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  • Questions on CIMT

    Just got my results and they seem pretty bad. I wish there was an explanation sheet that came with it, And maybe a CD with the images so we could actually view them,

    Here's my questions, or at least my 1st questions.

    What exactly does heterogeneous mean in relation to plaque?
    What exactly does echogenic mean in relation to plaque?
    Which is worse?

    If I have a high plaque burden, but none is listed as Soft, is that factored into cv event risk?

    Did the doctor receive information about my CIMT that isn't given to the patient? Are they given an interpretation or other assessment information?

  • #2
    Not the response you were looking for, but help us out:

    1) Are you eating a high fat low carb diet?
    If yes to #1
    2) Are you a carrier of APOE4? (or whatever the correct vernacular is)
    3) Have you done further genetic testing on 23andme to see if your body has trouble metabolizing fat?
    4) How much Niacin a day do you take?
    5) What statin do you take and how much?

    Comment


    • #3
      Yeah, I also had questions when I got my CIMT test done, and watching a couple of Dr. Brewer's videos filled in a lot of what I was wanting to know. Here is latest one.
      https://www.youtube.com/watch?v=KQdplHWQ9ZU

      As to your first set of questions, I answered those below in-line

      What exactly does heterogeneous mean in relation to plaque? There is a mixture of calcified and non-calcified plaque
      What exactly does echogenic mean in relation to plaque? Echogenic means dense calcified plaque
      Which is worse? Soft plaque is the worst as far as the ability of plaque to get inflamed and rupture, but given time and if cardiovascular inflammation isn't too bad it becomes partially and then fully calcified

      If I have a high plaque burden, but none is listed as Soft, is that factored into cv event risk? Depending upon who does the CIMT test, they may provide a breakdown of potential risk (this is on the referenced CIMT test video above).

      Did the doctor receive information about my CIMT that isn't given to the patient? Are they given an interpretation or other assessment information? If you got a sheet like the one shown in the CIMT test video, then probably nothing more went to your doctor. Depending upon the knowledge of the doctor to interpret CIMT tests, yes they could emphasize where the risk is greater.

      Generally the results are stated in plaque burden at least by arterial age (or where your results are for an age cohort) along with discrete plaque. There is some additional useful info in the average mean and max values if those are provided. The arterial age calculation makes it easier for people to understand if they have a higher plaque burden than most. On the discrete plaques, then you would prefer to not have any on either side. If you do, then once those reach 1.3mm, then you are considered to be at higher risk. If a good bit of that plaque is heterogenous and echogenic, likely you are in the healing phase. The danger is when you have continuing strong immune response to the LDL particles/cholesterol which results in the "hot" plaque in the soft plaque, along with cardiovascular inflammation which will weaken the fibrous cap over a plaque that can potentially rupture and create a clot.
      Last edited by Tom; 05-26-2019, 03:35 AM.

      Comment


      • #4
        Thanks Tom,

        I knew I had plaque from cardiac cath and echo, so I was hoping the CIMT would be more defining than it appears to be.

        I did the Cleveland heart Labs test and every single lab was low risk for CD. Overall my other labs are good.

        I believe the problem that caused the plaque buildup was my poor ability to digest and metabolize saturated fat. Fat leaking through the gut wall caused massive inflammation, high levels of ldl and sdldl, and the liver couldn't keep up with removing ldl from the bloodstream. This resulted in plaque buildup for most of the last 50 years.

        When I pieced all this together about 3 years ago, I started limiting saturated fat and moving toward a vegetarian diet. This resulted in a loss of about 40 lbs I had been unable to lose on a high fat diet, and great improvement in my labs, including lipids. I believe this dramatic change in diet stopped the plaque buildup, but I have no way to prove it. I think the great CHL labs, my lipid panels, the elimination of stroke level blood pressure spikes, and my overall energy level are good indicators, but not proof. Of course, no cardiologist has been willing to entertain the possibility.

        As this was my 1st CIMT, I have no reference point. I suspect if I had a CIMT 5 years ago, the results would have been even worse. None of the plaque on this CIMT showed up as Soft - plaque was labeled Echogenic or Heterogeneous. I would think if plaque was still being created, there should be some soft plaque.

        I guess if one believes that calcium can be removed from plaque and the plaque "removed", then hetergeneous plaque is better. On the other hand if one can only stop and not reduce plaque, then echogenic is better. I guess the normal progression is heterogenious to echogenic, but can it also reverse? People with several CIMTs might be able to see if this happens.

        Comparing me to the population at large doesn't help me very much. I really wish each value on the report had at least a paragraph explaining what it means. Something like the report from Cleveland Heart Labs would be fantastic.

        I had already watched Dr Brewer's CIMT video, but it only answered a couple of questions. Maybe he has new videos that will go into more detail. I'm at the point I'm "trying" to read scientific studies to see if I can find more specific information.

        A lot of people are 1st time CIMTers, so they can't compare it to a previous CIMT. They need more information on how to interpret a standalone CIMT. Comparing it to the general population seems a cop out. Comparing me to a population that also has a high rate of cd, I guess means it's even worse than it looks.

        What are optimal values? Could a risk table be created that shows risk level at different levels? What are strategies for improving the numbers. Maybe that's where Todd and Ford are heading. I realize it's not as simple as if one does a, b, and c, plaque burden will reduce by x percent, but we need to at least be moving in that direction. An app could duplicate a lot of the Bale/Doneen method and other apps could be developed. If I was about 40 years younger, I would be inclined to head up the app development. A virtual business might be a good solution.
        Last edited by rich; 05-26-2019, 07:06 AM.

        Comment


        • #5
          To my understanding on your question about whether plaque levels can be reserved over time, absolutely as Dr. Brewer's videos show his overall plaque burden getting lower. I suspect that most of that reversal was in soft and heterogenous plaque. I have heard that calcified plaque can decrease in size to a degree over time with a healthy lifestyle and low cardiovascular inflammation, but it doesn't disappear entirely. At that point it generally isn't what causes a stroke or heart attack.

          If the CIMT test results don't compare you to a population cohort (by sex and age group), I am not sure who they can compare you to for your test results. To my understanding the Cleveland Heart Labs test result range values are based upon population studies, but perhaps you are referring to something else. It is very true that there is no guarantee that you or any single person will absolutely fit well within a specific population based spread for these test results.

          After thinking about this for a few minutes, the comprehensive evaluation that you are hoping for needs to include a lot of information beyond the CIMT test for future risks. The CIMT test provides one piece, but it doesn't incorporate your inflammation panel, your lipid panel, glucose metabolism, hypertension issues if any; and all of these and more are needed to tell just how much risk you should expect going into the future. The MESA risk scores and others for CAC score tests are based on some assumptions including not changing your lifestyle. If you have got a bad whatever score and change your lifestyle, then there are no hard numbers out there. There are numbers to tell you if you are at higher risk.

          Dr. Brewer recently released a video book review of Todd Eldrige's book for physicians giving CIMT tests which might provide some of the answers that you are looking for. Here is the video: https://www.youtube.com/watch?v=Dl0rBm5pDbU

          That video intro piece is:
          Todd Eldredge, the founder of CardioRisk, wrote a book called Cardiovascular Wellness Management Success Plan. His stated readership was going to be docs. But most of the viewers of this channel will understand it better than a lot of docs. He engages the reader quickly in describing his own family tragedy, losing a brother unexpectedly to a car wreck. The point is that this happens throughout the country on a regular basis. Heart disease is the #1 killer and half of them are unpredicted. He's got great sections describing the science on CIMT. He also describes an interesting patient portal for CV risk management. Unfortunately, like CIMTs in general, there is not enough recognition - so it's vastly under-utilized. I personally got a lot out of the book. I'd recommend it. Here's an Amazon Associate link to the book: https://amzn.to/2RvphVF
          Last edited by Tom; 05-26-2019, 08:42 AM.

          Comment


          • #6
            What I meant by comparing to the general population is it doesn't really tell me anything. What does it mean to be 3 years older or 3 years younger than a population that has a high degree of hd? What I would like to see is how do I compare to people who don't have CD. In other words, optimal. If I am 70 years old, how do I compare to 70 year olds that don't have hd?

            When Dr Brewer did the book review, I looked up Todd's book on Amazon. No reviews and I saw no indication he went into more detail on what the values mean. I'm rereading the Bale/Doleen book and I am finding the same thing - they say to get one but don't really get into interpreting it.

            Cleveland Heart Labs has optimal values. That is my biggest complaint about CIMT. Comparisons to general population are somewhat relevant, but what are the optimal values? You don't become optimal by shooting for average.

            Comment


            • #7
              Everybody has cardiovascular disease to an extent if you consider having plaque means cardiovascular disease. We are all on a continuous spectrum of having cardiovascular disease as we age. I don't think that there are optimal ranges for plaque burden (at least not that I am aware of), just that the lower the better. Even for CAC scores the only optimal score is 0, and even that isn't a guarantee of no risk over the next ten years.

              Age is the most important determinant on whether we will get a heart attack or stroke (i.e. a male with an equivalent CIMT plaque burden to me who is ten years younger will have a lower risk, and thus why they stratify in age and sex). The result for a plaque burden is mapped to an age because most people can process that better than 0.65mm vs 0.58mm makes a difference. If your arterial age (or plaque burden) is much higher than your age, that is a sign that you need to address some issues (inflammation, lipids, glucose, hypertension, etc). If you have discrete plaques, especially if those are bigger than 1.3mm you are at higher risk.

              Comment


              • #8
                I've done some research and found that there are 2 or 3 primary reasons for getting a CIMT.
                1) Baseline when you are young
                2) Asymptomatic but at risk for cad
                3) Have CAD and CIMT is used to measure treatment plan

                I can see for 1 and 2, the CIMT report may be adequate. On the other hand, for 3 I think it is inadequate. I doubt if many primary care doctors can properly assess a CIMT report and certainly most patients can't. As I said before, a report along the lines of the Cleveland HeartLab report would be very beneficial.

                Here's an example from their site:

                What can I do to help lower my hsCRP levels?
                • Lifestyle changes, such as exercising more, eating more heart-healthy high fiber foods such as fruits/vegetables and whole grains or following a Mediterranean diet.
                • Quitting smoking helps reduce the amount of general inflammation in your body.
                • Taking good care of your teeth can also help lower hsCRP and reduce your risk of heart disease.
                • There are prescription and nonprescription medications that also can help lower hsCRP.

                Comment


                • Tom
                  Tom commented
                  Editing a comment
                  Fair enough. It wouldn't be a far stretch to say that optimum levels of the plaque burden arterial age calculation should be no higher than the patient's current age, and the optimum is no discrete plaques. If that patient has less than optimum results, then they need to work on a plan with their primary doctor. Did your primary doctor give you your less than stellar results and then say "have a nice day"? I would hope not.
                  Last edited by Tom; 05-27-2019, 10:22 AM.

              • #9
                Tom - had cIMT recently. As plaque transitions towards being calcified, how does that effect the plaque thickness, in mm, does it typically increase it? What usually causes increases, more soft plaque or more calcified plaque, or both? How would Crestor influence plaque transition? Thank you
                Last edited by Joby; 05-27-2019, 06:26 PM.

                Comment


                • Tom
                  Tom commented
                  Editing a comment
                  If cardiovascular inflammation is reduced in particular, over time calcified plaque will shrink to a degree (difficult to say how many mm because it could vary between people and their lifestyle at the time). A person will lay down more soft plaque due to some combination of moderate/high cardiovascular inflammation and LDL family particles. The goal is to not put down more soft plaque, and older plaque will calcify over time. Calcified plaque doesn't grow, what happens is new layers of soft plaque is laid down over calcified plaque over time, and as those become calcified they look sort of like tree rings. Crestor or statins in general will lower LDL family of particles and perhaps even more importantly lower cardiovascular inflammation (ACE inhibitors also help, see Dr. Brewer's video on this). Crestor as will statins in general tend to accelerate the calcification process of existing soft plaque to help stabilize that plaque. I should add that it is entirely possible that some soft plaque, and perhaps to some degree heterogeneous plaque can go away entirely under the right conditions.
                  Last edited by Tom; 05-27-2019, 10:20 PM.

              • #10
                Originally posted by Joby View Post
                Tom - had cIMT recently. As plaque transitions towards being calcified, how does that effect the plaque thickness, in mm, does it typically increase it? What usually causes increases, more soft plaque or more calcified plaque, or both? How would Crestor influence plaque transition? Thank you
                Wouldn't it be great if that kind of information was included in the CIMT report?

                Comment


                • Tom
                  Tom commented
                  Editing a comment
                  rich, what you are looking for is wisdom from your results. We start with data/information and then come to conclusions with knowledge. Knowledge is those few sentences you find with a test result. When you are looking at CIMT test results, you need more because the scope is so much broader. I don't know of an easier way to find wisdom than looking for a doctor who knows what they are doing and has evaluated many patients over time. Otherwise, you are just shooting in the dark, hoping to find a tidbit here and there to sort of make up your own wisdom. That might be enough if you carefully choose what tidbits to consider. If you have a CIMT test that indicates a problem, then you won't find the answer in a paragraph or even two. You have to go to over your entire range of lifestyle and medical tests to come up with a reason and a plan. Self service is not without its limits. If you do go the self service way, then I would recommend that you look at your lifestyle over the last decade or two. If you were overweight, ate less than healthy, didn't exercise, had metabolic syndrome, etc. all of these will push for higher blood glucose/insulin and cardiovascular inflammation. That cardiovascular inflammation will over time cause endothelial dysfunction and let more LDL family particles get stuck ultimately resulting in plaque. Look across your advanced inflammation panel, lipid panel, regular physical check and see if anything is out of line. Get an OGTT or even better a test that includes insulin measurements. If you don't have a blood glucometer, get one and use it to see what your results are after eating various kinds of foods. This isn't a cookie cutter approach that a CIMT test report is supposed to tell you what a statin will do for you. It depends, and that why some wisdom is most helpful.
                  Last edited by Tom; 05-27-2019, 09:01 PM.

              • #11
                Thx Tom.. how about significance of arterial age below actual age, and does having a lower age and low avg mean, suggest some help to decrease plaque?
                Last edited by Joby; 05-28-2019, 05:23 PM.

                Comment


                • Tom
                  Tom commented
                  Editing a comment
                  If you have a calculated arterial age lower than your actual age, then you will in general have a lower risk. However, you also have to look at discrete plaques, because if you have those and a lower calculated arterial age then the risk is still higher (this is my result). My one and only CIMT test result was stated a little differently than those shown by Dr. Brewer with my age mapped along with the 25th/50th/75th percentile values. I attribute my lower plaque burden values (left and right side a little different) to having taken a statin for the prior four years and losing some weight which I think helped lower my cardiovascular inflammation. I eventually switched my hypertension medication from an ARB to an ACE inhibitor to continue to lower my cardiovascular inflammation, and fortunately I didn't get the coughing episodes that some people experience. I am waiting for five years until my next CIMT test (and CAC score), and in the meantime had a Kraft insulin survey and MACR (microalbumin-creatinine ratio) test done to get additional insight into my aging process beyond an earlier advanced inflammation panel and lipid panel.

                • Joby
                  Joby commented
                  Editing a comment
                  Thx again, Tom.. my situation has some similarities with lower age and discrete plaques. I’ve been on Simvastatin for 9 years and over the last year, moved to Crestor. My first inflammation panel last Dec, was very good. But, I have no idea what it was before, since I didn’t know of these tests until I found Dr Brewer. I’m in the the 24th percentile for my age, and the CCM is just over the target. I don’t have the min max calculations. I’ve recently switched from an ARB to Ramipril, so far so good.

              • #12
                Originally posted by Joby View Post
                Thx Tom.. how about significance of arterial age below actual age, and does having a lower age and low avg mean, suggest some help to decrease plaque?
                I'm not Tom, but it appears to be arbitrary. If your score is more than 70% of the mean of your age group, you are considered at risk. I have no idea where 70% came from. There has to be a table some place that has this type of information. I would think a lot of this is being done by a computer program, so the information is out there someplace.

                Comment


                • #13
                  Tom, you come across as very protective and even apologetic for doctors. In my lifetime, I have had 1 doctor I would give an A, and that's my current integrative doctor. Of course I have to pay out of pocket to see her. I have seen 6 cardiologists and the first 5 I would give a D or F. If they had paid the slightest attention to what I told them, I might not be in the situation I am in now, I've only seen my current cardiologist once, so the jury is still out.

                  About 5 years ago, I finally realized the only way I was going to get better was if I did the research, ordered my own labs, developed my own diet, researched what supplements might help. and I used my gp at the time as my sounding board, as she had run out of ideas after the 1st 2 years. My health now is the best it has been in 30 years, based on my own research, ignoring conventional wisdom, and more recently because of my new doctor who is an amazing doctor.

                  I think the medical community may be purposely withholding information to maintain their control over patients. If not, why are doctors not demanding that misleading drug commercials be corrected or removed? The last thing they want are educated patients, because when patients are educated they don't walk into the doctor's office and ask for the drug most recently advertised on TV. They ask for labs, the ask for alternatives to dangerous medications, they ask if procedures are absolutely necessary, etc., and doctors can't make money spending that much time with a patient.

                  If a doctor, say Dr Brewer, can analyze a CIMT for a patient, then that logic can be put into a computer program. It won't be perfect, but neither will a doctor. Not to be too cynical, but does the fame and fortune of publishing books and holding conferences come before the free distribution of knowledge that could educate patients today? By no means am I referring to Dr Brewer. He freely gives his knowledge and is one of the good guys. There just aren't enough of them, especially cardiologists. Although she is a PhD doctor and not a Md, Dr Rhonda Patrick is a great model of what I am talking about. As her goal, she looks into medical research and then communicates in a way most people can understand. And she's brilliant at it. She is always one of the most viewed Joe Rogan interview videos.

                  It just dawned on me earlier this week, that cardiologists are not there to provide continuing care and guidance when it comes to heart disease. They think you are going to magically find a gp that has the expertise to guide you as to diet, lifestyle, labs to be run, etc. My experience so far is health care for heart disease is totally inadequate, unless you consider open heart surgery to be the goal. Just for the fun of it, try asking every cardiologist you meet if they can give you the name of a doctor that focuses on diet and lifestyle to treat heart disease.

                  I had one cardiologist, who I personally liked, tell me it was impossible to manage lipids with diet and lifestyle, and that niacin had never been proven to lower LDL. Would you expect me to trust that cardiologist to review my CIMT? Or how about the 3 cardiologists I asked about CIMT and all 3 said it wouldn't be of any value. Same for CAC score. I don't know where you are finding these great doctors, but it certainly isn't in my neck of the woods.

                  And why is cardiac rehab after a cardiac event rather than as soon as the disease is diagnosed? Why do they recommend a diet after you have had a heart attack instead of before? Why don't they tell you a stent doesn't increase your lifespan, but in may reduce your angina?

                  I have what I think is a solution. Make insurance companies, including Medicare and Medicaid, cover a yearly 45 minute appointment and 4 30 minute follow-ups per year, plus the normal in and out type appointments. I think this could result in health care savings that would exceed the increased cost in doctor payments. Plus more doctors would start offering this type of care.
                  Last edited by rich; 05-28-2019, 06:48 PM.

                  Comment


                  • Tom
                    Tom commented
                    Editing a comment
                    I am all for being an informed patient and finding a doctor who I can trust. I haven't become as jaded as you seem to be on the medical establishment, but I haven't had as much contact either. Money does drive a lot of the health care decisions no doubt, but I don't think that it is all a big conspiracy (there are enough small conspiracies going on). On the doctor's side, most patients don't want to change their lifestyle more than minimally possible in response to their inevitable lifestyle induced health issues, and the patients want a pill to fix all their problems. The doctors likely see patients every day who have read some stuff on the Internet which may or may not be accurate, and they want their doctor to change their practice to meet their new expectations. By all means not every doctor is up to date, but when you have such cross-currents going on here on health information imagine what its like for the doctor who sees patients every day who demand this or that based upon something that they read on the Internet. I do recommend that people learn a bit about biology so that they have a framework from which can absorb new material and really understanding it vs. so-and-so doctor on the Internet said this theory which obviously must be true.

                    As to why there isn't cardiac rehab until later, that is likely driven by what insurance companies pay. Many doctors spend a significant amount of their time arguing with insurance companies on what treatment is appropriate. If you had been going to a doctor for 20+ years let's say and you showed the obvious signs of needing to manage your diet and exercise more, but your doctor never mentioned it once? That would be a problem. A lot of patients don't want their doctors to tell them to lose weight (diet, exercise, sleep, stress, etc.), and it isn't much fun being a doctor these days. On your other question on stents, I imagine that it has taken time for cardiologists to understand that stents should primarily be used for stable angina with pain or unstable angina and more serious cases vs. just because your artery is mostly blocked. Is there some money involved in these operations driving opinions, absolutely.

                    In the end, we the patients are responsible for our bodies. The doctor should be considered a coach. BTW, who exactly did review your CIMT test results with you? I hope that somebody medically trained did do that vs. you receiving a one page result.

                    One more thing that I thought about that is really important to how a doctor will determine a treatment for a patient. The doctor needs to keep to AMA or some recognized guideline for treatments or else face the potential for getting sued, rightly or wrongly. I imagine that this is a major factor at times.
                    Last edited by Tom; 05-29-2019, 05:14 AM.

                • #14
                  I had an echo yesterday as ordered by my new cardiologist. I asked the person doing the echo if she was trained to do CIMT. She asked what CIMT was. When I said carotid intima media thickness test, she knew what I was talking about.

                  She said it wasn't offered. I said I knew it was available at the university and she said it was probably offered by vascular health and not by cardiology. I wonder what I should read into that, if anything?

                  Comment


                  • Tom
                    Tom commented
                    Editing a comment
                    I think that a good number of cardiologists don't use CIMT tests. To my thinking, a CIMT test is a wellness or preventative health test. When you go to the cardiologist, you are there for a known problem or highly suspected problem. When I asked my primary doctor about getting a CIMT test done, he said that he could give me a consult with a cardiologist whose office does CIMT testing, but I would have to pay for the consult and CIMT test myself because health insurance won't pay. Once you get sent to the cardiologist, they are likely trying to decide on whether to operate on you immediately vs. later rather than take wellness measures as their primary role.

                • #15
                  Originally posted by rich View Post
                  Tom, you come across as very protective and even apologetic for doctors. In my lifetime, I have had 1 doctor I would give an A, and that's my current integrative doctor. Of course I have to pay out of pocket to see her. I have seen 6 cardiologists and the first 5 I would give a D or F. If they had paid the slightest attention to what I told them, I might not be in the situation I am in now, I've only seen my current cardiologist once, so the jury is still out.

                  About 5 years ago, I finally realized the only way I was going to get better was if I did the research, ordered my own labs, developed my own diet, researched what supplements might help. and I used my gp at the time as my sounding board, as she had run out of ideas after the 1st 2 years. My health now is the best it has been in 30 years, based on my own research, ignoring conventional wisdom, and more recently because of my new doctor who is an amazing doctor.

                  I think the medical community may be purposely withholding information to maintain their control over patients. If not, why are doctors not demanding that misleading drug commercials be corrected or removed? The last thing they want are educated patients, because when patients are educated they don't walk into the doctor's office and ask for the drug most recently advertised on TV. They ask for labs, the ask for alternatives to dangerous medications, they ask if procedures are absolutely necessary, etc., and doctors can't make money spending that much time with a patient.

                  If a doctor, say Dr Brewer, can analyze a CIMT for a patient, then that logic can be put into a computer program. It won't be perfect, but neither will a doctor. Not to be too cynical, but does the fame and fortune of publishing books and holding conferences come before the free distribution of knowledge that could educate patients today? By no means am I referring to Dr Brewer. He freely gives his knowledge and is one of the good guys. There just aren't enough of them, especially cardiologists. Although she is a PhD doctor and not a Md, Dr Rhonda Patrick is a great model of what I am talking about. As her goal, she looks into medical research and then communicates in a way most people can understand. And she's brilliant at it. She is always one of the most viewed Joe Rogan interview videos.

                  It just dawned on me earlier this week, that cardiologists are not there to provide continuing care and guidance when it comes to heart disease. They think you are going to magically find a gp that has the expertise to guide you as to diet, lifestyle, labs to be run, etc. My experience so far is health care for heart disease is totally inadequate, unless you consider open heart surgery to be the goal. Just for the fun of it, try asking every cardiologist you meet if they can give you the name of a doctor that focuses on diet and lifestyle to treat heart disease.

                  I had one cardiologist, who I personally liked, tell me it was impossible to manage lipids with diet and lifestyle, and that niacin had never been proven to lower LDL. Would you expect me to trust that cardiologist to review my CIMT? Or how about the 3 cardiologists I asked about CIMT and all 3 said it wouldn't be of any value. Same for CAC score. I don't know where you are finding these great doctors, but it certainly isn't in my neck of the woods.

                  And why is cardiac rehab after a cardiac event rather than as soon as the disease is diagnosed? Why do they recommend a diet after you have had a heart attack instead of before? Why don't they tell you a stent doesn't increase your lifespan, but in may reduce your angina?

                  I have what I think is a solution. Make insurance companies, including Medicare and Medicaid, cover a yearly 45 minute appointment and 4 30 minute follow-ups per year, plus the normal in and out type appointments. I think this could result in health care savings that would exceed the increased cost in doctor payments. Plus more doctors would start offering this type of care.
                  I feel your pain and agree that this a terrible way to run healthcare. But I do not believe that we can put the blame on the individual doctors.

                  A major part of the issue is something called standard of care practices. Any doctor who does what you are advocating is likely in violation of the standards of care guidelines. This is a serious concern for any doctor. Violating these standards can result in the doctor being brought before medical boards to answer to inquisition like boards. They could get their medical liscense revoked. Youtube is filled to the gills with doctors who preach lifestyle interventions, who end up getting attacked by colleagues who disagree with their ideas, even if those ideas and practices work very well. Furthermore, any cardiologist who dares to practice lifestyle and or alternative treatments is directly threatening the hospital's bottom line and this will not be tolerated by the medical directors and accountants. Again, the doctor who so dares to do this can suffer from license revocation. I do not fault the doctors for how they behave. They are pawns in medicine for profit system that we have.

                  My Bale/Doneen preventative doctor used to be the Chief Medical officer at a large hospital. He told me that there is no way that he could ever practice the way he does if he were still in the conventional medical system due to what I mentioned above. He actively tries to recruit other providers to do preventative care, but it is a hard sell. There is significant financial and professional risk involved in practicing prevention

                  The system is profit driven. Their M/O is to make money, not make people well. Individual doctors are virtually powerless to change this.

                  Comment

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