Disappointment in Heart medicine

by Dr. Alan Kadish NMD

It’s never easy when a new patient comes in the door with their records and finds that the level of care provided was far less than optimal. In heart and vascular assessments, this seems to be the norm, not the exception.

When you want to know how’s your ticker you should be receiving a long list of tests from those that are typical, an EKG, cholesterol, inflammatory markers, perhaps even some newer well-proven indicators such as C-reactive proteins (CRPhs) along with Lipoprotein pLA2 and other fancy terms.

One of the key points one learns in medical school is that change and continuous learning are the cornerstones of being able to provide great service to your patients. Unfortunately, there are limited fiscal incentives in many fields of medicine, to put the time and effort into gear.

If you’re experiencing chest pains,  pressure, tightness or a squeezing sensation around your chest it’s probably a fairly good indication that something is going haywire and should be addressed ASAP. This is not the time to think about things or make excuses. It may be your last chance for a quick and effective ride to the ER and to maintain your ability to get to spend more days on the planet. Don’t head over to the local urgent care clinic as they will not have the adequate facilities to do a complete workup and intervention if needed.

Take the hint and move quickly. It may make sense to chew an aspririn….yes it tastes less than appealing however, it might help if you’re having a heart attack. Obviously, if you have some nitroglycerine tablets, patches or paste you might be able to alleviate the symptoms but….you should still go in to evaluate the rest of the story and get some resolution.

One consideration when you’re in the ER is to make certain that they are not just rushing you through the process. Not infrequently due to time there is a failure to do a second set of tests, after a period of time, to compare the results. Don’t leave the ER without a real answer to what’s going on.

In some hospitals, they might do a calcium score which is the use of a CT scan to evaluate the calcium in your heart arteries. You’re hoping for a score of zero. Keep in mind that it appears that this simple test is far more accurate than the commonly ordered stress testing. It does not need to be used with dyes. That is a different test to evaluate your circulation.

Another non-invasive approach to checking how your vessels are working is the classic ultrasound examination of your carotid, aortic and femoral arteries. Basically, a probe is passed over your skin sending an audio wave into your body. The reflection of the sound displays as a picture telling us what’s the flow of blood and diameter of your vessels. This set of tests is commonly offered as a group for ~ $100ish. It may not be covered under your insurance unless ordered by your physician unless of course, you have a health savings account (HSA) insurance policy.

One of the biggest and still continued shams in medicine is the use of the simple lipid panel. It’s only 50% accurate, read that again, please. Yes, a coin toss would be as good. Since the late 1980’s all laboratories have moved to more appropriate testing …. the catch your doc has to order the right set. When we look at a full spectrum of understanding the type of cholesterol members floating around in your blood the picture along with other tests gives you an approximately 85% chance of knowing if you’re at risk for either a cardiovascular event or a stroke.

Ask for a coronary artery calcium scan (CACS). Your score should be zero, and anything higher should prompt you to see a preventive cardiology expert. Some of the terms you should see include on a real cholesterol panel evaluation includes, the Lipoprotein A (Lpa) and remnant lipid particles (RLP) the two key types of cholesterol that cause substantial disease.  These are among others but give you great insight into disease risk.

For 20+ years now the association between inflammation and heart disease has been well developed and researched. We use a number of easily available tests including homocysteine, C-reactive protein, highly sensitive (CRP-hs) along with others to determine your levels of inflammation. It’s interesting to note that there is a direct relationship with your neurochemical makeup when it comes to inflammation. When we test using urine, we see a higher level of kynurenic acid which also tells us that your serotonin pathway is disturbed. Think in terms of sleep disturbances, depression and a host of ongoing health problems.

An interesting finding is that what you eat will make a very substantial difference in some of the inflammatory markers. The food you consume determines your gut bacteria. When you’re eating the typical American diet you gut bacteria favor higher levels of inflammatory signals to the immune system and maintain an imbalance of the correct flora (bacteria). Eating a much more plant-based whole foods diet, referred to as the PBWF diet is a very good move and has showen to be excellent when addressing heart disease. You can find a ton of great info regarding this diet approach at, Nutrition Facts.

In addition to all this testing, we should touch on genetic tests. Clearly, genetic differences in multiple areas play a part in creating heart disease and should be addressed. You might want to look at some excellent info at the Genova Diagnostics site. The information can literally lead you to long term interventions based on the risks.

This article should give you a good idea of what you should consider as a truly comprehensive approach, to your cardiovascular health.
Want care at this level ? Call us at the Center of Health 541.773.3191 

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Dr. Kadish is an unusual physician often referred to as a "doctor detective". His expertise is the evaluation and treatment of complex disorders, typically after other physicians have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders and chronic complex diseases.