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Uncertainty is certainty

April 1st, 2015


Uncertainty is certainty

As the world spins around, everything changes and nothing remains the same. Interestingly, there are things that change completely, not just gradually. One of those things is the medical world.

When I was a medical student, when we tried to save someone’s life such as when the patient stopped breathing or when the person had a heart attack, giving sodium bicarbonate was a must. Neglecting to give that medicine was considered wrong at the time. Now the coin has flipped, and giving that said medicine is considered a wrong thing to do.

It is not a surprise because doctors are not always 100% right. Some medicine could be a must 5 years ago, but a must not today. For example, some hormones and vitamin E were considered good for your heart health , some medicine with harsh side effects which were found after being used for sometime are now banned and discontinued. Nothing is certain, except birth aging, sickness and death.

The same goes for treating heart disease. Around 70 years ago, if any doctor asked a patient who had had a heart attack to get up from the bed would probably get a lot of disapproving look. The patient would be advised to take absolute bed rest for months because it was believed that the heart should not overwork otherwise the condition would become worse. That was the “correct” practice back then, but then again, even a fact is uncertain.

Fortunately, two “quirky” doctors came up with an idea that maybe a heart attack patient should get up and go instead of rest in bed. They tried the “chair treatment” which meant the patient rested while sitting on a chair instead. That was a groundbreaking discovery and they became famous for their new method (but if the patient got worse, their names would instead be infamous). That happened about 50 years ago.

Even more recently, we found that electricity could help patients whose heart had stopped beating temporarily due to acute myocardial infarction. Before that, if a patient’s heart was in such a condition, there was nothing any doctor could do. At present, technology has become so advanced that the device could work automatically without a doctor’s presence. These automated defibrillators are even placed at public places overseas such as on airplanes or at airports. If the heartbeat goes flat, the device could help instantly. Some Thai people also have automated implanted cardiac defibrillators inside their body. Imagine if you said 50 years ago that you were going to use electricity to bring a heart back to life. You would probably be called a lunatic.

Later, around 40 years ago, more and more heart disease patients survived. About 30 years ago, balloon angioplasty was developed to save even more lives. New medicine was also developed and all the new technologies changed the way heart diseases are treated. As a result, people with heart disease could live longer. However, there are still some people with heart failure because they have not been properly treated, but in general, the advancement has helped people with heart disease live longer and have better health.

Now it is believed that absolute bed rest could in fact be bad for those with myocardial infarction. Patients are advised to get up and sit or walk, and they could be discharged in 5 days if there is no complications. However, recovery should be under close supervision. For those with balloon angioplasty or stent placement, they could even go home the next day if there is no complications. On the flip side, it makes some patients feel that heart disease is not fatal and so they neglect to take care of themselves. Some even say balloon angioplasty is not as big a deal as appendix removal!

So do not be surprised if in a few years I say that treating narrowed artery disease could be done by restricting diet, exercise and using a massage machine instead of balloon angioplasty! Anything is possible.

A patient of mine was about 40 years old. He came to see me with sharp pain in his chest after a big meal with his girlfriend. Luckily, the restaurant was near the hospital, so he made it to the hospital within 30 minutes. After examination it was found that his artery was clogged, so I gave him anti-platelet medicine and balloon angioplasty with stent placement within 40 minutes.

When removing the balloon, he said he could feel weight being lifted off his chest. I felt the same because it was actually a tricky and risky case. Without my skilled team, it wouldn’t have been so successful.

Two days later he went home, and went out with his girlfriend again without a problem. He still came back for heart rehabilitation program to make sure his heart is strong. Only recently I heard that he entered a marathon to prove to his girlfriend (I’m not sure if it’s still the same girl) that even after a heart attack, his heart is still strong. He told me later that when he told the girl that he had had a heart attack, she did not want to marry him because he would not be able to be with her forever!!!

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.


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