Procedures 'R Us

Kay came to the office for an opinion.

Over the past 8 months, she'd received a stent to the left anterior descending coronary artery and, during a separate procedure, a stent to the left subclavian artery.

"My cardiologist was very capable doing procedures. But when I asked, 'What do I do now?' he barely said a word and handed me a presciption for Crestor."

This kind of incredible neglect is the norm: Write a prescription for statin drug, delegate dietary advice to the hospital dietitian who advocates a heart disease-causing low-fat diet, followed by hospital discharge. You are expected to report any recurrent symptoms (which are inevitable), at which point you might "qualify" for another procedure.

It would be malpractice if it were not the prevailing standard in the community. Yes, the prevailing standard is neglect--neglect to identify, quantify, and correct all the identifiable causes of heart disease; neglect to discuss the nutritional methods that actually correct the abnormal patterns that cause heart disease; neglect to discuss nutritional supplements or medications beyond statins that further reduce heart disease risk and "need" for more procedures. In other words, the prevailing community standard is to stent, bypass, prescribe statin. It is not to understand why the disease occurred in the first place, correct the causes and minimize or eliminate any future danger or need for procedures.

I see consultation after consultation involving stories just like Kay's. People are frightened and they sense intuitively that nobody raised the question of why they have a potentially fatal disease.

Don't allow yourself to fall victim to this incredibly neglectful mode of practice, the one that has enriched hospitals, the drug industry, many cardiologists, but does little to address the actual disease.

Comments (20) -

  • larry

    9/22/2009 11:15:10 PM |

    A similar experience happened to me. In my case I had a stroke, a triple bypass on my left coronary artery, a stent the size of Rhode Island on my right coronary artery, all preceded by v-tach.

    It was a near death experience and surprizingly enough, I never had a heart attack. I am in my mid-50's and very fit when this happened and it wasn't until my final meeting with my Heart Surgeon where he asked, "how did this happen?"

    Not one Doctor previous to that asked me why I had heart disease. I had an answer yet nobody bothered to ask.

    I refuse to take a statin. When medicine has an answer for LpA I will be all over it!

  • epistemocrat

    9/23/2009 1:22:54 AM |

    Awesome essay, Dr. Davis.

    Question: How could this be improved upon via Medical Education? It appears to be a deeply-seated cultural problem, aside from the prevailing financial reasons for why we treat instead of prevent:

    "In other words, the prevailing community standard is to stent, bypass, prescribe statin. It is not to understand why the disease occurred in the first place, correct the causes and minimize or eliminate any future danger or need for procedures."

    In other words, is there a cultural / professional development approach to (partially) attacking this problem; or, is our maligned financial landscape the sole culprit that must be changed?



  • Mark K. Sprengel

    9/23/2009 1:28:38 AM |

    My fiance's dad is being treated in a similar matter. Unfortunately, he won't listen to her or info that I've found and modify his diet much. He also seems highly sensitive to Niacin so won't take it all anymore. Fish oil and Vit. D3 are no starters as well. It really saddens me how people could make simple inexpensive changes and improve their health and yet they don't due to lack of information or unwillingness to believe or make change.

  • JohnP

    9/23/2009 3:50:44 AM |

    This is exactly my story. I'm 49, heart attack and stent in rca in May, script for 80mg lipitor and plavix. Heart Association diet, etc. and see me again in 6 months. When I googled lipitor, I ended up here eventually. Thank God. A goldmine of information and advice and pointers to many other resources. Thanks Dr.Davis for providing this service to the public. It should be required reading for anyone in cadiology, and all their patients as well. One day when time permits I'll post my entire experience, maybe it will help someone else. Thanks again.

  • denparser

    9/23/2009 9:06:58 AM |

    OMG! that's not good. why most people heart disease is the problem? I think this kind of disease will happen to those people who are working in offices and no limit in oily foods.

  • Stan (Heretic)

    9/23/2009 11:40:53 AM |

    Absolutely!   There is a very simple and effective defense against this kind of new medieval "culture" you have described - science and reason.

    I am surprised how little of that is being used or taught.

    Stan (Heretic)

  • Pete

    9/23/2009 3:14:57 PM |

    This totally rings true with many and/or most of my personal experiences with the medical profession. Many doctors seem to be only interested in treating the symptoms, not getting at the underlying root causes.  When I've pressed them on the issue of cause, I've gotten vague answers along the lines of "sometimes these things just happen, and you have to learn to live with it" (direct quote from an ophthalmologist recently).  It's hard to determine whether they don't care, or don't know, and won't admit it.  
    I wish there were more sources available online such as where you could get info on a doctor before you see them - it seems I can be better informed about the company coming to clean my carpets, than the doctor who may hold my life in their hands.

  • Dr. William Davis

    9/23/2009 10:25:03 PM |

    Hi, Brent--

    I think that change needs to come from several directions, including changes in education and attitude.

    However, I believe that the quickest way to change the system is for patients themselves to agitate with their doctors and express their dissatisfaction with their care. The system still supports 2nd and 3rd opinions and free-market access to doctors who try to do better.

  • Anne

    9/24/2009 1:33:51 AM |

    I was on that merry-go-round. Age 54 and had my 1st stent. My cardiologist came into my room and told my husband "I fixed her." Funny, he did not say that when he did #2, #3 and #4 stent. He did once mention that my heart reblockage was probably due to inflammation, but no one was looking for the source. Not surprising I went on to have bypass.

    I have noticed that doctors seem to be focused on diagnosis. They want to give a name to the disease and then there are evidenced based treatments to do and prescribe. What is missed is looking for underlying causes. CAD may be a diagnosis, but it does not reveal anything about what might have caused it. When my doctors looked at my heart, they saw a plumbing problem. When I started looking at my heart, I found low vitamin D, low B12, low folate, low B6, hypothyroidism, hypertension, insulin resistance, gluten sensitivity, belief that trans fats were safe, low fat/high carb AHA diet and probably low EFA's. Slowly I am figuring out how to truly improve my health.

    Physician are rewarded for procedures. There is little money in counseling a patient about diet and lifestyle. Nutrient levels are rarely tested. Patients too often want the quick fix and are unwilling to make lifestyle changes.

  • Anonymous

    9/24/2009 4:43:36 AM |

    Forgive me for this--but what is heartbreaking are the infants and children I transcribe consultation letters for.  And this is for a large Eastern children's hospital, pediatric cardiology department.  The doctors are true believers, are genuinely interested in helping their young patients, and deal with heart disease and anatomical problems, but still the families are referred to the dieticians and the low-fat diet.  Some conditions are prescribed Gatorade and salty snacks like pretzels...carbs, but perhaps some electrolytes in fluid and/or fluids and just plain salt might help (I am only a transcriptionist, obviously not a doctor) but I transcribe consultation after consultation where I wonder what lies ahead for these youngsters when the heart disease you address here piles onto their congenital problems because of the dieticians and cardiologists' take on how to treat.  They have saved many an infant or young child though but that is not the whole picture.

  • Anonymous

    9/24/2009 4:51:34 AM |

    A friend who was moving Labor Day weekend in 2004 developed chest pain and tachycardia and so presented to the emergency room and there was narrowing in two vessels (do not remember which ones), was stented (the cardiologist even went so far as to call the Italian cardiologist who had stented before in an awkward junction of vessels to get advice before he proceeded).  So my friend ended up with two stents and lost the house she was moving into, so I offered to have her stay with me.  She then suffered a heart attack---right at the stent where the "awkward junction" was.  So what caused this heart attack?  In my lay opinion, the cardiologist's approach to treatment is partially to blame here, but legally his treatment was up to the community standard of care.  My friend and I parted when I moved to another state but as much as i talk to her about sugar--she is addicted to cake and sweets, takes more drugs then I know anyone takes, has ignored the Vitamin D Cure I sent her, the Carlson's fish oil I sent, and the Carlson's Vitamin D3 I sent.  She is on statins/2, pain killers galore (I wonder why she hurts), antihypertensives/2, but she is on Armour thyroid.  Still thinks that cardiologist knows what he is talking about.  I have tried.

  • Alan S David

    9/24/2009 12:58:21 PM |

    I went for a cardiology workup as I have some blockage in one artery. I was prescribed Crestor, and told to eat some tuna once in awhile.  Not even close to what I know to do already, thanks to the Track Your Plaque web site information.

  • Tara

    9/24/2009 3:33:25 PM |

    Dr. Davis,

    PLEASE stop stereotyping dietitians as if we were all Stepford bots programmed to relay the same canned information.  Would you not take offense to me categorizing you as a typical doctor who knows nothing about preventative care, prescribes medications only offered to him by pharm reps, and adheres to everything the AMA decrees?

    Perhaps instead of blasting us, you could encourage dietitians to build on their knowledge and training base by providing some resources?  Maybe offer seminars?  Research?  

    Also, how do you expect us lowly dietitians to make radical changes when the cardiologists and other docs we work for have limited knowledge and certainly no support for dietary intervention and non-pharm therapy?

  • Dr. William Davis

    9/24/2009 5:16:13 PM |

    Hi, Tara-

    You are absolutely correct.

    A good friend of mine is a dietitian. She eats no wheat, cornstarch, or dairy. She's slender and has corrected a complex lipid abnormality with her diet.

    So there are good dietitians and there are plenty of "Stepford bots." Sadly, most are the latter.

    I absolutely agree that my colleagues are failing miserably in delivering intelligent preventive nutritional care. So don't yell at me; yell at my colleagues and your colleagues.

  • Carl

    9/25/2009 10:08:49 PM |

    Hospitals employ dietitians. How many dietitians are willing to go out on a limb to buck current,dated, nutritional recommendations?
    Wheat? C'Mon! They must go with the flow.

  • Bill

    9/27/2009 4:15:59 PM |

    There is a similar "neglect" following treatment that may be quite widespread.  I was treated for depression and after the prescription medications were over, I was 25 lbs heavier.

    I asked the prescribing psychiatrist what to do to get the weight off, and he said, "Go on some kind of diet, I suppose".

    I then and now consider this response inappropriate and inadequate and unprofessional.

  • Paddler Peril

    10/31/2009 12:43:29 PM |

    Same here in Sydney. MI in June, five stents then discharged with paltry dietary advice and the usual list of poisons. Only by searching the web was I able to find sites like this and advice that made sense. Needless to say its over the counter treatment all the way for me now.

    Still unsettling having to steer a course on my own. None of the medicos I've spoken to have been willing to consider a programme for being healthy, they just want to treat me

  • Loradae

    7/10/2011 4:26:11 AM |

    Super informative wriitng; keep it up.

  • Twiggy

    7/11/2011 2:39:18 PM |

    At last! Someone who unedrsatnds! Thanks for posting!

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