Yesterday’s LA Times health section had an important article about what to do in the event of a heart attack.  In the last decade our understanding and treatment of heart attacks has improved dramatically.  The best treatment for a heart attack is immediate angioplasty, a procedure that inserts a tiny balloon in the closed artery, opens it and leaves a metal stent to keep the vessel open.  Studies have shown that this immediate intervention saves lives compared to the previous standard of care.  Studies also show that the time between onset of symptoms and the angioplasty is critical to a good outcome.

This is when a wrong decision can cost a life.  Many medical centers can not maintain the staff and facilities required to provide emergency angioplasties 24/7 to any heart attack patient in the emergency department.  Those medical centers give the next best therapy – intravenous clot-dissolving medicine.  So if you decide to have a relative drive you to a nearby ER when you think you’re having a heart attack you are risking two very dangerous hurdles.  First, you’ll be triaged with all the other patients who come into the ER.  Ideally, the triage nurse should give heart attack patients immediate priority, but human systems don’t always work ideally.  Second, you may find yourself at a hospital without facilities for immediate angioplasty.

So always call 911 if you think you’re having a heart attack.  Paramedics have EKGs that can help them determine the likelihood of a heart attack, and they automatically take potential heart attack patients to medical centers that treat heart attacks with immediate angioplasty (like UCLA and Cedars-Sinai).  And when the paramedics bring you to the ER, you won’t wait with everyone else in the waiting room.

How do you know if you’re having a heart attack?  This WebMD article has a good review of the typical symptoms, the most common one being a squeezing or pressure in the center of the chest that lasts longer than a few minutes.

Tangential Miscellany:

Another problem that deserves emergency department attention is transient ischemic attacks (TIAs) or mini-strokes, about which I wrote two years ago.

Human growth hormone (HGH) has been receiving a lot of media attention recently because of the controversy of performance-enhancing drugs in baseball.  This made some researchers curious about how much evidence existed that HGH actually improves athletic performance.  They reviewed the scientific studies on HGH in an analysis published in the Annals of Internal Medicine.  The study received a lot of coverage in the lay press, including this Wall Street Journal article.

The authors conclude that the scientific literature does not support that HGH improves physical performance, and that it may actually have some side effects like fatigue.

Earlier this week (before I had heard of this new study) a patient of mine who is a voracious reader asked me about HGH, and when I expressed skepticism about it, asked “Then why is everyone taking it?”  That’s a great question.  I’m not certain of the answer though I suspect it has to do with desperation to try anything that may help, and the (mistaken) belief that so many people can’t be doing something without benefit.  In other words, everyone is taking it because each one of them is impressed that everyone else is taking it.

The broader point is that people will do lots of things because of fads, rumor, marketing and a myriad other reasons.  This might be a terrific way to pick a brand of jeans, but I wouldn’t trust my health to what “everybody else” is doing.  I would want to see a good study in the scientific literature.  Smoking was unhealthy in the fifties even when “everybody” was doing it, and cardiovascular exercise would still be good for us even if it became uncool.

Or, as your mother used to say, “If everyone else jumped off a bridge, would you do it too?”

Tangential Miscellany:

My wife Janet and I wish all of you who are celebrating a happy Easter and a happy Purim.

I am constantly encouraging patients to exercise.  Usually, the motivation is physical health – the patient’s weight, or blood pressure, or cholesterol, or sugar is too high and exercise is the healthiest way to normalize it.  But I’m increasingly impressed by the ability of exercise to improve mental health.  Patients tell me all the time that their mood is better, their anxiety lower, and their thinking sharper when they exercise than when they don’t.

A recent study adds evidence to that belief.  A study presented this week at an American Heart Association meeting and covered in this USA Today article examined the effects of exercise on quality of life.  The study involved over 400 sedentary overweight women who were randomized into four groups.  One group did no exercise.  Another group was instructed to do about 73 minutes of physical activity per week.  The third group did 135 minutes of exercise per week, and the fourth did 193 minutes.  They were closely supervised with heart rate monitors and pedometers to make sure they were compliant with their instructions.

The women filled out questionnaires that assessed different aspects of quality of life, from emotional health to participating in social activities.  One questionnaire was completed before the beginning of the study and another after the women had been exercising for 6 months.  Not surprisingly, the women who exercised most showed the greatest benefit in quality of life.  What was surprising, however, was that even the women in the group that exercised the least did better that those who didn’t exercise at all.  Even a little exercise improved their quality of life.  The other surprise was that this improvement was independent of weight loss.  The women who exercised felt better whether or not they lost weight.

So take a walk this weekend.  You’ll feel better.  And let me know if you want a pedometer.

Tangential Miscellany:

If you use a web service that gathers headlines from various sources for you, like an iGoogle personalized page or some other news reader, you can automatically get the headlines of my weekly posts with the rest of your news.  Just use the RSS link on the left column of my web page, or ask me for help.

Colon cancer is a leading cause of cancer death in the US, second only to lung cancer.  Fortunately, there are effective tests that can diagnose colon cancer early, or even prevent colon cancer while it is still a pre-cancerous polyp.  Given that this is one of the few cancers for which effective screening exists, I have been very enthusiastic about recommending colon cancer screening to all my patients over 50.

The options for screening thus far have been colonoscopy, sigmoidoscopy, fecal occult blood testing, and barium enema.  Each of these tests has some benefits and drawbacks, and none have been directly compared to each other in any large studies.  Of these tests, colonoscopy has become the standard of care in our community, largely because it examines the entire colon and allows for the removal of polyps during the examination.

This week, the American Cancer Society released new recommendations for colon cancer screening.  This generated much coverage in the general media, including this NY Times article.  The major change in these new recommendations is the addition of two new testing options for colon cancer screening: CT colonography (also called virtual colonoscopy), and a stool DNA test.

Though these new options may be helpful for the occasional patient that has specific problems that preclude conventional colonoscopy, I think for most patients the new options will not be helpful.  First, there have still been no studies that directly compare the accuracy of any of these screening tests.  Second, CT colonography while less invasive than colonoscopy, still involves the most uncomfortable part of colonoscopy: the preparation the night before that evacuates the colon.  CT colonography also can’t remove any polyps.  So if any polyps are detected with CT colonography, a conventional colonoscopy is then needed to remove the polyp.  Finally, the stool DNA test is too new and impractical.  It is difficult to administer (don’t ask) and its accuracy is not yet well understood.

Many of my patients are squeamish and quite reluctant when I recommend colonoscopy for colon cancer screening.  After the test almost all of them tell me it wasn’t nearly as bad as they feared.  I try to reassure my patients by promising them that on my fiftieth birthday I’ll get a colonoscopy too.  That promise still stands despite the new recommendations.