The longer I spend as a doctor, the more frustrated I become at how poorly we do at primary prevention, or in lay terms, preventing problems before they arise. Healthcare is extraordinarily expensive for governments to deliver the world over, yet resource always seems to be spent too late, at which point the costs are greater still – care after a disabling stroke, bypass surgery after a heart attack and so on. I get it, governments work on election cycles, and health programmes which only deliver a benefit some years down the line simply end up at the back of the queue when there are so many other things that require funding. It is often therefore up the to individual, keeping checks on themselves in the same way they might maintain their car. This applies to a great many areas of health, for example neuro-degenerative disease, or cancer. However, in the case of cardiovascular disease (predominantly heart attacks and strokes) the difference is we can massively influence the chance of developing it in later life by addressing risk factors early. In other words, it is for example much easier to reduce your risk of having a heart attack than getting stomach cancer.
Since turning 47 a few weeks back, I have been thinking more about my own risks. Regular readers will know I am probably on the spectrum when it comes to a healthy lifestyle, planning out exercise regimens, nutrition, sleep….all the good stuff. But although I feel really good, how can I be sure? I regularly see patients younger than me in hospital with heart problems, and my Dad had a TIA in his early 50s, with 2 more since. I’ve had the occasional chest pain too, many people have. Very atypical, but it’s human nature to start to wonder.
Time to find out.
It’s a funny thing becoming a patient as a doctor. I also think it’s good for us to see the other side of the curtain once in a while. And so it was that this week that I had a CT scan of my coronary arteries. I was actually a bit nervous beforehand. Not about the scan itself, but about what it might find.
Do I really want to know? What if….?
As I lay there and the scanner started to whir into life, I figured the likely worst case scenario was I would need to take some medication, most probably statins. Was that so bad? No, I could easily do that. If I got side effects, no problem, these days there are a number of alternatives if needed. It also got me thinking about my own mortality, not in a morbid way, just curious. I think it’s probably fairly healthy to give this some thought now and again.
I’ve written about CT coronary angiograms before, so won’t discuss it now, but members can read the article here
The process itself was really slick. I had a cannula put in my arm, through which was given a beta blocker (despite my resting heart rate being in the low 50s, it prevents it speeding up if I got anxious in the scanner) and the contrast agent (dye). I also had a nitrate tablet under my tongue which helps dilate the arteries and make then easier to assess. The tube I went into was surprisingly large, so no claustrophobic issues! The whole thing was over and done with in minutes. My doctor was kind enough to go through the results straight away; there are some benefits of being in the profession!
The result: the arteries of a 20 year old (his words not mine).
I honestly wasn’t expecting that outcome, but I am, of course, delighted. It was actually fairly surreal for the rest of the day, and I’m still reflecting on it. I joked to a friend I was off to buy some cigarettes and a cream tea, but that couldn’t be further from the truth. Instead of relaxing my rules on how I live my life, I’m doubling down. The things I’m doing are clearly working for me, so it’s more of the same. Doing the boring things really well, except they’re not so boring when you see the results. Yes, I may succumb to some sort of cancer, but cardiovascular and metabolic disease probably not. Of course I do have a family history of dementia, but many of the measures demonstrated to reduce the risk of cardiovascular disease are shared with the neuro-degenerative diseases and in fact many cancers too (just to a lesser extent), so I’m doing all I can in that regard. I’m also fairly hopeful that by the time I get to the age my Mum got dementia, medical therapy for that condition will be much better than it is today.
A normal CT coronary angiogram has been shown in studies to be associated with significantly lower risk of a heart attack, but it is the behaviours that result in the normal scan that cause the good outcomes – maintaining a healthy weight, not smoking, good blood sugar control, optimal blood pressure, good nutrition, exercise… I could write a book on that.
More importantly than anything though, I want to preserve my quality of life for as long as it possible. I want to thrive in my 70s, and 80s, playing golf, going cycling, climbing mountains. It looks like I’m getting my primary prevention right, so far so good.