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Show ? n op B Landers B2 0 Garden B4 3 Weddings B5 i- -i p Th Daily Herald Sunday, April 2, 19S5 Vhors you live Influences the haart treatment you receive By DANEL Q. HANeY AP Scieoce Writer NEW ORLEANS An elderly heart patient in North Dakota is almost four times more likely than ope in Wyoming to get a coronary bypass operation. In Missouri, the chance of undergoing an angioplasty procedure for the same problem is nearly four times higher man in New York. . "Where you live influences the kind of cardiovascular procedures you will get," said Dr. Norman S. of UCLA Medical Center. Kato released bis analysis of nationwide Medicare statistics Wednesday at a meeting of the American College of College. He documented starkly different rates for common treatments across roe United States, yet there is no evidence people are any better off in the states where the procedures are used most often. Previous studies have found similar differences between regions, states and even hospitals for other procedures. Together, they raise questions about whether many of the, expensive and potentially risky medical procedures that people take for granted are really necessary. lAbout 800,000 Americans undergo bypass or angioplasty each year, mostly to relieve chest pain caused by clogged heart arteries. In angioplasty, doctors insert a tiny balloon into the clogged arteries and inflate it briefly to force them open. During bypass surgery, they sew in small pieces of blood vessel to reroute .blood around die blockages. Many patients with chest pain can be treated successfully with heart pills alone. Ks up to the physician when to give up on medical therapy and recommend angioplasty or bypass. , "Bypass surgery and angioplasty Slave become growth industries," Tsaid Kato, a surgeon. Their use expanded explosively during the 1980s. Now they are increasing especially fast among people over age 80. Using 1991 data, he found that doctors in North Dakota perform more bypass operations on elderly patients than in any other state. There were 872 of these procedures ifor every 100,000 people over age :65, Other states with high surgery rates included Alaska, Arkansas, Missouri, Nevada and Tennessee. By contrast, surgeons in Wyoming performed just 235 of these operations for each resident over age 65. Other states with low rates included New Mexico, Rhode Island, New .York, Idaho and Colorado. Cardiologists in Missouri performed the most angioplasties 617 for every 100,000 elderly people. Other states with high angioplasty rates included Indiana, Alabama, North Dakota, Nevada and Montana. ; In Wyoming, doctors did just 152 per 100,000, while in New York they did 1 59. Other states with low rates included Idaho, Maryland, Massachusetts, New Hampshire, .New Jersey, New Mexico, Rhode Island and Vermont. : Doctors often recommend angioplasty as a first choice for patients because it is less invasive and debilitating than surgery. Kato said it wouM make sense that if doctors are doing a lot of angioplasties, then they should need to do fewer "bypasses. But this is not the case. States with high angioplasty rates generally also have a kx of bypasses. One possible explanation is that the same economic forces are driving both therapies. These include Wide availability of hospitals and dimes set up to perform tike procedures as well as intense competition among doctors to recruit patients. Kato's findings were confirmed in part by a study of drugs known best by its acronym that is based at the .GUSTO Cleveland Clinic in Cleveland. Dr. ; Louise Pilote and colleagues looked regional differences in the fre- -' QuetKy with which dxtors per-- '. formed angioplasty and bypass ' surgery following heart attacks in patients of all ages. She found that in general, doctors in New England treat p&jents much more conservatively than physicians elsewhere. They perfornsol angioplasty on 22 percent of heart attack patients, compared with 35 percent in (he upper Midwest And they did bypasses on 9 percent compared with J7 percent in the South Central stales. your Ko Paula Faddis, right, goes oyer the medi- background questionnaire that each woman must complete before her mam-c- al mogram. to breast self examinations plays while patients change into a hospital gown for their mammograms. An informational video on Hospital making b mammograms a Sy JANET HART Daily Herald Lifestyle Editor Fear of the unknown is something everyone has experienced at one point in their life or another. in experience mammography suite at American Fork Hospital, I felt there was no better time to find the answers. The suite consists of a waiting room, two dressing rooms, the room, a dark room and processing center and a sonogram room. Each is tastefully decorated in mauve colors with floral accents found in the furniture, paintings and wall hangings. All of the decor helps eliminate the cold feeling some people get when visiting a hospital as does the fact that the suite is located in a quiet area of the X-r- ay It could be on the first day of high school or walking into a new job. Or it could come when a doctor prescribes any one of the many medical procedures necessary to stay on top of today's deadly diseases. For women, one of those procedures is a mammogram or of the breast tissue to detect lumps that may or may not be cancerous. Medical research has proven mammograms, combined with monthly self breast examinations, are a vital tool in the detection of breast cancer. The American Cancer Society encourages women to have their first or baseline mammogram at age 35 unless their family history indicates a higher risk for can- X-r- ay cer. After that, mammograms should occur every one to two years from age 40 to 50 and every year after age 50. But what does a mammogram feel like? Is it painful or embarrassing? How long does it take to have one done? Although not quite 35, 1 have asked these exact questions while reading stories on the importance of having a mammogram. So, with the opening of a new .V' v. ! i' . .t ,. V' t f'MHi" ' ' . ' 'i? , ' ' ' 'i . . . " ' war . . f a- 4 'Ulili :ii e i building. A patient first checks in at American Fork's medical imaging reception desk and answers a few basic questions such as name, address and date of birth. In the waiting room at the mammography suite, a woman completes a short medical questionnaire that asks such things as the date of her last menstrual period, if she had a baby before age 30 and if she's taking birth control pills. She also fills out a card that will be sent to her when it's time to make an appointment for her next mammogram. "All of ihe medical information is very important," said Paula Faddis, a mammographer at American Fork Hospital. "Estrogen or certain times in a woman's menstrual cycle can make the breast tissue more tender." Pally Herald photoaJannrfar A (See FEAR, Page B2) of the breart tissue to mammogram is an various lumps which may or may not be X-r- Qrig is taken first by compress-identifcancerous. The ing the tissue flat and then in a diagnol position. X-r- JT.Hi to Uw$ y ikVfln 1 , . - than jHcsiy tee ,000 (tje yearly to happ$n to yomn oyer femiiy nwit-- csn nms tJ3s-firs- m breast cancer, w& mm over 30 . W$ : - Hye your .fejl 40-4- AO Q is completed so the patient doesn't have to wait more then a few minutes for the results. ft pr iwtso ho cfty f& 40: Haw Dr. Wtttiem EiUngeon, a radiologist et American Fork Hoe- pttal, reeds a mammogram. Each mammogram is read as s 9: Ha bnxte (iodor tfsck frssst Xay tn&mrncg:i'? tecior PA mr. Have $ it5f yap, s7 ' o ftf rrjti ' y |