Randy Travis

[Bill in Oregon]

I see he has been released from Baylor Plano to rehabilitation following his cardiac crisis and stroke. Randy is probably my favorite country musician, and I for one am praying for his complete recovery.

http://www.youtube.com/watch?v=8x1aV_zzo44

[Blaine]

I didn't know he was sick... I should get out more.....

[Streetstar]

I didn't know he was sick... I should get out more.....

yeah -- he has had problems with very heavy drinking --- probably has for years , maybe decades, but just came out public recently when he started getting a DUI or two

3 Wooden Crosses is my favorite song of his -- I hope he gets better too so he can put out a few more songs like that

[zzr7ky]

My girlfriend had a very serious stroke last year at this time. She couldn't speak, swallow, or move anything on her left side. they cut out a piece of skull the size of my hand. By December she was walking again. No speach or cognative issues. She still has no use of her left arm but she feels very fortunate indeed. She just got a great job in California in May. Working hard in therepy and believing is important.

Hopefully this is an opportunity for a broad based recovery.

Mike

[AJMD429]

All you folks who don't want to be "surprised" by a heart attack or stroke need to be sure you're not just doing the 'bare-minimum' stuff the insurance companies reward us (MD's) for sticking with. We rely on LDL cholesterol (instead of Apo-B or better yet LDL-P counts) and still miss 40% or more of the people with bad arteries, and we rely on 'fasting glucose' (instead of fasting insulin) and miss 3/4ths of the opportunities to treat insulin resistance and prevent diabetes instead of reacting to it after damage is done. We do expensive nuclear treadmills and stress echos (instead of cardiopulmonary stress testing) that miss early disease we should be treating, only to wait until there are large visible 'lesions' justifying invasive procedures, even though lots of the data point to stents and CABG as not providing nearly as many years of productive life saved as simple management of the proper risk factors. We don't measure hormone levels unless patients have e.d., even though often levels are off far enough to make a patient gain 50 lbs and cross into diabetes, long before any bedroom problems happen. We adhere to 'normal' values for thyroid function that don't make sense in the real-world, and we are scared to prescribe several simple vitamins that can work wonders (but in some cases can be dangerous if you don't monitor levels).

If your doctor works for a hospital, then he/she essentially is working for an insurance company through the hospital as an intermediary, so will focus on keeping visits under six minutes (under four if they want a bonus), and will stick to whatever tests and prescriptions generate the best bottom-line for the insurer and therefore to the hospital. The Family Physicians defer to the Cardiologists, who are experts in repairing damage after heart attacks, for managing and reducing risk of heart attacks, which is about as sensible as expecting body shops and tow-truck drivers to be enthusiastic about diverting their time from what they are good at doing (fixing cars) to administer a program to reduce motor vehicle accidents. (The few FP's who dare provide expert preventative care wind up spending lots of time un-doing bad advice their patients have been given at the local cardiac clinics... )

Anyway, if you don't ask for quality you won't get it in the current environment - it is way easier for us to 'go with the flow' and just do whatever obsolete or inaccurate tests are profitable to our employing institution/insurer, knowing that when the patient infarcts and has to have a surgical procedure of some sort (if they survive), the money coming into the 'accountable care organization' for that procedure will be routed back to us as a bonus for keeping our visits short and staying away from effective medications if they aren't on the "formulary".

[Blaine]

Geeez, Doc...Randy would of died waiting for you to finish that speech....

[3leggedturtle]

He is s'posed to perform Sept 20th at the Mille Lacs Band Casino in Minnesota.

[Grizz]

that sounds like it's probably useful information Doc. it would maybe make more sense if you would edit by highlighting in red the desireable, useful, effectual components and leave the rest black.

if you could hypothesize the possible vitamins that are possibly effective that would be useful also.

everyone self-medicates. for example, when I go to sea I use a product called 'bonine' to prevent and control sea-sickness, which I get in a debilitating and life-threatening condition. I use caffein when I am managing sleep-deprivation to keep my reflexes topped up, to keep alert when it's critical, and to keep from over-caffeinating myself to the point of shut-down. I would be interested to know what if any vitamins actually improve physical health, v.s. the health of the seller. Most OTC meds I try are in the placebo category and rabbit pellets have as much expectation of usefulness....

liked the list tho...

... Grizz

[AJMD429]

Geeez, Doc...Randy would of died waiting for you to finish that speech....

True enough, but a pet peeve of mine is that every day it seems another man or woman I know strokes, has a heart-attack, or often - just dies needlessly, because they weren't getting some very basic, modestly-priced, testing done, or weren't being treated the way 'special' people (doctor's family members) are - instead just getting whatever looks 'ok' on paper...

[earlmck]

Randy T is one of my favorites also, Bill. Thanks for the update. Hope he's got lots of great singing left in him...

And thanks for your additional healthcare info, AJMD. I've been passing some of your "rants" on to the wife (retired RN) so she can keep reminded how good it is to be away from that field these days. Although we both have to be consumers of such stuff occasionally.

[Old Time Hunter]

Hey Doc, could you explain this comment:

We don't measure hormone levels unless patients have e.d., even though often levels are off far enough to make a patient gain 50 lbs and cross into diabetes,

Do not have any indication of diabetes, but gained about 40lbs really quick about seven-eight years ago. Have blood tests done at least twice a year, what do they call the hormone level?

Strokes seem to run in my family, they start showing up at around 75 (survived until 82 then she had another) and have been the primary reason for mortality on one side of my family. My Dad had one a year ago last October, they gave him less than 10% chance of living independently again. He is just about 84 now and uses a walker to get around, but other than that he is forging ahead. Oh yeah, they stuck a bovine artery in his neck...opened his artery way up. Doc says maybe that would be good maintainence for me in a couple of decades...

[olyinaz]

Now you've done it Doc!

[AJMD429]

Now you've done it Doc!

Yah. The disclaimer part is that anything I say without having an active patient-doctor relationship is just 'general advice' so "check with your own trusted healthcare provider(s)".

Often the weight gain is due to more than the usual eat-too-much and too-much-television stuff, though television is BAD stuff for the body (and mind, usually).

The testosterone may drop and shift the metabolism into an 'insulin resistant' mode, and/or the thyroid may be off, but measuring thyroid function is a very fuzzy and controversial 'art' these days.

The red flags I see most often are:

• LDL-P more than fifteen times greater than LDL-C (probably the earliest sign of trouble).
  Trigs more than 3.5 times greater than HDL-C.
  Fasting Insulin level greater than ten.
  Lp(a) elevated despite other lipids being normal.
  Free OR Total Testosterone levels less than typical for the patient's age.
  TSH climbing and greater than 2.5.
  Glucose Tolerance Test with normal fasting and two hour levels, but spike in one hour level.
  LpPLA2c may be elevated (a really bad sign).
  pro-Brain Naturetic Peptide can be elevated, even without any overt signs of heart failure (another baddie).
  Acanthosis (darker skin in folds of neck, abdomen, under breasts, highest inner thighs).
  Snoring, daytime somnolence, un-restful sleep.
  CIMT (high-sensitivity carotid ultrasound) shows thickening of lining, even though no plaque yet.
  CPET ('MetTest') shows divergence of heart rate and cardiac output during mid-range exercise.

At this point, fasting sugar will be normal, "bad cholesterol" levels (LDL-C) is likely still normal, and if the patient had a heart cath it would often be normal. Even a nuclear treadmill or stress echo could be normal. Traditionally we wait for those tests to be abnormal, THEN we act, but by then there is much damage. Way better to prevent it early on.

Like I said, it's more an art than science, but there is 'evidence-based' stuff we can and should be doing that isn't expensive and can postpone cardiac events and stroke for several decades. Instead, we wait until the last minute and only postpone the end stages a couple years with our procedural interventions. Those are vital if you let things get to that point, but even then, we should be more aggressively doing the other preventative things to prevent the next event.

Think of all this like 'gunsmithing' - we all see how often there are only a few gunsmiths that really seem to care and who are willing to do the hard stuff and do it right. So, we become proactive ourselves, and do much of our own 'gunsmithing' work at home (in this case, diet, exercise, reading about tests and treatments, and discussing options with the doctor vs. just following along like a puppy). Then if we do have to go to a gunsmith we carefully select one who we think won't just do some crappy job, and we are prepared to talk with them respectfully (of their knowledge) but also 'on their level' because we are an informed consumer. We do that with our guns, cars, motorcycles, and other important gear. Women often do it with their health, as well (though they are often scammed and taken advantage of despite their best efforts). Men need to take their health as seriously as they do their toys, and pick their physicians as carefully as their gunsmiths and mechanics.

[Blaine]

You are, of course correct. Several years ago I was a mess. Always tired, falling asleep driving/at work. Felt like poopoo all the time. VA, no doubt, saved my life. Started treatment for diabetes, and got a sleep test and set up with a CPAP. At this VA if you have diabetes, they treat you like you have already had a heart attack, and I'm on a statin, and several BP drugs. They are not having much luck with my BP and it stays fairly high. I should exercise more. The only thing I've found that will bring my BP down is a couple beers (and I've already told THAT story ) So, keep preaching Doc.....I hope you know I was only flippin' ya Pelosi....

[Griff]

Prayer's up for Randy.

[Bill in Oregon]

A steaming pile of Pelosi. Blaine, I'm liking it!

[AJMD429]

A steaming pile of Pelosi. Blaine, I'm liking it!

I don't know, it sounds redundant to me... "steaming pile" pretty much IS the same thing as "Pelosi" isn't it...???