Face to face

I am one of those individuals who believe the power of the Internet is a blessing and a curse, particularly as it relates to the ones that give diagnoses. And while these sites can be educational and informative, the truth is, nothing can substitute for the unique face-to-face relationship between you and your doctor.

Many websites allow individuals to input symptoms they are experiencing and after a few clicks, receive an output of a diagnosis that was generated by key words, right from the comfort of their home computers. Most of these sites include disclaimers—as they should—but what concerns me about these sites is there are so many variables that need to be considered before a proper and accurate diagnosis.

This is because we each bring valuable and critical information to the table. First, a patient who is open about their feelings, what stresses they are under, their family history and what aches and pains they experience gives me a picture of their unique self. And, in turn, as the physician, I have the responsibility to foster a close relationship with the patient and to channel my inner-scientist. Take for example the results of the three studies related to acute coronary syndromes (ACS) mentioned in this issue of Impulse. We consider the latest research in medical and scientific journals, combine that with what our patients tell us about their health and map out a plan that can help us properly diagnose, prescribe, monitor and treat our patients.

All these variables are best understood and interpreted by a professional, proving the necessity of the very personal patient-doctor relationship—a relationship that I continuously learn from and personally enjoy.

Yours,

Asad U. Qamar, MD

FACC, FCCP, FSGC, FACP, FSCAI Cardiologist

A close look at antiplatelet drugs

Finding the best medication to fit a patients’ needs means that physicians need to know not only what is going on at the ‘bedside’, but also what scientists are learning in their labs.

Take treatments for acute coronary syndromes (ACS), for example. First, ACS is a broad term for any condition that prevents the blood from flowing properly to the heart. Heart attack are examples of ACS, which occur as a result of blockage in the coronary arteries. The blockage is formed by platelets, or remnants of cells. While blood clots are important as they stop bleeding from a cut, they are very dangerous when formed in the arteries. As a result, individuals who are at risk are prescribed an antiplatelet medication to prevent and even reverse blockage.

One popular antiplatelet medication has come under scrutiny in recent years. Dual antiplatelet therapy (DAPT), which usually consists of Plavix (clopidogrel) and acetylsalicylic acid (aspirin), seems to be related to a growing number of major cardiac events including heart attack and stroke. Researchers say that the reason is because the clopidogrel does not provide the body with enough of the ADP-mediated platelet inhibition activity it needs to be successful in preventing or reversing arterial blockage. The reasons, they say, are typically related to either interactions with other medications or a person’s genetics.

A look at three different studies can shed some light on how researchers work to find new options for treating and preventing ACS. In one study, scientists looked at new antiplatelet drugs including Effient (prasugrel) and Brilinta (ticagrelor) and conducted a randomized clinical trial with patients who suffered from acute coronary syndromes (ACS).

TOM TRAN, P.A.-C , conducted a study on 71 patients of a new process of spraying the leg with a cold anesthetic.

The results of this study were positive, showing that both of these antiplatelet drugs were superior to the other medications in terms of the occurrence of adverse cardiac events. Ticagrelor showed a mortality benefit over the other medication, but the study revealed that both compounds significantly increased the risk of spontaneous bleeding. But overall, they reported that the compound prasugrel and ticagrelor has a higher safety ratio than clopidogrel. Based on these results, the new drugs found their way into recent international guidelines for treatment of patients with ACS.

Researchers found similar results in two additional clinical trial named TRITON-

TIMI 38 and the PLATO trial. TRITON-TIMI 38 also found that in patients with ACS and scheduled PCI, prasugrel reduced cardiovascular mortality and morbidity but increased bleeding as compared with clopidogrel. And in the PLATO trial they discovered the superiority of ticagrelor over clopidogrel in reducing cardiovascular mortality and morbidity.

At the end of the day, how can physicians and individuals apply this sometimescomplicated information to their practices and lives? An understanding that not all medications are perfect and their success varies depending on an individual’s genetics and overall health. And, for physicians, it is critically important to stay aware of their patients’ unique situations and of latest discoveries in their field.

Case review: healing from within

A patient came to us with multiple, non-healing, venous ulcers that he had tried to heal with other physicians for more than five years. He presented with skin color changes, swelling in his legs, and large bulging varicosities.

To diagnosis the severity of his problems, we ran a venous reflux ultrasound.

We look at the size of the deep veins and superficial veins to see how much blood is pooling in them. We also look at the different perforated veins and structures that normal ultrasounds don’t treat.

His great saphenous vein was enlarged with a lot of blood pooling. The great saphenous vein is the underlying vein that causes all the symptoms that appear on the outside of the leg, such as wounds, ulcers, and swelling.

We proceeded with radio frequency ablation, a new procedure out to treat vein disease. The procedure is done through one little needle hole so there is no cutting, no suture, and no down-time. We use a new process of spraying the leg with cold anesthetic, which differentiates our vein center from others, so patients feel little to no pain.

Since his procedure, the patient’s ulcers have not returned and his veins continue to be closed. He has been able to resume activities without any pain, discomfort, or leg swelling.