Tuesday, July 12, 2022

Science marches on

Or maybe the title should be 'welcome to another revenue stream.'

I got to experience a new-to-me preventive medicine screening procedure yesterday. A few weeks ago I had my annual wellness meeting with my primary care practitioner, the encounter I always refer to as the 'yes, I'm still breathing' encounter because it's not a physical exam in the old-fashioned sense of an annual exam. It's a question-and-answer session that doesn't go much beyond the practitioner demonstrating that yes, she does still know how to use a stethoscope to make sure you have a heartbeat. 

Anyway, as part of the Q & A, my PCP ascertained I had managed to dodge the tits-in-a-vise for over five years, had never been tested for Hepatitis C, couldn't remember the last time I'd gotten a tetanus booster, and had never even heard of being screened for an abdominal aortic aneurysm, let alone had that screening done. When did routinely doing ultasounds of geezers' guts become a thing? 

I do like to feel like I'm getting my money's worth out of my insurance premiums, though, so when I got told it was a covered procedure under Medicare, I said sure, schedule it. It's summer. I don't mind the drive from the ranch up to Portage Health in Hancock when the weather is good. I acquiesced on the tits-in-a-vise, too. I figured it's a waste of time, but didn't feel like arguing it. 

Then I started Googling abdominal aortic aneurysms. No surprise -- they're pretty common in the elderly. Not super common, but of all the age groups, old people are the most likely cohort to end up with blood vessel problems. You get old, stuff starts wearing out, including major arteries. And arteries don't come any more major than the aorta. If you think of the aorta as analogous to a rubber hose that is being repeatedly inflated and deflated multiple times per minute day after day, month after month, decade after decade, it's not surprising that it's doing to develop some odd bulges as it fatigues. Eventually the bulges can get bad enough, the tissues thin enough, that leaks develop. Or, worst case scenario, blowouts. 

So when did screening for potential blowouts become a routine procedure? As far I could tell, it goes back to 2015 and the recommendations of the United States Preventive Services Task Force. The USPSTF is an independent organization, a panel of experts that evaluates findings in scientific medicine, and comes up with recommendations for improving preventive care. Seven years ago the Task Force reviewed the extant research on abdominal aortic aneurysms and decided screening older persons who presented certain risk profiles would be a good idea. 

Who fit that profile, you ask? Overweight elderly men with a history of long-term smoking and high blood pressure. How did the Task Force feel about screening old ladies? Probably not beneficial for women. So why did I, a woman who has normal blood pressure and quit smoking over 40 years ago, end up getting referred for a screening? See the subtitle suggested above: revenue stream. 

In a Facebook post where I mentioned the screening, I described the experience as the hospital trolling for surgery patients. After all, that is the fix: treat the aorta like a bad tube on a tire by patching it. It can be patched in a minimally invasive way (insert a stent by slicing into the femoral artery and sliding a stent up to reinforce the aorta from the inside, a procedure that's still going to require a general anesthetic and no stair climbing for a few days) or you can slice the patient open and work directly on the bad section. So, yes, I'm still thinking trolling for candidates to slice and dice is an accurate assessment. The more old people you screen, regardless of whether or not they fit the high-risk patient profile, the more likely you are to reel in a few potential occupants of a surgery suite.

Am I likely to be one of those candidates? Based on the statistics I saw, this is a case where the odds are in my favor. Geezers might be the most likely group to experience abdominal aortic aneurysms, but even among geezers aneurysms are pretty rare. And then when you get into just how many people who have been diagnosed with an aneurysm, the numbers who experience actual ruptures isn't especially high. Yes, it's a risk, but in the overall scheme of things that might kill a geezer, it doesn't make the top ten. 

As for how I'd react if I did get told to consult with a surgeon, my feelings on medical interventions once a person hits their sell by date (or is close to it) have been documented elsewhere. Watching my mother age did a good job of convincing me I have zero desire to be a centenarian. She actually aged pretty well (no cognitive decline, for example) but it's still depressing as hell to become increasingly frail while watching everyone in your age cohort drop dead before you. Involuntary tontines suck; being the oldest person in the audience at someone else's funeral doesn't seem like much of a pay-off.