Can a song be anti-inflammatory?
I do not speak nor understand French. (I wish I did.) But it is not necessary to enjoy this song. I think it is as close to anti-inflammatory as a tune can get.
I discovered this beautiful voice from a blog–a cycling blog at that.
I have written often that success in social media comes when you offer value.
The In The Crosshairs cyclocross blog does this. The #Svenness (Sven Nys) and #LikeAVos (Marianne Vos) videos are montages of words, astute observations, compelling music and bike racing action. And they are free.
Here is perhaps the best 15-minute cyclocross video ever made. You need the sound. And watch it unti...
Source: Dr John M - February 9, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The medical decision as a gamble
The medical decision–to have a screening mammogram, to take warfarin, to undergo a catheter ablation–is, at its core, a gamble. We pit the treasure of the win (benefit) against the pain of the loss (harm).
In times past, medical gambles were easier. You took the antibiotic or you lost your leg. Most medical decisions today are hardly that clear. We say they are preference-sensitive.
Many factors determine these preferences.
The digital revolution notwithstanding, what a patient prefers turns substantially on how the decision is framed. (Wear this vest or you could die.) How the decision is framed depends on the...
Source: Dr John M - February 2, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
My Concussion Story…
Concussions are serious. This I know from personal experience. My concussions changed my view of life. Thumps on the head are like that.
My first concussion happened in a cyclocross race. The track had 2 grassy mounds, both about 3-feet high and in close succession. You approached them at speed. Physics dictate that going over mounds on a bike pushes your body forward. (Think front wheelie.) I had done them numerous times in practice. I thought to myself, John, you had better keep your weight back going over these things during the race.
The thing about thinking during a bike race is that it is not so easy. So I forgot abo...
Source: Dr John M - February 1, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The power of the specialist physician — and stewardship
My latest column over at theHeart.org discusses the disordered balance of power in the doctor-patient relationship.
As most of you know, I harbor strong biases about the quality of medical decisions, especially in the elderly. Attached. Yes, I am attached to the issue of decision quality. Nearly all of electrophysiology, and much of cardiology, involves preference-sensitive decisions. This means doctors are called to align treatments with the goals of the patient. We hold great power; we must use it justly and wisely.
My latest essay arose from an unusual source. The prominent medical journal Circulation Outcomes publishes...
Source: Dr John M - January 30, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Antibiotics and the heart — Think hard
My colleague and friend Dr. Melissa Walton-Shirley wrote a nice review article on antibiotics and cardiac issues over at theHeart.org.
It is worth a look. MWS is a heck of writer. Although she is writing to doctors, the issues she raises about antibiotics are relevant to everyone.
I recently reviewed a case in which a serious cardiac rhythm problem occurred in a patient given multiple medications, including an antibiotic.
In our current culture of pills-for-everything, even, “pre-diseases,” drug interactions and adverse effects have never been more important.
Neither patients nor doctors can know all these...
Source: Dr John M - January 27, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Ten things I recently learned (and sort of knew) about social media
I am prepping for an upcoming talk on using social medial to improve health care delivery. The thing about these sorts of lectures is that canned talks have no shelf life. What does in the digital era?
It is strange that I get asked to talk with other doctors about digital media. I am hardly an expert. I have zero background in computers. I do not know HTML. I could not explain either side of the net neutrality argument. And, although I have a good number of followers on Twitter, it is nothing compared to real public figures.
As I tell my family, all I have is me. “It is I, John.”
And this may be the key feature. At le...
Source: Dr John M - January 25, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Is healthcare careful? Is it kind?
Research now indicates 50% of middle–aged people live with one chronic disease. Translation: half of middle-aged people are not healthy. (You don’t need a reference there. Just walk out into the world and look around.)
This new normal creates a challenge for caregivers. How will we care for the onslaught of chronic disease?
Surely not with the current model of care. What happens now is that doctors treat diseases–and even “pre-diseases.” We once had diabetes and hypertension and heart failure. We now have pre-diabetes, pre-hypertension and Stage A (no symptoms and no findings) heart failure.
G...
Source: Dr John M - January 24, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Dr. Bernard Lown and the first rule of doctoring
I knock, then enter the exam room.
“Hi. My name is John Mandrola.” (Maybe it is my age but I am moving away from calling myself Doctor Mandrola.)
“I am a heart rhythm specialist. I have looked at your chart so I know a little about your medical history.”
“Can you tell me how you are? What complaints bring you to see me?”
What follows is increasingly (and painfully) common:
“Doc…I feel good…I have no complaints. The doctors say…”
At this point, I reflexly make a questioning face. The patient sees it. He repeats: “No, really, doc, I am okay. I walk three...
Source: Dr John M - January 18, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Medicine, lifestyle disease and the pool-safety post
What follows is an introduction to my most recent post on theHeart.org | Medscape Cardiology. It was published yesterday. Many of the comments are excellent. The link is at the end of this post.
You might wonder what pool-safety has to do with lifestyle disease. Here is how they relate:
I am currently reading an excellent book by social media guru Dr. Bryan Vartabedian. In The Public Physician, Dr. V helps physicians understand the intersection of social media and medicine. One of the chapters is titled: We don’t need another pool-safety post. “Every summer,” Dr V writes, “pediatricians and childre...
Source: Dr John M - January 14, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Does exercise have to look a certain way? Can Yoga deliver heart health?
One of my good friends, a guru of sorts, once told me during a ride that things change. He was 50 years-old at the time and the change he was referring to was cycling abilities and priorities. At the time, I was in the peak of my cycling prowess; we were part of strong masters team and things were rolling beautifully. Ah…you are strong, I said. We can keep this up for many more years. He shook his head. “You will see, John.”
Now that I have reached that milestone, I realize the wisdom. Things do change. Bodies change. Priorities change. Pegs on which people hang their self-esteem change.
One thing that re...
Source: Dr John M - January 9, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
A scary new medical intervention…
This is a story about a new medical intervention. It’s an important one because it affects all doctors—and therefore all patients.
1. It’s expensive. Of course.
2. There is no credible evidence that it works. But its marketing is aggressive.
3. The overwhelming majority of physicians disapprove of it.
4. Cheaper alternatives exist.
5. The company that makes the treatment is rich and influential.
It’s hard to believe something like this could be approved in the United States. But not only is this new intervention approved; it is being forced on physicians—and patients—by eminence-based fiat.
The treatment is the...
Source: Dr John M - January 8, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Will wearables and other gadgets make us healthier?
Is good health really all that digital?
I am not so sure. I am a skeptic.
I realize this is a risky thing to say these days. It’s hard to bet against Apple. And It was only seconds after Tweeting such doubt that John Nosta, an expert in digital health technology, tweeted back:
@drjohnm Health is very digital. @EricTopol #digitalhealth
— JOHN NOSTA (@JohnNosta) January 4, 2015
Well, yes, surely digital technology is important in the diagnosis and management of diseases. I couldn’t do ablation without engineering and technology. We use digital devices to monitor the heart’s rhythm, and said devices...
Source: Dr John M - January 4, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The year in Cardiology 2014 — a top-10 list
When the editors at Medscape asked me to put together an essay on the Top 10 stories in cardiology in 2014, I thought it would be an easy project. I was wrong. It turns out there was a lot to say about the happenings in cardiology this year. In the end, the final essay had 37 references–a bunch for a blogger.
The link to the piece is at the end of this post. What follows is a regular-language breakdown of the ten topics. The first five deal with specifics; the second five touch on trends.
Here we go:
1. Renal denervation is the medical name given to a procedure in which a doctor uses a catheter to ablate (burn) n...
Source: Dr John M - December 21, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Opposition to ABIM — A tipping point for physicians?
I know physicians. They are smart, hard-working and prideful. They do a lot of good in this world. But one thing we have been utterly incapable of doing is organizing together and speaking as one voice.
The American Board of Internal Medicine may have changed that. The hubris, overreach, and tone-deafness of ABIM may have gone too far. Now, there may be a glue strong enough to hold physicians together.
Dr Wes Blog
My colleague Dr. Wes Fisher culminated a 2-month investigative journalism adventure yesterday. He published his piece on the inner workings of ABIM, its foundation and its $2.3 million condominium in Philadelphia...
Source: Dr John M - December 17, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Ten things to expect after AF ablation
Here is a list of ten things to say about the experience of having an AF ablation.
(Note: This list concerns standard radio frequency catheter ablation for AF.)
1. AF ablation is a big deal:
The first thing to say about AF ablation is that it is a big procedure. I tell patients to expect AF ablation to be hard on them. How could it be easy to undergo hours of general anesthesia, insertion of big tubes in the leg veins, 50-75 burns in the atrium and hours of bed rest? Although a minority sail through the recovery without complaints, most patients tell me they were surprised at how hard it was on them. I recommend taking a ...
Source: Dr John M - December 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
