Friday, January 12, 2007

You could cut the irony with a knife (updated)

Basketball player from the DeBakey High School for Medical Professions collapses on the court and coaches use portable defibrilator to save his life. Now, I certainly hope the player comes through this OK. Heart Arrythmias are nothing to joke about, I know, I have one myself. But the very day before, HISD contemplated RELAXING the rules for athletic exams so that RN's and Chiropractors can do the exams. Neither are qualified to run or read 12 lead ECG's or exercise stress tests, which by the way are NOT required for participation in sports, despite the fact that Houston had four deaths due to congenital heart problems last year alone. Chiropractors are NOT medical doctors, no matter WHAT they may claim. They may not prescribe medications. They may not order medical tests, and most insurance won't pay for Chiropractic services. All they may do is a variation on massage and physical therapy WHICH IS ALL THEY ARE LICENSED TO DO. Their main contribution is one of a placebo effect. It is clear to me, and I believe it should be clear to the UIL, that the current exam is woefully inadequate to protect our children.

UPDATE
For once The Chronicle's staff editorial makes sense.

9 Comments:

Blogger Melissa said...

Read up on Chiropractic, the education required, the actual treatments they do, the studies. I believe, unless you can't read, that you will have a very different understanding of chiropractors from your current opinion

January 13, 2007 9:48 AM  
Blogger Rorschach said...

Nope, Chiropractors are still quacks in my book. And they STILL are not qualified to do cardiac stress tests, stress echocardiograms or even 12 lead ECG's. Neither are RN's. AND THAT IS STRICTLY CONTROLLED BY STATE LAW. Virtually EVERY child that dies due to athletic participation dies due to either arrhythmia or an enlarged heart. Both are things that can be tested for, and can be done for under a couple hundred bucks. They do not die because their spine is out of alignment.

January 13, 2007 3:44 PM  
Blogger Melissa said...

Read up on Chiropractic. I'm not advocating/stressing what they do or do not do in this blog. Sounds like you have quite a bit of energy and emotion in regards to this situation. It always help to calm yourself down with a little bit of objective reading. And, your argument sounds much better when you come from a place of understanding the big picture. If you don't, you just get lost in the 'quack'.

January 13, 2007 8:07 PM  
Blogger Rorschach said...

Melissa, you clearly misunderstand me, I DO know what Chiropractors do, and that has not changed my opinion one iota. They are quacks that live off of the pseudoscience they wrap themselves up within and keep patients coming back through the power of placebos. How would an examination by a chiropractor be able to prevent this kid from collapsing from a heart arrhythmia? Or an RN for that matter? Instead of getting wrapped up in defending Chiropractors, you should in fact be asking yourself why is HISD contemplating relaxing the examination requirements when in fact they should be tightening them?

January 14, 2007 12:31 PM  
Blogger Melissa said...

Rorschach, I really appreciate your concern about making sure children are protected and have available all the appropriate medical intervention necessary to keep them alive and healthy. It's very reassuring as a parent to know that there are folks like you who think well about kids. So, as a parent, I'm asking you to make a more sound argument so that you CAN make a difference. Your argument comes across biased and bigoted, not very clear with facts and looking at both sides objectively. I agree that all kids, adults - everyone should get stress tests before playing sports. Have you had one of these tests? Who or more specifically what type of practitioner did this for you? Did you go to a physician's office and actually have a physician perform the test, or was it their assistant, RN, or other? Do you understand what Chiropractic is, what kind of education they experience? What is the pseudoscience that you're referring to that Chiropractic is based on that makes you wholeheartedly staunch against their treatment? Look, you say that you love to debate and argue, but I must say that one of the important aspects of debate is to learn about and understand what you're talking against by actually debating that side.

Please, I actually enjoy reading your notes and debating with you, but I'd sure like you to take a step up and experience what you're talking about. You'd really sound much better.

I agree that there are varying differences between a medical doctor who prescribes drugs, a chiropractor whose focus is on the musculoskeletal system and biomechanics of the spne and an RN who experiences and has skill in just about every type of medical test given, and in my experience, I'd much prefer the individual with the most 'specialized' experience. That said, I've only ever been able to get an RN, Nurse, or LVN (step down from RN in terms of education and responsibility as I'm aware) to give me that kind of test.

Give me more information, Rorschach, from your experience and more thoughtful, provoking information. Just to be fair, I come from a family of MD's, DC's, RNs and LVN's. My stepfather was a medic in Vietnam and continues to serve voluntarily in Iraq. I am trying to stir the pot, so to speak, with you. I don't feel that any person has all the answers, but the point I'm making is that it's good to listen to all sides to get the 'why's' and come to an even better truth than just one person's opinion.
cheers,
Melissa

January 16, 2007 11:52 AM  
Blogger Rorschach said...

Mellisa, the type of doctor that specializes in heart rhythm problems is called an electrophysiologist (they are called EP's in the vernacular of cardiology). They are a very narrow sub-specialty of cardiology. There are only about a dozen or so in Houston. (they are the "electrician", whereas the general cardiologist is the "plumber") I have had several stress tests (and flunked every dang one of them.) All were administered by my "regular" cardiologist, who happens to practice with my EP. My regular cardiologist is DR. Raymond Stainback at Hall-Garcia Cardiology, my EP is one of two that keep four of the cardiac cath labs at the Texas Heart Institute busy round the clock. His name is Dr. Ali Massumi. He has tried twice to surgically correct my problem and has been unsuccessful both times, despite having a 98% success rate.

In theory, any GP or FP MD could administer such a test, but studies published in the NEJoM have shown that 80% of FP's and GP's misread ECG readouts in one way or another. And they are SUPPOSED to be able to do so. There is no way that a Chiropractor or an RN would be able to do so, even if the law allowed it.

Whether you agree or disagree that Chiropractors are quacks is really irrelevant. They are not qualified to do the one test that SHOULD be done, and which is not REQUIRED by law anyway. Even most GP's and FP's are not qualified to do the test although the law allows it. You might as well ask an auto mechanic or a secretary to perform the exam for all the good it does.

January 16, 2007 12:15 PM  
Blogger Melissa said...

Yes, I agree that I wouldn't trust a chiropractor to interpret an ECG readout since that is not what they're trained for. I agree that there should be stricter guidelines and more heart/stress testing done for kids who play sports - especially the more cardiovascularly rigorous ones. It is unfathomable to me that these are not required. I do feel chiropractors should stick to more musculoskeletal-related issues.

I'm sorry you haven't had better luck with your heart arrythmia. How long have you known you had the condition? Did it keep you from being able to play sports? I was 8 years old when I was told that I had a heart murmur, but also told not to worry since it is a very common condition - and one tends to 'grow out of it'. But my mother is a worrier, and pulled me out of everything I was doing at the time and consequently kept me out of sports as much as she could until I took up running in high school. I've been running for about 20 years now, but keep it within certain limits - not running in extreme temps, or running half-marathons, etc. Just a good run to get the heart rate up a bit is good.

January 18, 2007 10:36 PM  
Blogger Rorschach said...

Melissa I was officially diagnosed about 9 years ago (I'm 40) after some strenuous aerobic activity caused my heart to switch to Atrial Fibrillation and it refused to revert on it's own. But I have known all my life that I was unable to keep up with my classmates. That in of itself is an incitement of the ability of GP's to diagnose these things. As a child I had several ECG's, all "resting" which of course did not indicate enough of a change in the waveform to indicate a problem, it is only under exercise or emotional stress that the waveform changes become pronounced, although even "resting" my heart rate is around 85 which is a tad fast. But at no point was I ever referred to a cardiologist or was there any indication there was a problem. I grew up just thinking I was a wuss, and that my inability to keep up was a personal failing. I guess it was this self esteem issue that prevented me from getting myself into trouble by avoiding sports.
To be specific, I have Atrial Flutter with enhanced AV node conduction. Essentially the sinus node tells the atrium to contract, the signal normally flows from the atrium to the AV node which acts as a speed governor, and then on to the ventricle. In my case there are two or more conduction paths between the sinus node and the AV node, one is a bit slower (and that speed varies during stress) than the other so one electrical pulse arrives behind the other causing the Atrium to double beat. If that were the only problem, it would be quite minor, but my second problem is that my AV node apparently lacks a speed governor. So both pulses travel though the AV node into my ventricle causing it to double beat as well. During my initial stress test, unmedicated my heart rate momentarily hit over 300 bpm. My sister has it worse, she had to have her AV node burned out and a pacemaker installed.

January 19, 2007 8:13 AM  
Blogger Rorschach said...

excuse me, firefox replaced indictment with incitement and I didn't notice....

January 19, 2007 8:15 AM  

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