I'm dying, but let's be honest, so are you. The difference is that I keep trying to die sooner than later. If my body were a car, I'd be recalled. No wait, I'd be repaired and restored and I guess that's just what's happening.
When I read stories about the awful health care in Canada, I shake my head. The stories are so simplistic and so wrong. Health care is a problem all around the world, not just in Canada. But there are also health care solutions and they too are appearing all over the world.
Health care is expensive and it's getting more and more expensive with each passing year. When I was born mitral valve heart repair didn't add a cent to health care costs. Why? The procedure hadn't yet been done. The first successful mitral valve repair wasn't performed until 1948. That lucky dude had his sternum cracked open and his rib cage spread in order to give surgeons access to his damaged heart. Trust me on this, I bet he considered himself very lucky.
Eight years ago I had my badly leaking mitral valve repaired robotically in London Ontario. I did not have to have my sternum split; I have no huge scar. All it took was a little incision hidden in a fold under my right nipple, some little surgical tools, a talented surgeon and one big robot: a million and a half dollar da Vinci surgical robot. I consider myself very lucky.
I came upon an article by Michelle Meadows on the SurgicalTechSuccess site that said: "complete robotic heart surgery, which is commonly done in Europe and Canada, is considered experimental in the United States."
It was an article from 2002, it was written almost a decade ago, and yet I was surprised. I had thought the U.S. had always led the world when it came to robotic surgery. But when I looked into the history of my robotic operation I learned that some of "the first minimally invasive mitral valve surgery using Aesop (was done) in Austria and South Korea and the first robotic mitral valve surgery using DaVinci (was done) in England, India, Italy, and Thailand."
I don't want to get into a "who-was-first" argument. My point is that medical advances are being made all around the world. Clearly, more is being done in India than just running call centres and more is being done in Thailand than shrimp farming.
Last summer, seven years after I had my heart repaired, I suffered a V-tach event in California. My heart raced to 300 bpm and I was rushed to emerg where doctors hit me with 200 joules, jolting my heart back to reality. One could say they "rebooted" my pump.
Once you have a V-tach event there is a good chance that you will have another. These events can kill you in minutes. This does not leave much time to get help. A few weeks ago a doctor using a high-tech 3T MRI discovered why I suffered the runaway heart event. My pump is badly scarred, possibly because of a relatively rare type of heart disease, leaving it electrically unstable.
The LHSC uses pacemakers and implantable defibrillators made by Medtronic.
It was clear I needed an ICD — an implantable cardioverter defibrillator — and I needed one soon. Just weeks later I have one. I no longer need to go to emerg to have my heart rebooted. I carry a micro defibrillator in my chest. The battery is good for seven years and maybe longer.
An ICD isn't cheap. I gather from what I read on the Web that implanting one can easily cost from $65,000 to more than $100,000 in the States depending on the sophistication of the device. The high price may be part of the reason that less than 40% of U.S. patients in need of an ICD receive one according to Dr. Kenneth Stein, chief medical officer for Boston Scientific's cardiac rhythm management division
I found an interesting article How Much Will We Pay To Save A Life? by Douglas P. Zipes, MD. This American doctor warned: "In the final analysis, many medical decisions are based on how much money society is willing to spend to save a life." He wrote, "Some therapies are inexpensive and others are not, and society has to make difficult choices about how to use our limited resources."
If having an ICD implanted in the States can cost in the six figures, how much did mine cost to have implanted in Ontario? I don't know but I bet the Canadian approach saved money, coming in at the low end of the scale. My ICD was implanted in an outpatient setting. I entered the hospital at ten in the morning and left by mid-afternoon. The operation itself took a bit more than an hour. I was home for dinner.
If we, as a society, plan on offering everyone high quality health care we've got to perfect methods of delivering such care at reduced cost. Whether it's European socialized medicine, the Canadian single-payer system or the very mixed approach in place in the United States, every health system must address the issue of climbing costs.
Methods of doing more with less must be developed. Cutting the time spent in the hospital cuts costs dramatically.
Encouraging manufacturers to develop sophisticated equipment that cuts costs by increasing efficiency. This is a balancing act, of course, the additional expense must be offset by greater efficiency. The 3T MRI unit used to diagnose my heart condition is one example. I ran up a $25,000 hospital bill in California and yet the cause of my V-tach event went undetected. One scan in a high-powered 3T MRI could have answered all the questions that were swirling about my heart.
We must take advantage of technological breakthroughs. Robots, controlled by experienced surgeons, may very well work better and quicker than surgeons on their own. Minimally invasive surgery performed robotically can cut hospital stays dramatically and speed patient recovery.
Careful patient selection is important, and we may have to make some tough, unpopular choices when it comes to medical treatments that are covered.With limited resources, only those with a good chance of benefiting from a medical procedure should be considered. And some procedures are very expensive and yet have very poor track records. I know a person who was so desperate to lose weight that they longed to have their stomach stapled. OHIP refused to cover the cost and no Canadian hospital was interested in performing the operation. This person was told that the procedure they sought would be very risky for them and that in the end they might well put back all weight they lost following the surgery. The person turned to a hospital in the States. The U.S. hospital performed the operation for a fee and today, four years later, this person has ballooned right back to their former obese size. They needed a new attitude toward food and not a new, smaller stomach.
And maybe all hospitals don't have to have the latest and greatest equipment to enjoy some benefits from advancing technology. There are indications that the original da Vinci robot may be getting a little long in the robotic tooth. Children's Hospital Boston demonstrated a tiny surgical robot at TEDMED that put the size of tools used by da Vinci to shame. Maybe smaller hospitals can pick up a used da Vinci robot on the cheap.
As I recuperate from my ICD operation, it'll be a month before I can lift my granddaughter again, as the wire lead screwed into my heart must heal firmly into the heart muscle. I wouldn't want to tug it free. I will follow all my doctors' orders faithfully.
I am going to use some of my time to rewrite my will, add a codicil. I'm leaving something to LHSC and to the Robarts Research Institute. Our health system has earned my support.