Sunday, October 23, 2005

Rx.. Care of the heart

Those of you who want to prevent a heart-attack or some of you who have already suffered a heart attack but want to prevent the next one, take heart. Your doctor can now prescribe the latest class of statins which, by lowering cholesterol levels, can cut down the risk of heart attack by 30%. The dosage will vary from person to person and will be determined by a simple formula. The doctor will examine your salary slip closely and fix the dosage in such a way that you spend 50% of your salary on the statins. That's the simple formula.

But statins are known to interfere with the functioning of the liver and can also cause muscular atrophy in 0.0005% of the patients. So your doctor, ever alert to business opportunities, will prescribe additional drugs to tone-up the liver, apart from inorganic supplements to make up for the weakening of the muscles. Some of these supplements can increase the toxicity of the blood and can affect the kidneys. So you would be forwarded to a nephrologist who will quickly assess how promising a candidate you are for a kidney transplant . He will also make a mental note to refer a patient with mild urinary infection to your cardiologist for a routine ECG, as a return favour. The entire medical fraternity subscribes to this quid pro quo arrangement.

Back to the heart. Statins also need to be supported by ACE inhibitors which help dilate the blood vessels and reduce blood pressure. Controlled experiments on rats have shown that those rats that were administered ACE inhibitors, lived a week longer than those that went without the drug. Considering that a rat lives for hardly 16 weeks on an average, a week’s extension is significant. What works on a rat must surely work on you ? You are just a scaled-up, biped version.

It is also good to take some anti-coagulants and blood-thinners like aspirin to keep the flow through the vesels as smooth as possible. Alas, aspirin is also known to cause intestinal bleeding and coupled with the fibrous diet prescribed by the thoughtful cardiologist, will induce acidity and flatulence. To tackle these symptoms, your doctor will ask you to take some antacids every day. Antacids can interfere with the absorption of some key nutrients into the system and your doctor will tell you when exactly to have them, before or after a meal. Usually, he will advise you to have them instead of the meal.

The statins, the aspirin and the ACE inhibitors together make a formidable combination and some research indicates that you have a good chance of reducing a 60%- blocked-artery to a 20% blocked one. Too bad that new evidence shows that in a 20%- blocked artery, the chances of the plaque breaking loose, clogging the vessel and causing a heart attack are much higher than in a 60%-blocked artery. Well, you can’t have everything.

About the diet. Don’t gorge yourself on fried food which contain polyunsaturated fat, bad for your heart. Eat plenty of green salads. A word of caution here. It has been observed that salads are quite often washed with contaminated water and can cause severe infection of the stomach. Not to worry. Your clueless gastroenterologist will prescribe some broad-spectrum antibiotics ostensibly to kill the bacteria. These antibiotics will be still protected by patent, and therefore your salary for that month will be used up for the noble cause of amortising a substantial chunk of the R&D expenses of the drug company. The good doctor will also recommend an ultrasound scan of the abdomen partly to rule out cysts and tumours, partly to look for other danger signals , but mainly to earn his 30% commission from the owner of the scan machine.

And get plenty of exercise. Your doctor will advise you that walking is the best way to keep fit.. The considerate doctor will not want you to blow up good money on fancy gym equipment. In fact he will want you to reserve your income, fixed deposit and other savings purely for medical expenses and not to sqaunder it on non-essential needs like food, clothes, petrol, etc.

A final piece of advice. Don’t fret and fume about the doctor’s fees and the expenses on the medicine and the visits to the diagnostic centres. Anxiety over such trivial things can induce high levels of stress and high blood-pressure and can lead to heart attacks.