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Steps to follow before choosing the best Lasik eye surgeon

Choosing the best Lasik surgeon is not an easy task. One needs to be careful before entrusting one’s eye care with anybody. There’s no doubt that the world is going digital. But even at that, people still suffer before getting a competent eye surgeon online. I was shocked the day a woman told me that she searched for a Lasik surgeon online and all her effort were abortive. Nowadays, there’s no rest even after communicating with one eye surgeon online. 

The online stuff is the most difficult one. What do I mean? People can be easily deceived by the ranking of eye clinics on search engines. You can assume that you’re picking the best Lasik surgeon because to choose according to the ranks on search engines like Google. Let me be frank with you, the first Lasik surgeon suggested to you by Google might be an incompetent surgeon. How do I know? You don’t judge a book by its cover. It is wrong to assume that the first surgeon that Google will suggest to you is the best. 

Please permit me to share an important secret with you. Web pages can be designed to top the search engines. Some experts help in ranking web pages on search engines. So, if you depend on the rankings, you might fall into errors. Remember, Lasik requires specialized knowledge in its operation. That is why you can’t even assume that all Ophthalmologists can handle Lasik eye surgery.  

However, what is the way out? You’ve landed in the best place. This article aims at revealing the necessary steps to take before choosing your eye surgeon. There are some things you need to check and take note of. But before I take you through that, it would be nice to talk about what Lasik surgery entails. 

What are the occurrences in Lasik? 

The Laser is used to reshape or correct the corneal tissue underneath the flap. The flap will be lifted to ensure the corneal tissue underneath is corrected without any complications in this procedure. Do you know why this is done? This procedure is done to ensure the light focus better on the retina. So, if this process is handled carefully, the cornea flap can be fully restored to its normal state. One beautiful thing about this process is that it remains the best method of solving eye problems like myopia, hyperopia, and astigmatism. However, one thing is crucial. If you don’t want to undergo this surgery again, make sure you’re connected with the right source. What do I mean by being connected with the right source? Ensure that your Lasik surgeon is competent and reliable. Visit http://heartsenseblog.com/limitations-of-undergoing-lasik-eye-surgery/ to read about the Limitations of undergoing Lasik eye surgery.

Why do you need an experienced eye surgeon?

This surgery that I’ve been talking about requires well-trained personnel to handle it. There are unpleasant outcomes for people that have once allowed an incompetent Lasik surgeon to handle their eye. To be candid, one can lose one’s eyesight permanently. Therefore, to avoid spending more money on surgery again, you need a competent eye surgeon. Not only that but if you don’t want to use eyeglasses after the surgery, there’s a need to be connected with a reliable surgeon. You can also read about Increasing Access to Cataract Surgery by clicking here.

Steps to follow in choosing the best surgeon

Step 1: Pay attention to the details of reviews

This is the first step you must take so seriously whether you want to choose your surgeon online or not. Check the surgeon’s website for positive reviews. What are positive reviews? Positive reviews are people’s testimonies about a good or service. There is a place on every website to make either a positive statement or a negative one about the goods or services. So, you must check the percentage of positive reviews on the surgeon’s website. Let me give you a clue. Make sure you see at least 98% of positive reviews on a surgeon’s website before you strike a deal with such a surgeon. 

Step 2: Ask some questions.

The write-ups on their web pages might not be accurate. So, you can ask them questions that will invoke accurate responses. Of course, you need to be sound psychologically. Pay rapt attention to gestures. This step is helpful for those that want to choose their surgeon online. Also, it is an essential step for those that want to visit an eye clinic close to them. If you have a clinic close to you, then ask the surgeon questions physically. You can ask the surgeon some questions to know if he has done Lasik surgery before. Questions like; how long have you been doing this surgery? When was the last time you did this surgery on someone? What are other experiences you’ve learned so far since the time you’ve been doing this job? I just give you a template. Other questions will flow within you organically in front of the surgeon. Please ask! 

Step 3: Do research about the surgeon.

This step is crucial. It is good to embark on knowing if the Lasik surgeon is well trained or not. Once you know your surgeon’s name, you can go online to read his profile. This will give you a clue about the surgeon’s personality. Knowing the surgeon’s academic background will assure you that you’re in safe hands. 

Step 4: Pay attention to the surgeon’s person during a consultation

The surgeon’s personality has a unique way of contributing to the success of Lasik surgery. If the surgeon is not friendly and harsh, I want to advise you to terminate the appointment with him and look for another surgeon. Then, how will you know the surgeon’s personality? Please pay attention to how he responds to questions you’ll ask him during the consultation period. If the surgeon is willing to attend to all your eye health questions, you’re safe. But if the reverse is the case, one needs to be careful.

On a final note

Dear reader, hopefully, you’ve seen something profound here. I believe if you can follow the steps above, you’ll have a lovely story to share. Finally, a question regarding this topic might cross your mind while reading this article. Please drop your question in the comment box.  

Can LASIK eliminate the need for reading glasses?

Millions of individuals have benefitted from LASIK surgery, yet many still have concerns regarding the procedure and wearing reading glasses. Despite the fact that the majority of patients notice a significant improvement, reading glasses may still be necessary in certain cases, even after the treatment. A great deal is dependent on the individual’s circumstances.

If you are under the age of forty and have both eyes laser corrected for distance vision, it is likely that you will not need reading glasses after having the surgery performed. If you are over forty years old and have the identical treatment done, you will almost certainly need reading glasses soon after the procedure. Consider monovision as an option if you want to avoid wearing reading glasses. If you are over forty, this procedure may be a possibility for you. It entails having one eye corrected for distant vision and the other adjusted for close vision. It is recommended that you test this procedure out first using contact lenses before deciding to go through with it via eye surgery lasik.

The development of a method in which a laser forms a multifocal cornea is now under investigation. This would allow both eyes to be used for reading and distant vision. However, these approaches are still being refined, and they have not yet been authorized by the Food and Drug Administration.

The capacity of the lens to expand and contract is the source of the issues associated with nearsightedness and farsightedness, respectively. This process is referred to as accommodation, and it is something that we lose as we get older and our eyes become less adaptable to new environments. It is possible that you may have trouble reading for a few days after LASIK surgery if you undergo laser vision correction. Wearing over-the-counter reading glasses is a realistic approach that will have no negative impact on your recovery. However, even once your eyesight has stabilized, you may still have difficulty reading, in which case your doctor might prescribe reading glasses.

While some individuals may discover that LASIK removes their need for reading glasses, others may find that their answer entails a combination of LASIK and prescription reading glasses.

Once individuals reach the age of 40, a separate ailment known as presbyopia may begin to impair their ability to see up close. The condition known as presbyopia happens when the eye lenses begin to lose their flexibility, making it harder to concentrate on objects up close. Over-the-counter reading glasses in Rapid City are offered in a variety of strengths to assist with the adjustment to this change in visual ability.

Presbyopia cannot be corrected with LASIK. LASIK is a treatment in which the cornea is gently altered in order to enable light to correctly concentrate on the retina (the back of the eye) in order to obtain clear vision after cataract surgery. Because presbyopia is not caused by the structure of the cornea, LASIK in its most basic version is ineffective in treating this visual problem.

However, there is a snag in the system!

It is possible to have monovision LASIK surgery in Personal Eyes done to offer clear distant vision in one eye and clear up-close vision in the other, resulting in clear vision at all distances. Because this treatment may be difficult to adapt to, you may be given trial contact lenses before you undergo the operation.

Treatment with laser eye surgery: Can laser eye surgery reduce or eliminate the need for reading glasses (presbyopia)?

Is it possible to get laser eye surgery to eliminate the need for reading glasses? Yes, it is possible.

This is a topic that is often misunderstood. There is an urban fallacy regarding laser eye surgery that is perpetuated by a large number of eye surgeons: laser eye surgery is only beneficial to young individuals. This is simply not true. It can only be used to entice individuals to take their distance vision glasses off, and it has no effect on their reading ability.

This subject has undergone several changes in the previous five to ten years, many of which are positive. Diverse laser systems are derived from a variety of different ways. The laser platforms, in my view, are the clear winners when it comes to providing an effective and safe therapy. This ice male 90 platforms treatment profile, which uses the Presby blended division treatment profile, is used to address the requirement for reading glasses in patients who have had LASIK. 

Can LASIK eliminate the need for reading glasses?

It is built on the foundation of something that happens naturally. While we’re in our twenties and thirties, we’re fortunate enough to have access to housing that has the magical capacity to shift focus from afar to close in less than a second. A portion of this is accomplished by increasing the amount of an optical flaw known as spherical aberration in the image. That is one of the things that happens as we accommodate, when our attention shifts from a distant to a closer distance. When a regulated degree of spherical aberration is employed to improve the depth of focus on each eye, the Presbyond laser blended vision software is used to achieve this result.

Afterwards, we may ask each eye to do a slightly different task, which will benefit the great majority of patients. If I look at myself, for example, my dominant eye is my right eye. As a result, my right eye would be configured for distant through intermediate vision, and my left eye would be configured for intermediate through close vision, thanks to the Presbyond laser platform. It is critical that they overlap in order to create a blend zone, a region where both eyes are contributing to the conversation. This enables me to concentrate from a distance all the way through to intermediate and close range, providing me a full range of focus.

Can LASIK eliminate the need for reading glasses?

It’s a middle-of-the-road solution. However, it is not the same as being twenty-one and having perfect distance vision that you can shift seamlessly to near and back out again, but it is an extraordinarily powerful and effective solution that provides 90 percent of my patients with complete vision that is independent of spectacles, and it is not expensive. All of the other patients are only utilizing readers for very small text or when they need to read for a lengthy amount of time, especially when under poor lighting circumstances, such as in the evening when they are fatigued and the lights are turned down low.

As a result, the urban legend that laser eye surgery cannot address the need for readers, which has been spreading via the grapevine, is incorrect. We provide LASIK with Presbyond blended vision, which enables us to provide our patients with distant, intermediate, and close focus, allowing them to be free of glasses. Learn more about Femto LASIK.

Heart Disease Deaths Decline 27.8% — Now let’s do our part and commit to healthy living

Heart Disease Deaths

 We are continuing to put ourselves at risk for getting heart and circulatory diseases through improper diets, lack of exercise, and even the continuation of smoking. “As risk factors for coronary disease increase in a population, we also expect the future incidence of coronary disease to increase within the population. Control of risk factors is critical in the prevention of coronary disease,” said Edward K. Kasper, clinical director of cardiology at Johns Hopkins Hospital and co-author with me of Living Well with Heart Failure, the Misnamed, Misunderstood Condition. And Daniel Levy, director of the Framingham Heart Study says that with regard to heart failure, “in the majority of cases, it is preventable.”  That is an amazing statement.
Dr. Roger urges people to take responsibility for their risk of getting cardiovascular diseases through personal “risk factor management.”

Most of us know what to do.  We just need to start doing it. 

We need to lose weight. Two out of three of us should lose weight! Even losing a little weight can improve your chance of avoiding heart disease. We need to control our blood pressure and cholesterol.  One-third of adults have high blood pressure but only 48% of those aware of their condition have their blood pressure controlled to a safe level. We need to eat less sodium, less saturated fats, and NO trans fats. We need to eat whole grains, fruits, vegetables, and unsaturated fats. We need to exercise regularly, and some of that exercise should be vigorous enough to give our hearts a workout, which means breaking into a sweat or increasing our heart rate and starting to breathe faster and heavier. Stop smoking and if you have not started, don’t smoke.

I am going to renew my commitment to heart-healthy daily habits and I ask you to join me.  A colleague on Twitter got in touch just yesterday to say she has put on some weight and do I have advice.  Well, I have put on some weight, too.  I need to do better at eating right every day and doing the right exercises every day.  Let’s make this commitment together.  As winter approaches, it is all the easier to fall into bad habits of not exercising, sitting too much, and eating too much.  In the coming weeks, I’ll discuss our goals in more detail.  Adopting these healthy daily habits is the best present you could give your loved ones this holiday season.

Heart Failure a scary name that doesn’t make sense

For the last week, I have been mulling over the name heart failure, questioning why the collective conditions that bear its name ever got such a name, and looking into the very murky area of heart failure death statistics.  , many of us who were shocked to get the frightening diagnosis of “heart failure” do not have hearts that have failed.  We got treated, some more quickly than others, and went right on with our lives.  Others are not so lucky and die of heart failure, sometimes suddenly and sometimes after years.  Trying to discuss what heart failure is getting very difficult because it is not a disease, it is a syndrome brought on by many different underlying causes including coronary artery disease, disease of the heart muscle, high blood pressure, valve malfunction, poor artery connection, alcoholism or drug abuse, and certain chemotherapies, to name just a few.  And heart failure affects the heart in different ways. 

The term heart failure covers conditions ranging from no symptoms to severe shortness of breath from fluid collecting in the lungs, swelling of the abdomen, ankles, and feet, and fatigue even at rest — see American College of Cardiology/American Heart Association Stages of Heart Failure and New York Heart Association Classification of the stages of heart failure here.

Somehow the field of medicine has allowed so much under the same umbrella of heart failure that discussing heart failure becomes confusing for physicians and patients.  “Skilled clinicians have difficulty with this and most fumble around,” James B. Young,  Professor of Medicine & Executive Dean, Cleveland Clinic Lerner College of Medicine, told me in an e-mail. So trying to write about what medicine calls heart failure, what’s wrong with the name, and what, if anything, to do about it is challenging. 

Then yesterday something happened that clarified the picture for me.  I knew when I got a pit bull from a rescue organization a year ago that he had a kidney problem and I agreed to take him because he had a terrible earlier life that included months spent in a cage that nearly drove him insane.  I wanted to give him a loving home for whatever time he had, a year or two.  He arrived with skin hung over his skeleton, but he had a great appetite and put on weight, filling out very normally, enjoyed his walks, and loved to play catch-me-if-you-can with a nylon bone or an old house shoe in his mouth every time one of us who had been out during the day returned home.

Heart Failure a scary name

Then in the last week, things changed.  He started throwing up and for the last four days he could not keep anything down.  He was noticeably losing weight.  His very thick neck thinned in a matter of days and his spinal column began protruding.  He would only go one block on a walk before turning to come home.  He quit playing catch-me.  He lay constantly on his bed or, at night, my bed.  Monday we took him to the vet and yesterday morning we got the results of his blood tests.  His blood urea nitrogen (BUN) was 237, the highest my vet said he had ever seen. 

A normal BUN level in a dog is 6 to 31, the vet said.  A high BUN level indicates that toxins are not being removed by the kidneys.  My dog was in kidney failure, my vet told me.  That was the first time I was told he was in kidney failure.  And those words made a lot of sense.  Teddy was not in kidney failure for the last year, only for the last few days.  His kidneys indeed had failed.  If he were a person, he would have to either go on dialysis or get a kidney transplant in order to live.  Teddy was miserable, had noticeably lost weight quickly, and also had grown a tumor which I would have wanted the vet to operate on, were it not for the kidney failure.  The dog doctor said that the anesthesia itself could be so toxic on the kidneys that it might kill Teddy.  And so at noon, with tears and heavy heart, to end his suffering, we had him put to sleep. 

Yesterday afternoon in a house far too quiet, I tried to return to writing.  And then I got to thinking.  Kidney failure.  Heart failure.  The two terms sound alike but are used by doctors for very different health problems.  But why?  In kidney failure, the kidneys don’t work anymore.  It’s so obvious you hardly need a blood test to prove it.  As with heart failure, many different things may have caused it, and the kidney failure may have come on gradually or acutely, but kidney failure is kidney failure.  It means what it says.  Contrast that with heart failure, where most of the time the diagnosis is made, the heart is still working. 

It has not failed, although something about the heart is not normal and may have begun causing symptoms.  But if the heart had failed, an analogy to kidney failure would mean that a person with heart failure would have to regularly be on a machine that circulates blood throughout his system or get an implanted device that takes over at least partial function of the heart or get a heart transplant in order to live.

Heart failure is an appropriate name for patients who are now said to be in “end-stage heart failure” in which they have only months or less to live unless they get mechanical aid to take over part or all of their heart function as in a ventricular assist device ((VAD) or get a heart transplant.  But I submit that this is the only true heart failure.  Just drop the first two words, because “end-stage heart failure” is redundant.

Heart failure is not an appropriate diagnosis for people who have no symptoms or who have symptoms that can be improved or even disappear under treatment.  

Why does it matter what conditions are called heart failure?  Why does it matter how many people hear their diagnosis is heart failure?  Shouldn’t I just leave the naming of medical conditions and diseases to doctors and mind my own business?  What’s in a name?  

Here’s why it matters.  As I consider the words heart failure, and the effect those two words can have on the person diagnosed with it, I am reminded of an event that happened to me while I was in college.

Occasionally someone can say something to you that is so scary it seems it might scare you to death.  Near final exam time, I quite suddenly came down with a paralyzing illness, transverse myelitis, and had the misfortune of being hospitalized where doctors had never seen a case of transverse myelitis, did not recognize it, and decided to operate on this viral illness, looking for an obstruction they did not find. While inside me for “a look-see”, the general surgeon cut into inflamed tissue to take out my healthy appendix.  Already very sick and rapidly becoming paralyzed, I nearly hemorrhaged to death from the surgery and was placed on the hospital’s “critical list” of patients who may die.

While I knew how terrible I felt, neither doctors nor family had let me know how very sick I was.  The sight of my 8-year-old blonde cherub-faced nephew cheered me. This was his first visit and I could tell he was excited about something and wanted to share it with me.  How sweet.  He came right up to my bedside. 

“Hey, Aunt Mary,” he gushed, “Do you know you’re on the CRITICAL LIST?”  

AAAAAAhhhhhh!  Terror hijacked my entire body. 

No, Gary, nobody had told me I’m on the CRITICAL LIST.  Who let this kid in the room?  There’s a reason why children shouldn’t be allowed in hospitals.  I couldn’t speak.  A numbness began in my feet and crept up my legs. 

This story, still so vividly recalled, comes to mind as I write about the diagnosis of heart failure because like those other two words critical list the term heart failure is very frightening to hear.  And much of the time heart failure is an unnecessarily scary diagnosis.  Every day thousands of people are frightened to learn they have heart failure.  I was.  

Never having had any known heart problem, I sat in shock when a cardiologist told me in 2003 that I had HEART FAILURE.  When a doctor tells you that, it’s like being told you have end-stage cancer. You know nothing about heart failure, probably have never heard of it, and it sounds quite fatal.  I went home and made out a will, then spent several months educating myself about heart failure and going from doctor to doctor, searching for the right treatment, afraid that I could drop dead at any moment. 

It’s one thing for an 8-year-old kid to scare a sick patient, quite another for a grown-up doctor to do it.   I realize that there are many times when a doctor has to give a diagnosis to a patient that is frightening and I appreciate that this is emotionally hard on many caring doctors. 

But, doctors, do you ever wince when you tell a patient she has heart failure when you believe that proper medications may make a big change in her symptoms?  I ask doctors to be more aware that a diagnosis is a two-way act of communication:  It words the physician says and it is worded the patient hears. One is just as important as the other.  Your diagnosis is not complete, doctors until the patient has heard it.

I was not able to find out who originated the term heart failure as a diagnosis.  Renowned cardiologist historian Arnold M. Katz, who is the most likely source, told me “It will be hard to find out who (first) used the term heart failure as most of the early texts were written in Latin, a language I do not speak.”  But the name got into the medical literature long ago before modern therapies were available.  

I wish the medical community would find a new term — how about Heart Flux or Heart Fatigue or Heart Stress Syndrome — or multiple terms for diagnosing this condition that now wears one inappropriate label disturbing and confusing for the person diagnosed and those in the labeled person’s close circle at home and at work. How much easier and more exact to tell your patient and for him to hear the words, “Your heart is in a state of flux/or fatigue/or stress/ and I have some medications to give you that have a good chance of helping it a lot” instead of “You have heart failure.”  

Until then, I hope that, when pronouncing the scary words “heart failure” to a new patient, doctors will take the time to explain that, much of the time, it’s not what it sounds like.  

Heart Failure Death Statistics: Don’t believe what you read on the internet

In its website section on heart failure facts, the Heart Failure Society of America directly faces the question all people with heart failure and their loved ones desperately want to know:

“Q: What is the prognosis for a patient with heart failure?

A: Less than 50 percent of patients are living five years after their initial diagnosis and less than 25 percent are alive at 10 years. Poor prognosis can be attributed to a limited understanding of how the heart weakens and insufficient private and government funding.”  

I was startled to see those grim statistics on the HFSA website, given that clinical studies published in peer-reviewed journals have shown that ACE inhibitors and beta-blockers prolong the lives of people with heart failure and in the last decade those medicines have become standard recommended therapy.  Implanted defibrillators known as ICDs that prevent sudden death by shocking the heart when the heart goes into a chaotic rhythm, cardiac resynchronization therapy (CRT) which corrects abnormal beating of the left ventricle, and other effective treatments have also grown in use in the last decade.  

I also felt uneasy reading the HFSA answer that tied “poor prognosis” to “insufficient private and government funding.”  That seemed to have a political tinge to it, out of place in an answer directed to worried patients and family members about how long someone can live with a diagnosis of heart failure.  Many conditions can cause heart failure in which the heart is not pumping out enough blood to meet the needs of the body. 

When a patient with heart failure has a poor prognosis, there can be any number of reasons, including these:  the doctor did not order the most effective medications that could have prevented progression of the heart failure, the patient didn’t faithfully take the correctly prescribed medications either because she couldn’t afford them or was not reliable, the patient didn’t observe a low-sodium, low-fat diet and get regular exercise, and, frequently, the patient has other significant health problems. 

Also, despite excellent care, a patient may have a heart too damaged from a heart attack or from a genetic malfunction to be able to successfully pull out of heart failure.  But I doubt any doctor ever tells a patient’s family, “Your husband and father is in late-stage heart failure and has only a few months to live because the government didn’t fund enough grant money for heart failure research.”

Working on the assumption that a journalist or a person with heart failure or, for that matter, any member of the public could ask what HFSA’s source is for its grim prognosis and get an answer, I contacted HFSA.  I sent an e-mail to Cheryl Yano, HFSA longtime executive director, explaining that I was writing this blog report on heart failure death statistics, and then a second e-mail, but did not get a reply, so I called.  She would not talk to me. 

Loreen Anderza, HFSA administrative assistant who answered the phone, said there is no specific source for the HFSA statement on how long people with heart failure can expect to live.  It is “a consensus of experts in the field.  They have no source for it,” she said, after putting me on hold to speak to Cheryl Yano.  I asked if Ms.

Yano would talk to me about whether or not heart failure is becoming more of a chronic condition that can, for most people be managed, and Ms. Anderza said that Ms. Yano is not the right person to talk to because she is not an MD.  I asked who at HFSA I could talk to and she said Ms. Yano had no one to recommend.  Ms. Anderza said that everyone uses the same numbers and suggested that I ask the American Heart Association if they know what the source is for the scary prognosis that is on the HFSA website.

Instead, I contacted the president of HFSA, Barrie M. Massie MD, Chief of the Cardiology Division at the San Francisco Veterans Affairs Medical Center who responded in an e-mail:

“This is out of date.  It is based on Framingham data and several trials largely dating back 10-20 years.” 

The Framingham Heart Study

The Framingham Heart Study supported by the National Heart Lung and Blood Institute, part of the National Institutes of Health, is an ongoing project begun in 1948 that has enrolled over 14,000 members of three generations and periodically issues reports about the risk factors for developing heart disease.  The study here has provided many important findings including the risk of cigarette smoking, cholesterol, high blood pressure, and much more.  But the study is set up to find information on all forms of heart disease and its ability to track heart failure patients is quite limited. 

Original Framingham participants are seen at a clinical visit every two years and their offspring are seen every four years. “Participants with heart failure often undergo treatment between a clinic visit and before death and these interventions are not captured in our clinic visits,” said Daniel Levy MD, director of the Framingham Heart Study. Therefore his report did not have information on what treatments heart failure patients who died were using.

Many sites on the internet including HFSA that offer a prognosis for heart failure base their projections on a Framingham study published in 2002 in the New England Journal of Medicine that used data going back 15 to 20 years ago.  Even the American Heart Association’s Heart Disease and Stroke Statistics 2010 Update quotes the Framingham death rates for heart failure. 

I examined the Framingham report on heart failure and found that the prognosis the study gives is based on a very small number of deaths — 86 deaths of men and 80 deaths of women.  This study occurred before the modern therapy of ACE inhibitors and beta-blockers which are proven to prolong life in heart failure.

The Framingham study followed 323 people (145 men and 178 women) who developed heart failure between 1990 and 1999.  Dead in five years were 59% ( 86) of the men and 45% (80) women.  The study did not learn whether these men and women died of their heart failure or of some other cause, said Dr. Levy, lead author of the report that appeared October 31, 2002, in the New England Journal of Medicine.            

The Framingham study on heart failure deaths also looked at deaths in  decades going back to the 1950s and said that “Overall, there was an improvement in the survival rate after the onset of heart failure of 12 percent per decade.” 

In the decade since the Framingham study of the 1990s, “there is optimistic evidence that we have improved treatment for people with heart failure,” Dr. Levy said in a telephone interview, though he would not estimate by how much.

Other Clues to Heart Failure Prognosis

I talked to eight nationally known cardiologists in preparing this article, to get a sense of where heart failure stands as a treatable condition vs a progressively fatal condition.  Not all are quoted.  One cardiologist who asked not to be identified because he knew what he was saying was “controversial” commented on the annual AHA Heart Disease and Stroke Statistics Update:  “These are not really current data.  They are estimates extrapolated from NHANES (National Health and Nutrition Examination Survey) … with changes based on changing size and age of the population. 

Hence, they are unlikely to be accurate and will not reflect real or measured changes.  Consider them propaganda for those that thrive on high event rates. These data are useful for those seeking investment in development programs for heart failure treatment.”  NHANES, a part of the Centers for Disease Control (CDC) surveys about 5,000 people in the United States a year and estimates results for the national population. The AHA Heart Disease and Stroke Statistics 2010 Update here bases its estimated incidence of heart failure and prognosis of life expectancy largely on NHANES and the Framingham Heart Study of the 1990s.

One clue to how long people with heart failure live comes from clinical studies that try to prove a new drug or device is better than standard care at prolonging lives.  Both Dr. Massie and Alice Macette MD, chief of the National Heart Lung and Blood Institute’s Heart Failure and Arrhythmias Branch, point to the improving life expectancy for people in the placebo group of these trials — those who are on the existing standard therapy against which the new treatment is being tested.  

“For instance in the SOLVD study of 1991 which first showed the benefit of ACE-inhibitor drugs,  the three-year survival rate was about 65% in the group receiving placebo, whereas three-year survival rates were approximately 80% (or greater) in two studies (one on eplerenone and one on use of CRT for mild to moderate heart failure)reported this week at the American Heart Association here and here dealing with heart failure patients of varying degrees of severity,” said Dr. Macette.  In fact, the improvement of heart failure outcomes has helped set the bar higher for any new therapy being tested,” she said.

Dr. Massie agreed.  “If you compare the placebo groups over time there is a substantial decline in the placebo group mortalities,” he said.  “Used to be up to 20% per year and now is close to 8% per year.  This low (death) event rate has made the conduct of clinical trials hugely expensive, which is why there are far fewer of these and even fewer positive ones.”

I also asked cardiologists to judge from their own experience how treatable heart failure has become.  Edward K. Kasper MD, director of clinical cardiology at Johns Hopkins Hospital and a specialist in heart failure, (disclosure:  I co-authored Living Well with Heart Failure, the Misnamed, Misunderstood Condition with him) said “I expect most to improve with modern therapy for at least some period of time – say 75%.”

“Indeed there have been great advances and people do live longer, but progress has been slow and we need to do better,” said Dr. Massie.

I asked Mariell Jessup MD, chair of the American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Heart Failure in Adults found here if heart failure has become more of a chronic condition:  

Question:  “From your own patient experience, do you find that most people diagnosed with heart failure will be able to manage their condition, keeping it from advancing, or even improve with the right treatments?”

“I agree,” she replied. She pointed to a study of 2,029  people taken from the general population in Olmsted County, Minnesota.  Study participants were classified according to how sick they were.  Since this was a random sample, it included healthy people called stage 0.  Stage A had risk factors for heart failure, stage B showed cardiac structural or functional abnormalities found by testing but were not experiencing symptoms, stage C had symptoms of heart failure, and stage D had end-stage heart failure.  Survival at 5 years was 99% in stage 0, 97% in stage A, 96% in stage B, 75% in stage C, and dropped to 20% in stage D, by far the smallest group with only 5 people. The study published March 12, 2007 online in Circulation can be found here.  “It is only those patients who present with intractable symptoms that do poorly,” Dr. Jessup said.

Needed:  A Huge National Prospective Study or a National Registry

The Minnesota study, though still small numbers, gives some window into a more accurate prognosis for heart failure.

But the only way doctors and patients and their families will get a really accurate handle on prognosis with current therapies is if a huge prospective study is undertaken or at least a national registry that includes tens of thousands of patients seen at many academic centers and those seen in the community by both cardiologists and general practitioners. The study or registry should include a variety of races and ethnic backgrounds, male and female.  Much could be learned by such a study, including this information:

  • modern survival rates and deaths due to heart failure and not some other cause
  • percent of people with heart failure who die suddenly from ventricular fibrillation
  • possible geographic differences in death rates
  • treatments patients were on up to and at the time of death
  • a library of data on the genetics of heart failure

Such a study or registry should have no funding from pharmaceutical companies.

Just before publishing this article, I checked the website of the Heart Failure Society of America.  The unnecessarily scary prognosis for heart failure is still there with not even an asterisk explaining how old and outdated the data are on which it is based.

My Journey with Heart Failure

I got to know something about heart failure the hard way, by having it.  I also happen to be a health journalist.  So when I got the stunning diagnosis in 2003, I began researching this condition that sounded so fatal.  Not only was my diagnosis overwhelming, but my first encounters with the health care system were dismal.  It took me three and a half months to find good care.   My story is worth sharing because it illustrates how important it can be for a patient to become knowledgeable about an illness and get involved in her own treatment plan.

Heart failure is a condition in which the heart can no longer perform well enough to get adequate blood and oxygen to the body.  With 6 million people living with heart failure in the United States alone, it is already a huge medical problem and will get bigger as baby boomers continue to hit their fifties and sixties.  Heart failure is a serious condition that can be fatal, but I would learn that it often can be managed with the right treatments.  My own research about heart failure changed my life.

In December 2002, I found myself getting fatigued and easily out of breath, with swollen ankles and abdomen. My asthma was normally under control, but I turned to my asthma specialist because of the shortness of breath.  He noticed my swollen ankles and said he didn’t think my problem was asthma.  I had begun to think the same thing.   He told me to see my internist right away who referred me to a cardiologist who gave me a diagnosis in words that roll off the tongue of a heart specialist but shock the patient who hears them:  “idiopathic dilated cardiomyopathy and biventricular congestive heart failure.”  It was those last two words that got my attention. 

I tried to get over my shock and digest the big words of the diagnosis,  searching the internet to make some sense of what had happened to me.  Cardiomyopathy, I learned, is a disease of the heart muscle, and dilated cardiomyopathy means that the heart is enlarged.  When a heart stretches, it is trying to work harder, but an enlarged heart actually functions more poorly.  The “idiopathic” in my diagnosis means doctors don’t know what caused my cardiomyopathy.  Half of the people who are told they have dilated cardiomyopathy have no known reason why it developed.  An echocardiogram that uses sound waves to show the heart beating on a monitor revealed that the amount of blood my heart pumped out to my body with each beat was only 15-20% instead of the normal 55 to 65%.  The left side of my heart was enlarged, the result of struggling to work harder.

My search to understand my condition led me to national treatment guidelines for heart failure developed by expert panels of the American College of Cardiology and the American Heart Association.  I recommend every person with heart failure and their loved ones read these guidelines.  To my dismay,  I saw that I was not on two of the basic medicines proven in clinical trials to treat heart failure and prolong life, an ACE inhibitor, and a beta-blocker.   I turned to a second cardiologist.   He insisted I have an angiogram in which a catheter is threaded through an artery in the groin up to the heart to see if the heart’s main arteries are blocked by fatty buildups that could prevent blood from getting through.  The question he wanted to answer did I have severe coronary artery disease that could cause a heart attack.  I didn’t agree to the angiogram immediately. I didn’t want to have this test because  I am extremely allergic to the dye used in the exam.  So he suggested I see a heart failure specialist, which I did. 

My Journey with Heart Failure

The specialist blew me away with his advice: I needed a heart transplant.  He ordered a stress echocardiogram, the same sound-wave test I had gotten before in a cardiology group practice center, but this time, it would show how my heart functioned when challenged by activity. However, the doctor running the test stopped before getting to the stress part.  “We found what we need to know,” he said.  The specialist would come in to talk to me.

I waited for about half an hour wondering what the heck.   The specialist arrived, sat down beside me, and drew a rough outline of my heart on a piece of paper, shading an area from the left side down and around the bottom.

 “This part of your heart is dead,” he said.  “You have either had one large heart attack or several small ones.”

I felt shocked to my bones because this was news to me and, next, oddly, I felt a deep embarrassment, almost shame.  I was a veteran health journalist and I had not known when I was having a heart attack?  How incompetent of me.

The specialist agreed that I must have an angiogram and said he could give it to me.  The test would take 30 minutes and would likely find several very occluded arteries, he said.  The second cardiologist I had seen, the one who referred me to the specialist, had told me he could do the angiogram in 20 minutes and held out more hope than the specialist did that he could perform some intervention during the angiogram to open the dangerously occluded arteries he expected to find.  I chose the 20-minute man, reluctantly agreeing to this dreaded test.  

I warned this doctor who would perform the angiogram that I am very allergic to the dye he would use in the test.  I had never had an angiogram, but the same iodine-based dye is used in CAT scans as a contrast medium, and years earlier during a CAT scan I suddenly couldn’t breathe.  The doctor assured me he could give me medicines before the procedure that would prevent any allergic reaction.  I took the medicines, the procedure began, and I thought this isn’t so bad, piece of cake.

Then a technician called out “Mary, how do you feel?”  

“I feel strange,” I said.  I had no pain or heaviness in my chest but felt a very abnormal and unsettling sensation in my heart.  “Very strange.” 

The next thing I knew the procedure was over and the doctor who administered my angiogram was hurrying out of the room.  “But I have questions to ask you,” I said to the back of the departing cardiologist.  “You won’t remember the answers,” he said over his shoulder.

As soon as the doctor left the procedure room, a technician who had helped with the test spoke up.  “We had to shock you,” she said.    

 I was dumbfounded.  “I didn’t feel anything.”

“It’s a good thing you didn’t.  It would have been very uncomfortable.” 

I looked down and saw three burn marks on my chest and later found one on my left ribs.  I had died on the exam table and been resuscitated with four electric shocks.  But we found the answer to the doctor’s question, which I would soon learn. 

My accidental worldly departure during the angiogram led the doctor who gave it to admit me for an overnight stay in the hospital for observation; but, although I asked to see him, he would not visit me. He turned my care over to the third cardiologist, the heart failure specialist.  I’m a big believer in all’s well that ends well and was glad to be alive. 

The specialist came to my room and told me what the angiogram had revealed:  my arteries were not at all blocked. I did not have coronary artery disease.  Therefore, reversing what he had told me days earlier, he said I could not have had a heart attack.  My face lit up with a huge smile. “That’s great!” I nearly shouted.

“Not really,” he said, no smile on his face.  “We could have fixed that.”

“So where do we go from here?”  I asked, feeling deflated that he did not share my joy.

“Heart transplant,” he responded.

None of the three cardiologists I had seen, including this one, had put me on the two major recommended medicines for heart failure, an ACE inhibitor, and a beta-blocker.  Yet, without seeing what these drugs could do to improve my own heart’s function, the specialist wanted to take my heart out of my body and sew in a new one.

No, no, no!  You’re jumping the gun, fellah. I was so surprised that after getting such good news from a test that nearly cost me my life he would want to proceed with the same plan as before the test.  I knew I had to get away from this doctor and look once again for good care.  It was now three months since my diagnosis of heart failure and the clock was ticking.  Without proper treatment, heart failure progresses and is deadly.  And one aspect of heart failure is that a person who has it can experience sudden death, dropping dead in an instant unless someone can get to them with a defibrillator to shock their heart back to work.

Frightened and very stressed, I asked myself, “Who do I trust?”  That’s not grammatically correct, but it was what my brain was asking.  The answer came to me:  a neurologist I had seen many years ago at Johns Hopkins Hospital.  I contacted him and explained my situation.  He contacted a colleague who was a senior cardiologist at Hopkins who told me the person to see was Edward Kasper, then director of the Heart Failure and Transplant Service.  Uh, oh, I thought, concerned about the “transplant” part of his title.  But a doctor I trusted was sending me here and I felt this was the right thing to do.

Dr. Kasper listened to my story and then said that he would not consider a heart transplant.  The first thing to do, he said, was to see how I did on an ACE inhibitor and a beta-blocker, along with some other medicines for heart failure.  And if those didn’t work well enough, there were other things to try such as implanted devices to help the heart work better.  A heart transplant was only a last resort.  I was scheduled to begin teaching a university writing course in a few weeks.  Would I be able to do that?  Yes, he said, he was sure I would be feeling much better soon.  I thought he seemed almost nonchalant about my situation, which, actually made me feel relieved.  He expected me to get better.  

I took my new medicines faithfully and began improving. My attitude toward heart failure changed as I relegated it to the background of my life and got back to teaching writing and co-editing a book.  We decided I should get a biventricular pacemaker to correct an electrical timing problem that made my left ventricle beat out of sync.  This problem called a left bundle branch block was not the cause of my heart failure.  But the uneven beating of my left ventricle caused my heart to work harder.  I recovered from heart failure.  I still have my own heart which returned to normal size and is pumping blood out at a very normal 65%.   I continue to take low doses of an ACE inhibitor and beta-blocker, avoid high-sodium foods, and exercise.   Since we don’t know what caused my cardiomyopathy which caused the heart failure, I want to do all I can to avoid its returning.  

My experience with heart failure and the health care system made me realize just how important we, the patients, can be in deciding a treatment plan.  The patient must truly be a partner with her doctor and not passively accept whatever any doctor says to do.  In order to be a strong partner,  you will need to educate yourself to become informed and then get involved in planning your treatment.

What turn might my life have taken if I had not done some research and continued looking for the best care?  Getting the gift of a new heart is a miraculous second chance for those people with severe heart failure who have not responded to medicines and devices to help their hearts work better.  But a heart transplant also means a lifetime of taking many medications, having some serious side effects, and getting tested repeatedly.  Let’s be sure those who get this precious gift need it.  I, thankfully, did not.

The HeartSense Helpathon

Helping Each Other Have Good Health

The holidays and cold weather are upon us and with them come stress, overeating, bad food choices, and less incentive to exercise.  So HeartSense is fighting back.  Today we begin a helpathon, a series of blog posts, some by guest writers, some by me, on ways we can help each other be fit and prevent heart disease and other illnesses.  In the coming weeks we will discuss different types of exercise, eating healthy foods, losing weight, and throwing away stress. A couple of friends I talked with on Twitter prompted me to begin this series.  One asked my advice on how to lose the extra weight she has put on.  Another shared that he has felt overwhelmed and tired this month. In the midst of all our commitments to career, the holidays, family, friends, and special projects, we need to make time for ourselves.

Do you have tips you can share with the rest of us on exercising, eating right, busting stress, losing weight, staying serene and happy and healthy?  Please let us know in the comments below and in weeks to come.  I would love to hear from you. 

We who have experienced heart problems have much in common with our friends who have met the challenges of cancer. We all need to eat a healthy diet and exercise regularly. Jody Schoger, a well-known cancer advocacy blogger and communications consultant with a passion for cycling and walking kicks off our Helpathon with the first of our posts on exercise.  Don’t be scared off by the distances and time Jody puts into cycling and walking.  Start the exercise habit and do it regularly, even for 20 to 30 minutes a day.  I think you’ll find the joy she gets from these great exercises.

Jody Schoger turned to exercise to help work her way out of two health issues as she explains below in her delightful account of becoming an accidental athlete.  She is now cancer-free after receiving a diagnosis of stage IIIB breast cancer in 1998 and she is a constant advocate for other survivors as a member of the Breast Health Collaborative of Texas, running a cancer support group, and helping plan Life Beyond Cancer’s annual survivorship conference. She explores healthy survivorship and women’s cancer issues at her blog Women With Cancer, http://womenwcancer.blogspot.com/.

The Accidental Athlete

Thirty years ago if someone told me I’d be cycling 170 miles over the course of two days I would have said:  Why? 

Why in the world would anyone want to subject themselves to something like that?

Today, at 57, my answer is “because I can.”  I am fit enough, in body and spirit, that I can cycle one mile after another in Texas where I live, up long, graded peaks in Colorado, or across the rolling hills of Iowa.  This is the measure of good health, a blessing I’ve had to work hard to first achieve and then, maintain.

By nature, I’m a sloughed.  I’m not at all coordinated, nor do I have any particular athletic gifts.  Let me be honest.  I don’t have any athletic gifts.  My greatest asset is the ability to put one foot in front of the other.  I can walk, I can ride a bike and I can usually have a big laugh at myself.   Given my preferences, I’d squirrel away the winter months under a down comforter with a pile of books, quilt projects, and some Pepperidge Farm Milano cookies. 

But things change.  We grow up, we grow a little wiser.  With that comes understanding of who we are, the gifts we have, and how to make the best of them.  In my case, two different health conditions moved me forward – chronic depression and cancer.  I’ve been knee-deep in both.  The path through clinical depression following the death of my mother when I was in my early 30’s led to permanent changes that helped me cope with breast cancer a decade later.  My deep understanding of cancer’s emotional signature evolved from family history, beginning with the death of a beloved uncle from Hodgkin’s disease.  Both of my parents died of cancer before the age of 60.  My breast cancer appeared in 1998 and then my husband was diagnosed with malignant melanoma in 2001 and again in 2004. At some point in our lives, we need to re-learn how to take care of ourselves in the basic, essential ways, from healthy eating to a deeper look at how we think about and react to stress.  Therapy helps you haul off the real garbage and discover more creative ways to deal with daily debris. 

Helping Each Other Have Good Health

That is how I recovered from depression and how I recovered from cancer.  I walked my way through, and out of it.  The most empowering walk I’ve ever taken was the day I started chemotherapy.  My port had been installed.  I tucked the pump that would dole out adriamycin and cytoxin for three days into my overalls and set out for a walk.  Because I could.  It seemed bizarre, funny, and weird to me that I was out as plain as day, going about my business, and I was a cancer patient.  The thoughts didn’t all add up but that didn’t really matter.  The walk did.

I started a new garden.  I made a bucket list and started quilting, something I always wanted to do. I later switched from walking to cycling to cope with the side effects of a new treatment.  Cycling, since it is a more intense form of exercise, was the best thing I could do to combat the side effects of tamoxifen – severe hot flashes, depression, and thinking difficulties.

Following treatment, I started training for the Avon Three-Day, which is now run by Komen and less rigorous than it used to be.  In 2001 it was a sixty-mile walk, twenty miles a day for three consecutive days.  What a blast!  I followed their training plan, which was excellent. When I’m training for a cycling event I like to cycle four times a week (Mon, Wed., Fri., and Saturday) and walk on alternate days.  

The beauty of walking is you can do so any time of day, anywhere.  I usually take the dog out for at least an hour.  Our minimum walk is probably thirty minutes.  Cycling is more time-consuming but provides greater aerobic benefits.  My rides range from 20 – 45 miles, so the time spent ranges from 90 minutes to four hours.  You have to factor in traffic, stoplights, and pit stops.  On the weekends if I’m training for a specific event, I’ll travel to another location away from city traffic for greater stretches of highway.  In March my husband and I are traveling with a group from The Woodlands to cycle the wonderful expanses surrounding Big Bend National Park.  The weather should be perfect.

The key is to find an activity that you enjoy, know you’ll maintain, and works for your schedule. 

If you want to do the first best thing for your health, take a small step forward. Take a walk. Take a longer walk the next day. You’ll be amazed by the feel of fresh air pumping through your lungs, then suddenly realize that you’ve walked five miles and lost track of time.  Once this happens – and it will — if you keep taking those small steps – it is impossible to go back. 

 And please, take it from this accidental athlete, you won’t want to.