Cardiovascular Crystal Ball

Let me preface the following words with the confession that I AM NOT A CARDIOLOGIST.

I am a doctor of internal medicine who takes an intense personal and professional interest in the PREVENTION OF CARDIOVASCULAR DISEASE.

IN 2014, 24 years into my career as a physician, I was grieving the senseless loss of my father due to cardiovascular disease and frustrated that I could not achieve compliance with my patients to take the medications which would help decrease the nation’s number one cause of death and disability.

After much complaining to the universe, I fortuitously, landed a seat at the HASPA (Heart Attack and Stroke Prevention Alliance) conference. That day I learned about ALL the different technologies which would help me care for my patients’ vascular health. The cardiopulmonary exercise test (CPET), however, was the winner by far. Interestingly, there are 2 groups which use the test. Cardiologists who care for persons with congestive heart failure and athletes to improve their functional capability. The bike test tells the VO2 max which is each person’s capability to use oxygen maximally. It is the closest thing to crystal ball that I have found in my 29 years of being a physician.

Prior to the bike test we were attempting to achieve compliance by discussing risk factors. This was like trying to mix water and oil. A fair number of patients, if they had no OBVIOUS SYMPTOMS of cardiovascular disease, would tell me, “All I need to do, Dr B, is exercise and eat healthy.” Every year they would return heavier, transitioning fully into diabetes or have a heart attack. Prior to the bike test we looked at cholesterol, blood pressure, sugar levels, family history, calculated risk scores and other risk factors. More than 50% of the time I would hear this, “Dr Baksh, My strong personal philosophy is to do this naturally.” I have actually had patients pay THOUSANDS of dollars for supplements, spas, purging and other ‘natural remedies’ while resisting medical recommendations.

With the bike test, the answer is personalized and clear cut. This is YOUR VO2
max. You use oxygen optimally ..great. You use oxygen poorly…let’s fine tune the different areas where oxygen plays a role and recheck you in 6 months. Your level is <70%. Is that because of airway inflammation, anemia, cholesterol plaque buildup OR ALL OF THE ABOVE? Let’s find out the specifics, the details and then let’s sit down and discuss what exactly is going on. NOT SURPRISINGLY , THIS makes SENSE to each person. Not all patients “get it” and some, for whatever reason, decide not to have the tests. That’s okay too..because, at the end of the day, we offer excellence of care and the patient decides if that fulfills their philosophy.

Other reasons it makes sense from a self care standpoint is that I am not sending patients to a cardiologist to have nuclear medication injected and then exposed to radiation (a test that is wrought with false positives and negatives) and you will not need to get an invasive procedure unless my ultimate evaluation (a CT angiogram) shows that you have a blockage. This is a very rare step. I have had to do this 2-3 times in the last 3 years.

Further, this makes great sense not only from a personal care standpoint. It resounds with wisdom from the viewpoint of national medical debt control.

Dr. Husna Baksh, MD Dr. Baksh is the founder and medical director at Healthy Steps

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