…just two packs a day!

by Dr. S. Russell Vester, MD 10. November 2013 11:08

Dr. S. Russell Vester

Everyone wants to know why we spend so much money on health care in our country. Where do the costs come from? The following are just three examples from patient encounters I had just last week. Every week presents new examples, but the theme, unfortunately, never changes.

Patient A had a stent placed in one of her coronary arteries two years ago. She came back in with a mild heart attack and return of blockage in and around her stent. She admitted that she had not been taking her Plavix as had been prescribed. She said she could not afford it. The Plavix was too expensive. Without missing a beat she then admitted to continuing to smoke two packs of cigarettes per day. Oh, and the year before she had moved into a new and larger house because of beneficial interest rates. You do the math on this one.

Patient B is in her early fifties. She came to the emergency room with unrelenting chest pain and had what ended up being a mild heart attack. She is 5 feet 6 inches tall and weighs 260 pounds. She had been smoking two packs per day for over thirty years. She had lost her mother and father, both smokers, to heart disease when they were in their fifties. She had lost a younger sibling, also a smoker, to heart disease. Her husband has already had two heart surgeries and he was still smoking about two packs per day (actually closer to one and a half packs per day according to him). She had developed significant shortness of breath and chest pain with exertion six months earlier. Her response to this was to decrease her smoking to one half a pack per day. She had been admitted to a different hospital a month earlier for this same problem but left that hospital without treatment and against medical advice. I saw her in consultation and she again wanted to leave against medical advice. Fortunately she ultimately decided to stay and have the bypass surgery she needed. She refused to promise to quit smoking because she didn’t want to break her word. I’ll give her credit for honesty here. Again, do the math on this one. You may need a calculator.

Patient C is in his mid to late forties and came to me for consideration of lung volume reduction surgery to treat severe emphysema. He had been smoking two packs of cigarettes per day since he was seven! He cannot walk across a room without becoming completely winded. He needs to wear oxygen all the time to stay just barely oxygenated enough. He is grey and pasty. He is still smoking two packs of cigarettes per day. His wife smokes a bit less. He had looked up the Medicare guidelines for eligibility for lung volume reduction surgery which, according to him, state that a patient must be completely free from smoking for a minimum of two weeks to be a candidate for this type of surgery. In light of this he wanted me to admit him to the hospital for two weeks so that he couldn’t even get to a cigarette and then operate on him. He figured that the two weeks before surgery plus the time and discomfort of his post surgical recovery would give him sufficient time and motivation to stay away from cigarettes after discharge. In the “Come to Jesus” session that followed, he learned that neither I nor any other surgeon would consider this type of high risk surgery until he had demonstrated his commitment and ability to be cigarette free.  This first step toward making himself better, let alone the trial of pulmonary rehab, will require real effort and dedication on his part. The patient and all of his caregivers need to be rowing the boat in the same direction. He is due back in the office in a couple of weeks. I sincerely hope he makes the right decision for himself. Unfortunately, I have grown used to frequent disappointment in these matters.

Now do you understand? Click here to learn more about stopping smoking.

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Adult Tricycles
Adult Tricycles
1/1/2015 12:48:02 AM #

Happy new year everybody. Hope this year will be a better one than before. Enjoy your holiday!

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