Cardiac catheterization is useful to confirm diagnosis of cardiac tamponade, evaluate and differentiate between constrictive pericarditis and restrictive cardiomyopathy, and evaluate degree of coronary artery disease(CAD). If you do not know what these things are, I suggest you look them up, and pay particular attention to the epidemiology.
Catheterization entails introduction of a catheter into femoral(thigh) or brachial(arm) arteries from which the tip of the catheter can be manipulated into the chambers of the heart by way of the aorta. It provides data on pressures and blood flow through the heart. In particular, a dye can be injected at the first part of the aorta which comes off the left ventricle through the aortic valve. The aortic valve is made of three cusps-left semilunar, right semilunar and posterior semilunar. In the left and right semilunar cusps are the openings for the left and right coronary arteries, respectively. These two arteries are responsible for supplying nutrients and oxygen to the myocardium, or heart muscle. Of course there are slight variations on this. For example, about 4% of people, there is an accessory artery. The dye will run through these arteries while a "picture" can be taken to see where the dye has gone(cardiac arteriogram).
There exist anastomoses between the ends of the arteries. These are interconnections that allow transfer of blood if occlusion of any of the large branches of the coronary arteries occurs. However, this blood supply is inadequate for myocardium should there be a sudden occlusion of a major branch. An area of myocardium that has undergone necrosis(permanent death) is called a myocardial infarct(heart attack). This region is gone forever, to be replaced by fibrous scar tissue. The three most common sites for coronary occlusion are:1. anterior interventricular branch of the left coronary artery; 2.right coronary artery; 3.circumflex branch of left coronary artery
The most common cause of ischemic heart disease is coronary insufficiency, resulting from atherosclerosis of the coronary arteries. Coronary atherosclerosis begins during early adulthood and results in slow narrowing of the arteries. As progression occurs, the anastomoses expand to compensate for the narrowing in certain arteries. However, this is not good enough, so as one performs exercise(such as a stress test) inadequate supply of blood to a faster beating heart results in substernal discomfort and/or pain.
Various procedures are available to correct obstruction of coronary arteries that are not necessary to mention here.
From a financial point of view, WE have a company that provides this diagnostic service to private practice physicians as well as hospitals. This company also sells equipment. Many physicians are looking for this type of service since it is more cost effective. In order to have their own cath lab they must buy the equipment, maintain it(warranties, repairs, updates), and staff it. This costs money and time. It is hard to justify this when there is not a constant flow of patients keeping the machines or staff busy. Here comes MIOA. They can do this for several practices- you have 10 people needing Cath this month with 25 waiting for the next month because of overflow to the nearby hospital or their existing lab. MIOA could see your patients, all 35 this month. (This pattern can be extended as far as you want). This allows the practice to have more patients coming for visits and less waiting for the diagnostic procedure to be done. Why can MIOA have constant patient flow-because they can deal with many practices, say 5, needing 35 caths, and have 175 people come through their fully staffed, maintained and JACO accredited laboratories each month. Everybody wins!!! This is not a new product-every hospital can do it anywhere. It is totally up to the management of MIOA to go out and sell this concept. MIOA can do it if MedCath can-MCTH is unaccredited and trying to produce for profit hospitals in Cardiology. This is risky business in this day and age.
So we got a great thing right, sort of. It is as if this company just went public at $2.00 with over $18 million in debt to start with. That is anything but a head start, and everything of a deep valley to climb out of. There is strong management and few shares out there. Yeah they keep adding, but there is only 4.5 million out there right now. Sweat if they soar past 10 million without adding significant profits. Hey didn't they just add at least $5 million(unrealized) in revenues without dilution. Applause was in order! About this last quarter, we made a profit, but we had to sell equipment to get it as I see it, but it was STILL a profit. Now that there is a cath lab at FPII revenues should be better this quarter. It will take time to prove to everyone that MIOA is for real, but they can do it(remember MCTH). Give management time to do their thing-we are smart people, we know that it takes more than one profitable quarter to be a winner, don't we!? It is okay to be multidimensional, manage a practice, sell cath labs, and operate cath labs. As long as we are growing, making a profit and saving people's lives, we are successful.
I know we all want to make money, but in the end, this company, our company is all about saving our mom's and dad's and grandparents for many more cherishable years to come.
Last but not least, in the philosophical spirit of a pretty successful investor, if you are not willing to hold a stock for ten years then you shouldn't hold it for ten minutes. Long-term play.
Miller |
