Voluntary (calcium) heart scan - what am I risking?

A

Anonymous10

Guest
There are places in town offering this new (I guess) type of heart scan to determine blockages and such. Calcium? They are offering them for only $50, and claim that there is no insurance paperwork or anything like that involved.

I was thinking of signing up for one, because 1) it's cheap, and 2) I do have a history of heart problems in my family. So it would be nice to know where I stand.

However, I have no other indications of heart trouble at this time. I am 50, maintain a 1st class medical, fly professionally, and would like to keep it that way.

So, what am I risking? If I get this scan and it tells me I have blockage of some percent, have I just voluntarily put myself into long and costly SI territory? Have I screwed myself over when I should just have eaten more vegetables instead?

I would kind of like to know where I stand with my heart, you know, for the obvious reasons. But there are enough horror stories on here about people unknowingly setting themselves up for problems with their medical that I'd really like to avoid.

Let me stress again that no doctor (AME or PCM or otherwise) has recommended or mentioned or required that I take this test. It's strictly voluntary and self-initiated.
 
I’d be having this conversation with my PCM, but then again I see him annually, at a minimum.
 
TCABM said:
I’d be having this conversation with my PCM, but then again I see him annually, at a minimum.
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I guess, being here, he's asking how to weigh the risk of losing his medical against the risk of losing his life from a heart attack.
 
Anonymous10 said:
I am 50, maintain a 1st class medical, fly professionally, and would like to keep it that way.
Click to expand...



Health

Fly

Ya gotta figure out which is more important.

If I had my heart checked a couple months earlier I would have avoided a lot of problems.
 
For $50, I don't think a medical practice will even invite you to have relations with yourself. How does this business model work?

If you have a family history of heart issues, I'd pony up the dough for aortic aneurysm screening or an echo or angiogram or whatever an actual doctor recommends.
 
172andyou said:
I guess, being here, he's asking how to weigh the risk of losing his medical against the risk of losing his life from a heart attack.
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That doesn’t really impact my position.
 
GeorgeC said:
For $50, I don't think a medical practice will even invite you to have relations with yourself. How does this business model work?

If you have a family history of heart issues, I'd pony up the dough for aortic aneurysm screening or an echo or angiogram or whatever an actual doctor recommends.
Click to expand...

Calcium scoring test are relatively cheap (local hospital here is $125.00) and it seems most insurance won't cover it. Generally used to see if it's time to start adding statins to your collection of meds ...
 
Coronary CT / Ca Score testing has been around for awhile, but only recently became affordable for patients paying out of pocket. 50 yo male with family history is the target population for this study. An elevated score doesn’t necessarily mean you have Coronary Disease. If the score is significantly elevated, and depending on risk factors (family history, diabetes, blood pressure, abnl lipids, smoking, obesity) and your score obviously, your doc may recommend a stress test. If you pass the stress test with flying colors you‘re good to go. What you need to be careful with is how your PCP, or the cardiologist, codes the workup in order to get it covered by insurance. I’ve see a diagnosis of “rule out X disease” end up being ”X disease” in the medical file dozens, hundreds, of times. For most people it’s not important, but for pilots it’s critical. Make sure you have a good relationship with your doc and the R/O stays a R/O. At your next FAA exam the answer to 18G is “no” and under 19 you’d just note you saw “Dr Bigbucks, cardiologist, cardiac screening, results negative.” If you have good communication with your AME then just explain what happened (why you did the Ca Score, the results, and the stress test results). He shouldn’t even bat an eye. I’d recommend you take your reports to your next FAA exam and let your AME scan them into your file, he can make an explanation on your application, and issue your Certificate, but that’s between you and him.

now, if you flunk the stress test to the 10th degree, then you need to take care of that and deal with your Medical later. I’ve never met a pilot who said “I wish I hadn’t had those stents put in my widow maker, now I’m gonna have to deal with the Special Issuance process to get back in my airplane ”

FWIW, if you do end up having a stress test, make sure the cardiologist does it the way the FAA wants it done, in case you send it in, or there is a reason you need to send it in (basically 9:00 and 100% MPHR (maximum predicted heart rate)). That way if it’s normal the FAA will believe it’s normal and may avoid a repeat.

Good luck
 
If you have a coronary caclium scan an dthe score is over 100, a stress treadmill nulear becomes FAA-mandatory
If it's 300 or over, 3rd class you are demended to have a stress TM nuclear immeidatly and annually.
If it's 300 or over for 2nd and first classes you are demanded to have a HEART CATH, and annual Stress TM nuclear.

I would not do this. Ever. I would do a Stress treadmill to 90% of your heart tare Vmax and ine minutes. That is predictive and known.. ...if I "had" to know something.

But mostly I would not be sedentary, control my hypertension, and control my lipids.

What are you going to do different because of a $50 test? your're going to
not be sedentary, Control the hypertension, and control the lipids.

So who's making money here with a $50 retail test? THINK CLEARLY and CRITICALLY about enterprenureal medicine. Why isn't insurance paying for it. THINK!!
 
Anonymous10 said:
I was thinking of signing up for one, because 1) it's cheap, and 2) I do have a history of heart problems in my family. So it would be nice to know where I stand.

However, I have no other indications of heart trouble at this time. I am 50, maintain a 1st class medical, fly professionally, and would like to keep it that way.
Click to expand...

Whaddaya mean no other indications of heart trouble?! From what you've told us, you have zero indications. So what if others in your family have had heart trouble? That's meaningless without knowing their diet, physical activity, weight / BMI, cholesterol levels, and a whole host of other stuff and how it compares to you.

My dad had multiple health problems that began when he was much younger than I am today and I've had none of the same problems. Dad worked as a welder all his life, breathing toxic welding fumes. He was considerably overweight, didn't exercise, and had a very unhealthy diet. Should his medical history cause me to get tested for his same health issues? Absolutely absurd.

For someone in your career, unneccessary bear poking is often ill-advised. If you have some real reason to suspect you're susceptible to a heart problem (like you weigh 300lbs and your cholesterol is out of sight and you can't walk to the refrigerator without your heart pounding), then see a doctor. But to get screened because it's cheap and someone else had a problem? That's silly.

(And of course it's cheap. It's a way to get people in the door that they can sell treatment to. The profit is in the treatment, not the discovery.)
 
bbchien said:
I would not do this. Ever. I would do a Stress treadmill to 90% of your heart tare Vmax and ine minutes. That is predictive and known.. ...if I "had" to know something.
Click to expand...

Is 90% of 220-age the target?
 
Thank you all for the discussion so far. I appreciate it.

Yes, of course my life is more important than my flying career. But I don't think that's really the question here, at least for me. Several of you have stated that of course yes, I should get this, or a stress test, done if I have any concerns at all. But that is exactly opposite to what Bruce (and a few others) have said - I think they understand my concerns and my point.

bbchien said:
If you have a coronary caclium scan an dthe score is over 100, a stress treadmill nulear becomes FAA-mandatory
If it's 300 or over, 3rd class you are demended to have a stress TM nuclear immeidatly and annually.
If it's 300 or over for 2nd and first classes you are demanded to have a HEART CATH, and annual Stress TM nuclear.

I would not do this. Ever. I would do a Stress treadmill to 90% of your heart tare Vmax and ine minutes. That is predictive and known.. ...if I "had" to know something.

But mostly I would not be sedentary, control my hypertension, and control my lipids.

What are you going to do different because of a $50 test? your're going to
not be sedentary, Control the hypertension, and control the lipids.

So who's making money here with a $50 retail test? THINK CLEARLY and CRITICALLY about enterprenureal medicine. Why isn't insurance paying for it. THINK!!
Click to expand...

Bruce, this is exactly the type of information I was hoping you would post. And on one level, I absolutely agree that whether or not I got the test, I should still be trying to eat healthier and exercise more. But on a practical, "human" level, I know that while I try to do those things now (and think I do a halfway decent job), if I scored poorly on a test like this (or a stress test), I sure would try a lot harder. Knowledge would be motivation.

But I also don't want to jeopardize my career just to "know" something without having any actual symptoms.

And no, I have no idea how they make any money at $50 a pop. I guess I assumed they were selling something afterward, like fitness programs or something - kind of like a timeshare presentation has free dinner, etc.

Thanks.
 
GeorgeC said:
For $50, I don't think a medical practice will even invite you to have relations with yourself. How does this business model work?
Click to expand...
When the results are undesirable or ambiguous, boom, you're a new patient for their cardiology practice.

My doc handed me a pamphlet for this. I explained the FAA medical system and that I didn't want any test that might lead to an ambiguous result if it wasn't medically necessary. He took the pamphlet back.

It's one thing to put your health first. That you should do. But that doesn't mean going on medicine-for-profit diagnostic fishing trips.
 
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Anonymous10 said:
Thank you all for the discussion so far. I appreciate it.

Yes, of course my life is more important than my flying career. But I don't think that's really the question here, at least for me. Several of you have stated that of course yes, I should get this, or a stress test, done if I have any concerns at all. But that is exactly opposite to what Bruce (and a few others) have said - I think they understand my concerns and my point.



Bruce, this is exactly the type of information I was hoping you would post. And on one level, I absolutely agree that whether or not I got the test, I should still be trying to eat healthier and exercise more. But on a practical, "human" level, I know that while I try to do those things now (and think I do a halfway decent job), if I scored poorly on a test like this (or a stress test), I sure would try a lot harder. Knowledge would be motivation.

But I also don't want to jeopardize my career just to "know" something without having any actual symptoms.

And no, I have no idea how they make any money at $50 a pop. I guess I assumed they were selling something afterward, like fitness programs or something - kind of like a timeshare presentation has free dinner, etc.

Thanks.
Click to expand...
Really, it's the downstream tests that make the $$s.
 
bbchien said:
If you have a coronary caclium scan an dthe score is over 100, a stress treadmill nulear becomes FAA-mandatory
If it's 300 or over, 3rd class you are demended to have a stress TM nuclear immeidatly and annually.
If it's 300 or over for 2nd and first classes you are demanded to have a HEART CATH, and annual Stress TM nuclear.

I would not do this. Ever. I would do a Stress treadmill to 90% of your heart tare Vmax and ine minutes. That is predictive and known.. ...if I "had" to know something.

But mostly I would not be sedentary, control my hypertension, and control my lipids.

What are you going to do different because of a $50 test? your're going to
not be sedentary, Control the hypertension, and control the lipids.

So who's making money here with a $50 retail test? THINK CLEARLY and CRITICALLY about enterprenureal medicine. Why isn't insurance paying for it. THINK!!
Click to expand...
Bruce, can you share where you got this information? I've seen you post this before, but when I asked my RFS office about this specifically, they said to just indicate that the test was done "routinely and for preventative reasons." I.e. it wasn't done as part of a workup for chest pain, so it's not a problem.

Btw I'm also an AME
 
As a physician, I can see a legitimate use for the test in the OP's case. If it is going to be useful in making decisions about future risk factor reduction, then it could be worth it. For example, if the result of the test would change whether or not you start statin therapy for risk reduction, then it could be worth it. Having a really good primary care doctor who knows your case well and can make an individualized decision is incredibly valuable, as this test is not good for a large majority of the population. If it would not change anything with the OP's management, then it is not useful. Heart disease is a process that takes 30 years to become established. Waiting until you are symptomatic is waiting until the 11th hour to do anything.
 
SamIAm: Direct from a medical officer’s mouth! The external consultant rec’d this about a year ago.
 
bbchien said:
So who's making money here with a $50 retail test? THINK CLEARLY and CRITICALLY about enterprenureal medicine. Why isn't insurance paying for it. THINK!!
Click to expand...
Agree with the comment about entrepreneurial medicine, however using whether or not insurance is paying for something as a reason to determine if a medical procedure or medication is useful is fraught with danger. There are a lot of things insurance pays for that are useless and possibly dangerous, and likewise there are a lot of things that insurance will not pay for that are life-saving. That being said, if you are worried about a health condition that could potentially be life changing or life ending the last place I would be looking for advice is a forum about flying. The first place would be my PCP or other health professional who is familiar with my health history. Flying is important but I personally can live without flying, but at the end of the day optimizing my health trumps flying every day. "THINK!!"
 
OP here.

Thanks all for your advice. I decided not to do it.

But since I was still interested in what the whole deal was, we signed my wife up for the $50 heart scan. She's a non-pilot, "normal" person. I went along. That appointment was today, and I wanted to come back and share how it went.

About an hour start to finish, most of which was a sale pitch, as expected.

Paperwork including medical history up front (expected) out in the waiting room. Of course as she's filling that out, playing on the TV there are testimonials of people whose lives were saved through early detection of various health issues.

Then the sales pitch began. I felt like we were buying a car at a dealership. We went into the consultant's office. She was very nice and looked through my wife's medical history. Asked some questions about it. Then started in with trying to sell us full-body scans, various other targeted scans, packages of scans so we can come back every year, etc. She included such stereotypical sales gems as "if you sign up today, I can throw in an extra scan for free" and stuff like that. Of course we resisted (having discussed before that we're not buying anything), using the excuse that we'd want to see how the heart scan process went, quality of the results and such, before deciding - basically putting off any high-pressure tactics. (Afterward we had to wonder how many people would pay for these various packages without even having done the "teaser" heart scan first. Doing the sales pitch after the heart scan would seem more logical to me.)

Full-body scan was $4300 and allegedly could detect just about anything wrong with you, the way they talked about it. They had packages up to $30,000 for multiple visits. And of course various interest-free payment plans available.

After about 30 minutes I think the consultant realized we definitely weren't buying anything today, and so next was the actual scan. That took just a couple of minutes. We should have the results back in a few days. I am really curious to see how things are worded, I'm sure it will be that she's near death and we should get more scans.

The whole sales pitch wasn't seedy or anything (like a stereotypical used car salesman), but it was quite obvious, and quite clear they wanted us to pay for more even before getting the intro offer. She was very much trying to impress on us the importance of early detection and how the typical medical exams fall far short (which I don't think I can disagree with at all, but it was all rather grim and of immediate importance, and seemed sensationalized like you'd expect).

So, thanks again all.
 
Anonymous10 said:
OP here.

Thanks all for your advice. I decided not to do it.

But since I was still interested in what the whole deal was, we signed my wife up for the $50 heart scan. She's a non-pilot, "normal" person. I went along. That appointment was today, and I wanted to come back and share how it went.

About an hour start to finish, most of which was a sale pitch, as expected.

Paperwork including medical history up front (expected) out in the waiting room. Of course as she's filling that out, playing on the TV there are testimonials of people whose lives were saved through early detection of various health issues.

Then the sales pitch began. I felt like we were buying a car at a dealership. We went into the consultant's office. She was very nice and looked through my wife's medical history. Asked some questions about it. Then started in with trying to sell us full-body scans, various other targeted scans, packages of scans so we can come back every year, etc. She included such stereotypical sales gems as "if you sign up today, I can throw in an extra scan for free" and stuff like that. Of course we resisted (having discussed before that we're not buying anything), using the excuse that we'd want to see how the heart scan process went, quality of the results and such, before deciding - basically putting off any high-pressure tactics. (Afterward we had to wonder how many people would pay for these various packages without even having done the "teaser" heart scan first. Doing the sales pitch after the heart scan would seem more logical to me.)

Full-body scan was $4300 and allegedly could detect just about anything wrong with you, the way they talked about it. They had packages up to $30,000 for multiple visits. And of course various interest-free payment plans available.

After about 30 minutes I think the consultant realized we definitely weren't buying anything today, and so next was the actual scan. That took just a couple of minutes. We should have the results back in a few days. I am really curious to see how things are worded, I'm sure it will be that she's near death and we should get more scans.

The whole sales pitch wasn't seedy or anything (like a stereotypical used car salesman), but it was quite obvious, and quite clear they wanted us to pay for more even before getting the intro offer. She was very much trying to impress on us the importance of early detection and how the typical medical exams fall far short (which I don't think I can disagree with at all, but it was all rather grim and of immediate importance, and seemed sensationalized like you'd expect).

So, thanks again
Click to expand...
Yea, I wouldn't have done that to my wife. Just saying. Hopefully she comes out clean.
 
Anonymous10 said:
OP here.

Thanks all for your advice. I decided not to do it.

But since I was still interested in what the whole deal was, we signed my wife up for the $50 heart scan. She's a non-pilot, "normal" person. I went along. That appointment was today, and I wanted to come back and share how it went.

About an hour start to finish, most of which was a sale pitch, as expected.

Paperwork including medical history up front (expected) out in the waiting room. Of course as she's filling that out, playing on the TV there are testimonials of people whose lives were saved through early detection of various health issues.

Then the sales pitch began. I felt like we were buying a car at a dealership. We went into the consultant's office. She was very nice and looked through my wife's medical history. Asked some questions about it. Then started in with trying to sell us full-body scans, various other targeted scans, packages of scans so we can come back every year, etc. She included such stereotypical sales gems as "if you sign up today, I can throw in an extra scan for free" and stuff like that. Of course we resisted (having discussed before that we're not buying anything), using the excuse that we'd want to see how the heart scan process went, quality of the results and such, before deciding - basically putting off any high-pressure tactics. (Afterward we had to wonder how many people would pay for these various packages without even having done the "teaser" heart scan first. Doing the sales pitch after the heart scan would seem more logical to me.)

Full-body scan was $4300 and allegedly could detect just about anything wrong with you, the way they talked about it. They had packages up to $30,000 for multiple visits. And of course various interest-free payment plans available.

After about 30 minutes I think the consultant realized we definitely weren't buying anything today, and so next was the actual scan. That took just a couple of minutes. We should have the results back in a few days. I am really curious to see how things are worded, I'm sure it will be that she's near death and we should get more scans.

The whole sales pitch wasn't seedy or anything (like a stereotypical used car salesman), but it was quite obvious, and quite clear they wanted us to pay for more even before getting the intro offer. She was very much trying to impress on us the importance of early detection and how the typical medical exams fall far short (which I don't think I can disagree with at all, but it was all rather grim and of immediate importance, and seemed sensationalized like you'd expect).

So, thanks again all.
Click to expand...
See post # 10.
 
Anonymous10 said:
OP here.

Thanks all for your advice. I decided not to do it.

But since I was still interested in what the whole deal was, we signed my wife up for the $50 heart scan. She's a non-pilot, "normal" person. I went along. That appointment was today, and I wanted to come back and share how it went.

About an hour start to finish, most of which was a sale pitch, as expected.

Paperwork including medical history up front (expected) out in the waiting room. Of course as she's filling that out, playing on the TV there are testimonials of people whose lives were saved through early detection of various health issues.

Then the sales pitch began. I felt like we were buying a car at a dealership. We went into the consultant's office. She was very nice and looked through my wife's medical history. Asked some questions about it. Then started in with trying to sell us full-body scans, various other targeted scans, packages of scans so we can come back every year, etc. She included such stereotypical sales gems as "if you sign up today, I can throw in an extra scan for free" and stuff like that. Of course we resisted (having discussed before that we're not buying anything), using the excuse that we'd want to see how the heart scan process went, quality of the results and such, before deciding - basically putting off any high-pressure tactics. (Afterward we had to wonder how many people would pay for these various packages without even having done the "teaser" heart scan first. Doing the sales pitch after the heart scan would seem more logical to me.)

Full-body scan was $4300 and allegedly could detect just about anything wrong with you, the way they talked about it. They had packages up to $30,000 for multiple visits. And of course various interest-free payment plans available.

After about 30 minutes I think the consultant realized we definitely weren't buying anything today, and so next was the actual scan. That took just a couple of minutes. We should have the results back in a few days. I am really curious to see how things are worded, I'm sure it will be that she's near death and we should get more scans.

The whole sales pitch wasn't seedy or anything (like a stereotypical used car salesman), but it was quite obvious, and quite clear they wanted us to pay for more even before getting the intro offer. She was very much trying to impress on us the importance of early detection and how the typical medical exams fall far short (which I don't think I can disagree with at all, but it was all rather grim and of immediate importance, and seemed sensationalized like you'd expect).

So, thanks again all.
Click to expand...


Sounds like a timeshare pitch, tailored to the medical profession.
 
bbchien said:
If you have a coronary caclium scan an dthe score is over 100, a stress treadmill nulear becomes FAA-mandatory
If it's 300 or over, 3rd class you are demended to have a stress TM nuclear immeidatly and annually.
If it's 300 or over for 2nd and first classes you are demanded to have a HEART CATH, and annual Stress TM nuclear.

I would not do this. Ever. I would do a Stress treadmill to 90% of your heart tare Vmax and ine minutes. That is predictive and known.. ...if I "had" to know something.

But mostly I would not be sedentary, control my hypertension, and control my lipids.

What are you going to do different because of a $50 test? your're going to
not be sedentary, Control the hypertension, and control the lipids.

So who's making money here with a $50 retail test? THINK CLEARLY and CRITICALLY about enterprenureal medicine. Why isn't insurance paying for it. THINK!!
Click to expand...
I may have been Dr. Bruce's poster child on this, which is to say the FAA switching from "Agatston Score isn't indicative of CAD" to "a high score means you need to PROVE you don't have CAD. Every year." And they decided this a year after my medical submission and put me in special issuance territory. Take a look at how much radiation is involved with a Stress TM Nuclear and see if you're willing to do it every year to comply with an SI. I did two (and a Stress Echo) before wising up and going Basic Med (which I know is NFG for someone who needs a 1st or 2nd).
 
Anonymous10 said:
OP here.

I am really curious to see how things are worded, I'm sure it will be that she's near death and we should get more scans.
Click to expand...
I wouldn't worry about that. I see the results of these things every day. I can't remember the last time someone had an expensive follow up test or treatment. OTOH, I know one guy who had an unknown left main ("widow maker") lesion and was in the Cath lab the next day. I know someone else, a 55-year-old, 110# woman who eats like a rabbit and nevertheless has elevated cholesterol, who had a coronary calcium scan done. Her coronaries were perfect, but they discovered an aneurysm of the ascending aorta which required surgery within less than a year.

The point is: unless they're really terrible, deliberate crooks, they'll give you an honest reading.

The point is not: this test is always worth getting.
 
The real problem is the underlying science. Calcifcation of coronaries is not well understood. The hypothesis is that when placques rupture, they calcify. But calcification of coronaries is NOT well understood. There are many other vessels in the system in which calcification occurs EXTERNAL to the intimal lining of the artery. And you could just take rosuvastatin (Crestor), and stop the process.

One of the comments that I hear from the medical officer(s): "how did we get sold this bill of goods?"

I remember way back at an AOPA "summit" (about ~13 years ago), a person at the back of the auditorium stood up to advocate for Coronary calcium scans. He obviously had a pecuniary interest. Dr Tilton allowed me to answer the man as I could say some things he could NOT say...and I chided him for converting an informational session into an advertisement.

Well these guys NEVER go away. It's like the guy who bought the spectrum that is crapping up Radar Alitimeters. That telecom mogul, has been on a 10 year "I'm gonna get my money out of this spectrum" hunt and he has. So apparently have the coronary calcium guys.

This is America. Follow the $$s.
 
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