30 November 2009

Dr. Bimal Chhajer
W hy not Angiography

Angiography - the common name for “Invasive Catheter Angiography” is something Saaol advices people to avoid. There are three reasons behind this. One is that the test is invasive and thus full of complications; secondly the results are very inaccurate and the third is that following angiography the cardiologists create a scare of heart attack to push the patients towards further treatment (i.e. Angioplasty or Bypass Surgery) in their hospitals. Lets consider each of them. Invasiveness: In Catheter Angiography a long tube (called Catheter) is pushed blindly inside our body through a cut made in the thigh (Femoral Artery) or the Hand ( Radial or Brachial Artery). The wire is now somehow pushed towards the heart by trial and error method ( similar to the pushing of the clutch wire in a scooter or mobike). During this time the catheter scratches and damages the inside wall of the tubes it passes through. It may also puncture any tube leading to the death of the patient. Once the tip of the catheter reaches the heart, a dye is pushed and scanning photography is done. During this whole procedure a continuous x-rays are done. One such test exposes a person to a radiation equivalent of 250 x-rays. Complications like false puncture, infection, embolism (which can lead to paralysis once it reaches the brain), allergy and even heart attack can take place during this procedure. I know a person who remained in the hospital for eight month as the leg artery got damaged and infected after angiography ultimately the leg had to be amputated. Inaccuracy: If you ever see the report of an angiography you will find the blockages are all in round figures 70%, 80% and 90%. These are all eye estimations. Blockages can not jump from 70% to 80%. They can also be 77.92 % or 82.30% if you estimate accurately - which is possible (Quantitative Angiography). Most of the hospitals only do a qualitative angiography and give the report roughly. The reports vary from cardiologist to cardiologist even if they see the same CD records of angiography. Many of the cardiologists knowingly estimate the blockages as more, to create pressure for further treatment. One patient once came to me in Delhi and said that he has reversed the blockages by 10% in one day. I said who was that possible. He said “ Sir, the Escorts Hospital who performed the angiography two days back, said that the blockage was 80%. Today I met a cardiologist in Apollo Hospital they said that the blockage is only 70%.” Scare and pressure from the Cardiologists: The third problem has resulted from the commercialization of the hospital system. Once the angiography is over, the doctors immediately and invariably tell the patient that the condition is very critical and we want to operate immediately. If you meet an Invasive cardiologist the opinion is an immediate Angioplasty and if you meet a heart surgeon the opinion will be an immediate surgery. If the patient does not agree, they use scare of heart attack to push him/her for operation. Though they do not know when the heart attack may take place they just tell patients that it will come immediately, and as soon as you leave the hospital. Even if the blocked tube is not so important, they say it may cause a death. If the patient do not agree, they put the same pressure on the relatives who are emotionally charged. Once the relatives are also scared the pressure comes also from the family members. They often refuse to discharge the patient or delay the discharge and take turn to convince the patients. The things are so much overdone the motive becomes obvious. People, who have little intelligence and courage ask the doctors about the cause and preventive steps- the doctors say “ There is no time to discuss these. It's a life and death situation, you just say what you want”. Majority of patients of mine had undertaken this Angiography and from them I have collected some pet dialogues of these cardiologists and some of them I am reproduced in the last issue of Saaol Times. One of my patients told me that all these happened to him. But still he refused to do surgery. The doctors refused to discharge him from the hospital - as they would not take a risk, as the condition was too serious. Ultimately the patient got a new idea. He explained to the cardiologist that he had no money and needs to go home and sell his property to get the money. Then only the patient was able to get a discharge. Then the cardiologist asked him how long it may take and when he said that it will take two months. Ultimately the doctor agreed to postpone the operation by two months.