Off-Pump Heart Bypass
(Courtesy of mail from Dr JB Lim)
Thursday, 17 June, 2010 11:42 PMDear all,
I have already said that for most of the cardiac operations, the heart need to be stopped completely using a cardioplegia especially if the surgeon need to change or repair the mitral, bicuspid or aortic valves. There is no other way.
Changing pistons and valves with engines running:
This is exactly like changing the pistons and the valves of an automobile engine without wanting to stop the engine? There is just absolutely no way for a car mechanic to de-carbonize the engine chambers, change the valves, and change the piston with the car engine running. How is he going to do this when he is asked not to open up the whole engine? Is he trying to perform circus tricks? He is an absolute NUT if he claims he can do this?Minor repair outside the engine:
But if he is just trying to repair or clear up a blocked fuel line, it is possible to do this using another temporary bypass fuel line while the engine is still running, as the blocked fuel line is taken out for cleaning or replacement. This is not a magic show, a circus act, or an aerobatic stunt that requires people to applaud or clap their hands.
Birds of the same feature:
This is exactly the same as that off-line or ‘off-pump CABG’. The above is neither a problem for the mechanic for a car engine, nor would it be a problem for a heart surgeon for a beating heart. The engine can continue to run as long as there is still fuel and air is being fed while the fuel line is being replaced.
The same as with the heart! The heart can continue to beat perhaps at a much slower rate while repair to the blocked coronary is being done or replaced. Using a temporary shunt to supply the heart with blood this is no big deal. There is nothing to shout at this ‘achievement’ .
Inside beauty, not outside:
It is the main coronary vessels which are normally blocked. This is outside (not inside) on the walls outside the heart. The main car fuel line is outside the engine, not inside the engine. The surgeon is not going to get a Nobel Prize in medicine for this by replacing a vessel outside the
heart without stopping the heart. This is neither a circus act either. There are now a lot of advances in surgical techniques such as keyhole surgeries where you don’t even have to open up the entire chest cavity. All the surgeon needs is just bore a small hole outside the chest cavity and sends in a thin probe through the hole and monitor the procedure over a TV screen. This has being going on for years already. There is nothing to shout about. I have already mentioned that, and I am repeating it again right here.
But try to change the car piston, clean the combustion chambers, repair or change the valves or spark plugs without stopping the engine in order to open up the whole engine, and overhaul it completely (for the car mechanic), or change the mitral or aortic valves or perhaps close up the hole in the septum between the chambers (inter-septal defect or hole-in-the-heart) by sewing a patch over the hole without wanting to stop the heart (for the surgeon)? All these defects are inside (not outside) the heart. Only Jesus can perform this sort of miracle.
Inside achievement, not outside:
If that ‘famous’ nutty surgeon who claims through his ass-hole that he can perform all those complicated internal repairs without stopping the heart, then he can shout, and shout, and we will all listen to his miracles. Then perhaps he deserves, not just one, but 10 Nobel Prizes, and we will all adore and worship him as a god. But if he was just doing a minimally invasive operation over (outside) on the walls of the heart, then he needs to be paid minimally for a relatively easy job. He can then go to the bank to fatten his account, and shut his mouth tight.
Nobel Prize for deserving tough problems only:
By the way, not a single Nobel Prize in Medicine or Physiology has been given to any heart surgeon so far, because there are far, far more complicated and tougher and pressing problems in health and medicine such as fighting against malnutrition, malaria, emerging infectious diseases such as tuberculosis, hepatitis, AIDS, H1N1, diabetes, high blood pressure, degenerative disorders, etc affecting millions of people.
These are the real extremely tough problems against Mother Nature we have not being able to overcome yet. These have brought untold sufferings and miseries to billions of human lives in poor and developing countries till this day. We were always discussing these real problems at scientific conferences. There don’t seem to be a solution even in the distant horizon. It fact they are getting worse even after scientists have spent hundreds of billions of US $ conducting research and studies for decades world-wide. Even WHO does not know what to do now? WHO does not know how to offer a solution for these increasing problems?
Costly operations that benefit only a few patients:
Doing ‘fantastic’ things like Fontan heart operations, heart transplants, off-pump bypass surgery, etc are very low priority to WHO and to all countries throughout the world. A heart transplant cost about RM 400,000 for each patient, and it benefit only him or her, but not the billions of people out there.
The patient also has to take horrendously expensive anti-rejection drugs for life after the transplant. This only enriches the already fifthly rich drug companies even more, and sucking out the pockets of those who can afford it. They rob also those who do not wish to live healthy lives. Drug companies, private hospitals and the surgeon takes advantage of this – on people bad lifestyles, and of course the business-run private hospitals, drug companies and surgeons are very happy about this. They take advantage on people’s unwillingness to lead healthy life-styles. But these surgeons, drug companies, and the hospitals do not benefit anyone else.
They deserve to die early:
These are the patients who apparently ate a lot, overweight themselves out of control, smoke a lot, refuse to exercise, watch TV all day long on a couch, think only how to make more money, stressed out a lot on how to become richer, etc, etc. These are the patients who deserve to die early because they are very rich, care not for the hungry, the poor and deserving. They are of no use to society. It is just selfish lives.
Spending effort on wrong patients:
Neither does any heart surgeon who spends his time and effort treating these entire ‘potatoes couch’, and collect a lot of money out of them deserve any award. Pound foolish, penny wise! Robbing the poor to pay the rich!
The same as with space-circus act:
This is like spending RM 5,000 000 of tax payers money to send a so-called ‘Malaysian astronaut’ to take a taxi ride into space to spin round and round Earth to enjoy the view of sun set and sun rise, while down-to-earth, people are without jobs, without security, without proper housing, without social care, without future for their children, but with political fighting here and there, etc, etc…down the list. How does this ‘fantastic space achievement’ which was not even our home-grown technology, benefit the masses down here on Earth?
Find a ‘cure’ for ‘simple’ diseases first:
If a scientist can find a permanent cure for cancer, for cardiovascular diseases, for all the emerging infectious diseases I listed above once and for all, diseases that afflict hundreds of millions of people every year, costing untold economic and social losses, and untold miseries – all these pressing diseases we are fighting a losing battle against Mother Nature.
If any scientist can do that, we will all bow down to worship him, and the Swedish Academy will instantly give this medical scientist 10 Nobel Prizes. It will be a real medical achievement. We in the medical research professions and the Ministry of Health have been discussing these problems among the best experts and brains for years at countless meetings, national and international conferences until all of us retired without an answer.
Doing ‘fantastic’ thing like off-pump CABG (OPCAB) to benefit only the rich who eats a lot, overweight, cannot learn to relax or wanting to find spiritual inward peace for himself, and paying RM 50 000 (perhaps) each time to the surgeon and the hospital and the drug companies for them to drain away the bank savings of the ‘victim’ is of no use to anybody. In any case the maximum human life span is just 120 years no matter what we try to do.
That surgeon has not solved any problem for humanity. He has only increased the miseries, the hunger, the poverty and the squalor of millions out there in poor and deprived countries – especially the children who don’t even have a meal a day. He is not going to get any Nobel Prize for doing OPCAB for sure. The Swedish Academy does not think so. .
Prioritize if they want an Award:
Get our health priorities and health services right in the first place, and this world will be a much better, happier, and healthier planet to live in.
No wonder all the Nobel Prizes in Medicine or Physiology were, are, and will continue to be given to scientists whose discoveries are going to benefit the billions out there. It is not going to be easy. It is not going to be given to a car mechanic or a heart surgeon who can do circus act of repairing from outside without stopping the engine. That’s for sure!
That surgeon is a nut if he claimed he can do complex intracardiac (inside the heart) surgeries without stopping the heart. That includes that mechanic who compared. Both of them are nuts who need to get their health priorities right first.
Sorry!
JB Lim
------------------------------------------------------------But if he is just trying to repair or clear up a blocked fuel line, it is possible to do this using another temporary bypass fuel line while the engine is still running, as the blocked fuel line is taken out for cleaning or replacement. This is not a magic show, a circus act, or an aerobatic stunt that requires people to applaud or clap their hands.
Birds of the same feature:
This is exactly the same as that off-line or ‘off-pump CABG’. The above is neither a problem for the mechanic for a car engine, nor would it be a problem for a heart surgeon for a beating heart. The engine can continue to run as long as there is still fuel and air is being fed while the fuel line is being replaced.
The same as with the heart! The heart can continue to beat perhaps at a much slower rate while repair to the blocked coronary is being done or replaced. Using a temporary shunt to supply the heart with blood this is no big deal. There is nothing to shout at this ‘achievement’ .Inside beauty, not outside:
It is the main coronary vessels which are normally blocked. This is outside (not inside) on the walls outside the heart. The main car fuel line is outside the engine, not inside the engine. The surgeon is not going to get a Nobel Prize in medicine for this by replacing a vessel outside the
heart without stopping the heart. This is neither a circus act either. There are now a lot of advances in surgical techniques such as keyhole surgeries where you don’t even have to open up the entire chest cavity. All the surgeon needs is just bore a small hole outside the chest cavity and sends in a thin probe through the hole and monitor the procedure over a TV screen. This has being going on for years already. There is nothing to shout about. I have already mentioned that, and I am repeating it again right here.
But try to change the car piston, clean the combustion chambers, repair or change the valves or spark plugs without stopping the engine in order to open up the whole engine, and overhaul it completely (for the car mechanic), or change the mitral or aortic valves or perhaps close up the hole in the septum between the chambers (inter-septal defect or hole-in-the-heart) by sewing a patch over the hole without wanting to stop the heart (for the surgeon)? All these defects are inside (not outside) the heart. Only Jesus can perform this sort of miracle.Inside achievement, not outside:
If that ‘famous’ nutty surgeon who claims through his ass-hole that he can perform all those complicated internal repairs without stopping the heart, then he can shout, and shout, and we will all listen to his miracles. Then perhaps he deserves, not just one, but 10 Nobel Prizes, and we will all adore and worship him as a god. But if he was just doing a minimally invasive operation over (outside) on the walls of the heart, then he needs to be paid minimally for a relatively easy job. He can then go to the bank to fatten his account, and shut his mouth tight.
Nobel Prize for deserving tough problems only:By the way, not a single Nobel Prize in Medicine or Physiology has been given to any heart surgeon so far, because there are far, far more complicated and tougher and pressing problems in health and medicine such as fighting against malnutrition, malaria, emerging infectious diseases such as tuberculosis, hepatitis, AIDS, H1N1, diabetes, high blood pressure, degenerative disorders, etc affecting millions of people.
These are the real extremely tough problems against Mother Nature we have not being able to overcome yet. These have brought untold sufferings and miseries to billions of human lives in poor and developing countries till this day. We were always discussing these real problems at scientific conferences. There don’t seem to be a solution even in the distant horizon. It fact they are getting worse even after scientists have spent hundreds of billions of US $ conducting research and studies for decades world-wide. Even WHO does not know what to do now? WHO does not know how to offer a solution for these increasing problems?
Costly operations that benefit only a few patients:Doing ‘fantastic’ things like Fontan heart operations, heart transplants, off-pump bypass surgery, etc are very low priority to WHO and to all countries throughout the world. A heart transplant cost about RM 400,000 for each patient, and it benefit only him or her, but not the billions of people out there.
The patient also has to take horrendously expensive anti-rejection drugs for life after the transplant. This only enriches the already fifthly rich drug companies even more, and sucking out the pockets of those who can afford it. They rob also those who do not wish to live healthy lives. Drug companies, private hospitals and the surgeon takes advantage of this – on people bad lifestyles, and of course the business-run private hospitals, drug companies and surgeons are very happy about this. They take advantage on people’s unwillingness to lead healthy life-styles. But these surgeons, drug companies, and the hospitals do not benefit anyone else.
They deserve to die early:These are the patients who apparently ate a lot, overweight themselves out of control, smoke a lot, refuse to exercise, watch TV all day long on a couch, think only how to make more money, stressed out a lot on how to become richer, etc, etc. These are the patients who deserve to die early because they are very rich, care not for the hungry, the poor and deserving. They are of no use to society. It is just selfish lives.
Spending effort on wrong patients:
Neither does any heart surgeon who spends his time and effort treating these entire ‘potatoes couch’, and collect a lot of money out of them deserve any award. Pound foolish, penny wise! Robbing the poor to pay the rich!
The same as with space-circus act:
This is like spending RM 5,000 000 of tax payers money to send a so-called ‘Malaysian astronaut’ to take a taxi ride into space to spin round and round Earth to enjoy the view of sun set and sun rise, while down-to-earth, people are without jobs, without security, without proper housing, without social care, without future for their children, but with political fighting here and there, etc, etc…down the list. How does this ‘fantastic space achievement’ which was not even our home-grown technology, benefit the masses down here on Earth?Find a ‘cure’ for ‘simple’ diseases first:
If a scientist can find a permanent cure for cancer, for cardiovascular diseases, for all the emerging infectious diseases I listed above once and for all, diseases that afflict hundreds of millions of people every year, costing untold economic and social losses, and untold miseries – all these pressing diseases we are fighting a losing battle against Mother Nature.
If any scientist can do that, we will all bow down to worship him, and the Swedish Academy will instantly give this medical scientist 10 Nobel Prizes. It will be a real medical achievement. We in the medical research professions and the Ministry of Health have been discussing these problems among the best experts and brains for years at countless meetings, national and international conferences until all of us retired without an answer.
Doing ‘fantastic’ thing like off-pump CABG (OPCAB) to benefit only the rich who eats a lot, overweight, cannot learn to relax or wanting to find spiritual inward peace for himself, and paying RM 50 000 (perhaps) each time to the surgeon and the hospital and the drug companies for them to drain away the bank savings of the ‘victim’ is of no use to anybody. In any case the maximum human life span is just 120 years no matter what we try to do.
That surgeon has not solved any problem for humanity. He has only increased the miseries, the hunger, the poverty and the squalor of millions out there in poor and deprived countries – especially the children who don’t even have a meal a day. He is not going to get any Nobel Prize for doing OPCAB for sure. The Swedish Academy does not think so. .
Prioritize if they want an Award:
Get our health priorities and health services right in the first place, and this world will be a much better, happier, and healthier planet to live in.No wonder all the Nobel Prizes in Medicine or Physiology were, are, and will continue to be given to scientists whose discoveries are going to benefit the billions out there. It is not going to be easy. It is not going to be given to a car mechanic or a heart surgeon who can do circus act of repairing from outside without stopping the engine. That’s for sure!
That surgeon is a nut if he claimed he can do complex intracardiac (inside the heart) surgeries without stopping the heart. That includes that mechanic who compared. Both of them are nuts who need to get their health priorities right first.Sorry!
JB Lim
The Blogger's Comment: .
The question "why the mechanic and the heart surgeon are NOT equally remunerated" can best be answered, in my shallow opinion, by the simple fact that one operates on machines, while the other on humans. Humans or machines, which are more valuable?
I wholeheartedly share Dr Lim's humanitarian sentiment or rather lament for the on-going medical predicament and social injustice around the globe.
Isn't that "all men are created equal (as endowed by their Creator)"? But how come there are these RICH people who are more equal than the POOR? When will the sufferings and miseries of all the less fortunate people on Earth stop, like the heart or engine must do prior to operations? I just wonder.博客感言:
学识渊博、多才多艺的资深医学家---林老博士的人道主义者立场和悲天悯人的情怀，充份洋溢在他的论文中的字里行间。"嫉恶如仇"的辛辣用词，读来实在大快人心! (请参阅前一则贴文)
常言道:人人生而平等。然则，世间上不平等的人与事，又何其之多?此正是: “天若有情天亦老,月如无恨月长圆!”
(Literally translated: "If heaven shows mercy, it will also age; if the moon has no regret, it will always be full." -- From an ancient Chinese poet)
Labels: The Thoughts of Dr JB Lim
posted by taionn @ 8:00 AM
0 Comments
0 Comments:
Post a Comment
Subscribe to Post Comments [Atom]
<< Home