Wednesday, May 23, 2007


The aorta is the largest artery in your body, and it carries blood away from your heart. Your aorta runs through your chest, where it is called the thoracic aorta. When it reaches your abdomen, it is called the abdominal aorta. The abdominal aorta supplies blood to the lower part of the body. Just below the abdomen, the aorta splits into two branches that carry blood into each leg.
When a weak area of the abdominal aorta expands or bulges, it is called an abdominal aortic aneurysm (AAA). The pressure from blood flowing through your abdominal aorta can cause a weakened part of the aorta to bulge, much like a balloon. A normal aorta is about 1 inch (or about 2 centimeters) in diameter. However, an AAA can stretch the aorta beyond its safety margin. Aneurysms are a health risk because they can burst or rupture. A ruptured aneurysm can cause severe internal bleeding, which can lead to shock or even death.
As I have written about in a previous blog, I had AAA repaired on the 28th of March. I spent five days in ICU after the open surgical repair procedure and then another two days on a surgical unit. Two months later I am moving well, but I am still on what the military calls “light duty”. My surgery and aftercare took place at the James H. Quillen Veterans Administration Medical Center, Mountain Home, TN.
Even though both VA hospitals and military hospitals have been in the news because of the poor care they are giving some people and the overall lack of coordination between the two systems, I personally am a lucky man. My wife is my personal advocate and she is a great one and we always do our homework before going to see the doctor.
The tragedy pointed out in a recent report released at a meeting of state hospital directors is that if you have a mental illness you will most likely live a shorter life. Joseph Parks, director of psychiatric services for the Missouri Department of Mental Health and lead author of the report according to USA TODAY “thinks agencies such as the Centers for Disease Control and Prevention should track the health of adults with mental illness, just as they do other vulnerable groups, to identify problems and solutions.”
When I had a tube down my nose into my stomach in ICU, I asked about my psych meds and was told I would have to wait till the tube came out. I looked at the doctor and said, “You had better think long and hard how long you want me under your care off my meds for my bipolar disorder.” My meds were there in just a short while and I swallowed them down beside the tube. The point is the vascular people nor the folks from cardiology who had been called in cared about my psych meds.
The problems are not hard to identify. The medical specialties do not communicate well with each other. Even vascular and cardiology did not in my case and neither cared about my psychiatric needs. If we have a physical problem lots of times we do not get good medical care once it is known we have a mental illness. The psych meds themselves have side effects that cause health problems. We have habits that cause health problems. The leading cause of the AAA I am told is smoking and I smoked from the time I was twelve years old till February 13th of this year and I am 58. You do the math.
The solution is harder to identify than it is to identify the problems. The solution should be an integrated system where you get your mental health and other health needs taken care of at the same place where they are talking to each other. However, they can be in the same system and even in the same building, but that does not mean they will talk to each other. The Vascular Clinic does not speak the same language as the Primary Care Clinic or the Mental Health Clinic does not have the same language as Cardiology. There is a language barrier and a territorial battle to be settled even if they are all under the same roof and organization. If they are under different organizations and are being paid from all sorts of different pools of money, then getting them to talk and work as one seems to me to be an impossible task.

I don’t have a solution. I know some of the problems. I know we die early. USA TODAY said in the article written by Marilyn Elias that those of us in the public system die about “25 years earlier than Americans overall.” That tells me we need a solution. Who should we look to for one?

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