Dr Melissa Walton-Shirley


November 16, 2008

  So, after a long and eventful week at this year's AHA meeting, we have all returned home  to settle into another long and eventful week in our practice lives. Here's a brief look backward:

 Steve Stiles, one of our very own heartwire journalists  took home the Howard L Lewis award which honors those who have made outstanding journalistic contributions in the realm of heart disease and stroke.  We are proud of Steve and his very meticulous reporting on these topics. No doubt, his writings  have changed what goes on in hospitals and offices around the world for the good of all of our patients. 

The internet outage at the Morial Convention was of almost catastrophic proportions.  I have NO doubt that many news outlets experienced delays of a few minutes, to hours or greater in reporting some stories because of these problems.  Before we go back there, I hope that whomever is reponsible for containing those Gremlins will get a grip on them post haste.

Folks were buzzing about Jupiter and how it would increase the number of Crestor prescriptions written, but my bet is that it will increase the number of HsCRP's written even more.

I-Preserve will rightly discourage the use of Irbesartan in dyspneic patients with normal EF's but will wrongly propagate the mislabeling of many of these patients as having  "CHF" when in truth, many may not even have it to begin with.   I hope the  many discussions surrounding this study will instead stimulate a complete work up in  patients who are in as much need of a real diagnosis as they are a real treatment.

The oral hypoglycemic agents Rosi and Pio glitazone have played a significant role in the number of peripheral edema patients masquerading into my practice as "CHF".  I have never felt these drugs were worth the extra birthe of echos and consults driven by them and I don't see where they are making much difference with regard to wall physiology.  I stop them in every patient with edema and shortness of breath, especially when their symptoms are temporally related to their implementation.  However, much like "Jason" of Friday the 13th fame, I'll bet we'll continue to witness multiple attempts at resurrection much like Folate and Vitamins C and E over at least the next decade.  Meanwhile, we'll just keep upping the arb/ace doseages to treat more side effects of more side effects.

Our NYH Class II -IV patients should not only be "encouraged" to exercise, they should be placed into a situation early into their diagnosis that begats a 30 min/day-3day/wk program, so says HF-ACTION. Cardiac Rehab centers should flourish, but we will see if they can overcome a failing economy that often leaves behind the frailest of patients first.    Not only will our CHF patients  feel better, they will be happier according to a life quality survey administered.  After all, if you aren't happy, no matter how sick or well an individual may be, it still spells misery. So, no longer should we "fear" daily exercise in this population.  We should embrace it.

If only we could study what actually goes on in the world of anticoagulation in America.  Not only do we not use enough coumadin, we obviously don't monitor it very well either and we know this from experience, not the THINNRs' trial.  If we had compared real world care in America with point of testing and another arm of home monitoring, there is NO doubt that we would be insisting upon home "point of care" or office "point of care" monitoring.  I insist that if we are going to prescribe this medication, we should invest in a point of care testing unit as well.  Delays in INR reporting can = death for many patients.  Also, it doesn't take an accountant to see that one bleed or one stroke costs hundreds of thousands of dollars that would be better spent in other areas of health care.  An even greater mystery is why on earth those who control reimbursement in this country haven't yet figured it out. Another Bill Cosby  " COME ON PEOPLE!" moment.  So COME ON PEOPLE. 

Dr. Oz was a welcome delight and departure from the world of p -values and meeting jargon.  His practical approach to prevention is admirable.  Although I didn't question him about it specifically, I would  caution anyone with established disease to not rely soley upon "nature" to drive change.  I think after disease has been established, nature needs a little help.    If more of us were medical evangelists like Dr. Oz , the world would be a better place for our patients.  Dr. Oz you rock.  I think I might even buy your book "You , being beautiful".  I think at this meeting, we got an opporunity to see "you" being beautiful as a human being and a physician.

New Orleans is still a beautiful and magical city.  Artists hopeful to sell a piece of their talent display their hard work on the  black iron fence that surrounds Jackson square every morning.   From  sidewalk portraits  to grandiose Rodanian  pieces,  we saw some  very important work on the  morning before the meeting.  At first, I thought I was seeing everyday scenes from New Orleans, but on a closer look, a water line is seen in every piece, depicting the beauty of a waterlogged  post -Katrina New Orleans.  From etouffe' to Benet's (which I did not eat!), there is something  for everyone.  The chefs'  create savory dishes in every restaurant and the people are friendly and accommodating.  The Starbucks line at the convention center ,  only slightly longer than a line of  ticket hopefuls the night before a Final four UK Basketball  game ,  drove us outdoors and across the street in beautiful Louisianna Sunshine . The weather was perfect until the very last day of the meeting. I confess  that rain in the Big Easy still makes  visitors like me a bit Un-Easy as my mind drifts toward the same Levys that our  tour guide described as "unstable and prone to break" just 2 years before the great flood. 

 Even though the city is still fighting back from a near drowning,  I was a bit sad when my family and  I attended church on Sunday.  When I turned to ask where all the members had gone, a lady behind me sadly  said, "they left after Katrina and just never came back", thus echoing what has happened all over the southern Louisianna Coast.  Large buildings and meeting places ring hollow , a sign of shifting priorities in a civilization grown tired of fighting the forces of nature. 

Just as with the close of any meeting, we look forward to the next.  For me, I hope to be able to attend the ACC 2009 which from a blogger's perspective is a veritable candy store of provocative data.  More than that, we at theheart.org have happily managed a 6:30 am - 11 pm schedule many days to bring you the best meeting information  possible.  Our  hope is that  each and everyone of you found something interesting and most of all, helpful  in your daily walk as a cardiovascular  health care provider.  We respect your challenges and celebrate your victories as we continue with you on your journey to the bedside of your next cardiac  patient.    








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