Tik Tok, Coronary Arteries, & Healthcare

Plus a new direction for the Heme Queen

I had a different post to send you tonight, but I decided on something else. Let me know what you think.

A new doctor and coronary CT scan

I am not sure what will be of Tik Tok tomorrow, but I had been reminiscing on making my videos on that platform the past week. My first few videos now make me cringe — zero editing, basic and “noisy” 3D models as I was just starting out in 3D design, and recording in my apartment’s kitchen without a microphone. Many of them were related to blood, but some videos emerged from your questions. One series that came to mind was on the Framingham risk score for heart attack which later led to videos on coronary CT calcium scans. These were not typical Heme Queen topics, but today, I am very happy you led me to making those videos.

I learned from many of you that a coronary CT calcium scan was not something offered to you by your physician, regardless of your risk for coronary artery disease (risk for heart attack in other words). For those who were offered this test, many of you told me that the test itself was not covered by insurance. A few of you even told me your coronary CT calcium scores. I remember a few scores in the hundreds.

At the time of recording those videos, I had to research on the topic since this did not fit neatly into my hematology and coagulation knowledge. But I am so happy for that research today. Yes, today TODAY.

I am currently in the airport after visiting family. Earlier today, one of my family members took a call from their doctor (if it is ok with this family member, I will tell you more details in the future if you would like to explore this topic further). I thought — huh, that is strange, it is Saturday. This very diligent doctor called to report on their coronary CT calcium score. It was 2,004.

For reference, 0 is negative, meaning no calcium. That would be normal, but it is inevitable that our blood vessels will eventually have calcifications. It is a part of life. How much and how quickly that calcium shows up differs between people — from genetics to lifestyle. Greater than 300 means extensive calcium in the heart’s blood vessels and a higher risk of heart attack. 2,004 is a very, very alarming score. I broke down in tears when I heard the score. I broke down in tears at the airport a few hours later. The amazing curbside bag agent who took care of my checked bags asked if I would be ok. Yes, I will be, because thankfully, the doctor taking care of my family member sounds incredible and already has a cardiology consult pending. I hope to share with you the next steps.

What is so interesting to me is that I calculated this person’s Framingham risk score. This person is totally asymptomatic and very active — playing golf and tennis regularly. They do not have any chest pain at rest or upon exertion. They do not have shortness of breath. Their risk score is as follows: 9.3% risk of a heart attack in 10 years. Their blood pressure is normal. They have never smoked. Their age is near 70 for reference. Their calcium score is extremely surprising.

I even wondered how this test was even suggested. By the way, after reviewing the chart, insurance didn’t cover this test at all. I wonder if insurance covers this test for anyone. These are questions I hope I will have the chance to ask the doctor another time. What is even more interesting is that this person was “shopping” for a new primary care doctor by chance since they were not satisfied with their current care. I even remember rolling my eyes at this because, I, in Boston, cannot find a primary care doctor (more on this in a bit). During my three week visit, this person found a new doctor, secured an appointment, and had that appointment with additional testing. Within three weeks!!! How fortunate to find a PCP. How fortunate to find a GREAT PCP. How fortunate to get an appointment and have testing completed quickly.

“Real” Posting

With Tik Tok either leaving or changing, I have been thinking about what I would like to cover. My most recent video on Tik Tok was on G6PD deficiency. I didn’t have access to my rendering computers but I had to use some sort of art — I resorted to AI, mostly out of curiosity. I later saw the comments of many people not liking the AI. I get it — I don’t like it either. Someone commented that it is here to stay so we need to get used to AI. But to me, there is a bit of fakeness when used for creative purposes. AI in medicine has the capability of being an incredible asset, particularly in radiology and pathology. I am happy to discuss further if you would like.

After posting that possibly final video on Tik Tok, I thought about what is “real” for me. For posting on whatever platform is available after tomorrow. I love blood, no doubt. I love teaching about blood — the history, the physiology, and how to make a diagnosis. I have taught several courses in blood for the doctor or laboratory scientist-in-training — from “Everything Erythroid” (red blood cells) to the very creatively named “Coagulation Course.” I received lots of kind words for my work in those courses but the most impactful words have come from “patients” — meaning non-medical people who wrote to me that they were grateful I explained their condition to them from my Tik Tok videos. Never in a million years did I imagine hearing from “patients.” My content was geared towards helping students in school — because I struggled so much in medical school.

Now add to that in 2024, I myself became a patient. I am totally healthy today, but let me tell you — despite my own knowledge, I was so scared to be in the hospital. I got the best care from the best doctors in arguably the best hospital in the world (but one where I cannot get a PCP oddly enough, despite calling every Friday for a month as instructed). But I was scared. I thought becoming a doctor was very difficult. I thought being a doctor with sick family members (even before today’s 2,004 score) was slightly more difficult because of the emotions. But today, with what happened to me, I wonder if being a patient (perhaps in the USA?) is the most difficult.

Our own primary care doctors?

When I walked into the sister hospital of where I was treated, looking for a primary care appointment for anytime within the year, I was dismissed. “We are not taking new patients. Unless you know someone who knows someone, you aren’t getting in.” Exact words from the front desk. When I took a different family member for their specialist appointment for an autoimmune disease at this same hospital, I asked the doctor if he could help me. This was a world-renowned doctor. He laughed and said, “even I can’t get a primary care doctor.” I laughed, too, since there was nothing else to do. I said to him, “so we become our own primary care doctors?” He shook his head yes.

So with all that — this coronary CT score, my own time in the hospital last year, and words from my non-medical followers, I would like to shift the focus to empowering all of us, especially those not in medicine, with knowledge. I feel pulled to create content explaining what coronary artery disease is (in 3D of course — and better models than what I created back in 2022, ha!) and add in what we can do, from a “patient’s” perspective, on how to prevent and/or treat conditions.

Full disclosure: I am not a biohacker. I am not against biohacking, but I think that some of the stuff I see on social media, like the all-or-none or excessive stuff, is not necessary. What do you think?

After my brief stint in the hospital, I left with the utmost awe for the human body. My body knew exactly what to do after discharge — I simply needed to support it. Actually, I just needed to get out of its way and let it rest and do its thing. My body didn’t need cold plunges. It didn’t need a strict morning routine. It didn’t need excessive workouts. It didn’t need 1,000 supplements per day. It didn’t need 30 g of protein multiple times per day. It just needed the common sense basics. And that it is what I would like to incorporate with the 3D scientific knowledge — just easy-to-implement knowledge. For example — if you go to a restaurant anyways, and you plan to have a lovely non-restrictive meal, what are the better options? Not the best bland options. But the best for you that make you happy and enjoy life. And if you plan to have a drink, what is the better option? Not everyone wants to let go of their supposed “vices” but perhaps, we could have better vices that still do the trick. Does that make sense?

If you made it to the end here, let me know what you think. I have never received a comment on any of my posts. In case you did read this, let me know what you think about our shift in direction. A “bonus” regular hematology post will be headed your way in a few days. Thank you for your support, particularly to my paid subscribers. You are the ones who inspire me to write here weekly.