Thursday, December 29, 2005

Atrial Fibrillation and Conflicts of Interest

Man, lots of interesting read from the Wall Street Journal about the relationship of the Cleveland Clinic and their investigators failure to disclose conflicts of interest with their patients.... Big centers like this can leverage their name for professional and even personal gain it seems. There are lots of smart docs out there looking for ways to develop equity in the field of their expertise, but they HAVE to disclose this relationship. The technology with Atricure is cool, tho' (uses a scissor-like clamp to burn tissue between the two blades using a bipolar application of radiofrequency energy during either open chest or "minimally" invasive "keyhole" cardiothoracic surgery to place insulating lines in the atrium to fix atrial fibrillation). I understand the surgeon's enthusiasm for the technology - but it still doesn't get these docs off the hook for non-disclosure. These are big boys in the big leagues. They took lots of tests and checked LOTS of boxes on standardized tests correctly to get where they are.... the "oops, I checked the wrong box" excuse just doesn't fly.

I actually worked with Mike Hooven (now"Chief Technical Officer" (but the real brains)) of Atricure which was a spin off from his first venture in bipolar scissors for minimally-invasive vein harvesting for coronary bypass grafting, Enable Medical) when I was in Cincinnati Ohio about 5 years ago. Atricure is now public and Mike has made a few zillion bucks, I'm sure. My hat's off to him. Mike's one smart "engi-nerd".... but I left Cincinnati for personal reasons (the medical climate there is tough, to say the least: too many hospitals, not enough patients/businesses) and was surprised to see all this! But the story really isn't about Mike, it's about the relationship of major centers taking stake in a company and "researching" and "teaching" without disclosing to the patient's or community to whom they teach (like fellow docs). Hmmm, seems the course at The University of Oklahoma Health Sciences Center Cardiac Arrhythmia Research Institute on "Minimally Invasive Surgical Ablation for Atrial Fibrillation" recently scheduled for 1 Feb 2006 was recently "rescheduled" after the Wall Street Journal piece appeared... Atricure, I'm sure, was to play prominently in the meeting.

Here's the problems in a nutshell:

The Cleveland Clinic has been an advocate of heart surgery with a device from AtriCure Inc. and has done the operation on 1,247 patients while having undisclosed ties to the manufacturer.
Among them:

A venture fund the Cleveland Clinic helped set up and put money into invested in AtriCure.

The Clinic's CEO (Cosgrove) helped manage that fund and invested in it himself.

The Clinic's CEO (Cosgrove) sat on AtriCure's board.

Cosgrove developed a device AtriCure plans to market, which would bring him royalties.

Another Clinic doctor, who used the device and reviewed it favorably in publications, was a paid consultant to AtriCure.

It might be best to let the dust settle a bit before having that conference....


PS: I recently updated my bit on atrial fibrillation with a few more figures. Hopefully it will help out folks trying to sort all the incredible information out there. If it's too technical, let me know. I can clarify if need be. The point is to take yet another approach to the discussion and evaluation of afib that keeps the patient first.... Hmmm, an interesting approach these days....

PPS: Oh, for purposes of disclosure, I am on the Speaker's Bureau for Medtronic, Inc. :)

Tuesday, December 27, 2005

Asthma? COPD? Other respiratory conditions?

As a parent of a child with reactive airway disease, and as a physician, it was abundantly clear that breathing is one of the most important things we do and take for granted. Millions of folks are out there struggling to breath, and need some support.... Recognizing this need, I asked a clever cardiology fellow (about to complete his cardiology training) if he could think up any ideas for a shirt just before we scrubbed into a case to install a defibrillator. He thought and thought and we tossed around a few ideas, then he smiled, and came up with this idea for a t-shirt:

It obviously harkens back to the days of Bill Clinton's election bid stance on whether he used illicit drugs "... but I didn't inhale!" and we tried to keep it acceptable to all ages by including a picture of an inhaler (yes, it's an Atrovent inhaler belonging to my son....). So enjoy! Share it with friends and feel free to contribute your ideas to make another person's day a bit brighter! Oh, yeah, you can find it at: A portion of proceeds are contributed to the American Lung Association.


Thursday, December 15, 2005

Back from the holidays

Well, it's been a wonderful Christmas season! Too bad we now have to get back to work to prepare for the new year. Got a really cool gift just waiting for summer....

The best part of these sandals is the bottle opener on the bottom! It should be great for the beach in the summer! Oh, they can be found here (I have no commercial interest...just thought you'd like to know). As we are entering into the coldest part of the season in the Chicago area, the thought of wearing these on the beach in the summer will help carry me through....

We'll get on to more interesting heart-related matters soon enough. Sometimes it's good to kick back and relax a bit!

All the best-


Wednesday, December 14, 2005

Power of the people

It's been a while since my last post here. It's a crazy time. My son is working for UPS off-loading trucks, and those guys are REALLY working LONG hours to make sure we get those packages we ordered, medical supplies delivered, and office gifts distributed. He had one guy INSIST that his computer was on that truck (it wasn't) and climbed on board and scoured through the back like a mad-man, complaining he had taken the entire day off from work waiting for this shipment! What a narcisistic guy! God forbid he call and track the delivery! Anyway, fortunately one jerk's behavior was quickly circumventented by plenty of other folks offering coffee and cookies to the laborers from UPS at many stops. It really shows that MOST folks are genuinely good people and can think about others toiling late a night to make the holidays a bright one. This holiday, be sure to remember your mailman, garbage man, postal worker, UPS deliverer (it might be my son :) ), FedEx worker, etc. Hey, we're all human and kindness goes alot further than narcissistic tyraids.

In case you're still looking for a gift for the office or your boss, there has been alot of interest in our shirt for "obsessive compulsives." It certainly makes a statement and makes folks think.... anyway, it's sure to bring a smile and, yes, a portion of proceeds are donated to the Obsessive Compulsive Foundation.

Also, just wanted to update folks on the puch to raise $500 for hurricaine victims through the sale of t-shirts on we're up to $329 from the beginning of the campaign! Thanks to all who have bought shirts.... Every little bit helps, and the contributions to the advocacy groups are also important. And we still have quite a few days before the New Year. We'll post our first 6 month's contributions in Jan '06 when we get a final tally.

Stay healthy-

-- Wes

Saturday, December 10, 2005

Power Medical Scooters

I had a lovely woman come to see me in follow-up for her heart arrhythmia and was impressed by her wonderful upbeat attitude as she sat there in her wheelchair with oxygen tubing beneath her nose and being pushed by her male "companion." She paused her speech between breaths, but was determined to keep going and was thankful that we had corrected her rapid heart rhythms through the use of a pacemaker and catheter ablation procedure.

When asked about her mobility at home, she said she was pretty much restricted to a chair and slept there because it felt better to be sitting up. I asked her how she gets around in her apartment, and she said it was VERY difficult. I asked if she had ever thought about a medical scooter. She had never considered this. I suggested several websites she could read more and knew that there was a rule she had to have a physical therapist or pulmonologist or rheumatologist provide a "Letter of Medical Necessity," but a little research on my part disclosed this requirement was removed this year! (Sometimes I'm a little late to the party.) Now ANY prescribing physician can provide a prescription for a medical scooter provided the patient has been seen "face-to-face" by their provider within 30 days and there is a FUNCTIONAL need for such a device.

Just thought you might want to know in case you're late to the party, too!


Thursday, December 08, 2005

Lemieux with Afib

Recent article about Mario Lemieux being let go from hospital for atrial fib. It can happen to anyone. Now his heart muscle function is probably OK so aspirin anticoagulation might be OK, but man, those hockey fights would be IMPRESSIVE if he were on coumadin! :)

Our thoughts and prayers go out to him.


Tuesday, December 06, 2005

One fake, one real, guess which?

The power of people to overcome their adversity continues to amaze me. Had a wonderful woman suggest the above tag for a new shirt for breast cancer survivors that we have up on our site now. Imagine, someone who's been through the diagnosis, biopsy, mastectomy, chemo, radiation, and eventual reconstruction with this shirt! Awesome. And to still be able to laugh a bit after all she's been through! This really shows the power of the human condition in a situation that defies imagination. And yet, there is a subtle and powerful message here that commands respect of anyone who'se gone through this ordeal. And this might be the most empowering for the individual after all. Way to go!


Friday, December 02, 2005

"All Conditions Suited to a T"

Thanks to all who have made this journey into the internet world so enjoyable. The story of our simple website,, is catching on and gaining momentum. A story and pics from Pioneer Press from 1 Dec 2005 touches a bit on the inspiration and motivation for the site. We've heard from TONS of folks about the power of humor and support to help them deal with their tough illnesses and continue to expand the medical conditions we cover and charities to whom we donate. We hope to generate the $5K needed to make us a REAL non-profit so that folks can be reassured that their donation will be tax-deductible. (Funny how lawyers always get their fees FIRST....oh, er, sorry, the doctor in me leaks out sometimes. :) )

If there's any graphic designers out there who'd like to design and donate a really cool shirt design for a medical cause near and dear to their heart, and in turn use our site as a marketing stepping stone to greatness, we'd be happy to post your design on a t-shirt and acknowledge you as the designer (and provide a link to your site).... it's just a thought, but who knows... it might generate some interest in your work.... just e-mail the design to me from the MedTees website under the "Contact Us" tab.

Oh, for those of you interested in purchases there, be aware there will be a TWO-DAY SALE on 7 and 8 Dec 2005 of $5 off on any purchase over $20, $10 off more then $40, and $25 off any purchase over $100. You'll have to enter a special code to get the credit on your purchase. So keep your eye on the sales graphic on the front page....

Happy holidays!


Monday, November 28, 2005

Sorry Mr. Smith, No Nurse is Available - But We Have a Camera Watching You...

Amazing article in the Chicago Tribune Business Section on cool new defibrillators that keep tabs of heart devices (Remotes keep tab on heart devices - Wireless tracking offers piece of mind," Chicago Tribune 11/28/05, Business Section, Section 4, Page 1). Cool stuff. But buried deeper in the article is information about NEW technology offered by a Chicago Firm called nPhase LLC, a firm that specializes in machine-to-machine communications, run by Steve Pazol, its chief executive.

"Insurance companies looking to reduce costs are driving this trend, Pazol said. 'They want to reduce hospital stays and increase home care,' he said. 'If you can have one person monitoring 100 pieces of equipment spread all over instead of 10 in a concentrated area, you get a huge cost savings.'
An example of such networking is underway in Joliet (IL) where Provena Health has specialists -- called intensivists -- who monitor patients in the intensive care units of six Provena hospitals in Illinois.
Digital cameras and microphones enable these specialists to see and hear the patients as well as gain access to equipment that monitors their heart rates, blood pressure and so on."

Now we are reassured by Dr. James Cowan, Medical Director for Provena's "enhanced intensive-care unit."

"Intensive care nurses are still on the scene to assist the patients, and the technology doesn't replace any personnel, said Dr. Cowan. We have one physician and three nurses looking at 120 patients."

Imagine: there you are, lying on a ventillator, and mucous plugs your breathing tube, but you don't know this because you're "asleep" from the sedation you've been given. Sally the nurse is changing the person's bedpan in the room next to yours and a sensor trips telling the "Wonder Monitors" that you might be in trouble. Oops, there are five other patients with simultaneous problems equally as grave, sounding alarms. "Which call to make first?," they think.... "we'll notify hospital Z first, then Y, then X (you're at X). But Sally can't get there right away....

Great system. Instead of training more intensivists, we're gonna substitute a "Command Center". And don't me started on the FALSE POSITIVE rates - alarms are MADE to beep MORE OFTEN to assure they don't miss problems (improves sensitivity to problems at the expense of specificity). All those calls to the ICU, more nurses on the phone, and fewer doctors and nurses TOUCHING and caring for patients...

Most ominous:

"But there aren't enough doctors trained as intensivists. So this technology helps us meet that need," Cowan said.

So what do we do? Get a computer. Forget the doctor. Why train more intensivists? Does anyone see the writing on the wall?

Let's see who's going to line up in favor of this technology. All the Big Boys: hospital administrators, insurance associations, Quality Assurance specialists....

We need to be keenly aware of our new "health care choices" when selecting insurers... Fun times are ahead...


Thursday, November 24, 2005

Happy Thanksgiving

Have a wonderful Thanksgiving. Each of us has tons to be thankful for this holiday season, even when things seem insurmountable, each of us can ALWAYS find something or someone which could be worse. Remember, helping others is the best way to help yourself.


Monday, November 21, 2005

Weight Consciousness For All

Wow, just met a really wonderful woman who has been battling weight gain. She's had 11 kids and devoted here entire earlier years to their well-being and support. Unfortunately, along the way she's gained WAY too much weight. She now has arthritis, asthma, and diabetes. At 5'2" and >230 lbs (privacy dictates this be withheld) she has decided to loose weight and joined Weight Watchers. She's lost 20 lbs! She's done great but her friend got sick and she has noone to help her through. So we've added a Forum on for her plight. Hopefully she'll register soon (I bet she will). If you're trying to loose weight, go on over and lend your support. Maybe we can start something to help fight the battle against obesity.


Sunday, November 20, 2005

Health-related Social Isolation

Anybody out there get diagnosed recently with a tough illness and care to describe your feelings, where you got help, who helped support you, and how you got through? It might help others... who knows?


Dead Meat Can Beat

Okay, you've had your heart attack and been told your heart muscle is weak. Your doctor tells you you need an internal cardiac defibrillator (ICD). "A what?", you say. "But I feel fine. I haven't collapsed, fainted, lost conciousness. Why do I need one of THOSE? What the heck ARE they, anyway?"

No doubt there are tons of you out in the blog-o-sphere that have an "ICD." Yet there remains an unmet need for folks with weak heart muscles to receive them. Doctors use an echocardiogram or nuclear medicine test to determine the "ejection fraction" of your heart (that is, the fraction of blood pumped out of the main pumping chamber of your heart with each heart beat - normal is greater than or equal to 50%). If you have an ejection fraction of 35% or less, you might need an ICD. You should DEFINITELY ask your doctor if you qualify and YOU SHOULD LEARN YOUR EJECTION FRACTION NUMBER! This single value correlates with mortality better than any indicator in cardiology studies.

Now you have to be careful.... turns out the estimation of ejection fraction is not quite as good in people who have irregular heart rhythms (like atrial fibrillation), but certainly folks in normal rhythm can be fairly accurately estimated and this number helps doctors recommend which therapy is best for you. Folks with EF's less than 30% can have an estimated 23% reduction in mortality if an ICD is installed over conventional medical therapy. Granted ICD's are not for everybody, but the word needs to get out. You can learn about ICDs and see what they look like after they are installed (yes real pictures!) here.

Yes, dead heart muscle can beat too fast, causing inadequate time for the main pumping chamber of the heart to FILL with blood, thereby limiting the amount of blood that can be pumped out. So dead meat CAN beat, and occassionally be fatal. ICD's can save lives. Learn your "EF" number and advocate for yourself.


Saturday, November 19, 2005

The Silent Epidemic

There's an epidemic out there, but most don't realize it exists. No, it's not bird flu (geez enough already... the regular flu 'll kill more people this year than bird flu...), or the spread of aids, or any other myriad infectious disease. I dare say this epidemic is ALREADY dwarfing all of those illnesses combined.

You see every morning across America and around the world people are being blindsided by the fact that they (or a loved one) were just diagnosed with a traumatic and unexpected illness. They've been through all the tests, and now feel they're the only one with the illness, don't know where to turn, and feel miserable. God forbid anyone mentions their problems except to their closest counterparts. And yet, if there was a way to get them to come "out of the closet" about these problems, they'd find there is a HUGE number of individuals who have been there, and done that, and most importantly, probably have significant insights they could contribute or suggestions on avenues to seek for help.

So if you're wondering what is in the process of doing, it's to break this silent epidemic through humor and support. Check it out, or send this site to a friend. You'll both be better for it.


Wednesday, November 16, 2005

Its NOT About the Tshirts

Ran into a friend today and told him about

“Oh, you mean the t-shirt site?”

Well, yeah, but it’s really NOT about the t-shirts, you know.


Well, the other night I had this guy e-mail me from out in the Internet ether – Bruce Rand – runs a forum for folks with inflammatory bowel disease…


Now really, turns out there’s TONS of folks out there with ulcerative colitis and Crohn’s disease (two different forms of inflammatory bowel disease). Ulcerative colitis is just that, tons of little ulcers in the colon that can do all kinds of bad stuff (like cause discomfort, bleed, diarrhea) – the CURE is total colectomy, that is, removing the ENTIRE colon. Tough stuff, you know. And Crohn’s disease if a different form of inflammatory bowel disease that can strike anywhere from the mouth to the rectum and causes narrowings and scars within the GI tract, often needing surgeries to resect and repair these areas… Not at ALL easy to cope with EITHER of these illnesses… and yet he runs a forum for these folks and offered to give us an idea for a shirt… in fact a really cool idea to increase awareness about inflammatory bowel disease. Wants to donate some of the proceeds to the Crohn’s and Colitis Foundation of America. Lot’s of great things going on and CERTAINLY a need for these folks to connect….

“What was it?”

A semi-colon. (See it here.)

You know what else was cool? A mom e-mailed me today to thank ME for putting up the shirts (we have three so far)... she has a 13 year old son with inflammatory bowel disease. And she suggested we put up a site for teens to connect that have tough illnesses.... so we did tonight.

The forum is dedicated to all teens with a difficult or challenging illness or disability who'd like to take the time to tell their story so that others might learn and gain support, and is NOT limited to just inflammatory bowel disease kids. View or add your posts to the forum here.

-- Wes

Tuesday, November 15, 2005

Health and the wonders/pitfalls of the World-wide Web

Yesterday, a press release about MedTees went out on the wire. Unbelieveable interest and TONS of wonderful comments by LOTS of folks, and with this came some fantastic suggestions from Bruce Rand, a moderator for a site concerned with GI disorders, particularly inflammatory bowel disease. We immedicately began posting some of his suggestions on MedTees. You can see them here.

Seems there's an incredible spirit out there, doesn't it? Folks afflicted with such tough problems, yet keeping their heads above it all. Completely and utterly awesome.

It reminds me of a story (courtesy of our church's pastor, Rev. Gil Bowen):
"One man tells how he and his wife visited an elderly woman in a hospital bed who spoke appreciatively of the light coming into her room towards the end of the day, of the colors of the flowers on the window counter, of her deep satisfaction with her life, of her pleasure in her loved ones, of her gratitude for our simple ordinary visit. On the way out, with a wink and a smile, she got me at a weak moment to contribute to our favorite charities. Then we stopped briefly at a social gathering where I met a young man in the prime of his success and health, who had so magnified some alleged, imagined, or perhaps real trickery of chicanery on the part of business associates, that he had worked himself into a rancor of bitterness, making himself a very miserable person. What a contrast. "

What's the secret then to being like the old woman? I'm not sure its the MedTees site, but perhaps it will help us keep our healh problems in perspective and continue to enjoy the good things we still have.

Have a great day-

Sunday, November 13, 2005

Neophyte in Blog-o-sphere

My first post. Yikes. Seems like another venture into the unknown. Yet I've seen others' blogs, and they really seem fairly benign. My real reason for starting this blog is to introduce the world to my newest project, one which has been remarkably rewarding: a small project called

It all started on a plane to our national meeting for cardiac electrophysiologists (heart "electricians" or cardiologists that treat heart rhythm disturbances) in May of 2005. There was an article in the Wall Street Journal about a website called "" that used t-shirt sales to support the site. It got me thinking....

I see and treat one patient at a time, and have a limited number of clinical appointment slots, relative to the number of patients out there with heart problems.... Maybe there was was a way I could reach more people to help them with their questions and concerns.... perhaps I could get a website to use humor and community to provide a break for some of my patients with the tough job of living with a new foreign medical device. Perhaps t-shirt sales could help support such a site.....

So I started designing t-shirts for patients I knew best: patients with pacemakers and defibrillators. The ideas came fast and furious: "Careful, I'm Wired, " "I've got big joules," "Keeping the beat," "Death, been there, done that, got the t-shirt," and so on. We shared the concept with friends. They thought, "You might have something there, but I know a girl down the street undergoing chemo for a brain tumor... could you make a shirt for her?" So "Bald is Beautiful" and the cancer section was born.

My wife told a former bridesmaid of hers (and dear friend) about the site, not realizing the site would strike a cord with her. You see she lost her leg to a malignant bone tumor at the age of 34, and had three daughers and a wonderful husband. "What about a section for amputees?" So that section was born.

Ideas were submitted from friends and cyber-friends. It grew rapidly. Diabetes, neurology, psychology (like a.d.d. and o.c.d. disorders, arthritis, and so on. And the cool thing is... it's still growing, and growing. The internet is like that ... an almost amoebic growth pattern. We also feel that we need to help others as well by contributing to research and advocacy groups that support folks with the ailments within each section. And contributors of t-shirt designs can specify to whom they'd like the proceeds contributed.

We also thought there should be a forum so folks could communicate with others about how they have managed to cope with the tough things life has thrown at them. Small things, like what tool to help with ambulation, where to find support groups, and so on. It's small right now, but hopefully will grow. I encourage all to contribute your questions, and check it out here.

So if you feel inclined, take a look, post a comment on the forum, and help someone out. After all, we'll ALL be sick someday and I dare say, probably know someone who already is. Perhaps a humorous t-shirt might make their day... you never know. It certainly beats bringing another pot of flowers.