On Jul 25, 2018, Jeff Liebermann wrote
(in article<tj6hld533mckmj3oholb15leakh9lafjgv@4ax.com>):
> On Wed, 25 Jul 2018 10:08:34 -0400, Joseph Gwinn
> <joegwinn@comcast.net> wrote:
>
> > On Jul 24, 2018, Jeff Liebermann wrote
> > (in article<ijkfld5lm6ctcqmfgdfbqv8lasr4gmc9ja@4ax.com>):
> >
> > > On Tue, 24 Jul 2018 16:02:32 -0700 (PDT), tabbypurr@gmail.com wrote:
> > >
> > > [snip]
> > > > Every doc & paramedic can have one to save time & costs. Imagine
> > > > a £10 pocket sniffer at home that can pick up on say 40% of disease
> > > > conditions in seconds. It'll get there in time.
> >
> > >
> > > Yep, that would be wonderful. In another part of this thread,
> > > krw@notreal.com announced that his doctor did not recommend that he
> > > purchase a cheap ECG/EKG devices (for unspecified reasons). If such a
> > > device existed, and Joe Sixpack has access to one, he could easily
> > > question a doctors diagnosis, which would certainly not be much fun
> > > for the doctors, who are used to being the sole source of medical
> > > wisdom. When such a device finally arrives, my guess(tm) is that it
> > > will have limited distribution to only those qualified to operate such
> > > a powerful device and be able to properly interpret the results.
>
> > Yes. I just had a ten-lead EKG a few days ago. A cheap pocket EKG would not
> > have helped me to interpret the resulting forest of squiggly lines. The
> > Cardiologist noted that the impulses were upside down in one trace for a
> > while. Turns out that this can mean any of a number of things (none
> > terrible,
> > by the way), so another test will be made.
> >
> > So, I also don’t expect that a pocket EKG will be much help for Joe
> > SixPack, for lack of years of medical training.
> >
> > Joe Gwinn
>
> Substitute my name for Joe Sixpack and let's continue from where I
> left off. I was trying to help a former ladyfriend with a problem.
> She seemed to be developing one or more types of arrhythmia. The
> events were sporadic and unpredictable. Her doctor wanted an EKG when
> it was happening. The choice was to either wire her for a portable
> EKG data logger, which was expensive, obtrusive, and had about a 10
> day battery life, or a cheap user operated device. They decided to go
> with one of these:
> <https://www.ebay.com/itm/163166560403>
> I think she paid about $100 at the time. Getting the data out of the
> machine was somewhat of a PITA, which is where I became involved. Once
> I had the data, I started to look at it and try to decipher what they
> meant. There are plenty of books, videos, and web sites on EKG
> interpretation:
> <https://www.youtube.com/results?search_query=ekg+interpretation>
> There is also software for EKG interpretation:
> <https://www.google.com/search?q=ecg+interpretation+software>
> A simple arm to arm EKG is not going to have all the detail of a 4
> wire or 12 wire test, but it's better than guesswork. So, we dived
> into the problem of decoding the squiggly lines. It turned out to be
> no worse that looking at an oscilloscope or spectrum analyzer. When
> she went back to her doctor for yet another EKG, we both had a much
> better clue of what was happening.
>
> Roll forward about 3 years and I start to develop PVC (premature
> ventricular contractions) that first appeared when I took a stress
> test on a treadmill. The doctor issued me a 4 wire data logged and
> ordered me to wear it for 2 weeks. At the same time, I had borrowed
> my friends EKG machine and was recording "events" whenever I felt that
> they were happening. That data from the data logger proved to be
> useless because the logic did not properly detect my style of PVC and
> therefore recorded random glitches and nothing else. The battery also
> died after about 8 days, but there was no indication on the unit that
> it was essentially useless. The handheld EKG was more useful.
>
> Unfortunately, I opened my big mouth and offered my analysis of the
> EKG, which was the last thing that my cardiologist wanted to hear. We
> had to negotiate a truce. If I would agree to stop doing his job, he
> would show me how he reached his analysis. That was a poor trade as
> he never had time to show me anything. There were later
> confrontations which followed the same pattern.
>
> The same cardiologist also did me a big favor and introduced me to
> running my own blood tests.
> <https://www.directlabs.com>
> Prices are about 1/4 to 1/2 of having PAMF do the tests. They were
> also more expensive. He wanted regular tests for cholesterol
> (lipids), but I expanded on the idea by getting a blood test I named
> "paranoid's paradise". The result looked good so I was happy, until
> the last blood test, where I was out of the acceptable range on some
> obscure item (eGFR). Furiously reading as much as I could on the web,
> I concluded that I must have some kind of horrible malady. When I
> mentioned it to the cardiologist, he indicated that I had not drunk
> sufficient water before the blood draw. Oops.
>
> Ok, so why the long rant? Because this is a small example of how I
> think medicine should work. The patients do what they can to help and
> the doctors do the part they do best. In other words, the patient
> becomes part of the recovery process, not a concerned bystander. At
> this time, all testing, all analysis, all the drugs, and all of the
> money is concentrated in the hands of the doctor. I don't think
> that's right and do my part to change it. I can say that if I had not
> been involved, had not done my homework, and had not double checked
> everything, the medical establishment would have successfully killed
> me at least 3 times in the past 20 years through medical mistakes.
>
> Then, there's the costs. Prior to 2014, I did not have Medicare
> coverage. I was paying cash, which oddly has its advantages if you
> have the cash. I was borderline but paid because I had no other
> option. So, I dabbled in ordering my own tests, pill splitting, and
> recommending drug substitutions. I arrived at the cardiologist with a
> spreadsheet showing my current drug prescriptions, and what I changes
> in type (switching to generic), and dosage suitable for pill
> splitting. Where a drug was a combination of two cheap ingredients
> combined to form one expensive pill, I recommended that two cheap
> pills instead. With only a few minor exceptions, my cardiologist
> accepted my recommendations. When it became apparent that I could not
> take statins, we lowered the dosage and monitored the lipids until a
> minimum acceptable dosage was found.
>
> You're correct that Joe Sixpack will not benefit much from home
> medical instruments or tricorders. He won't bother to spend the time
> to understand the numbers and waveforms. One it goes awry, his health
> is 100% in the hands of the doctors, assuming he does what they
> recommend. He could ask for help from someone medically
> knowledgeable, but do not the have the extensive training and
> experience of a real doctor. Maybe Joe Sixpack will buy a computah
> and run a computah program that analyzes his EKG waveforms and
> produces an intelligible analysis. Anything is better than doing
> nothing, trusting the medical profession with your life, or waiting
> until they kill you with a medical error:
> <https://www.ncbi.nlm.nih.gov/pubmed/28186008>
> Medical error - the third leading cause of death in the US
> <https://www.bmj.com/content/353/bmj.i2139>
Yes. And I do research medical issues a lot. I prefer to read the training
material used by medical schools. But I haven't tried to make my own EKG,
although I could.
I have been reading the New England Journal of Medicine for something like 20
years now. I started because I got tired of breathless media reports lacking
the necessary qualifications and details. The big issue was the Body Mass
Index, and its foibles. But the media reports always seemed to start with
“as reported in the NEJM”, so I decided to cut the middleman out. It took
a year to get comfortable with the jargon.
As for drugs, search on the name of the drug plus the word “pharmacology”
to get by the marketing bafflegab.
And I’ve seen my share of medical errors. Most are more annoying than
dangerous, but it helps to have some idea of possible errors, so as to know
when to speak up. Hospitals are necessary, but can be dangerous.
Joe Gwinn