Lee Kirksey, MD  
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Think your having a heart attack? Do you know what to do?

Sep 03, 2012 - 1 comments

Heart Attack


Ghost Stories


atrial fibrillation

The first minutes after the onset of chest pain or stroke are the most critical. Decisions made during this period can great influence that liklihood of success and the degree of recovery following a stroke or heart attack. From NY Times. Anahad OConnor


Anahad O’Connor tackles health myths.
Last week the entertainer Rosie O’Donnell surprised fans when she announced that she recently had a heart attack.

Ms. O’Donnell wrote on her blog that she felt an ache in her chest and soreness in her arms, followed by nausea and a “clammy” feeling. She took an aspirin, she said, but decided against calling 911. The next day she went to a hospital, where she learned one of her coronary arteries was 99 percent blocked, requiring a stent.

“I am lucky to be here,” she wrote. “Know the symptoms, ladies.”

Studies show that for men and women, the symptoms can differ. Men are more likely to experience the classic signs, like chest pain, shortness of breath and radiating pain in the neck and arms. Women are more likely to experience severe fatigue, indigestion and cold sweats.

Despite the differences, the response should be the same: Immediately call 911, then chew an aspirin, said Dr. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute in Los Angeles.

Some people may suspect that chewing an aspirin, which inhibits platelet activity that could block arteries during an attack, makes little difference. But a study in The American Journal of Cardiology highlighted its importance. In a group of 12 subjects tested in a laboratory, chewing an aspirin tablet for 30 seconds before swallowing on an empty stomach prompted a 50 percent reduction in platelet activity in five minutes. It took 12 minutes to achieve the same effect when the aspirin was swallowed whole.

Dr. Merz said people who suspect they are having an attack should chew one full-strength tablet, which is 325 milligrams. But most important, she added, is to “get to an emergency room.”


If you experience symptoms of a heart attack, dial 911 first, then chew on an aspirin.

Think your too young to have a strok, Think again

Sep 03, 2012 - 2 comments



Heart Attack


atrial fibrillation


irregular heart beat

Recently, I read a great article in NY Times that precisely describes the mentality of many unfortunate patients I see who have suffered a stroke at a younger than expected age. A disbelieft that sometimes still exists even after the stroke has visited and left its physical ravages. "I'm too young to have a stroke"

Six years ago, Todd McGee was a lean, athletic 34-year-old working in construction and living with his wife and toddler daughter on Martha’s Vineyard, where he spent summer weekends surfing. A stroke changed his life forever.

Today, with one arm useless and difficulty speaking, Mr. McGee, now 40, cannot work. He devotes most of his time to keeping as healthy as possible. Though he is able to drive and care for his daughter, now 7, everything takes longer, and he has trouble concentrating even on routine activities that others take in stride, like grocery shopping.

“I definitely wish I had my old life back, building houses and boats and surfing in my spare time,” he said.

His experience, complicated by a serious delay in diagnosis, is a powerful reminder that strokes can and do happen to young people. The sooner the correct diagnosis is made, the less likely the result will be lifelong impairment.

Although a vast majority of strokes occur in people over age 65 (the risk is 30 to 50 per 1,000 in this age group), 10 percent to 15 percent affect people age 45 and younger (a risk of 1 in 1,000). A study by doctors at the Wayne State University-Detroit Medical Center Stroke Program found that among 57 young stroke victims, one in seven were given a misdiagnosis of vertigo, migraine, alcohol intoxication, seizure, inner ear disorder or other problems — and sent home without proper treatment.

“Although young stroke victims benefit the most from early treatment, it must be administered within four and a half hours,” said Dr. Seemant Chaturvedi, a neurologist at Wayne State who directs the program and led the study. “After 48 to 72 hours, there are no major interventions available to improve stroke outcome.”

“Symptoms that appear suddenly, even if they seem trivial, warrant a meticulous work-up,” he added.

Follow-up analyses of the Detroit study showed that patients seen by a neurologist in the emergency room, as well as those who were given an M.R.I. as part of the initial work-up, were less likely to receive a misdiagnosis.

“Patients, too, should be aware of the risk of stroke regardless of their age,” Dr. Chaturvedi said in an interview.

The Centers for Disease Control and Prevention have reported a steep increase in strokes among people in their 30s and 40s. A rise in risk factors — obesity, diabetes, high blood pressure and sleep apnea — and improved diagnosis account for this upturn.

But younger patients are no better today at recognizing the symptoms of stroke. “Only 20 to 30 percent of patients get to the emergency room within three hours of symptom onset,” Dr. Chaturvedi said. “They tend to wait to see if the symptoms will go away spontaneously, and they show up in the E.R. 12 to 24 hours later.”

A Cautionary Tale

After an intense workout in the surf the day before, Mr. McGee awoke one morning with a headache and feeling out of sorts. He went to work but came home nauseated and chilled. He assumed he’d come down with the flu his family had just had.

Then in the middle of the night, a headache he described as “the worst pain of my life” prompted a trip to the emergency room. The attending doctor thought Mr. McGee had a muscle tension headache, treated him with intravenous pain medication, handed him some pain pills and sent him home.

Embarrassed that he’d gone to the hospital “for just a headache,” Mr. McGee took the pills when the pain returned the next afternoon. Soon after, he suffered what he thought were side effects from the medicine. Now he knows what it really was: a transient ischemic attack, a mini-stroke, that left him briefly unable to speak and numb on one side.

from NY times
Jane E Brody
Sept 3, 2012

Why health insurance mandates are Necessary...Pro

Jul 04, 2011 - 10 comments

health insurance reform


insurance mandate




International affair



There is no true way to reform healthcare in a meaningful way that does not involve insurance mandate, ie a system that requires everyone to buy into and be covered by some basic level of health insurance.  Universal coverage, as this is known, is agreed upon by all who seriously advocate for programs which can solve the sustainability problem of our current system
Why is mandatory healthcare necessary? In healthcare, where an individual can impose costs on society, the need for mandatory insurance is just common sense.  The explanation is similar to that offered for automobile insurance. Everyone who drives an automobile is required to have liability insurance in case they have an accident, they will not inflict costs upon others.  This means that one must carry insurance all the time, not just periodically when they feel it is convenient. When everyone contributes, the average price of insurance premiums should be lower. (Unless as we found out, health insurers are not passing on the savings to consumers which is one of the requirements of health reform.
The rationale for requiring health insurance is similar and if anything more compelling. Conceivably, you might own a car but elect to never get in it and drive-perhaps owning it only in case of emergency.  However, medical illness is totally unpredictable and entirely outside of one’s control.  The cost of treating uninsured individuals is huge and the onset of illness may be followed by years of costly treatment.  For example, the costs of treating uninsured individuals in emergency departments are passed onto insured individuals in the form of higher costs. Either in the form of higher health insurance premiums, free care pools organized by the hospital requiring them to bill insured individuals higher rates or higher taxes for state funded plans like Medicaid.
Although, there is an assumption that all people who are insured do so because of low incomes.  Research out of Massachusetts shows that over 38% of uninsured  have annual incomes over 58K.
Uninsured individuals are more likely to forego preventive health services like mammogram, colonoscopy etc, they are less likely to have early disease management for treatable problems like diabetes, hypertension high cholesterol and obesity and therefore more likely to prevent with severe costly conditions that otherwise could have been prevented and certainly treated.
Health insurance mandates do require the creation of fair and equitable subsidies for those who cannot afford health insurance.  Sliding scale systems based on accurately reported income is the most commonly described.  However, everyone must be required to pay into the system. It is important that mandatory coverage requirements be enacted at the same time as subsidies otherwise, people would be encouraged to drop their private coverage. Mandatory coverage should be instituted nationally, otherwise people would be incentivized to relocate or shift jobs because of state to state variation.

Obama Administration halts plans to spy on doctors based upon strong national feedback

Jul 03, 2011 - 11 comments

obama administration




healthcare reform


insurance reform

The Obama administration has decided to halt plans to survey physicians offices largely due to negative feedback that the administration has received and the longterm political implications.  Issues that affect Americans only change when individuals voice their feedback in forums like we have here on  Medhelp. However, this is not the last of this issue.  Please share via facebook and twitter this posting to continue to grow the feedback on this issue. Regardless of how people feel about the core issue, most don't like the "spying" connotation. We all know that if they are spying on our neighbor, they are probably spying on us.

Administration Halts Survey of Making Doctor Visits
Published: June 28, 2011
WASHINGTON — The Obama administration said Tuesday that it had shelved plans for a survey in which “mystery shoppers” posing as patients would call doctors’ offices to see how difficult it was to get appointments.

U.S. Plans Stealth Survey on Access to Doctors (June 27, 2011) “We have determined that now is not the time to move forward with this research project,” the Department of Health and Human Services said late Tuesday.

The decision, after criticism from doctors and politicians, represents an abrupt turnabout. On Sunday night, officials at the health department and the White House staunchly defended the survey as a way to measure access to primary care, and insisted that it posed no threat to privacy.


Health policy experts have long expressed concern about a shortage of primary care doctors, including family physicians and internists. The shortage, they say, could become more serious if, as President Obama hopes, more than 30 million people gain insurance coverage under the health care law passed last year.

Having coverage is not the same as having ready access to care — a fact demonstrated in Massachusetts, which has come closer than any other state to the goal of universal coverage. A recent survey by the Massachusetts Medical Society found that about half of family doctors and internists were not accepting new patients.

Plans for the federal survey were devised by the office of the assistant health secretary for planning and evaluation, Sherry A. Glied, and the government retained a big survey research company to help conduct it. Ms. Glied declined Tuesday to respond to questions about cancellation of the survey.

Administration officials evidently concluded that the survey could be a political liability. But Christian J. Stenrud, a Health and Human Services spokesman, said, “Politics did not play a role in the decision” Tuesday.

Doctors and many Republican lawmakers criticized the project, after a New York Times article about it on Monday.

“The cost and proposed clandestine method of collecting information from physician offices are questionable,” said a letter to the administration drafted Monday by Senator Mark Steven Kirk, Republican of Illinois. Mr. Kirk demanded answers to 12 questions about the survey.

Mr. Kirk asked why the survey was needed, since, he said, “there have been a number of reputable studies that confirmed many patients on Medicaid and Medicare cannot find a doctor to see them.”

Source NY Times.com