Lucky To Be Alive – Harvey’s Story (non compliance)
Dr. Steven Lamm, M.D.: I’ve performed hundreds of EndoPAT tests in my practice over the course of the past few years, and I have come to view it as one of the most powerful diagnostic tools a doctor has in his arsenal today. You will see the role that EndoPAT played with my patient, Harvey. His situation best sums up the importance of the EndoPAT test and how it can be equally helpful to both doctor and patient alike.
Having patients be compliant and take their medicine is a huge problem today. Studies show that for long-term drug therapy, the adherence rate drops off with time. It’s one thing for a person who is feeling miserable to remember to take a medicine that will relieve the pain, and quite another for someone who is feeling generally well to stick with a medication that is intended to prevent the future consequences of a chronic condition.
Statin therapy is the perfect example. Many scientific studies have demonstrated the benefits of statin drugs for preventing heart disease and extending the lives of people who already have heart problems. You get the most benefit from statins if you take them consistently for years. Even so, compliance studies have shown that, regardless of what the researchers say, people stop taking their cholesterol-lowering drugs as time goes by.
For example, in a study of older patients in Ontario, Canada, only 40% of the people prescribed statins after a heart attack were still filling their prescriptions after two years. The track record was even worse for people taking statins to prevent heart disease: After two years, some 75% had stopped filling their prescriptions.
Harvey is my patient, and although he is not from Canada, he fits the profile of one of the Canadians in the study who was non-compliant with his medication regimen—and it almost cost him his life.
Harvey is 68, slightly overweight, and the only exercise he performs is when he has to run to catch the downtown bus. I worried about this, just as I worried about his poor eating habits. Fast food was a noon-time staple at work, and meals at home (he is a bachelor) were generally ordered in from local restaurants.
It was Harvey’s lifestyle that played a major role in his poor cardiovascular health. His cholesterol was high: 288 mg/dl, with an HDL of 39. At his previous visit with me, I had prescribed 10 mg of Crestor, a powerful statin medication, to be taken daily. I had also outlined a detailed nutrition and exercise program for him that would improve his health and help lower his cholesterol.
Six months later, when Harvey came back to see me, I was not happy with his lab results, and I told him so. His cholesterol had gone up, not down, and his blood pressure was now an issue as well.
“I started taking the statin,” Harvey said, “but then I sort of forgot about them after a while.”
Harvey’s Low EndoScore
Harvey had to turn his health around, I told him. Although his body was doing its best to fight off the inflammation caused by his poor eating habits and lack of exercise, it was starting to lose. His endothelium, the lining of his arteries, was being bombarded by free radicals, and plaque was building up in his arteries. Even though he felt fine, he wasn’t. The absence of illness does not mean that you are well, I told him.
I explained how the EndoPAT test would give him a real picture of the current health of his arteries and he was intrigued. Twenty minutes later, he got his results.
His EndoScore was 1.58, which I told him was low. He was in the danger zone. It was his choice now. Take his medication and make changes in what he ate and how much he exercised, and his EndoScore would start to go up. Continue on the path he was now on, and he was only inviting trouble.
Harvey agreed to take his medicine and come to see me in four months. He almost didn’t make the appointment.
Harvey Gets Religion
Sitting in synagogue one Saturday morning, Harvey felt a crushing pain in his chest and then he started sweating profusely. He got up, took one step forward, and suddenly he was on the marble floor, staring up into a circle of faces. That’s all he remembered.
As luck would have it, there was a cardiologist at the service and he quickly ran over to Harvey, who was not breathing; his heart had stopped. The doctor revived Harvey, got his heart going. Not once, but twice.
Two weeks later, recovering from a major heart attack and after having three stents placed in his coronary artery, Harvey was sitting in my office.
“I finally got religion, Doctor,” he told me. “You warned me about bad things to come. The EndoPAT predicted it. And now I’m finally a believer.”
Steven Lamm, M.D., has reported extensively on a variety of medical issues on television and radio. A great communicator, Dr. Lamm has been the long-time medical correspondent for The View (ABC-TV) because of his ability to talk to women about their important health issues, and the health issues of the men they love. As a practicing Manhattan internist for over twenty-five years, Dr. Lamm has provided medical care and compassion to thousands of patients. Dr. Lamm has published four books that have explored the intersection of medicine, science, and health.
Taking Control of Your Health – Lisa’s Story (cholesterol issue)
Becoming a grandmother was the greatest joy of my life, aside from having my own children. Seeing the smiles on their faces makes me the happiest grandmother in the world. It’s exactly because of those smiles and that happiness that I went to see my doctor about my cardiac health.
I knew that even though I didn’t have a family history of heart disease, I did have high cholesterol and that every year I am in my postmenopausal period, the risk of coronary artery disease increases significantly. I wasn’t going to allow a possible heart attack keep me from seeing my smiling grandchildren.
Sitting in my doctor’s office, my doctor and I discussed my situation and what I could expect.
"Knowing where I stood was the best news I had heard in a long time and my EndoPAT test made that all possible. Now I spend my free time playing with my grandchildren and I am worry free.” -Lisa - Chapel Hill, North Carolina"As he reviewed my case history, he said he was a little surprised. “You are actually underweight, which is good, so your food consumption doesn’t seem related to your elevated cholesterol level. Eliminating any more fat from your diet will be tricky. You have to be careful not to deprive yourself nutritionally, due to the fact that you already have a hard time maintaining your weight.”
My doctor was very happy to see that I had a high HDL level, the good kind of cholesterol, and low triglyceride levels, and that I was following through with hormone replacement therapy.
It was then that he recommended the EndoPAT test to me. He said we could use it to determine whether my elevated cholesterol levels were associated or correlated with coronary artery disease, or were merely a genetic anomaly.
Delighted And Relieved
I agreed to take the EndoPAT test and was both delighted and relieved with the results. My EndoScore of 1.98 was excellent, a significant finding because, as my doctor said, some plaque build-up was expected in my age group—regardless of cholesterol levels. Happily, my doctor told me I had nothing to worry about and to just come in for periodic check-ups so that he could continue to monitor me. At that time, I’d take another EndoPAT test and compare it with the first to see how I was doing.
Knowing where I stood was the best news I had heard in a long time and my EndoPAT test made that all possible. Now I spend my free time playing with my grandchildren and I am worry free.
Seeing is Believing – Bob’s Story (Cardiac risk factors)
My name is Bob and I am a the luckiest man alive because not only do I get to coach baseball every day for a living, but I also get to be a full time dad. Being a father and watching my kids grow up is really what got me to go in and speak to my doctor in the first place.
I am 51 and I’m very concerned about my family’s cardiac history. My dad first suffered a heart attack when he was 47 years old and later succumbed to massive cardiac arrest nine years later. On my mom’s side, I can’t tell you how many of my relatives have suffered with heart disease.
Before I got my blood test back I thought I was in pretty healthy for a guy my age. I’m an avid bicyclist and I spend my days hitting grounders and pop ups to my team, so it’s not like I just sit around all day. Yet, when my doctor got the blood work back hewas concerned. I had high cholesterol and my triglycerides were a lot higher than my doc felt comfortable with. He said a guy like me shouldn’t have a cholesterol over 200 and mine was 260, and that my triglycerides, which are supposed to be around 160, were actually 290.
Due to my cardiac risk factors and my inability to lower my cholesterol, my doctor recommended a cholesterol-lowering statin medication. I had seen the commercials for statins on TV, but didn’t really know what they did. He walked me through how they lower cholesterol and can reduce the fat-filled plaque that affects the health of the arteries.
"Diet and exercise were now going to become my top priority, because I wasn’t going to let what happened to my dad happen to me!" - Bob - Jacksonville, FloridaDue to my cardiac risk factors and my inability to lower my cholesterol, my doctor recommended a cholesterol-lowering statin medication. I had seen the commercials for statins on TV, but didn’t really know what they did. He walked me through how they lower cholesterol and can reduce the fat-filled plaque that affects the health of the arteries.
I was very was reluctant to use the drugs. Not only would I have to take them for the rest of my life, which really worried me, but they were also pretty expensive. A thousand dollars a year is a lot of money for a guy like me with a family.
I made it clear to him that at 51 years old, if I were going to make a commitment likethis for the rest of my life that I was going to need some more proof that it was absolutely necessary to take statin medication.
It was at that point that my doctor told me about the EndoPAT test. He said, “I see where you are coming from and I suggest that we hold off the final decision on the statin regimen until we review the test results.”
Taking the EndoPAT Test
I thought we were going to schedule something for a week or two later, but to my surprise we walked into the examination room and I lay down on the table. The beauty of the EndoPAT test is that I didn’t need any special preparation. I didn’t even need to change my clothes, because clothing doesn’t interfere with this new technology.
The doctor attached special finger probes to the index finger of each of my hands, and put a blood pressure cuff on my left arm. Then I lay there quietly for five minutes as the EndoPAT began charting my pulse. When my five minutes were up, the doctor increased the pressure on my arm cuff. He told me, “This will significantly reduce the blood flow in the brachial artery of your arm, and the EndoPAT will be charting changes in Peripheral Arterial Tone of your endothelium on the screen.”
Once he deflated the arm cuff, the blood rushed back into my arm and fingers. The monitors on my index fingers captured the PAT signal, sent the results to the EndoPAT hard drive, and the computer began to compute my EndoScore. My EndoScore was automatically generated by comparing the difference in PAT signals detected in me before, during, and after using the arm cuff and then comparing it with measurements obtained from my other arm, which served as the control.
We printed out my EndoPAT results and went over them together. My EndoScore of 1.70, which was low, was an indicator of underlying atherosclerosis. Fortunately, it was highly treatable at this stage with a statin.
Seeing was believing for me and as I sat there looking at my printout, my EndoScore was all the proof I needed. I told my doctor that not only was I going to go on the statins, but things were going to change. Diet and exercise were now going to become my top priority, because I wasn’t going to let what happened to my dad happen to me.
I Reversed My Endothelial Damage
I kept my promise to myself. I began taking my daily statin medication to lower my cholesterol and eliminated the fat-laden and salty foods in my diet. Within six months my cholesterol was under 200 and my triglycerides went to 180. I lost seven pounds, but more significantly, my percentage of body fat fell from a decent 24% to a much healthier 18%. My follow-up EndoPAT test yielded an EndoScore of 1.94, a significant boost to the health of my blood vessels.
Looking back on it now, I can tell you that it was that initial low score I received from my EndoPAT test was the turning point I needed to get healthy. EndoPAT changed my life forever and gave me years that I know I wouldn’t have had otherwise. I don’t know where I would be today if I hadn’t taken the test.
Seeing is Believing – Bob’s Story (Cardiac risk factors)
I spend my life negotiating outcomes for the labor unions that I represent. I’ve been doing it for 25 years and never once did I stop to think that by not paying more attention to my health that maybe I was negotiating with my own life. When I was 50 years old, I had a heart attack that nearly killed me. I knew then that I had to make some big changes in my life or else I may not be so lucky in the future. I immediately went on a statin to get my cholesterol down and started to set up a plan of attack for dealing with my health.
Right around the time I was starting to get used to what had become my new life, my world was turned upside down yet again. My wife of 21 years and I got divorced and I found myself facing the two biggest challenges of my life all alone. Angry and confused, I stopped taking my statin, though I kept working out when I could because it took my mind off things.
I twisted my knee playing golf and when it didn’t get better, I actually started to have trouble walking. I went into see my doctor and talk about it. When I was there we went over the pain in my knee, which was a simple ligament strain he said, but he was more concerned about how I was feeling otherwise.
I told him the truth: I was still having chest pains, but I was also starting to feel very tired, so much so that I had to cut my golf game back from eighteen holes to nine and that even 30 minutes on the exercise bike wiped me out. I also told him that I was really feeling stressed out from work and being alone.
My doctor told me that he was very worried about my complaints of fatigue. The fact I had stopped taking the statin was also real reason for concern. He gave me some stress management tips to help defuse my daily work-related tensions, and he really wanted me to restart my statin therapy.
I had serious problem with becoming “drug dependent,” and I told my doctor that I would only take the statins if I knew that there was no other option.
After some discussion, in which he explained the important role played bythe endothelium and how endothelial dysfunction is a reliable indicator of impending heart problems, I readily agreed to have an EndoPAT test that day. I needed to know where I stood and my doctor assured me that an EndoPAT test would let me know just that.
A Second Chance
"If I hadn’t taken that EndoPAT test, I would have just kept fooling myself and avoided the issue. But now that I’ve been given a second chance at life, I intend to take full advantage of it and change my ways for the better." - David - Port Jefferson, Long IslandAfter the test, which only took about 20 minutes, we sat down in his office and reviewed my EndoScore. I was very upset to find out that my low EndoScore of 1.52 foreshadowed another, perhaps more devastating heart attack. He told me that, “With an EndoScore this low and your symptoms so pronounced, you should see a cardiologist very soon.”
One week later, I was admitted to NYU Medical Center and underwent a successful coronary bypass procedure.
When I got home from the hospital, I finally knew that I had to get realistic about my health. I was sicker than I let on when I first took the EndoPAT test and it turned out I was very close to having a second heart attack.
If I hadn’t taken that EndoPAT test, I would have just kept fooling myself and avoided the issue. But now that I’ve been given a second chance at life, I intend to take full advantage of it and change my ways for the better.
Changing Destiny - Carmen’s Story (fatigue)
I have been a community college teacher for 20 years and even though there have definitely been some trying times; I have loved every day of it. I never saw myself doing anything else or ever even retiring, even though I am 58.
I have been pretty healthy my whole life, but about a year ago, I suddenly started to get fatigued. It started soon after I awoke and became more pronounced as the day went on. I felt like something was not right, so I made an appointment to go see my doctor.
I told him that I simply had no energy, and that the most basic of my household chores knocked me out. Feeling like this just wasn’t like me—and I wanted to know what was wrong so that I could fix it.
The doctor said, “I am concerned with the fact that your one symptom, fatigue, is a coronary artery disease equivalent. I have seen a number of patients with critical coronary disease who told me that for a period of several months before their problem was diagnosed, they had no energy and felt washed out. They’d wake up in the morning and feel fine, but as the day went on, they’d try to do something but feel exhausted for hours afterwards.”
As you can imagine, hearing something like that is really quite shocking. Lucky for me, my doctor was really on top of this and didn’t waste any time.
You Can't Change Destiny?
"I really feel like the EndoPAT is what saved my life. If I hadn’t had that test I never would have known how urgent the situation was and that I had to act fast. I feel like I have been given a new lease on life and there is no doubt in my mind that is because of my EndoPAT test.” -Carmen - Portland, OregonMy doctor put me through a series of tests, one of which was an EndoPAT test, which he described as a test that could predict a heart attack seven years in advance. The EndoPAT measured changes in my Peripheral Arterial Tone, which contributed to my final EndoScore. He said this score would be a very strong indicator of the health of my heart, future risk, and would basically tell us where to go from there.
My EndoScore was 1.56, which was very low, and indicated to my doctor that further examination was needed. He referred me immediately to a cardiologist and it later turned out that I had an almost complete blockage of the left anterior descending coronary artery in my heart.
A week later I underwent a successful balloon angioplasty procedure to correct the damage. As I was lying there in the recovery room I couldn’t imagine what would have happened if I hadn’t gone and seen my doctor.
A few weeks after that I went back to my doctor to not only talk about my progress, but also thank him for giving me an EndoPAT test. I really feel like the EndoPAT is what saved my life. If I hadn’t had that test I never would have known how urgent the situation was and that I had to act fast.
I look at life in a very different way now and make sure to make the most out of every day. My fatigue is gone and that allows me to do what I love the most, which is teaching. After my surgery, I started using a pedometer to make sure that a day never goes by where I don’t walk 10,000 steps.
Four months later, I went back in to see what my new EndoScore was and it was a much higher 1.69. Needless to say we were both delighted!
I feel like I have been given a new lease on life and there is no doubt in my mind that is because of my EndoPAT test.