The “Standard of Care” and Facts of Life

It had been a shock to be told a few years ago that I had so much plaque in my coronary arteries that I was in imminent danger of a heart attack or stroke. The cardiologist told me that I must immediately follow the protocols of the “standard of care” in cardiology and begin a course of treatment using a strong statin drug or risk the grave consequences of the failure to do so, that’s all. “Stat!” Crestor was the latest highly promoted statin, widely prescribed around the time doctors began recommending statins as “preventive” treatments for suppressing the dreaded cholesterol.

Yet, I still had questions. Why, as I mentioned previously, had I performed so well on the standard stress test? I had walked the accelerating tread-mill, climbing its increasing incline, while monitored by multiple instruments tied to me by a dozen wired sensors. I had done fine; no anomalies whatsoever. And, why had the multiple imaging methods shown no arterial blockage at all? The answer: “you’re lucky.” It was assumed that ‘so far’ the dreaded plaque was so evenly spaced that blockage had not occurred – an unlikely scenario, it seemed to me.

Now isn’t this just the typical thing a man is likely to encounter in his mid-seventies? Medical challenges abound, as do anomalous events. We don’t usually expect what we don’t want to happen.

We take our Vizsla puppy to a nearby dog park every day because she has so much energy. By nature she is a major runner and loves to play with the other dogs. Most of the dog owners there are retired too. As the dogs run and play, we sit around and chat – no, we don’t run and play, we’re not pups anymore. I’ve noticed that conversation often turns from politics to health issues. Experiences with failed diagnoses, spouse’s failing health, our own, etc., are routine. Various “alternative” health practices are a common topic of conversation. “I hate doctors,” is often heard.

But the dog park conversations were not the source of my hint of another approach to what is commonly called cardiology. Apparently, there is more to it than meets the cardiologist’s eye. One friend, a retired obstetrician, told me that he had been seeing a “lipidologist,” who had an approach to cholesterol, plaque, and heart disease in general, unlike that of the cardiologists. “I get thousands of dollars worth of advanced lab testing, and it is all covered by Medicare or is written off by the lab as part of their research.” My ears perked up. I’m always looking for some good science in medicine as an antidote to the stagnation of the “standard of care.”

Another friend who is a consummate researcher and whose wife was doing well despite having been diagnosed with stage 4 lung cancer metastasized to her brain four years before, recommended that I see the same lipidologist my other friend had mentioned. This friend had been tracking all the latest clinical trials of new experimental cancer treatments and jumping through all the hoops to get his wife into the most efficacious ones. Cancer treatment techniques are fast approaching the ability to target specific cell mutations and kill only cancer cells. If he and his wife had simply listened to the “authority” of the local oncologist and gone with the “standard of care,” (chemotherapy and radiation) I am convinced that she would have died years before she did. Even the latest treatments cannot stop some cancers. But many diseases characteristic of aging can be prevented, moderated, or delayed by wise choices, which have little to do with the “standard of care.”

Next time: the Mad Jubilado encounters the Eccentric Lipidologist.

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