Monthly Archives: January 2013

Singing On The Table: Be Activated in 2013 with a Non-Resolution

Opera Singer

An operatic tenor in action…

One of the intriguing things about angioplasty when it was first introduced, was that patients undergoing this profound, life-changing heart treatment remain awake throughout the procedure.

In the 1980’s my partner Burt Cohen, a filmmaker, began producing live televised training courses to teach cardiologists this new non-surgical way of treating heart disease. Procedures were broadcast from a hospital catheterization lab, and projected on giant screens set up in a conference center auditorium. The patients on the hospital cath lab table would look into the cameras and wave to the audience of physicians gathered in the auditorium, all of whom were waiting to see, in real time, how the procedure turned out.

One of the most memorable moments from that period was at a live teleconference broadcast to the US from Dr. Antonio Colombo’s cath lab in Italy. The screen filled with the face of a tenor from the Milan Opera who was lying on a cath table as he began singing O Sole Mio, reaching a crescendo as a buzzing catheter-based device in his heart began shaving plaque from his arteries.

The physician audience burst into applause, it seemed remarkable that a patient whose heart was being ‘operated on’ could be that alert, aware and energized.

So now when I think about the idea of the activated patient, that opera singer comes to mind.

Of course no one is 100% activated during a catheterization – you are sedated, and probably afraid, possibly even feeling fundamentally powerless.

But the evolution of less invasive, less traumatic techniques is part of a general trend toward improving the experience of medical care from the patient’s perspective. And a focus of 21st century healthcare will be on patients actively participating in their own individualized treatment, especially heart patients, who only 40 years ago were told to rest, avoid activity, and expect to deteriorate, and today are encouraged to exercise, self-manage and assume they can live a long, full, vigorous life.

We spent a long time choosing a name for this blog: the empowered patient, the informed patient, the educated patient, the engaged patient, we tossed around many of the trending terms that signal a more patient-centered attitude toward heart health.

But activated stuck because, like that tenor’s will to sing, it seems to capture a quality that belongs to the patient and comes from within – not something health professionals do to patients (educate, inform), or permit (empower, engage), but something patients summon up and create for themselves.

An activated patient is endeavoring to do whatever she or he has to do, to get what they know in their gut they need, in order to feel well and in control, hopeful and moving forward.

In the practical sense, an activated patient is an individual who has embraced the possibility of consciously acting in their own interest by equipping themselves with the information and skills they need to be an expert in their own care.

But while an activated patient is, by definition, self-directed, an activated patient can only prevail in a system that responds.

Activated patients not only need the motivation to be well, but a ton of information, skills, confidence, support, options and perseverance. That’s where educational projects like this one come in – hoping to help provide the coaching, the techniques, the libretto, the throat lozenges, the accompaniment, and the encouragement the singer needs to sing.

I’m not a fan of resolutions, because I’m not a fan of setting myself up for failure. But I am a fan of new beginnings, fresh opportunities and future plans. It would feel pretty good to me to be activated in my own life in the coming year. Most of us would benefit from taking an activated stance toward our bodies, our ailments, our daily routines, our work and our personal lives.

Whether it’s heart disease, or aging, or family issues, or career challenges, or finances, or any of a million obstacles, there are always pretty powerful forces at work promoting discouragement, disempowerment, inaction and anxiety. Activating doesn’t mean denying these realities, it means living in and with our lives as they are, assessing our options, and acting with commitment to our own best interest.

Activating entails trusting ourselves and seeking the help we need. I’m not the type of person who could sing opera with a catheter in my heart, but I sure like the idea of doing what defines you, no matter what.

Taking steps to get better, to feel stronger, to give ourselves breathing space, to engage deeply with life, and to enjoy as much as we can, could be posited as resolutions, or shoulds, or burdens we need to discipline ourselves to take on.

Or, we could think of becoming more activated as remaining awake, as allowing ourselves to be entitled to possibility, and to hope, to want more for ourselves, because it’s what we deserve.

Becoming activated is the opposite of easy or effortless, but it feels strong, it feels purposeful, it feels good and, it turns out, it’s better for our health and our hearts.

posted by Deborah Shaw, Angioplasty.Org Patient Education Editor


Filed under Diagnosis & Imaging, Education, History, Patient Empowerment, Shared Decision Making, Treatments

The Edutainment Approach to Health: Dr. Oz and the “Radical New Procedure” of “Wrist Catheterization”

frame from the Dr. Oz show

Dr. Tremmel appears on the Dr. Oz show

Millions of people were exposed to the concept of the radial, (or wrist), approach to angioplasty recently, when the Dr. Oz show featured catheterization via the wrist in its “Dr. Oz’s Ultimate Insider’s Guide: The Newest Medical Breakthroughs.”

This story placement was definitely a win for patients; people are likely to start seeking out the wrist approach as a result of this highly visible coverage. At Angioplasty.Org we’ve been advocating the advantages for patients of this 20-year-old technique of conducting catheter-based heart procedures via wrist rather than the groin – fewer complications, less bleeding and faster recovery — since 2007. Even a brief mention of this technique on a hit TV show reaches a massive number of patients who are not seeking out in-depth reporting at sites like ours, so we’re excited to see the information get out to a larger audience.

The slight downside, of course, is the sensationalizing and de-contextualizing of the concept, which seems to be part and parcel of obtaining media attention. Dr. Oz’s guest Dr. Jennifer Tremmel did a great job of explaining the benefits of the wrist approach and how the procedure is done. But Dr. Oz, in his enthusiasm, swept away the nuances of when and why one would need a catheterization in the first place, and how this “breakthrough” does or does not change heart treatment. Patients might well be mislead by his statement positing the wrist approach as

“…a radical new procedure that can help you find out if you are at risk for heart disease and treat it at the same time.”

Ironically, two years ago Dr. Oz stated that half of all angioplasties done were unnecessary, and he now seems to be advocating Ad Hoc PCI (treating blockages with angioplasty immediately upon diagnosis), which many experts believe to be one of the primary drivers of over-stenting… but more on that subject in another post.

Wrist angioplasty is a relatively new (in the US at least) improved technique (accessing the heart via the wrist) for doing an old thing: cardiac catheterization (taking angiography images of the heart vessels to determine extent of disease and treating blockages via catheters).

Cardiologists have been diagnosing and treating heart disease via catheters for 35 years, and the wrist approach has been the predominant technique in Europe, Japan, etc. for almost a decade. “Wrist catheterization,” as Oz calls it, is a great technical improvement, but not a fundamental breakthrough in the actual treatment and diagnosis of disease. The peculiar thing is that Dr. Oz must understand this difference, of course — as a cardiac surgeon, he’d fully grasp the vocabulary around the procedure, as he’s been looking at patients’ catheterization images for his entire career.

So why not just say, “Hey, here is a better way of getting a cardiac catheterization. And sometimes, when you get that catheterization, you and your cardiologist may choose to go ahead treat your blockages with a stent”?

I would guess that, as an edutainment expert, Dr. Oz also knows that an urgent, breathless story like “New, radical, secret, unknown, exclusive thing! This changes everything, you should get it!!” will grab attention, and will be remembered. It sounds a lot more exciting than explaining “Here is a safer, less invasive option to consider, under specific circumstances, when you and your doctor have determined that a diagnostic cath may be warranted. These choices should be made in the context of being an informed patient who is seeking to understand all the options in managing and treating heart disease and seeking out physicians who offer the most current treatment techniques.

The more patients that know about this less invasive alternative the better, so the story is still a good thing overall. It’s just that, as an educator, I have to wonder, do patients really require or prefer this hyped up, less nuanced approach? Does it serve them better? It does seem to be what it takes to get big time media coverage. But hey, that’s showbiz.

For a more in-depth understanding of what “wrist catheterization” is, visit our Wrist Angioplasty FAQ and our Transradial Section; to find one of the many cardiologists in the US offering this option, visit our Radial Hospital Locator.

posted by Deborah Shaw, Angioplasty.Org Patient Education Editor


Filed under Media Coverage, Radial Approach