usatoday.com
The inside story
Reporter takes uncertain plunge into his own body
Aug. 25, 2000
By Robert Davis, USA TODAY
NEWPORT BEACH, Calif. — That little
bulge on my aorta is the first tick of a time
bomb.
"That's real," Harvey Eisenberg says, as he
takes me on a computerized ride down the middle of my body. He
stops at the aorta, my body's largest blood vessel, and points out a
nasty little bump that could very well be what ends my life.
Eisenberg, a controversial radiologist, uses a CT
scanner at his HealthView Center for Preventive
Medicine here to peer inside healthy people's
bodies in order to tell them what unsuspected
health problems lurk there.
HealthView, one of the first such centers in the
nation, initially attracted the wealthy, worried
well. But as insurance companies pay for more of
these scans, and the prices have come down, there are more average
people in the waiting room.
Critics say these unwarranted tests waste money, cause false alarm
and put a strain on the rest of the health system.
But business is booming.
At HealthView, nestled among plastic surgeons' offices in this
sunny and posh place where the palm tree and the Lexus are part of
the landscape, thousands of patients have sat in this multimedia
command center to see what their CT scans have found. They come
not necessarily on the advice of their doctors, but prompted by the
enthusiastic word-of-mouth from others who have seen inside
themselves. CEOs tell other CEOs. Actors tell actors. And wives tell
husbands.
Eisenberg and his team have scanned 15,000 people in the past 2½
years. The average scan costs about $710; most who choose to have
it done pay out of their own pockets.
In California, the patients range from the rich and famous to Los
Angeles beat cops. At Walter Reed Army Medical Center near
Washington, where Eisenberg works with the military, doctors scan
everyone from soldiers to members of Congress.
I came to HealthView to write a story about these inward
explorations. And now, seeing my aorta bulge, I come to
understand what people pay for.
Eisenberg moves the computerized image up and down so that we
can see the artery wall expand like a balloon and then constrict back
to normal size in an unmistakable sign of vascular vulnerability.
"There is some weakening," he says flatly.
That weakening will likely grow into a life-threatening aneurysm —
the kind that my father's father had late in life — that one day could
burst and kill me.
I can barely utter a word as I sit
with Eisenberg, seeing myself from
the inside out. I'm spellbound and
I'm also surprised, as he moves on
from the aorta to view other parts
of my body, that I am not bothered
by this finding or by the other
problems he identifies: an enlarged
heart chamber, holes and a bone
spur in my lungs, and degenerative
back disease.
I know I can deal with every problem he has found. The fixes for
each one have gotten much better recently. By the time the weak
spot in my aorta grows large enough to pop — if I can't heal it
naturally through more healthful living — the repair will be an
outpatient procedure. I just wrote about these improved repairs in
March.
More important, I feel a strong sense of control now that I know it's
there. No longer is my family history of aortic aneurysm something
that may or may not mean anything to me. From this moment
forward, it is something that I know I have.
Unlike traditional medical facilities where the doctor looks at the
pictures and makes a diagnosis before inviting the patient in for a
look, Eisenberg and his team make their journey with the patient by
their side. When a deadly tumor is found, the moment is raw and
real.
"Working through your body and coming across it together and
saying, 'Uh-oh, we got something here,' that's like the whole part of
building a team and making people do something about their
health," says Betty Kelepecz. The 44-year-old Los Angeles police
commander, one of the curious worried well, got her first glimpse
of a deadly cancerous tumor inside her kidney here at HealthView.
Her October 1999 scan found the tumor before it had spread —
even before she knew anything was wrong. Doctors removed the
kidney in November 1999, and today she remains free of cancer.
"They found the cancer before it had broken down my body," she
says, boasting that she was back on the job within six weeks. "My
body wasn't trying to recover from cancer at the same time they
were taking my kidney out. You think that what you don't know
won't hurt you, but I know (that) what you don't know can kill
you."
The service has created a buzz among the rich and famous.
"It takes the mystery out and gives you a new perspective on your
life," says actor Robert Wagner, 70, who heard about the scan from
actor James Woods. "I became more aware of the fact that
everything should be done in moderation."
Athlete-turned-celebrity businessman Bruce Jenner, 50, felt more
empowered after his scan last year. "You take your health more
seriously," he says.
Wagner's scan found plaque in an artery in his leg; Jenner's found a
kidney stone.
Critics say it's money wasted
Critics from the medical establishment say the dramatic, lifesaving
examples are too rare to offset the money wasted by scanning
hordes of healthy people. CT scanners should be used to examine
those with known medical problems, they say.
"While we have these tools that do pretty impressive body imaging,
we're not at the point where we can wave a wand over the body and
find out what's wrong," says Robert Smith of the American Cancer
Society. "Most of us don't drop dead early in life from something
unforeseen, and these are expensive tests."
Heart specialists agree. "There is not enough compelling evidence to
warrant widespread use at this time," says Robert O'Rourke of the
American College of Cardiology. "We would like to see some
proof."
Modern medicine relies on such proof, in the form of studies of
large populations over many years, to decide how health care
dollars should be spent. If a procedure saves money and lives, it
becomes favored over time. After studies proved that
mammograms and Pap smears found cancer early, doctors accepted
them as standard screening tools.
Many doctors suspect that these screenings of healthy people often
will be done without any measurable benefit. And when something
suspicious but ambiguous is found, other tests that are riskier, more
invasive and more expensive must follow to determine whether the
finding poses a real threat.
But Eisenberg, a former professor of radiology at both Harvard
and the University of California, Los Angeles, who is conducting
studies in hopes of offering such proof, bristles at what he calls the
medical establishment's "knee-jerk reaction."
"The criticisms are hypothetical," he says. "The realities are, with this
level of information, I have yet to see a normal patient. It's a daily
event for us to uncover unsuspected, life-threatening disease that is
either stoppable, curable or reversible."
Medicine today often chases after a disease with treatments when it's
already too late to reverse the damage to the body, Eisenberg says.
"In medicine, we're taught to sit and wait for people to develop
symptoms and react. But that's usually a late stage. People think the
body is this wonderful machine with bells and alarms that go off,
but in fact, your body compensates."
By the time a disease is diagnosed today, he says, doctors can only
try to "catch up." This approach is "expensive stuff both in terms of
morbidity and cost," he says. "That isn't right. Medicine has to
change its paradigm from being reactive to proactive. Crisis
management doesn't work."
But I want to see inside myself
I grabbed the assignment to come get scanned at HealthView (at
USA TODAY's expense) in part because I often think that I am
dying. When a friend is stricken with cancer, I am pretty sure that I
will be next. When I write about hepatitis C, I secretly prick a finger
and send my own blood in for screening because the horror stories
of millions of Americans who never suspected they had the disease
remind me it could happen to me.
Over the past few years, I've lost 90 pounds largely through
exercising regularly, and I felt confident when I first volunteered for
the story that my improving health would guarantee the absence of
any life-changing discoveries. But that feeling of confidence lasted
about 20 minutes.
Immediately after making an appointment to get scanned, I began
to worry about what might show up.
Did my youthful days in Margaritaville trash my liver? Did a
lifetime of obesity clog my cardiac arteries? Did those years of
smoking a pack a day seed cancerous tumors?
I grew increasingly anxious during my 20 minutes on the CT scan
table. As the electrons cut painlessly through my body and powerful
computers made sense of the mishmash of muscles, organs and
bones, I wondered if my life was about to change forever — for the
worse.
Before coming to California, I went to my doctor, Jean Drew, of
Fairfax, Va., for a physical and a promise that she would reel me
back in if I came home fearful of some little nothing. Remind me, I
urged her, that I felt fine before the test so there is no reason to
panic after I look inside.
The physical exam was overdue for me, but I also wanted to pit
traditional medicine against the new controversial screening. What,
if anything, would Drew miss?
Her questions, her pushing and her prodding led to a diagnosis of
good health. She didn't feel anything unusual pushing on my gut,
and my insides were normal as far as she could tell from her digital
exam — and I'm not talking about a cyber-check.
She called my cholesterol "excellent" at 144 with an LDL-to-HDL
ratio of 2.7. The ideal range is 120 to 200 with a ratio of less than
3.5. She commended me on the healthy stride I've hit in the past
few years. I've brought my blood pressure down from a dangerous
180/96 to a healthy 130/60. My heart now beats fewer than 60
times a minute.
I have not smoked for more than three years, but I strongly
considered bumming one from a friend one evening just before I
went to HealthView.
That isn't likely to happen again.
Damage, yes, but relief
As Eisenberg takes me through my lungs, he says they "look really
good but I see some spots." I look for solid white nuggets of cancer,
but he pauses on big black circles in the top of my lungs to show
me "the holes." The lung normally looks like a sponge. But cigarette
smoke has eaten away at these delicate cells where air enters my
blood. The smoke has left holes in my lungs.
There are about 4,000 chemical substances in cigarettes, he reminds
me, and "because smoke rises, it goes to the top of the lungs and
that's where we usually see this." That knocked out my urge to bum
a smoke.
The next blow was to my appetite. It's no news flash to me that
obesity wrecks the body. But seeing exactly how I've damaged
myself with food gave me new strength to keep the weight down.
I've damaged my heart's primary pump. The left ventricle, the big
pump of the organ that had to move blood through about 100
pounds of extra weight, has become thick from 30 years of
overwork. Without such a scan I would not have known about this
enlargement until the pump became too weak to perform its job. In
that condition, known as heart failure, the organ is unable to pump
blood throughout the body and fluid builds up in the lungs.
The good news, Eisenberg and Drew agree: Both my heart and my
lungs could repair themselves over time.
But my back is another story. Nothing comes without a price, and
my effort to shape up has taken a toll, Eisenberg says. Running
about three miles on concrete three times a week has damaged my
back.
"There is a lot of degeneration changes in the back," he says, twirling
my spine around in circles before zooming in on a damaged area at
the base of my back. "This is totally deformed."
Some disks are bulging, collapsing toward the nerve they otherwise
would protect. "That's from running," he says.
The spinal damage has begun to affect other organs, too. A bone
spur that has grown on my back is poking my lung, causing it to
swell. I've unknowingly stuck a thorn into the side of my lung. It
doesn't hurt, but the delicate tissue looks angry.
As Eisenberg changes the point of view so that we're moving down
the center of my spinal column to see how much the damage is
encroaching upon my nervous system, I wonder why I never
mentioned my back pain to Drew. She didn't "miss" the back
trouble in my physical because I never told her about the pain. My
back had been sore for weeks after helping my fiancée move. But I
never considered I might have a "back problem." I just wrote it off
as a symptom of middle age.
My scan does not guarantee that I'm not dying, of course. It doesn't
mean that I don't have cancer — it did not include my brain, and
the earliest stages of most cancers still can't be easily detected.
Because the scan is quick and non-invasive, there is a chance that
some trouble could have gone undetected.
But I feel better knowing that I don't have a tumor the size of an
orange in my colon, as some people find once the growth is big
enough to be noticed. And I see now why people who have looked
inside themselves feel they've gained some power over their fears.
The most noticeable change in my health following the scan is in
my hearing: My scan taught me to listen carefully to my body and
to ignore my irrational fears.
I feel more in control of my health because I have seen firsthand
what my unhealthy behavior has done to my body. When Drew
told me through my fat years that being overweight could bring me
heart disease, I found it easy to believe it wouldn't happen to me.
But now that I've seen my enlarged left ventricle and my bulging
aorta, I know better.
From here, I focus on what's real and stop worrying about what
isn't. I'll take calcium supplements to strengthen my bones. I'll see
an exercise physiologist to learn how to work out properly. And I'll
go back to HealthView in two years to see if I have changed my
destiny. |
