Questioning Your Doctor is Ok
I received a good question(s) from a reader: In your “Changing the culture” posting there is the comment: “Patients seeking medical treatment should not assume a prescribed therapy is beneficial just because a doctor says it is.”… How then does a patient evaluate a proposed treatment in a way that they aren’t thwarting a doctor from performing what may be a needed course of treatment? … Other writing I’ve seen describes doctors being too accommodative to patients reluctance at a treatment. A bad feedback loop if there was one. Patients sho...
Source: Dr John M - November 5, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Grander Lessons from a Failure of Robotic Surgery
This week on my podcast, I deviated briefly from cardiology to discuss a shocking and sad study highlighting the vital nature of doing randomized controlled trials in the practice of medicine. The reason I mentioned a trial comparing 2 types of hysterectomy (removal of the uterus) in women with early stage cervical cancer was not to opine on matters of cancer, but because the tragic story shows the harm doctors can do if we incorporate therapies without proper testing. The New England Journal of Medicine published a trial in which women with early cervical cancer were randomized to two types of hysterectomy: One...
Source: Dr John M - November 4, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Thoughts on the Apple Watch
Apple products are cool. I love them. But (even) Apple will struggle delivering health. Making healthy people healthier is fraught with problems. At the core of this issue are the many snags of screening people for disease. Here are 600 words I wrote for Medium: I’m a Heart Doctor. Here’s Why I’m Wary of the New Apple Watch Here are my thoughts in the Wall Street Journal:  https://www.wsj.com/articles/apple-adds-heart-monitoring-fall-detection-features-to-its-watch-1536792518 And the Washington Post:  https://www.washingtonpost.com/technology/2018/09/14/what-cardiologists-think-about-apple-...
Source: Dr John M - September 18, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

On Our Words
During a recent office visit an older women recited to me what I had said to her over a decade ago on the day she came to the hospital. The detail of her memory gave me pause. I could not remember the scenario but she said that my words had become part of her family’s stories. That is a big deal. And I hear this often. Illness induces a heightened sense of being. The ill and their families remember a lot about their caregivers, especially our words. Think about your own encounters when you have been ill enough to be in a hospital. I surely remember the interactions–both the good and the not-so-good. The dauntin...
Source: Dr John M - August 12, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

How dangerous are NSAIDs in patients with AF?
One of the most commonly asked questions in the office is the treatment of arthritis pain. This comes up because of the concern over taking NSAIDs (non steroidal anti-inflammatory drugs) in patients who are on anticoagulants (such as warfarin, or dabigatran, rivaroxaban, apixaban). My views on this matter have changed. But first, I want to mention a study published in JACC that addressed the issue of NSAID use in pts with AF who take an anticoagulant. This was a sub-analysis of the RELY trial, which pitted dabigatran vs warfarin. Remember, in the original RELY trial, the 150mg dose of dabigatran did better than warfarin at...
Source: Dr John M - July 13, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Cardiology Podcast Every Friday
My editors at Medscape warned me years ago that many people, especially younger ones, read a lot less. This saddened me because I’ve spent a great deal of time learning to write. One of America’s most accomplished writers, Malcolm Gladwell, began his podcast because he worried about not reaching younger people. Each week, I spend a great deal of time putting together thoughts on the top 4-5 cardiology stories of the week. Most of the ‘stories’ are studies, but not always. I have been doing this podcast for a couple of years now, but haven’t promoted it because I was not sure it would...
Source: Dr John M - June 25, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

Finding Truth: How Much Do We Need Experts?
I am planning a column on the role of experts in translating medical evidence. Evidence is important because it’s how doctors know they are helping not harming people. It’s hardly news that the new (digital) democracy of information has changed the rules of influence in Medicine. In the days of old, academic doctors generated, analyzed and translated evidence. We called these people key opinion leaders (KOLs). To become a KOL, you stayed in academics, published lots of studies, and crucially, you were not too critical of prevailing views. If you did that, you could get invited to speak at meetings, write editor...
Source: Dr John M - June 10, 2018 Category: Cardiology Authors: Dr John Source Type: blogs

A Corrosive Force in Medical Care
It comes in a large white envelope each month. It’s marked confidential. When I hold it up to the light, I can see through the envelope. I can’t see the details, but the colored graphs give it away. It’s my monthly productivity report. Most employed doctors get these graphs. These “dashboards” of value include your own productivity as well as many graphs on how you stack up with other doctors across the country. It shows your employer if you are a hard worker. The measure of productivity we use is called the relative value unit or RVU. Doing an ablation, cath, stent or valve replacement earns ...
Source: Dr John M - October 17, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Left Atrial Appendage Closure Does Not Prevent Strokes
Our cautionary left atrial appendage occlusion (Watchman) editorial is now published in a prominent medical journal, called Heart Rhythm. My co-authors are Drs. Andrew Foy and Gerald Naccarelli from Penn State. It was a peer-reviewed version of my previous theheart.org | Medscape Cardiology column. Watchman and other similar devices are plugs that occlude the left atrial appendage in an attempt to reduce the odds of stroke in patients with atrial fibrillation. It was a nice idea but it did NOT work. The link is here> Percutaneous Left Atrial Appendage Closure is Not Ready for Routine Clinical Use In the allott...
Source: Dr John M - October 12, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

The Nobel in Economics and Medicine?
Once again, the Nobel prize for economics–not science and medicine–has immense influence on the practice of medicine. Every day, in fact. This year, Richard Thaler, a behavioral economist at the University of Chicago, won for his work on human biases and temptations. The famous writer Michael Lewis (Moneyball) has a nice essay on Thaler’s work here. Along with Kahneman and Tvresky, the work of behavioral psychologists and economists directly relates to clinical medicine because it describes human decision making. Thaler made lists of irrational decisions. For example, we often make choices that don’...
Source: Dr John M - October 11, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

We get what we tolerate…
Richard Fries, a cycling-safety advocate in Boston, uses the phrase we get what we tolerate to describe the dire situation of drivers killing cyclists and pedestrians. Many humans die from these collisions because we tolerate it. An inattentive driver kills a person on a bike; then nothing changes. The phrase applies well to other dubious policies in the US. Before a gunman slaughtered 60 innocent people with a machine gun in Las Vegas Sunday night, I had planned to use the we get what we tolerate phrase in health care policy. I was going to argue that US citizens pay too much for medication, navigate a morass of bureaucra...
Source: Dr John M - October 3, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Medicare for All?
Maybe it’s sampling error, but I am seeing an increasing number of people who are being financially crushed by the US healthcare system. One recent patient had a real rhythm problem, one that could or should be fixed with a procedure. But he could not afford it. He had insurance but could not afford to pay his allotted portion. I felt helpless–because although I could agree to do it for free, the hospital charges would be over $100,000. Another patient suffers from stress-induced arrhythmia because her brother–whom she is close to– is hospitalized and she can’t be with him at the bedside. Why?...
Source: Dr John M - October 2, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Young people, stroke and a hole in the heart (PFO)
(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.)  *** We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may be the worst outcome in all of medicine. That’s because stroke can permanently remove basic functions of being human, things such as speech, thought, personality, movement, swallowing, and many others. Stroke is not supposed to happen in young people. But sometimes it does. And in some ...
Source: Dr John M - September 28, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Inflammation, Ablation, Fats, LDL, etc .. My review of ESC 2017
The European Cardiology Congress, ESC as it is called, has grown into the largest medical meeting in the world. This year, about 38,000 attendees came to Barcelona. I was busy. Here is an update of the big stories: Inflammation:  Experts agree that inflammation associates with heart disease. One of the keys to showing inflammation causes heart disease would be to show a reduction of cardiac events with a drug that blocks inflammation. The CANTOS trial tested the ability of a drug called canukinumab, which is already approved for rare causes of inflammatory diseases, to reduce cardiac events. Canukinumab exerts its ant...
Source: Dr John M - September 6, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Big lessons from my error
I was furiously tapping on the computer when he asked: “Doc, what happens if I don’t have the procedure you are recommending?” Glee spread through my body. I grinned and nearly jumped up from the stool to hug him. I enthusiastically answered. Few patients ask this vital question. I tweeted about the encounter: An older pt asked me: "what happens if I don't have this procedure" / I nearly jumped up to hug him!
Source: Dr John M - July 9, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

New Data Increase Caution on Left Atrial Appendage Occlusion
This study took data from more than 61 centers across the world. The details of the studies are included in my column: Real-World Data on Left Atrial Appendage Closure Does Not Reassure The gist of these studies was that clots on the device are not rare; potent clot-protecting drugs are likely required to prevent clots (at least for a period of weeks-months); the presence of clots increase the risk of stroke, and finally, major procedural complications are in the range of 4%. These findings bolster my already cautions approach to this procedure. Remember, left atrial appendage closure is a preventive procedure. Its be...
Source: Dr John M - June 27, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

2017 European Heart Rhythm Meeting Update
I attended the European Heart Rhythm Association meeting last week in Vienna. Here is an update on the stories I found most interesting–the ones I wrote about on the heart.org | Medscape Cardiology. Brain Lesions after AF ablation:  Electrophysiologists do not talk much about the small brain lesions that appear after procedures in the left atrium. MRI brain scans done before and after procedures such as AF ablation reveal the presence of “white sports” in a not insignificant number of patients. These lesions usually do not cause symptoms and mostly resolve over time. The cause of the brain lesions is...
Source: Dr John M - June 24, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Uplifting book — The Rosie Project
Good book alert: This holiday weekend I read The Rosie Project by Graeme Simsion. Simsion sets the story of a nutty genetics professor in Melbourne, Australia. The book is sweet, funny and uplifting. It’s a perfect escape from the mean-spiritedness of today’s news cycle. An Australian electrophysiologist who I had dinner with during the recent HRS meeting recommended the book to me. The sequel is called the Rosie Effect. I’ll read that one next weekend. I hope the Rosie Project gets made into a movie. It’s that good. JMM Related posts: A doctor’s review of The Book Thief… A vacation b...
Source: Dr John M - May 30, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

How important are short AF episodes?
A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes. Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF). SCAF is AF on a monitor that is often not felt by the patient. Doctors are seeing more of this because patients are increasingly being monitored–with pacemakers, ICDs, long-term event recorders and implantable cardiac monitors. These devices can pick up minute-long or hour-long AF episodes. In the past, AF could only be picked up whe...
Source: Dr John M - May 25, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Medicine at its best is a team sport
Patient safety, quality, and value are new buzzwords in healthcare. No doubt, these are all laudable goals. The problem is that true quality care cannot be put on a spreadsheet and publicly reported. It just can’t. Never. Why? My friend Dr. Wes Fisher explains in this beautiful post called “Wingman:” There is talk of quality in health care. There is talk of safety. Millions upon millions of dollars are spent on “quality and safety” in health care each year. After all, without “quality” and “safety,” how can you have “value?” Business people now call quality ...
Source: Dr John M - May 5, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

The Future of Predicting Heart Disease May Be In Your Genes
Three cases first: A young woman I met recently (outside the hospital) told me her Dad died suddenly a couple of years ago. He was fine, then he was stone cold dead. The wife went outside for a minute and came back to find her husband dead in the chair. There were no warnings. No chest pains, no breathing problems, and no real diseases, except well-controlled high blood pressure. A middle-aged man came to see me in the office because his brother died suddenly while jogging. The patient wanted to know his risk of heart disease and what he could do to prevent premature death. Both my patient and his dead brother were in dece...
Source: Dr John M - May 5, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

New Policy on Comments
I am changing my policy on comments. In the past, if you had one approved comment then all of your subsequent comments would post without moderation. I changed that. Now I will moderate all comments. That means there may be a delay. Another change is that I am not going to allow personal medical anecdotes. The reason is that heart rhythm diseases, especially atrial fibrillation, affect people in diverse ways. I counsel patients never to compare their problem with their friends’ problem. Therapy for AF has to be tailored to the individual. What’s right for you could be completely wrong for your buddy. I will als...
Source: Dr John M - May 3, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Beta-blockers, Statins, AF, and the Nocebo Effect
Our brains can easily fool us. No experienced doctor would deny the power of the placebo effect. Today I want to discuss the nocebo effect, which occurs when negative expectations of something causes it to have a more negative effect than it otherwise would. Drugs can exert a strong nocebo effect. If your brain thinks you will have a side effect, you may actually get that effect. Nocebo brain trickery is relevant to statins. That’s why I used this wording in my last post: (Note the italics) The actual frequency of muscle symptoms is hotly debated. Randomized controlled trials (in which patients don’t know wheth...
Source: Dr John M - May 2, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Statins, Like All Medicines, Are Neither Good Nor Bad
We have to talk about drugs. No, not illicit drugs, but medications used by doctors and patients. Plaintiff attorneys run ads on TV that fool people into thinking certain meds are bad. The current one I deal with is the clot-blocking drug rivaroxaban (Xarelto.) Before that, it was dabigatran (Pradaxa). If, or when, the makers of rivaroxaban settle a class action suit, you can bet apixaban (Eliquis) will be next. These ads are a problem because they use fear persuasion (see Scott Adams’ blog), and because they can induce patients to stop taking or not starting a beneficial medicine.  Lots of other medications suf...
Source: Dr John M - April 30, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

On the intolerance of ideas, and liberty …
I like thinking and learning. Birthdays surely make one slower on the bike, but birthdays, it seems, do not have the same drag on the brain. For me, birthdays have increased my appreciation of liberty. In the Constitution of Liberty, Hayek defines it as the absence of coercion. Such is a beautiful definition. Don’t coerce me to wear a bike helmet when I ride my Dutch bike to work. Don’t coerce an 85 year-old with life-limiting disease to stop smoking. And above all, don’t coerce people-without-complaints to have unproven tests in the name of health. Piotr Skrabanek wrote in the Death of Humane Medicine th...
Source: Dr John M - April 22, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Trust and Medical Science
Concerned citizens will march this weekend to defend science. Standing up for science is a worthy cause. Look at what medical science has accomplished in recent times: serious diseases, HIV, heart attack, many forms of cancer, have been tamed by the advance of science. We need more not less science. It’s nuts to cut funding to the NIH. But science, especially medical science, has a trust problem. My editor at theheart.org | Medscape Cardiology asked me to write a piece exploring the broken trust. The title of the essay is: Want More Trust in Medical Science? Embrace Uncertainty and Cut the Hype The essay has three se...
Source: Dr John M - April 21, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Should You Take an Anticoagulant for AF? — Applying the 4 questions
This study of nearly 1000 elderly AF patients found that the risk of major bleeding was not different between aspirin and warfarin. I, therefore, side more with the European guidelines. Aspirin confers significant bleeding with either no or minimal stroke prevention effects. 4. What happens if I do nothing? This is easy. For the patients above, who have two risk factors, the green faces depict what happens if they do nothing. The most likely scenario is that they will not have a stroke (approx 97%) and not have a bleed (98%). The North American AF treatment guidelines grade the strength of their recommendations. They give ...
Source: Dr John M - April 18, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Four Crucial Questions To Ask Your Doctor
I am seeing an increasing number of patients who did not know they had a choice about taking a medicine or having a procedure. Why did you have that heart cath? A: My doctor said I should. Why are you on that medicine? A: My doctor prescribed it. It’s time we re-review the basic four questions you should ask your doctor. I wrote about this in April of 2015 for WebMD. Here is 2017 update: 1. What are the odds this test/medicine will benefit me? Medical decisions are like gambles. Benefit is not guaranteed. In my field, catheter ablation of supraventricular tachycardia (SVT) has a success rate approaching 99%, but th...
Source: Dr John M - April 17, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Small Clots on Replacement Aortic Valves Deserve Attention
This study, like all good studies, raises many questions for future study. I look forward to learning more about this issue. This discovery also highlights the challenge of making progress in cardiology. It’s hard work. I may be wrong, but it’s likely we are in a period of slow incremental progress. JMM Related posts: Possible clot issue on replacement aortic valves slows momentum of TAVR Why shouldn’t Cardiology lead the way in shared decsion-making? The top three Cardiology stories of 2010…and three predictions for 2011 (Source: Dr John M)
Source: Dr John M - April 6, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Fake Atrial Fibrillation — A Growing Patient-Safety Issue
Fake atrial fibrillation (AF) is a growing problem. This is when the computer-reading on an ECG calls the rhythm AF, but it is not AF. When the doctor does not recognize the faulty read, the patient is misdiagnosed. Here are three pictures from the last month. (I have a stack of these.) Notice the computer-read at the top. Fake AF — This is sinus rhythm with periods of variable AV block Fake AF — This is sinus rhythm with PVCS Fake AF — This is sinus tachy The weird thing about misdiagnosed AF or fake AF is that it’s getting worse as our technology gets better. I think I know why. In the really old ...
Source: Dr John M - March 29, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Vitamin C and Sepsis: Resist the Urge to be Duped.
My Facebook feed has been buzzing with news of a breakthrough in the treatment of sepsis–a deadly condition caused by bacterial infection. Do not be fooled. Please. Resist the urge to be duped. A recent study published in the prestigious journal Chest concluded that a combination of high-dose vitamin C, anti-inflammatory corticosteroids and thiamine given to patients with sepsis “may prove to be effective.” NPR covered the story — the headline exuded hope: Doctor Turns Up Possible Treatment For Deadly Sepsis. The excitement surrounding this preliminary and inconclusive report is instructive on how o...
Source: Dr John M - March 26, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Divergent Views of Healthcare Reform
I want to point you to a rebuttal of my last post on healthcare reform. Dr. Rocky Bilhartz is a thoughtful cardiologist and an excellent writer. In a blog post titled Divergent Visions, he offers a completely different view of right care. Go read it. So what if you don’t agree. Christopher Hitchens said in Letters to a Young Contrarian that “time spent arguing is, oddly enough, almost never wasted.” Dr. B makes good points. I was most drawn to his take that central planning mandates more bureaucracy. Yeah, I guess that is true. Two things we can all agree on: health care policy is damn hard, and we need m...
Source: Dr John M - March 20, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Fight On Healthcare Reform Misses Core Problems
Politicians and policy makers are fighting over new health reform proposals. This debate misses the core problems in US healthcare. Look at this graph from the Our World In Data website: From Our World In Data website It shows that Americans pay too much for lousy health outcomes. Fixing the problem on that graph should be the focus of reform. I am no policy wonk but here are some obvious problems and potential solutions with our delivery system: I – Profit-driven healthcare must go. As long as health is big business, it will be impossible to control costs. Fee-for-service (FFS) payment models favor doing more things...
Source: Dr John M - March 12, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

AF Ablation is Overused in the US
Conclusion: AF ablation can be useful for highly selected and thoroughly educated patients. (Adverbs in that sentence used intentionally.) I feel confident that I have helped people with this procedure–even when it takes multiple procedures. I do AF ablation every week. But I do it with careful vetting, lots of patient education and an unease that history may kick me in the butt. Cardiology leadership had better wake up. I see us heading in the same direction we went with stents and ICDs. Thus far, our attempts at policing ourselves look dubious. Soon others will police for us. JMM Related posts: AF ablation still h...
Source: Dr John M - March 10, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Top-ten 2017 Update on Atrial Fibrillation News
I recently served on the faculty of the tenth annual Western AF Symposium in Park City, Utah. Dr. Nassir Marrouche of the University of Utah has grown Western AF into a huge gathering of global experts in atrial fibrillation. During the intense two-day meeting, I took notes and put together a post of top-ten highlights. The title of the post and link to it on theHeart.org are below: 10 Highlights from the 10th Annual Western AF Symposium The 900-word column includes short-writing notes on… Big themes in AF — this includes thoughts on prevention of AF, the fourth pillar of AF care, and the ceiling of AF ablati...
Source: Dr John M - March 6, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

My latest on the NOAC drugs for AFib
Three weeks ago I wrote about the growing dominance of the new oral anticoagulant (NOAC) drugs for stroke prevention in patients with atrial fibrillation. (Another common name for these drugs is direct acting oral anticoagulants or DOACs.) The post generated many comments–some privately and some on the blog. Your responses induced me to think a bit more about the warfarin-substitute drugs. Thanks for that. More thinking led to my most recent post on theHeart.org, which is titled: NOACs Are Favored Over Warfarin: I’m (Almost) Okay With That In this column, which is written for a medical audience, I start by noti...
Source: Dr John M - March 3, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Changing the mind of a doctor — Not an easy matter
Changing one’s mind is hard. Changing the mind of doctors is even harder. Doctors are supposed to be the medical experts. Often we are. But sometimes I wonder whether our attachments to old ideas gets in the way of seeing the obvious. I am reading Michael Lewis’s book The Undoing Project. Learning how Kahneman and Tversky made their discoveries gets me thinking about how our minds trick us into missing important clues. The information age levels the degree of expertise. Of course an internet connection and a smartphone does not transform people into skilled and experienced clinicians. What connectivity does do,...
Source: Dr John M - February 23, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

2017 update on the changing use of “blood thinners” for AF
Times have changed in the treatment of patients with atrial fibrillation (AF). First some background: The first of the four pillars of AF care is stroke prevention. The only proven means to protect patients with AF from stroke is use of drugs that block clotting factors–or anticoagulants. Some people call these drugs blood thinners. I don’t. That’s because they don’t thin the blood. They inhibit proteins in the blood that form clots; viscosity of the blood is not affected. Blockade of clotting factors works because static blood in the fibrillating (non-contractile) atria increases the probability of...
Source: Dr John M - February 13, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

Hacked By GeNErAL
Related posts: With vaccines…Is there no middle ground, no room for questions? The why and how of public distrust of vaccines…Surely, questions worth asking The “happiness quotient” and healthcare reform and Tiger… (Source: Dr John M)
Source: Dr John M - February 2, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

The Letter as Therapy …
Somewhere there is a quote about the therapeutic benefits of writing a letter. The editors of Medscape recently asked me to write a note for medical students. I am glad they did. It helped me. Reflecting on what we electrophysiologists do for people boosted my morale. It made me think about our core mission. The incessant bloat of administrative nonsense often overshadows our real job–caring for people. Admin-speak sounds less and less like English. You should know morale among doctors has never been lower. I enjoy a great setup at work, but even my morale dips occasionally–almost always it’s due to the n...
Source: Dr John M - February 2, 2017 Category: Cardiology Authors: Dr John Source Type: blogs

I am changing…
Seven years have passed since I started this blog. In that time… I have learned some basics about writing. (I almost wrote, “I have learned to write,” which would have been foolish, since, writing-wise, I have plenty to learn.) I have learned to stay upright on the bicycle. Concussions made me understand that the joys of criterium and cross racing don’t outweigh their risks. I still ride nearly every day; I’m a pretty fast bike commuter now. And I’ve shifted my endurance-sport goals to running, which is a far safer sport for the brain. My goal is to run 10k in less than 40 minutes. The ...
Source: Dr John M - December 17, 2016 Category: Cardiology Authors: Dr John Source Type: blogs

Graduation Day… From Blogger to Author
Hi all, I have graduated from blogger to author. My first book is now available. It’s called the Haywire Heart. I co-wrote it with Chris Case and Lennard Zinn. VeloPress is the publisher. The Haywire Heart by Lennard Zinn, Dr. John Mandrola, and Chris Case The book deals with one of my favorite themes: heart conditions in endurance athletes. Although exercise is a key component of health, excess exercise can lead to heart problems. In nine chapters and about 300 pages, the Haywire Heart attempts to be a comprehensive review of the topic. Chris and Lennard are terrific writers. All three of us are endurance athletes. ...
Source: Dr John M - December 14, 2016 Category: Cardiology Authors: Dr John Source Type: blogs

Say No to Watchman
Cardiology is on the brink of making a big mistake. We have embraced a new procedure called left atrial appendage isolation. You may be seeing the ads for a device called Watchman. Like this one> The appendage-closure idea was a good one: during atrial fibrillation (AF), blood can pool in the left atrial appendage, and this promotes clot formation. (The LA appendage has many nooks and crannies.) So… if we could put a device in there, see image, this would block clots from getting out and causing stroke.  Also, once the device has been in for months, the body walls it off and the patient can stop the anticoa...
Source: Dr John M - November 10, 2016 Category: Cardiology Authors: Dr John Source Type: blogs

Give Local Louisville — Have A Heart
Folks — I’ve written more than 1000 essays on this blog over the past 6 years. I have no ads. I don’t write to make money. (I have a good job.) I don’t ask for anything on this site. You have been supportive in your comments and emails. Thank you. This week, in Louisville, is a campaign called Give Local Louisville. It’s a one-day (tomorrow — September 15) giving campaign. My ask is that you consider donating to Have A Heart Foundation. Have A Heart is a non-profit I’ve been volunteering at over the past year. We deliver free cardiac care to those in Louisville who cannot afford it...
Source: Dr John M - September 13, 2016 Category: Cardiology Authors: Dr John Source Type: blogs

Are women with AF being under-treated with ablation?
This post is an introduction to commentary I made recently over at theHeart.org on Medscape. Gender features in the discussion, but there are lessons for men and women with AF. *** A large study from a group of Stanford researchers made three big observations on AF ablation: Women, compared with men, presented for first AF ablation at an older age and with more risk factors (higher CHADSVASC score.) At 30 days after the ablation, women compared with men, suffered from more complications. At one year after the ablation, women compared with men, had more re-hospitalizations but fewer cardioversions and repeat AF ablation. ...
Source: Dr John M - August 15, 2016 Category: Cardiology Authors: Dr John Source Type: blogs