The View From the Outback

• Thoughts While Staring at the Ceiling Fan
• My First Nominee For "Media Whore" at The Wall Street Journal
• FBI Meeting Resistance From Colleges re Foreign Student Info
• Media Bias Takes Many Forms
• Too Many Unneeded Heart Bypass Operations
• Suggested Reading From Past Columns

Remember Peal Harbor! Be more vigilant as a nation.

There is another search engine to rival Google.com, and in some ways it may be better. Check out: www.alltheweb.com and see what you think. I found that it indexed nearly every one of my Outback columns when I typed my name in the search box. When I typed in "Flying in Laos," I was surprised to learn that my article "Flying in Laos," was linked on the Air- America.org page. Some pretty obscure stuff was uncovered. A tourist to Laos commented on a sign in a hotel lobby: "No Opium Smoking in Lobby." That sounds about right.

Jack Welch, age 67, the ex-CEO at GE, is involved in a messy divorce. His second wife Jane, age 50, wants a ton of dough from the very wealthy Mr. Welch. Presumably she considers her original $4.9 million prenuptial cashout to be chicken feed. Mr. W. was caught in an affair with a 43-year-old woman. Mrs. Welch was caught in an affair with her Italian chauffeur and bodyguard. Several thoughts. If you peruse the personals on the Internet, you do not see any 43- year-old women "seeking male age 67." But, if the man is very rich, all ages are in play. Ironic that Jack Welch divorced his wife to marry a woman 17 years his junior, and then cheated on her with a woman 24 years his junior. Talk about a middle-age (senior-citizen) crisis. The current Mrs. Welch is receiving $35,000 a month for expenses. Poor baby. How does she scrape by? Here's a great solution. Mr. Welch, the current Mrs. Welch, the 43-year old mistress, and the chauffeur/bodyguard should all be required to live in the same house. And Jack Welch be required to set up a joint checking account to which they all have access. It will air on FOX as "Millionaire Cat Fight." I love it!

In an earlier Outback, when talking about the sniper arrests, I commented that one thing was sure. There would be fight over the $5000,00 reward - and the lawyers would get more than their share. One person is claiming that he had a "vision" that led to the arrests. There were 67,000 tips in the case! Well, if you divide $500,000 by 67,000 lawyers.... You get the picture.

A mother and daughter team on "Wheel of Fortune" on TV were confronted with the following Bonus Round puzzle: "On the Map."

_   _  R   _   _   _   _   _  

They had no clue. My guess was PARAGUAY, and I was right. It helps that I once traveled to Uruguay and that over the past 20 years I have talked hundreds of times to ham-radio friends in Paraguay. Just when I was ready to check myself in the VA old-soldiers home for senility, I get a reprieve.

I mentioned in an earlier Outback about the slaughter of Dolphins in Tuna nets and how I would not be upset if somebody simply wiped out the entire crews of the Tuna boats engaging in the slaughter. It is now estimated that since the 1950s about 6 million Dolphins have been killed. Due to public awareness, the slaughter is now down to about 3,000 a year. That is still a disgrace. Check the Tuna can for the symbol that says "Dolphin Safe."

In the Outback for October 12, 2002, I posted "The Main-In Rebate Scam." This week, both The Wall Street Journal   and NBC Nightly News ran something on rebate problems and scams. Honestly, I feel rather smug that I had an in-depth article about the subject back in early October. It does bug me, though, to wonder if either of them read my piece or was it just that they came late to the party - simple coincidence.

The biggest debate over the Homeland Security bill was about employees union rights and collective bargaining agreements. Now, the Bush administration would like to put as many as 850,000 government jobs (about half the fed's workforce) up for competition from private contractors in coming years. You can hear the screaming and cursing clear out here in the Outback. The Veterans Administration, for example, employs 11,000 lawn-maintenance workers, dry-wall hangers, janitors and so on - and 10,000 cafeteria workers. It will interesting to see how the American Federation of Federal Employees will try to justify keeping these jobs under the Civil Service umbrella, especially since many states and localities have for some time been saving money and getting more efficient with the use of outside contractors. None of the guys around here who mow lawns have any collective bargaining agreements.

A recent report stated that flu shots work for about 90% of adults, but are effective for only 30- 40% of the elderly. That's not very encouraging, since it is the elderly who tend to croak most often from the ravages of the flu.

A camera operator on C-SPAN seems to have found a new hobby. Time and again during recent showings of boring meetings, hearings, and so on, the camera has zoomed in on some member of the audience who is fast asleep. Often it is a Senior Citizen. Be nice. They need their rest.

The American Heart Association has a Web site about "Cholesterol Low Down." The site is sponsored by Pfizer. What is wrong with this picture? Is it any wonder that we have so little faith in the medical information we get about cholesterol?

For a long time, I have been defending the former Florida secretary of state, Katherine Harris. Now, she has been elected to Congress (R. Fla.) and has been named assistant majority whip. The whips are generally charged with getting fellow members whipped into shape to vote on specific pieces of legislation. We'll see how many media idiots continue to demean her, question her integrity, and make fun of her use of abundant facial makeup. You go, girl.

A review of the video game "Grand Theft Auto: Vice City" includes the following: "Raunchy language, strippers and frontal nudity. A player gains points by having sex with prostitutes, shooting police, beating up women and carjacking." And people are still trying to figure out why there is so much violence and such a lack of moral restraint in our society? Duh?

Lisa Marie Presley is divorcing Nicholas Cage. I am reminded of when her mother, Priscilla Presley, showed up on the set of the TV show "Dallas" for the ballroom scenes - which as I recall, was her first TV role. She was so beautiful that I once wrote that she was like a porcelain doll, and you feared that if you spoke too loudly she would crack. She seemed completely unpretentious, this ex-wife of Elvis. One day, the makeup people had her flip her head and reverse-combed her flowing locks. When she looked up at the 50 or so of us standing around her in a circle, she said, "Oh, you are going to learn all my beauty secrets." One day many of us (who did not care for the free lunch-wagon chicken) were in line to be seated in the coffee shop at the fancy hotel where the ballroom scenes were shot. I glanced back and there was Priscilla Presley, resplendent in a formal gown, standing in line by herself. I called to her: "Priscilla. Larry (Hagman) and Linda (Gray) already have a table. Go ahead and join them." She actually hesitated and apologized to the people in line before joining the other stars at their table. Nice lady. Fun days.

Al Gore has been on the case of FOXNews, The Washington Times , and Rush Limbaugh for being mouthpieces for the Republican party and conservatives. Gosh, Al, that is three against about 10,000 liberal outlets. Is it treason that not everyone lines up to print and voice liberal positions? You must really be nervous if a cable-TV news network, a David vs Goliath Washington newspaper (Times vs Post), and a windbag on the radio are getting to you.

My First Nominee For "Media Whore" at The Wall Street Journal

Never before have I used the term "media whore" to refer to a reporter at The Wall Street Journal. Jeanne Cummings, writing in the WSJ for November 26, 2002 "Gonzales Rewrites Laws of War" attempts to portray White House Counsel, Alberto Gonzales, as a legal loose cannon who is running roughshod over the Constitution.

Paragraph two begins "Since the Sept. 11 attacks, the former commercial-real-estate attorney from Texas has been rewriting the laws of war." This is biased reporting at its worst. Ms. Cummings picked about the most obscure portion of Mr. Gonzales' background in an attempt to demean and minimize him.

She neglected to mention that Alberto Gonzales had also been enrolled for two years at the Air Force Academy, had been General Counsel to Texas Gov. George W. Bush, the former Secretary of State of Texas, and a justice on the Texas Supreme Court. A few minor oversights? Alberto also was an attorney with Vincent and Elkins from 1982-1995. This is a firm known for its heavy hitters who either went into politics or joined V&E after a political career. It isn't exactly an obscure commercial-real-estate law firm.

As Ms. Cummings later pointed out, Alberto Gonzales graduated from Harvard Law School. The irony of her story is that during his tenure on the Texas Supreme court, Justice Gonzales was considered by many to be a moderating influence on a generally conservative court. Some conservatives had misgivings about his appointment as White House Counsel, saying that his views were too permissive.

So, I looked for a short bio on Ms. Cummings. What is her problem? No surprise. She is known, among other things, for her reporting on the political/money machine that helped finance Newt Gingrich's rise to power. Her articles are credited with leading to the ethics case against the former Republican Speaker of the House. Now sensitized to her political bent and apparent propensity to slant her writing, I will read all future "reporting" by her through a special filter. Ms. Cummings is a reporter, not a columnist. There is a big difference.

Ms. Jeanne Cummings will need to keep her liberal claws sharpened for the possible day that Alberto Gonzales might be nominated for the U.S. Supreme Court. It will be interesting to see how she then might attempt to minimize his accomplishments and intellect. She could always start by saying that he was a poor Mexican kid who grew up in Houston in a two-bedroom house as one of eight siblings. But, that's the point. No matter what your circumstances, if you force yourself to get a good education, there is no goal to which you cannot aspire. Al Gonzales is a brilliant man and a powerful role model for Latinos, not just a former "commercial-real-estate attorney" as Ms. Cummings chose to portray him.

FBI Meeting Resistance From Colleges re Foreign Student Info

The FBI is meeting resistance from some colleges in their requests for information on foreign students. Schools are now required to provide information on foreign students to the INS database. The FBI can search the database, but cannot make a copy of it. What sense does this make? So, the FBI is sending out their own inquires. Schools can voluntarily turn over to the FBI the following info: student's name, address, email address, and telephone number. The FBI must obtain a court order or subpoena to obtain the student ID number, Social-Security number, ethnicity, race, citizenship, and gender.

For a foreigner, studying in the United States is a privilege, not a right. Why should our intelligence and law-enforcement not be able to know all they can about these students? Do you think there are many foreign universities that would fail to provide student information to their local authorities? We are still caught up in the liberal hysteria about racial profiling and privacy. I suggest that a foreign visitor to the U.S. has no expectation of privacy, or should not have - for the sake of our national security.

I still like the idea, which I postulated many months ago, that ATM machines be programmed to monitor Foreign Visitor ID Cards (yet to be issued). Each foreign visitor would be required to "register" at an ATM once a month. It would provide: a file photo of the person, and a precise location for them on that day. This database should feed into both the INS and FBI files.

Let me take this a step further. Maybe we should also restrict the subjects that foreign students can take - especially from those countries that sponsor terrorism or harbor terrorists.

Should we restrict access to courses in Atomic Physics and related subjects, and electrical engineering and computer science? After all, we have export controls on technology. The export of knowledge is just as critical as the export of hardware. Let anyone study political science, medicine, law, accounting, paleontology, or business administration, for example. But, perhaps it is time to draw the line about unfettered access to courses that could assist a foreign power in its efforts to attack us, our infrastructure, or our computer networks - or thwart some of our military weapon's capabilities.

We have been a nation of soft-hearted rubes and suckers long enough. The world has learned how to game our systems and our institutions. It is time to stop pretending that every visitor to this country has the same rights under the Constitution as do our citizens. And time to completely re-evaluate our immigration policies. We are no longer the United States of America - with arms open to immigrants who seek a better life and have something to contribute. We have become the world's dumping ground. Have you ever examined the immigration policies of Switzerland or Australia, for example? How about Japan?

Media Bias Takes Many Forms

Have you heard about the terrible rider that the Republican House tacked onto the Homeland Security bill, and then that the Senate was forced to include it or face a presidential veto? Among hundreds of others in the media, Albert Hunt, writing in the WSJ for Dec. 5, 2002, says: "...it included surreptitious special-interest provision that gave Eli Lilly, a big GOP contributor, immunity from lawsuits over a drug it made that some have linked to autism." Surreptitious provision? I watched much of the Senate debate. Many senators commented on the provision, since it was written into the bill for all to read. Hardly surreptitious. Words can inflame, if not measured carefully by the reader. A careful choice of words can be insidious.

In the same issue of the WSJ, the editorial board set the record straight. Eli Lilly used to make an ingredient included in many vaccines called Thimerosal. The anti-vaccination crowd, who often have very little real scientific evidence, claimed that vaccines containing Thimerosal were causing Autism. Although there is conflicting and inconclusive evidence of the role of Thimerosal and autisim, that is not the main issue raised by Mr. Hunt. He stated that the Homeland Security bill provided immunity from lawsuits to Eli Lilly, who had manufactured Thimerosal.

Well, guess what? The Homeland Security rider does NOT give Eli Lilly "immunity" from lawsuits, as the biased media have so frequently reported. It simply requires that lawsuits regarding Thimerosal are first brought before the Vaccine Injury Compensation Program, which has expertise in judging the validity of claims of harm from vaccinations. The VICP was set up to ensure that plaintiffs who had been truly harmed by a vaccine would be promptly compensated. The plaintiffs are later still able to sue in regular courts (presumably if they did not receive compensation or contest the amount).

Once again, the media has attempted to demonize Republicans by saying they represent "special interests." In truth, the VICP was originally set up because frivolous lawsuits were driving vaccine makers out of business. Today, only four companies make vaccines. If the plaintiff's lawyers were allowed to go unchecked, it is probable that all vaccine makers would be driven out of business. At a minimum, they all devote millions of dollars to defending and settling lawsuits that could better be spent on research. Once again, the cry rings out from the ramparts" "Kill all the lawyers."

My apologies to the WSJ for my generous use of information from the Dec. 5, 2002 issue. So, sue me. You might get $1.50 from my fabulous net worth. Not everyone can afford to read the WSJ. This column is free - and worth every penny.

Too Many Unneeded Heart Bypass Operations

The investigation of the staggering number of heart operations and other cardiac procedures at the Redding Medical Center in Northern California has caused a stir. In one 12-month period, the doctors at Redding performed 923 open-heart operations and more than 16,000 catheterizations. The FBI is investigating the matter. There is something very wrong with the high number of procedures performed, given the small staff involved. One report estimated that between 25-50% of the patients underwent unnecessary invasive coronary procedures. This finally got me off my butt to write an article I had been making notes on for over a year.

One of the most outspoken critics of unneeded heart surgery is Julian M. Whitaker, M.D. ("Is Heart Surgery Necessary? What Your Doctor Won't Tell You"). There are about 500,000 heart bypass operations performed each year. Dr. Whitaker thinks that a large percentage of those are unnecessary. His assertion is supported by many studies and books.

Before I get into the specifics of who is and who is not a good candidate for a bypass operation, let's look at the some of the gory details. Except in some limited situations where "keyhole" surgery is performed, your breastbone will be cut in two with what one might call a surgical "skillsaw." The ribs are pried open to expose the heart and the arteries leading to and from the heart. If you saw a video of your bypass operation, you probably would pass out from shock. Unless you love "ER" on TV.

Depending on how many arteries need bypassing, veins or arteries must be harvested from your body. The first choice is arteries, such as the mammary arteries in your chest, since they have a better chance of remaining open for a long period, perhaps as much as 90% clear after 10 years and still functioning okay at 20 years after the operation.

If you need many by-passes, veins will be harvested from a leg, leaving a very long scar and some possible problems later with circulation in that leg. The veins don't have the potential for a long trouble-free life as a bypass graft. Some may start to close or deteriorate within five years. By 10-12 years, by one estimate, 50-60% of vein bypasses will have closed.

So, your long-term prognosis depends in large part on how many arteries need to be bypassed and how many can be done with your own harvested arteries - rather than veins. When your operation is completed, you should ask for a diagram showing how many bypasses were done and which ones used grafted arteries and which ones used grafted veins. That will give you something to think about over the next 5-20 years. By then, new and less invasive techniques will probably be in use.

Larry King, of TV and radio fame, was talking recently about his heart problems. In 1987 he had a heart attack, followed by 5-bypass surgery. One would assume that his doctor was forced to harvest both arteries and veins. In 1997, Larry developed a problem and had Angioplasty in one of the bypasses. That was 10 years from the time of the operation. The odds are that the Angioplasty was done in a harvested vein, not an artery. Now, five years later, he is apparently symptom free. Many celebrities have had bypasses, a long time back. As I recall, a couple were Henry Kissinger and Gen. Al Haig.

While you are on the heart-lung machine, which circulates your blood by mechanical pump, complications can arise - or crop up later. For example, you may be more subject to stroke during or after the operation, possibly due to some debris or an air-bubble that is dislodged and works its way to the brain.

There is strong evidence that a substantial number of bypass patients suffer post-op cognitive difficulties. In lay terms, your memory may suck and you can no longer figure square roots in your head. You may also develop an arrhythmia of the heart (an irregular rhythm) such as Atrial Fibrillation. While Atrial Fibrillation is not generally life threatening, it does increase your risk of stroke, for example. The treatments for Atrial Fibrillation are often more distressing and potentially more dangerous than the problem they attempt to solve.

A small percentage of patients die during the bypass operation or shortly thereafter (some mortality figures are cited later). If you make it through, they tie your breastbone back together with stainless-steel wires. On an X-Ray, they look like bread twisty-ties. On skinny people, the steel ties have been known to squeak, and are removed by the doctor after the breastbone is fused again.

Recuperation times and problems vary. You might be able to get right on a treadmill or a stationary bike with no problems. But, you do not want to cough! You will think a Mule is kicking you in the chest. You will be given a "cough pillow" to squeeze against your chest if you have to cough. This limits the movement of the "lashed-together" breastbone. It takes months for the breastbone to fully heal, and the scar can remain a red welt that looks like Zorro got to you with his sword. There goes parading around on the beach.

Many bypass patients suffer post-op depression.

Are you getting the picture? This is a horrendous operation, with many risks, and substantial post-operative fallout. You better be damn sure you need it!

Dr. Julian Whitaker talks in his books about who is actually a good candidate for a bypass operation. In his book "Reversing Heart Disease," he lists the following as potentially good reasons to have a heart bypass:

• Significant blockage in the left main coronary artery
• An "ejection fraction" of less than 50%
• Three or more arteries significantly blocked, and decreased left ventricular function
• Incapacitating chest pain

Other than those caveats, Dr. Whitaker implores the reader to question and question why your doctor(s) think you need a bypass operation. He cites studies that contend that half of all bypass operations are not needed.

Dr. Whitaker is only one doctor, but many others fall in the same ballpark with their suggestions of who might or might not be a candidate for bypass. Since Whitaker's book was written in 1995, Angioplasty has come on as a stronger alternative in many cases.

During Angioplasty, a small incision is made (often in your groin area) and a catheter with a balloon on the end is inserted in the artery and is worked all the way up to the blockage(s). You are not put "under" with anesthesia, so this is a plus. You are simply sedated. The balloon is inflated to open the obstruction in the artery. These days, it is most common after the balloon opens the artery to insert a "stent" (a metal or composite sleeve) in the artery to keep it open once the balloon is withdrawn.

With Angioplasty alone, about 40% of arteries reclog within six months (ask VP Cheney). Angioplasty plus leaving a stent in place reduces reclogging in the short term to about 25%. One problem with a stent is that the stent itself is an irritant that can set up inflamation that starts to reclog the artery. Newer, drug-coated stents appear to be much less prone to cause inflamation. Some two-year followup studies of those who got drug-coated stents show the patients to be remarkably free of inflamation or scar tissue around the area of the stent insertion.

The Angioplasty procedure is not without risks, since there is a "snake" being threaded through the arteries of the heart. A very few people die. Some have heart attacks and are quite often sent immediately to surgery for a bypass operation. The conventional wisdom used to be that you should not undergo Angioplasty unless you were in a facility that also had a heart bypass operating room and staff on standby. Recently, that advice is being tempered, probably because of the increased skill and successes of doctors doing Angioplasty. And there is some risk of damage to the arteries with the snake poking around in there and dislodging something that might cause a heart attack or stroke. But, in comparison to bypass surgery, it is a relatively simple procedure, with rapid recovery (time for the small incision to heal) and few side effects.

Recent studies indicate that comparable results to a bypass can often be obtained with Angioplasty, particularly when one of the newer stents is left in place to keep the artery open. Some blockages are in tight spots and bends where Angioplasty and stents will not work, and there are other situations that mitigate against using Angioplasty. Only an honest and forthright discussion and examination by both your cardiologist and a consulting thoracic (heart) surgeon can give you your best chance at picking the right option.

So, how do you know if you need - and would greatly benefit from - heart bypass surgery, or would Angioplasty be sufficient? It's not that easy. You might also want to consider the possibility that medications could allow you to hold your own, without surgery. And there are doctors like Dr. Dean Ornish and Dr. Julian Whitaker who believe that you can reverse the course of heart disease by a vegetarian diet and exercise. Dr. Ornish has a more holistic approach.

First are the diagnostic tests. Too many people are rushed into the "cath lab" to do an Angiogram. Here, as in Angioplasty (which might even be performed at the same time), a catheter is threaded into the arteries of the heart. A dye solution allows the doctor to see your arteries and any blockages on a TV monitor. You can look too, if you are not squeamish, because you are awake and mildly sedated. As noted earlier, this is an invasive procedure. There are several other tests that could (or should) lead up to the Angiogram. Ideally, the Angiogram is the last step in a series. Too often these days, it is the first step - possibly after only having a resting EKG (ECG).

Where to start? First with a resting EKG (ECG). If there are signs of trouble, then take a stress test, which is an EKG while on a treadmill (for most people). Frankly, a lot of people's resting EKG looks fine, but the stress test shows significant problems. But, the resting EKG is good to have on record for a baseline, even if it does not show a problem. You might have chest pains and your resting EKG could appear pretty normal, especially if your pain only comes on with exertion.

If you "fail" the stress test, which might show evidence of a prior heart attack, or improper functioning of the heart, or improper blood flow to the heart, another step might be a Thallium Exercise Scan. You start on the treadmill (monitored by an EKG), like on the stress test, but radioactive Thallium is injected into an artery as you walk. Once the Thallium is well distributed in your system, you move immediately to an X-Ray machine that takes pictures of your chest area from several different angles. Then, you are allowed to let you heart rate return to normal, and another set of identical X-Ray pictures are taken. The before and after can be projected on the computer screen to show graphically what kind of blood flow there is to your heart at rest and what kind of blood flow there is under exercise stress. The visualizations can show dramatically where your heart is failing to get blood during exercise. Oh, so that is why I have chest pains when I mow, you might conclude on your own as you view the color renditions on the screen.

Although the Thallium Scan can show you and the doc that you have reduced blood flow to various areas of the heart, it does not tell you which arteries are blocked.

A PET scan is also a very good heart blood-flow diagnostic test, but it is expensive and not widely available. An Echocardiogram of the heart can show the size of the heart and its chambers and its general functioning. These two test would not normally be given in the progression of tests to find if you have blockages in your arteries leading to angina and other problems.

Finally, but not in the first place, you are ready for an Angiogram, an invasive test. (Some patients might go from a "failed" stress test right to an Angiogram. But, if your insurance will cover it, the Thallium scan is less invasive and shows things that the Angiogram does not.) The small incision probably will not hurt much, depending on how many sedatives you were given. Load me up with pain pills, doc. The anxiety is probably worse than the physical discomfort.

But, you may be shocked when the Angiogram procedure is over and they get ready to send you home - that same day, usually. They tell you to make sure to keep your leg straight and maintain compression on the incision - for a long time - perhaps 12 hours. Otherwise, they say casually, "You might bleed to death." Oh, where was that in the brochure?

Here are some thoughts. Gather up all the diagnostic tests, including a VCR tape of your Angiogram (some labs give you a VCR tape of your procedure), and start getting second and third opinions. Cardiologists can do Angiograms and perform Angioplasty procedures. Only a Thoracic Surgeon can do a heart bypass operation. Ideally, look for a reputable cardiologist who does not do Angioplasty (but has in the past, or is current on the technology), ask him or her to review you case history and your diagnostic tests. He has no dog in the fight. That might be hard to do. But, do not approach the second opinion with the idea that you want an affirmation of the first opinion, but rather that you want somebody to question the earlier recommendation(s). If he thinks your problems are so severe that even Angioplasty will not cure them, have a reputable Thoracic Surgeon examine your records and tests. If I had the slightest doubt, I would seek out a third opinion, either from a Cardiologist or another Thoracic Surgeon.

(At least one "cath lab" in Dallas can provide a consulting doctor with a Super-VHS VCR tape of your Angiogram procedure. One cardiologist told me that the resulting pictures are the best he has ever seen on referral cases.)

Does all of this sound like overkill to you? Well, the sad truth is that doing Angiograms, Angioplasty, and heart bypass is very lucrative for doctors - as the Redding Medical Center case is bringing to light. There is no question that a certain percentage of heart procedures are done each year mainly to make the doctor and the hospital some money. My research indicates that there are a very large number of unnecessary Angiograms, Angioplasties, and bypass operations each year.

And let's go back to the beginning of this piece. Before you consent to a heart bypass operation, you better damn well be convinced that you absolutely must have it to survive or your pain is so bad you cannot function. Check out Angioplasty and the other alternatives. It is hard to imagine a more invasive, a more horrendous medical procedure, than a heart bypass operation.

Consider looking into the work of Dr. Ornish and Dr. Whitaker in reversing heart disease without surgery - largely by diet and exercise.

Don't come whining to me if you get a bypass operation you positively didn't need and are sitting around hugging your cough pillow and forgetting where you put the car keys - and saying, "Damn, they didn't tell me about all this crap."

There is good news. "Beating heart" surgery is becoming more common. You don't have to go on the heart/lung machine with all its perils. But, there are only limited situations where this technique can be used. Check to see if it would be possible in your case, and if no doctors in your area are proficient, it would maybe be wise to travel to have the procedure.

You should always ask how many procedures of any kind that your doctor has performed, say in the last year. And you should ask about the mortality rate of his patients and of those who get "your" procedure in the particular hospital. A mortality is usually defined as a death within 30 days of the operation. There are places to find the "mortality ratings" of hospitals for various procedures - and sometimes for the doctors.

I found on the Web a 45-page report on hospitals and individual doctors in New York State for 1996-1998. The risk-adjusted mortality rates for over 18,000 bypass operations ran from .82 % to 12.76%. There are obviously significant difference among doctors and among hospitals. A 3% risk-adjusted mortality rate is considered by many reports to be a rating of "good." If you can find the 1% to 1.5% doctors and hospitals, you have made a wiser choice. There was one doctor at Beth Israel in NYC with a patient mortality rate for bypass surgery of .94% - and he probably has a long waiting list.

In one NY hospital, a doctor had a 100% mortality rate. He operated on one patient and the patient died. Obviously, the doctor went into some other line of work. It is not uncommon for the active surgeons to perform 150 to 200 bypass operations in a year. Steer clear of the guy who has only done 10 in the past year. Let him practice on somebody else.

(The NY 12.76 % rate was in Bellevue in NYC. Bellevue is a large hospital, but is famed for its emergency wards, as in the TV cop shows "take 'em to Bellevue." Only 55 bypass operations were performed during the period. Many of the patients who show up at Bellevue are usually high-risk to begin with, so 4 deaths out of 55 operations is not surprising.)

Of course, if you have a serious medical condition, other than your cardiovascular problem, your risk during and after the bypass is greater than someone who only has some clogged arteries.

If your doctor is a straight-shooter, he or she will tell you of their experience level and patient mortality rates. The good ones expect you to ask. They have a good story to tell you. You might have an idea that death rates are much higher than the reality.

You would expect that mortality rates for Angioplasty would be quite low. In a 1996 New York State report, the mortality rate from Angioplasty had a low of .64% and an average of .87 %.

On the Web, I also found a .pdf document of "The Top 100 Hospitals for Cardiac Bypass Surgery." (From HCIA.com) These hospitals had .9% to 1.01% mortality rates!

Overall, I paint a pretty grim picture of heart bypass surgery, and I think fairly so. It is a horrendous procedure. But again, there is good news. If the operation is a complete success, you should be able to resume a full range of activities. I have played tennis in 100 degree heat with people who have had bypass operations. If they did not tell you, you would never know. Your sex life should be normal (if it ever was), you should be able to mow the lawn, carry heavy boxes, walk or run miles at a time (after a modest buildup), and so on. As I heard one bypass surgeon say to a 68-year-old patient in post-op, "You are a new man."

Just don't undergo the operation unless you absolutely need it to function with some semblance of normalcy. For example, you might have some pretty clogged arteries, have some pain in your chest under exertion, but not be in particular danger of a heart attack. It is the stuff that breaks loose that causes heart attacks. Of course, if most of your heart arteries get plugged, your heart may be starved for blood and you will either die or be near death.

The medical profession is still scrambling to decide which "plaque" is in danger of breaking loose and which is just going to stay there and clog up the arteries. And how to determine which kind you have and how to treat it. That is why they call it "The Practice of Medicine."

I am betting that heart bypass operations may be nearly extinct in 10 years. For years, researchers have been experimenting with VEGF, Vascular Endothelial Growth Factor. Using this technique, the body grows tiny new collateral arteries. new paths for blood to the heart. It is showing great promise in clinical trials in four hospitals.

But, less invasive ways will have to be devised to introduce VEGF directly into the heart muscle. In the trials at a hospital in Minneapolis, the VEGF is injected into the heart during open-heart surgery. That's no bargain. Insertion by keyhole surgery surely will shortly become an option, if not already. Now, you're talking. It appears that the VEGF procedure is about five years away from being approved by the FDA for general patient use - if all goes well in the trials. Some of the early results are dramatic and engouraging.

Here are some resources:

"Is Heart Surgery Necessary? What Your Doctor Won't Tell You," by Julian M. Whitaker, M.D.
"Reversing Heart Disease," by Julian M. Whitaker, M.D.
"Dr. Dean Ornish's Program for Reversing Heart Disease," by Dean Ornish, M.D.
"The New Living Heart," by Michael E. DeBakey, M.D. and Antonio M. Gotto, Jr., M.D.
"Heart Owner's Handbook," by Denton A. Cooley, M.D.
"Mayo Clinic Family Health Book" good general medical reference, with good discussions of various diagnostic tests
www.texasheartinstitute.org

There are a variety of Internet sources, which you can find by doing a search on "heart bypass," "angioplasty," and other key words.

You can read in-depth discussions of most every medical test or exam on WebMd.com (http://my.webmd.com). Here are some that are relevant to this article:

Electrocardiography (EKG/ECG)
Exercise Electrocardiography (Stress Test)
Angiography (Angiogram)
Thallium/Technetium (Sestamibi) Cardiac Scan (Stress Test with injected Thallium)

For example, if you think that an Angiogram is not a procedure with considerable risks, read the Angiography section. Of course, your doctor may tell you that all those risks are minimal. Still, you should be informed before you consent to ANY invasive test.

As I read this article over, I feel compelled, once again, to make this disclaimer. I am not professionally trained in any medical specialty. You should not take anything I say as medical advise, but only as a jumping off place for discussion with your doctor(s) and further research on your own.

It should be obvious that: I have had extensive personal experience with much of the subject matter of this article. I have discussed various aspects of the subject(s) with a considerable number of doctors. My research on the subject is extensive and almost a burden on my computer and my bookshelves. Obviously, nobody should copy this article as part of a Ph.D. thesis. My facts and figures may be off. But, they are close enough for government work.

COPYRIGHT 2000 Richard C. Rhodes

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