There I was, minding my own business and composing a post for the blog.
And it quickly grew to an unmanageable size.
Bounding over the gack
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| Cumulative mortality difference per 100k |
Almost half of the differences in mortality rates for 60-through-80 year-olds (final quarter) folks between the "healthiest" states and the "least healthy" is due to Heart disease and related vascular (blood vessel) issues. In rural areas, heart disease mortality is 113% higher (2015-2019) in the three bottom states (Oklahoma, Louisiana, Alabama) than it is in three of the more healthy states (Minnesota, Colorado, Utah).
In general, the three less healthy states have higher levels of smoking, obesity and fried foods than the healthier states. Those are "personal responsibility choices".
What has me puzzling is the availability and readiness to use thrombolytic drugs. Thrombolytic drugs dissolve clots. Thrombolytics differ from anticoagulants like aspirin, heparin, warfarin and Eliquis in that they dissolve existing clots while anticoagulants reduce the probability of clots from forming.
Another difference is the price. A bottle of low-dose aspirin costs about $3 while a single dose of any of the common thrombolytic drugs runs $2000-to-$8000. Those price-tags might cause pressure from insurance companies to challenge the use of those drugs.
The question on the table:
The question on the table is: If I showed up at a first-line medical facility in a rural area in Oklahoma-Louisiana-Alabama vs. Minnesota-Colorado-Utah with symptoms consistent with an ischemic event, would there be any differences in the probability of my being administered a thrombolytic drug?
I don't expect a Doc-in-a-box to perform an angioplasty or run a stent. That is highly specialized both in skills and equipment required. But being able to observe "Hey, Dude, I think you are having the Big-One" and running a Retavase IV before boxing me up and shipping me to "The Big City".
Statins
A note on the increased longevity associated with taking statins.
They were hailed as a game-changer when they were first introduced. They really do reduce cholesterol levels by dramatic amounts.
After the first wave of passion, studies were performed looking directly at longevity rather than cholesterol levels and inferring how much longer people might live.
The spoiler is that they do not prolong lives as much as it was originally hoped (and reported). According to this study the increased longevity is something on the order of one or two more days of life for every year you take statins.
Even though cholesterol may not be lowered as dramatically through improved diet and increased exercise, those two approaches may offer other non-cholesterol dimension improvements like reduced inflammation, better heart-muscle vascularization, better lung capacity, reduced blood-sugar excursions and so on.
Bonus link
https://www.ahajournals.org/doi/full/10.1161/circresaha.116.309115
Essentially, the mortality rates of the three "least healthy" states lags the "most healthy" by about fifteen years. At least for the rural areas.
***You are an idiot if you rely totally on the internet for medical advice. If you have any questions about your health, see your family doctor. If you don't have one, get one.***
You have been the victim of spell check-auto correction.
ReplyDelete"Morality difference."
Thanks. Fixt it.
DeleteI take the low dose aspirin daily. $3.00 bucks a bottle versus almost $600.00 a bottle for Eliquis, which I had to take for about six months after having the Ablation procedure for AFib... irregular heartbeat. The Ablation procedure was close to $180,000. Thank goodness for insurance.
ReplyDeleteSome doctors really like aspirin. Others don't. Mine does.
DeleteAspirin side effects can be mitigated by taking every-other day. The binding to blood proteins has a two-day half-life. Tums and water are also useful.
Aspirin also functions as an anti-inflammatory. Inflammation is linked to the initiation of clot-formation in the veins which is the precursor to blockages. It is also linked to certain types of cancer like bowel cancer.
The issue with stations is absolute vs relative performance. As an example if disease A kills one in a million and medicine Z reduces the death toll to one in two million. Wow, they cut your risk in half! Or the risk went from infinitesimal to lower than comprehendible. That is to say two million patients would have to take the drug for even one life to be impacted.
ReplyDeleteNow let's look at the side effects. Statins had a 25+% severe leg cramp side effects. So for this hypothetical example (grossly exaggerated for thought clarity,) you would have two million people take med A to save one life while 500,000 suffer from leg cramps. And that is if you believe "the science" coming out of big pharma's orifice.
My uncle was crippled by side effects of the statins his doctor prescribed. He didn't think that extra day of life was worth the cost.
ReplyDeleteAlso, lower cholesterol levels are associated with higher mortality. No surprise: your body is largely made of cholesterol, and it's essential to life.
Following your doctor's advice can be a fatal mistake.
Well I have AFib first diagnosed in 1997. I was on rat poison for a few years and then a new cardiologist said I could switch to a full size aspirin with only a few percentage points of risk so I did. Then they put me on a medium level anticoagulant and an 81mg aspirin. Now after another Dr retired the next guy wants to do the ablation and put me on a high priced anticoagulant and a statin. Since the heavy duty NISAD I take for severe arthritis increases the anticoagulant properties of what I’m taking I decline to go this route especially since I live 200 miles from major hospital. I’m 73 so I’m happy to continue as I have been doing for a third of my life, we all have to die sometime!
ReplyDeleteI am a nurse, and have worked in both medical centers and very small rural hospitals.
ReplyDeleteIf there is an Emergency Room, they should be doing the clot buster as the standard of care.
Thank-you, sir. That is what I was hoping to hear.
DeleteIf they do the clot buster, on many hospital and transport co. protocols, you're no longer considered "stable for transport".
ReplyDeleteIOW, neither the doc nor the paramedics (nor the insurance cos. for both) are going to assume medical and/or financial liability for you if you start bleeding out. So if you want to go to Big City Hospital, even via helo lifeflight, it's either/or.
The reason for increased mortality isn't just lifestyle choices. It's also access to first-tier medical care, and general compliance.
IOW, what NYFC or L.A. hospitals consider "morbid obesity", East Cackalacky family picnics consider "fun-sized", and folks don't run to the ER every time they feel a twinge or a symptom. (Lost track years back of the number of folks who came in after 2-3 days for chest pain, and stroke symptoms, and were already screwed.) Which is fine, until it isn't.
You makes your choices, and you gets what you gets.
Thanks for the insight regarding clot-buster and "stable for transport".
DeleteI chose Minnesota, Colorado and Utah and did not include Mass and Conn because I recognize that just because a county is labeled as "rural" does not mean that it isolated from first-tier medical care. The three states I chose have large regions far from cities.
At one point, the *average* time between first symptoms and seeking treatment for MCI was 13 hours for men. That might have something to do with the observation "The first symptom many (25%) people have of heart disease is death".
Ref "far from cities" as a surrogate for "far from first line health care": Contemplate Newberry, MI. Add folks who work in pulp wood industry, or farming, or meth. Stir, watch your morbidity/mortality foam to the top of your crucible.
DeleteHonestly, after this covid crap?
ReplyDeleteI'll take my chances.
Any doctor that suggested the shot, never did any homework and should lose their medical license. There WAS no proper testing, even for the 'at risk' profile, it was clearly inneffective early on, so to suggest it tells me you blindly follow others, obviating my need for you at all! Charlatans! They just want your money. The last good doctor I met was my child's pediatrician 15 yars ago!
As much as I enjoy life, I'm in the "keep that quack away from me so I can die in piece" camp.
ReplyDeleteWhile there are many medical professionals that are trustworthy, at the top, the decision making layer...
It's all about the benjamin's and the political agenda!
Patients are a disposable commodity to TPTB in the medical field.
Quote"***You are an idiot if you rely totally on the internet for medical advice. If you have any questions about your health, see your family doctor. If you don't have one, get one.***"
ReplyDeleteIf you still trust anyone in the medical industry, you need a lobotomy, or at least an education.
The ones that had the courage to stand up against the medical tyranny we've experienced over the last few years have for the most part lost their licenses and board certifications.
The ones that "went along" can no longer be trusted to give you honest opinions about how you should care for certain medical emergencies.
Your above comment shows an astounding ignorance of what is now common knowledge.
I had what I think ischemic event one month ago. First time. I have healthy heart, 118/83, no prior heart or vascular syptons or signs.
ReplyDeleteMy desire is to not die before my mother. She had been through so much with me as a young child. We are bonded, even knowing in many cases what the other is thinking It would break her heart terribly.
I’m making more than $25k by just doing very easy and simple online job from home. t Last month my friend sis received $94280 from this work by just giving only 2 to 3 hrs. a day. Everybody start earning money online. visit for more details…
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