Wow TSM I can only quote Carly Simon’s song: “You’re so Vain, I betcha think this song is about you”! That ER doc comment was not directed at you, but at his VA ER docs that were torturing him with ridiculous theories such as Reflux and reactions to Lipitor! You should all be ashamed for piling on me. I do apologize if it appeared I was critizing all ER docs, I know many excellent ones and have great respect for their profession.
Now that you’ve got my BP up lets consider a few things:
1) TSM you were originally demanding a CT way back when in POST 6 “What workup did you have done in the ER? There are conditions that can cause your symptoms that would not be discovered without a CT scan,”. Yet you then were led to believe he did not have a heart problem in POST 15 quote “Well, if you had a normal perfusion test while you were symptomatic, that lowers the likelihood of obstructive coronary artery disease as a source of your symptoms quite a bit.”
2) Only post-stent when I mentioned that he has a very high probability of other vascular disease and that he should have a doppler U/S and a CT did you then wage a battle against the OP from having a CT. Your fan club (I guess one has to have thousands of posts here to be in it) piled on. Yet neither you, the nurse, the hyberbaric doc, or others has any specialty in radiology or vascular disease. Is that the way you treat/respect your radiologists at your institution? Every other specialty thinks they are some kind of radiology expert and end up taking matters in their own hands without a consult.
3) In fact you claim I don’t hold you in high regard yet I complimented you on several occasions such as POST 93 “Nonetheless TSM I respect you as a very dedicated professional to this site and your advice is normally very prudent. You should rejoice in helping to hit a home run in this case. Divers helping divers, I really like it.” Did you return the favor, No! In fact you seemed to be on a crusade against my radiological advice.
4) When I mentioned some of my credentials (the nurse thinks I was doing it out of ego as opposed to trying to defend my opinion) I thought you might have the professional courtesy to backoff, yet you and your friends are hellbent on telling the OP not to pursue certain radiological tests. Haven’t you learned your lesson? He was in trouble here because the right tests were not run.
5) Let me teach you about two things you probably don’t know re this case and radiology: a) his nuclear perfusion stress test was botched, they did not adequately image his heart under load. They still haven’t! b) CT has advanced in the last two years to performing cardiac studies, it’s the greatest advancement in perhaps the history of CT. They have super fast, super multi-slice, dual energy CTS that can perform a Cardiac CT which measures perfusion, patency of vessels (CTA), atomic interrogation (via dual energy) of any material that may be occluding vessels (lipid vs calcification). This advancement is only in large university based hospitals on cutting edge such as where the OP is MUSC. The American college of Cardiology is proceeding to adopt this as a new standard of care (takes a long time with reimbursement etc.). Probably won’t trickle to your levels for several more years, although the coctor from Duke should be able to confirm this at his institution. But the OP can get this scan in Charlseton!!!
6) And nurse, as far as my credentials I don’t hide who I am when I am giving advice on this site as so many do. This is medical advice, the “patient” must be informed. Very dangerous the course I have seen some of you take on this site. You are free to research who I am via my profile and you might see I was being modest, but if you want to start and have a challenge on this site I am ready.
7) This case was/is about life and death. This is unlike the many others on this site re perforated eardrums, etc.. This is nothing to mess around with. Many people were telling him in previous posts that they agreed with his diagnoses, could be muscle spasm, etc. It’s when I chimed in hard because I also recognized where he was and his Vet status. Thank god I was also PMing him. Don’t you dare say I don’t understand what king of care he can get at the VA in Charleston because I know it intimately. In fact I find you can get what you need at the VA if you have advocates both in your family and 2nd opinions from outside medical professionals. They really want to do the right thing.
8) Your sudden statements that any medical student could have diagnosed me disgust me as Monday morning QBing and total grandstanding. When you were also sucked into his not having a heart problem. Let me teach you all something you must not know, something I am forced to know by being on the board of several hospitals and medical schools. The top 3 maldiagnoses resulting in Malpractice suits from the ER are MI, PE, and cardiovascular disease. In fact they are in the total top 5 for all of medicine. It’s stated in many papers and studies that maybe as much as half of all MIs are misdiagnosed on ERs. Yet you all act high and mighty and try to make it sound that even students can always get this right. Give me a break! Another point to weighing in of inappropriate diagnosis the other way is that half of all patients admitted for chest pain are not really having a cardiac event. In fact half of all patients sent to cath have nothing wrong. Do you have any idea what that costs society? That is why people like myself are spending millions to devise a better diagnostic test to be more specific. In fact we have, its called dual energy cardiac CT. In addition there is a new nuclear radioligands tracer for PET (positron emission tomography) that shows promise to be a better nuclear tracer than the Tc99 sestamibi Cardiolite SPECT tracer that the OP was given. Unfortunately takes time to go through Phase 1,2,3 drug approval trials.
9) If and when you ever read my bio you will see I am on a personal crusade against vascular brain injury, in particular Stroke (brain attack). Number three leading cause of death in USA and the #1 cause of disability. Yet these pre-historic attitudes, such as was discussed here, like let’s wait until somebody is having TIAs is ludicrous. You don’t want to wait that long, you want to correct and stop the disease process early. Once again a problem with our medical system that just wants to treat acute disasters as opposed to prevent them.
10) Viking, any radiologist can tell you that those numbers represent the average of the technical fees posted for Medicare/Medicaid for those studies. Our US govt. has set these fees. That doesn’t say that if you walk into a hospital and want a CT and get charged personally without insurance that is what the bill will be, more like >$1000. That also doesn’t say that is what the number is for reimbursement for private insurance. That can vary widely all over the country. Also there is a small professional fee for the read and also some other potential modifiers such as 3d reconstruction in the case of a CTA. But let me let you in on another great secret: Radiological studies even at these prices are some of the most profitable things that hospital do. When you see that the scanners are much faster and cheaper now, you can see they get paid off in months, the rest is gravy. In fact it ends up supporting loss leaders like the ER (this is not an attack on the ER profession for those of you vain posters). That is just a medical FACT.
Conclusion: I don’t expect my rant here to affect any of you much at all. I doubt if you collectively have the ego to apologize to me for your false accusation. Hopefully it has been informative to the OP or others in his situation. I will continue to help him because we are bonded by our military service and Charleston SC. You have soured me on this medical advice site and thus I will likely not leave my busy schedule to delve into this area again. (How you can afford to spend thousands of POSTS on here a year and yet still be busy practicing professionals really makes me wonder.) My trailing advice to you is to keep your Vanity in check, particularly when you have a case like this that really involves life/death. Many of you are giving advice to lay people without the proper experience, and outside of your professional/technical realm. Misdiagnosed MIs are a very, very common thing as I have discussed, the next one is just around the corner. Be careful.
PS: google Cardiac CT and click on images and you may be amazed at the 1million or more CT images.
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