Question about Stress Testing
My doctor will not put me on a treadmill, etc. He prefers nuclear testing Am I getting short changed?
This one I have to leave to the physician who has been treating you. There are several reasons that a doctor may desire not to put a patient on a treadmill. They are often involved with safety. Some factors limit the use of the treadmill. Such reasons may include orthopedic problems that may be aggravated by the stress of running uphill, instability of gait (the patient who might fall off), obesity (most treadmills will only accommodate people who weigh less than 300lbs, if the weight is much above this, the treadmill might collapse injuring the patient), inability to raise the heart rate (this may be due to medicines that may only be stopped at risk to the patient, or due to a cardiac problem that doesn’t permit the rate to go up), dangerous arrhythmias with activity, or previous failures to get an adequate test to answer the questions that the physician requires. I will do a nuclear test when I don’t feel that the patient is capable of cooperation on the treadmill.
A treadmill (or bicycle) stress test is only helpful if a patient is willing to go along with it until we reach an end point that helps make a diagnosis. Sometimes, the patient doesn’t fully understand the process. They may step off the treadmill before the heart rate is adequately increased, or resists by claiming inability to continue. The physician is then unable to learn anything from the test. This wastes time, energy and money. Pharmacologically-driven stress tests (those in which we inject certain medications to mimic the effect of exercise on the heart) give some information about whether or not there is a normal distribution of blood flow to the heart. The answer, however, is a yes/no answer. This does not tell us how much exercise is safe. If the reason for the doctor’s unwillingness to put you on a treadmill is something remediable, try fixing it.
I was in a health food market earlier today. Is there some reason that labeling cannot be kept honest? Does adding yogurt flavor to potato chips really make them a health food? Does deep-frying tofu or tempeh make it a nutritional improvement over a broiled fish? Can’t someone out there understand that organic chemistry doesn’t mean organic food? Farming organically may mean without pesticide to some, or without treated fertilizer to others. “Certified organic” doesn’t mean anything unless there is a properly accredited certifying organization with publicly acknowledged standards and policing authority. At the airport, I saw frozen yogurt being served. This seemed like a reasonably healthy idea until I noted that it could be bought with “added” chocolate chips, peanuts, cookie pieces, etc. Oh sure, that makes it “healthy”. How fat do we really need to be? Oh yes, I recall, “Obesity protects against suicide according to a large Harvard study of men…”
Larry Weinrauch is a cardiologist in Watertown, Massachusetts and is affiliated with Mount Auburn Hospital. He wrote for HealthCentral as a health professional for Heart Health, High Blood Pressure, and High Cholesterol.