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Old 06-05-2019, 11:24 AM   #41
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Originally Posted by jj View Post
Where online can you find rational discussion of the peer-reviewed options on care that is evidence-based?

Even on the Rightcare Alliance site there are no links.

nutritionfacts.org. It is all evidence based, written by a doctor and nonprofit. The book versions are How Not to Die and the How Not to Die Cookbook. It is vegan promoting but you don't have to go full vegan to get the benefits from the site. The site recommends a plant based, whole foods diet similar to the one in the Blue Zone book. We've had some amazing health improvements between us so far after just a few months even though we probably only adhere to it 70 - 80% of the time.
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Old 06-05-2019, 11:25 AM   #42
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Originally Posted by kcowan View Post
My cardiologist declined to install a stent when my angiogram indicated 50% blockage. He said it was general build up and if it got to be over 90%, he would do a bypass. Similarly, he treated my sudden rapid regular heartbeat (90 versus 50 pulse) tachycardia with drugs rather than ablation.

He is also a research scientist part-time. I consider myself lucky.
Just curious, but 90 HB does not appear to be that high. When my SVT showed up last Fall, I was recording 200+ HB.

Monitoring now with just walking, my HB is 90 - 100 with moderate effort.

Could be that we are all just a bit different.
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Old 06-05-2019, 11:28 AM   #43
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Originally Posted by AnonEMouse View Post
Not sure if this has been posted, but thought it relevant.

https://getpocket.com/explore/item/w...octors-say-yes
Very well written and interesting article which is noting among several things that

-Physicians often do not follow current evidence based guidelines
-Even the process by which medical science/evidence is published is subject to a host of confounding issues

I have no solutions to these problems but I wanted to offer my thoughts on what may improve the odds you will get good care, based on my experience as a health care provider and also as a patient and family member of patients:

-Try to get health coverage that preserves choices in providers-both doctors and hospitals. Favor regular Medicare over Medicare Advantage plans. Favor PPO's over HMO's.

-If you require surgery or have a complex medical condition, seek care or get a second opinion from a physician with a university based medical center. In my opinion, the clinicians at these centers are often more up to date and have less of a tendency to be influenced by factors not related to the patient's best interest.

-Be an informed patient. use websites like "uptodate" (my favorite) or as mentioned above by 6miths to learn about your disease and treatment options.

-If you or a loved one have a serious illness, be ready to do some hard work and recruit other family/friends to assist. It should not be the case, but there is a strong correlation between effort invested and quality of care received. I have been the primary person arranging medical care for several family members who were very ill and I don't think anything I have ever done was more high stakes, challenging and exhausting. Among other things, be ready to do battle with health insurance companies, research treatment options, health care facilities, health care providers, and spend hours arranging appointments, getting prescriptions, obtaining and delivering records.

-If you have a family member in the hospital, be there as much as possible, ideally around the clock. Keep a notebook in the room and keep it updated with information on what has happened and what is planned. As much as possible, double check everything being done-there is still no perfect system for preventing medical errors. Try to make sure everyone and everything that touches the patient has gloves or has been sanitized.

The above is of course all my opinion, very generalized and by no means applicable to every situation.
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Old 06-05-2019, 11:37 AM   #44
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Originally Posted by sengsational View Post
Never used it, but thought I'd comment on this snippet.

Some free sites, like maybe some government funded sites, might have a wholesome agenda aligned with the health of the population. As for this site, I was thinking "I'm grateful that it's a "pay site"; if it weren't then I'd wonder who's motivated to offer the site and why. And just because it's a "pay site" doesn't mean it's good; it might be good, it might not be. The point I was trying to make is that any site that's "free" likely has an agenda that may not be obvious, and might not be aligned with the patient's best interests.
Good thought. Sometimes you get what you pay for....
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Old 06-05-2019, 11:41 AM   #45
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Just curious, but 90 HB does not appear to be that high. When my SVT showed up last Fall, I was recording 200+ HB.

Monitoring now with just walking, my HB is 90 - 100 with moderate effort.

Could be that we are all just a bit different.
Keith is Canadian, so I think he must have meant 90 Celsius.
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Old 06-05-2019, 02:07 PM   #46
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Originally Posted by daylatedollarshort View Post
The site recommends a plant based, whole foods diet similar to the one in the Blue Zone book. We've had some amazing health improvements between us so far after just a few months even though we probably only adhere to it 70 - 80% of the time.

FWIW, I was once told by a nutritionist that if a person adheres to a healthy diet 80% of the time, a 'bad' meal is not an issue. He pointed out that eating good food 20% of the time will not overwhelm the bad effects of the 80% junk food meals. It makes sense for the opposite to be true; 20% bad food will not overwhelm the benefits of the 80% good food. It's the constant ongoing consumption of poor quality food that is the issue. 80% means that for most of us we can have one 'bad' meal every other day. 90% still allows us two 'bad' meals a week. That's really not that tough, IMHO.



Obviously, allergies and certain trigger foods cause exceptions to the general rule above. We are all different. And, rather than start another interminable nutrition discussion, I will let us each decide what are the good and bad foods we eat.
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Old 06-05-2019, 02:16 PM   #47
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Originally Posted by daylatedollarshort View Post
The site recommends a plant based, whole foods diet similar to the one in the Blue Zone book. We've had some amazing health improvements between us so far after just a few months even though we probably only adhere to it 70 - 80% of the time.
FWIW, the 80% rule works for me.
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Old 06-05-2019, 02:21 PM   #48
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FWIW, the 80% rule works for me.
When I began eating a LCHF diet a number of years ago I struggled with cravings until I got a great piece of advice from someone who was more experienced with it.

Every 6-10 days (no set schedule, just as I feel like it), I abandon my diet and have an "anything" day. Seems to work really well for me.
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Old 06-05-2019, 03:04 PM   #49
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FWIW, I was once told by a nutritionist that if a person adheres to a healthy diet 80% of the time, a 'bad' meal is not an issue. He pointed out that eating good food 20% of the time will not overwhelm the bad effects of the 80% junk food meals. It makes sense for the opposite to be true; 20% bad food will not overwhelm the benefits of the 80% good food. It's the constant ongoing consumption of poor quality food that is the issue. 80% means that for most of us we can have one 'bad' meal every other day. 90% still allows us two 'bad' meals a week. That's really not that tough, IMHO.
We went out with friends over the weekend to an expensive (for us) restaurant, and if I'm going to pay those kind of prices I'm not ordering a simple salad I could chuck together in 10 minutes at home. I think I ate my meat quota for the week in one sitting.

But I've lost weight without any effort (other than cooking healthier) or exercise and some scars I've had for a long time recently healed over, so I even with the 80% we're seeing the benefits.
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Old 06-05-2019, 04:00 PM   #50
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It is not always the doctor's fault in prescribing marginally useful meds.
Pharma companies do hide negative info at times. Example: Tamiflu.
"
But the full clinical study reports from those trials were locked away. There wasn't even a list of what trials were conducted; Cochrane initially figured there were about 36 and sought to read them all. It began negotiating with the drugmaker, filing freedom of information requests to the FDA and the European Medicines Agency (EMA), Europe's FDA equivalent, and backing pressure campaigns in the media. At one point early on, Roche offered to give Cochrane 10 reports, but only if it signed a confidentiality agreement keeping everything secret—including the existence of the agreement. Cochrane refused to sign.
After five years, Roche and the EMA opened up (the FDA has not, and did not respond to requests, both from Cochrane and Newsweek, to explain why). What Cochrane uncovered was more than 70 Tamiflu trials and well over 100,000 pages of unpublished reports. Among them were many trials where the results were negative or inconclusive. With this more complete picture of the testing, Cochrane concluded the trials don't prove that Tamiflu prevents hospitalizations, contagiousness or complications. The only thing it definitely does do, Cochrane said, is shorten the duration of symptoms, by about a day."
https://www.newsweek.com/2014/11/21/...em-284066.html
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Old 06-05-2019, 09:16 PM   #51
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+1

Good point. One thing that I didn't realize is how little education doctors get on nutrition and diet. Pitiful.
I wonder, are there cardiologists who don't know that heart disease is reversible through diet? It's known that atherosclerosis can get worse, but can it be reversed?

My sister has had one stent and is getting another soon. I gave her a book called "How To Prevent and Reverse Heart Disease" by Dr. Esselstyn. She took it to her doctor and the good doctor said Esselstyn was a quack.

Stents and bypass are big business.

https://nutrition.org/a-time-for-cha...n-in-medicine/

How many patients gettting on the surgery table even had the wherewithal to ask what their EFR (ejection fraction rate) was or why that might be important?

Can nutrition literally reverse heart disease? Important questions to ask the doctor before surgery. And if he doesn't answer those questions, should be liable for malpractice.
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Old 06-06-2019, 07:13 AM   #52
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<<-Even the process by which medical science/evidence is published is subject to a host of confounding issues>>

Like what was the assumption going in, even though you're not supposed to have any. Researchers are human.

What does "evidence based" really mean when 2 study results conflict? Or when medical / health pundits spin them to support their POV?

Nutritionist - there's another term that tells you nothing. At my club the nutritionists get paid by insurance. They put "healthy" recipes in the club newsletter that are all 10% some vegetable and 90% bread, honey, or high-fructose fruit. How can a nutritionist not have gotten the memo?
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Old 06-12-2019, 02:09 PM   #53
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Another sobering article along similar lines:

https://www.theatlantic.com/magazine...tistry/586039/
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Old 06-12-2019, 04:26 PM   #54
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I was a marathoner for over a decade, and I developed cardiac hypertrophy (normal in endurance athletes). Internal medicine doc diagnosed abnormality (ectopic heartbeat) and immediately ordered nuclear stress test and echocardiogram - even though she didn’t think the abnormality was significant. Naively, I agreed to the tests. Results were consistent with exercise-induced heart enlargement. Then came the bill - over $10K to tell me my heart was fine. And I had a $6K deductible. Ouch. Fast forward to this year. I moved to Florida and was trying out new doctors. I’ve been following a thyroid nodule for over a decade. Endocrinologist had been following it for 5 years with no change in size and no bloodwork abnormalities. I’m hypothyroid and take daily levothyroxine. New Florida doctor ordered bloodwork and thyroid ultrasound. Radiologist started jumping up and down screaming biopsy. I asked how much the nodule had enlarged (Iprovided several years of previous ultrasound exams). She refused to answer my question, so I self-referred myself to a local endocrinologist. She agreed with me that there was 95% chance the nodule was benign, but I let her talk me into a needle biopsy which of course was read out as benign. It scares me that the average person doesn’t have sufficient medical knowledge to be able to advocate for their own well-being.
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Old 06-12-2019, 05:18 PM   #55
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It scares me that the average person doesn’t have sufficient medical knowledge to be able to advocate for their own well-being.
It scares a lot of us, but many of us are figuring things out and trying to get smart on what may be the problem one has ahead of seeing a doc.

Last year, I developed an uncontrollable heartbeat and suspected (myself, through research) that it probably was SVT. I took action accordingly, found the right cardio person, did the right testing, and I was right. Got it fixed last December. Maybe I was lucky? Don't know, but the info and data is out there at your fingertips these days.
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When Evidence Says No, but Doctors Say Yes
Old 06-12-2019, 05:50 PM   #56
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When Evidence Says No, but Doctors Say Yes

Quote:
Originally Posted by whitet View Post
Another sobering article along similar lines:

https://www.theatlantic.com/magazine...tistry/586039/


Guesswork in dentistry! What could possibly go wrong?
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Old 06-12-2019, 09:03 PM   #57
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Maybe piling on but an article from one of my favorite medical authors, Atul Gawande - 'Overkill'
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Old 06-12-2019, 10:11 PM   #58
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Guesswork in dentistry! What could possibly go wrong?

I had a chipped tooth once and the first dentist I saw said I'd need braces and then he would have to rebuild my jaw. The second one just put in some kind of resin filling and it looks fine.
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When Evidence Says No, but Doctors Say Yes
Old 06-13-2019, 06:41 AM   #59
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When Evidence Says No, but Doctors Say Yes

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Originally Posted by Scratchy View Post
Very well written and interesting article which is noting among several things that

-Physicians often do not follow current evidence based guidelines
-Even the process by which medical science/evidence is published is subject to a host of confounding issues

I have no solutions to these problems but I wanted to offer my thoughts on what may improve the odds you will get good care, based on my experience as a health care provider and also as a patient and family member of patients:

-Try to get health coverage that preserves choices in providers-both doctors and hospitals. Favor regular Medicare over Medicare Advantage plans. Favor PPO's over HMO's.

-If you require surgery or have a complex medical condition, seek care or get a second opinion from a physician with a university based medical center. In my opinion, the clinicians at these centers are often more up to date and have less of a tendency to be influenced by factors not related to the patient's best interest.

-Be an informed patient. use websites like "uptodate" (my favorite) or as mentioned above by 6miths to learn about your disease and treatment options.

-If you or a loved one have a serious illness, be ready to do some hard work and recruit other family/friends to assist. It should not be the case, but there is a strong correlation between effort invested and quality of care received. I have been the primary person arranging medical care for several family members who were very ill and I don't think anything I have ever done was more high stakes, challenging and exhausting. Among other things, be ready to do battle with health insurance companies, research treatment options, health care facilities, health care providers, and spend hours arranging appointments, getting prescriptions, obtaining and delivering records.

-If you have a family member in the hospital, be there as much as possible, ideally around the clock. Keep a notebook in the room and keep it updated with information on what has happened and what is planned. As much as possible, double check everything being done-there is still no perfect system for preventing medical errors. Try to make sure everyone and everything that touches the patient has gloves or has been sanitized.

The above is of course all my opinion, very generalized and by no means applicable to every situation.


^Word.

A medical advocate as you’ve described is a tremendous gift to another - May there be someone special like you in your corner if it’s ever your turn to navigate a serious condition through the rapids of healthcare.
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Old 06-13-2019, 08:16 AM   #60
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Just curious, but 90 HB does not appear to be that high. When my SVT showed up last Fall, I was recording 200+ HB.

Monitoring now with just walking, my HB is 90 - 100 with moderate effort.

Could be that we are all just a bit different.
The 90 referred to % arterial blockage not pulse. In fact, my pulse was around 50 until I got tachycardia. But I did have chronic HBP and my pulse is now 65 and BP of 120/73 under medication.

I asked the technician about it and he said that they use stents if there is a single blockage. Otherwise they do a bypass. But he says they seldom put stents into the coronary artery because the risk of heart attack is too high.
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