Welcome to Straight Talk on Health. I’m your host Dr. Chet Zelasko. Straight Talk on Health is a joint production with WGVU in Grand Rapids MI. I examine the practical application of health information. Nutrition. Exercise. Diet. Supplementation. I look at the science behind them, and let you know whether it’s something to consider or not. You can check out other things that I do on my website Drchet.com and sign up for my free emails.
Have you ever had a moment where you were reading something, listening to an audio, or watching a video of something where you just had a moment of realization and you absolutely stopped? I mean you stopped in your tracks. The reason is that you just got hit with a realization of something, a discovery of something, that you had never considered before. That's what happened to me recently when I was listening to a podcast from one of my favorite cardiologists. The study was about pulmonary effusion and if you don't know what that is, let’s start there.
Effusion is the buildup of fluids between spaces in the body. For example, it can happen in the knee or any joint that gets damaged. It can be a lot more complicated if it happens in the pleural cavity. That's the space between the lungs and the outside connective tissue. If fluid builds up there, it's going to push on the lungs and ultimately push on the heart and make it very hard to breathe. In order to restore function, the fluid has to be removed whether it's in the heart cavity or in your knee or wherever it's possible. In this study, it was about removing the fluid in people with congestive heart failure. If you never understood what that meant, the congestion is not the buildup of fluid in the lungs; It's the buildup of fluid in the area between the lungs and the outside connective tissue.
The TAP-IT study, formally called Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial, was recently published in a leading heart journal. Maybe just a few more definitions to make all of the words I just said make sense. Thoracentesis is the removal of the fluid via a very long needle. The “cardiac pleural effusion” is what I began talking about: the buildup of fluid between the lungs and the outer connective tissue. What makes it cardiac is that the fluid becomes so great that it restricts the movement of the heart and its ability to pump blood.
The researchers selected subjects who were 80 plus years of age, with less than a 25% ejection fraction, and a whole host of other particular issues related to cardiac function. Why this age group? Because they are the ones most likely to suffer from pleural effusion due to advanced heart disease. What's an ejection fraction? That's the amount of blood pumped per minute put in percentages. A healthy heart should be between 50- 70%. For the people with CHF, walking across a room at that age could be maximal exercise.
This study was designed to compare typical treatment using thoracentesis in half the subjects and diuretics in the other half. The goal was to determine if there were any differences in outcomes as assessed by the number of days lived after beginning treatment. I could go into great detail about the results but it all comes down to this: there were no differences in outcomes between the two groups. That's amazing! But there were differences in patient comfort and quality of life. As you might imagine, sticking a 10 inch needle through the ribs and into the pleural cavity to drain the fluid is going to be uncomfortable if not downright painful. There were also 20 out of 80 pneumothoraxes with the needle approach while there were no complications noted in the group that took the medication.
How about one more thing? This was the first randomized controlled trial comparing the two approaches to reducing pleural effusion--ever. Diuretics were available in the mid 1980s but were not used for this purpose. Maybe it was because using the thoracentesis approach provided virtually instant relief because the pressure was relieved immediately. But the risk of complications is far greater when you break the skin and insert the needle into the inner cavities of the body then there is from a relatively simple medication like a diuretic.
You may be wondering why this created that stop moment for myself. My grandmother was 80 years old and had congestive heart failure in the mid-1980s. She had the needle procedure and they drained close to 20 lbs. of fluid from around her lungs. You can imagine the pressure that caused on her heart. But CHF is an unforgiving disease—at least it was back then. Without a real treatment other than the thoracentesis, there is no real cure.
Months later, the pulmonary effusion happened again but she refused treatment because the procedure hurt too much. She died a couple of weeks later. The realization that a medication like a diuretic might have prevented her a rather difficult death gasping for air with multiple bed sores just made me stop in my tracks. The fact that there was never a randomized controlled trial to compare the two approaches until 45 years later just absolutely astounds me. At least now there are options for the people with the same condition to get treated without the same type of complications.
Just to be clear: there was no coming back from advanced congestive heart failure as my grandmother had. Using either procedure would not have cured her. It would have eventually killed her anyway. But the difference was really in her quality of life. She may have lived longer and certainly less painfully using the diuretic, which was available even back then. But there was no supporting research.
Today, we have another issue. The overprescription of medications. Some people present with a problem once and they end up with several medications which may negatively impact their quality of life. Here’s an example of someone who recently contacted me about diet.
About three years ago, they were in a car accident. They were fine and had no injuries other than a very hard impact on their chest from the seatbelt. They were out of the auto and walking around with no pain. Because of their age (74 at that time) police insisted on calling an ambulance. The EKG showed atrial flutter and took them to the ER. After a thorough workup, everything checked out normal with a recommendation to see a cardiologist. They waited 4 months and then decided to see the cardiologist.
They did fine on the stress test with everything normal. They did a Holter monitor and after a week, they had an AFib event. Nothing before that and nothing since. They were put on three medications as a result. The heavy duty beta-blocker, which slows down heart rate, was discontinued after they told the doctor they couldn’t get out of the house due to no energy. That left a very strong medication to control HR and an anticoagulant. As they described it, it pretty much took their life away and recently kept them home and on a heating pad and ice packs 24/7 for pain and inflammation.
All because of a single episode of atrial fibrillation in two weeks. That type of AF occurs more often than people think and for the most part it’s benign. I know because I had it myself after two weeks on the monitor. I took the two week monitor again 3 months later and no AF. While the treatment protocol the cardiologist prescribed for this person may follow the USPTF guidelines, they don’t appear to treat the patient in front of them who presented with no problems. What’s the point of following guidelines that leave a person in chronic fatigue and pain?
I understand what the cardiologist did. There may be more to it than the person told me. If they had a ventricular abnormal rhythm as an example. Those can be serious and fatal. But short of that, the risk of being alive today is not zero and it never will be, especially if you’re over 70. There has to be a balance between quality of life and reducing the risk of what may happen.
But we have to do our part as well. That means to eat better and move more within the limitation of the body we have today. Putting in even the minimal of effort can help our body improve than if we do nothing. If we don’t want 3 or 5 or even 10 medications, we have to do our part. If we don’t, than we have to accept the life we chose.
That’s all the time I have for this episode. If you like this podcast, please hit the like button and tell your friends and colleagues about it. Until next time, this is Dr. Chet Zelasko saying health is a choice. Choose wisely today and every day.
