledge

Questioning Your Doctor is Ok

I received a good question(s) from a reader: In your “Changing the culture” posting there is the comment: “Patients seeking medical treatment should not assume a prescribed therapy is beneficial just because a doctor says it is.”… How then does a patient evaluate a proposed treatment in a way that they aren’t thwarting a doctor from performing what may […]

Categories
Atrial fibrillation Doctoring General Cardiology General Medicine Health Care Knowledge

How Hubris Impairs the Care of the Elderly

An elderly man with atrial fibrillation (AF) asks whether to continue taking a clot-blocking drug to prevent stroke. This is the gist of a case my colleague Dr Anish Koka recently posted on Twitter. It’s a great thread. Click here to get to the discussion. The first question Anish raised was whether you would keep […]

Categories
AF ablation Atrial fibrillation

Thoughts on CABANA — The biggest study in AF ablation in years

(The CABANA trial is slated for release in two days at the 2018 HRS Meeting. Here is a preview.) Technology has made modern life easier. This is good for lots of things, but not for avoiding atrial fibrillation (AF). As people in Western society grow older, heavier, less physically active, more distracted, and perhaps more […]

Categories
Doctoring Health Care Healthy Living

The Truth on Cancer Screening

This week is Cancer Screen Week. It’s a one-sided campaign sponsored by industry and the American Cancer Society that urges people to get screened. The truth is that the scientific evidence for cancer screening is not convincing. What’s more, screening comes with potential harms. I know; it’s counter-intuitive, but it’s what the evidence says. Benjamin […]

Categories
Doctoring General Cardiology General Medicine

Young people, stroke and a hole in the heart (PFO)

(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)  *** We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may […]

Categories
Doctoring Health Care Health Care Reform Knowledge

Big lessons from my error

I was furiously tapping on the computer when he asked: “Doc, what happens if I don’t have the procedure you are recommending?” Glee spread through my body. I grinned and nearly jumped up from the stool to hug him. I enthusiastically answered. Few patients ask this vital question. I tweeted about the encounter: An older […]