The patient has the toughest decisions. How much misery do you want to put up with to avoid surgery? The reason CABG was practiced for decades before it beat medical management in the statistics department was that it provided immediate and durable relief of symptoms. For me that would be worth a lot. Angina isn’t just painful, it is terribly distressing and triggers profound anxiety – in fact that’s one of the differentials for MI in chest pain. If it hurts AND you feel like the end of world is nigh, then it is almost certainly an MI.

In terms of medical management of angina here is what is absolutely necessary if the patient is to survive long term. Statin drugTx to reduce LDL cholesterol to ~ 80 mg/dl. Get the HDL as high as possible. The statins are pleiotropic anti-inflammatory drugs and they are absolutely indicated in documented CAD, unless they cannot be tolerated (rhabdo, etc.). Regular daily exercise such as walking 2K. Don’t walk or take other exercise = DEATH. The MacDougal and Pritikin Diets have been shown to reverse atherosclerosis in clinical trials, and the addition of a statin to the MacDougal Diet increases the speed and efficacy of the diet (seen this in pts myself). However, most people can’t or won’t eat that way, and the Pritkin Diet does not extend lifespan because the gains in decreased CAD mortality are more than made up in death from cancer, suicide and homicide. Hypertension MUST be converted top normotension within a few months, at most. It is often necessary to use 2-3 drugs to do this, and it is without question worth it – there is lots of Level-1 evidence. Even using toxic, crappy old drugs is better than hypertension. Today, with the angiotensin II receptor blocker (ARB) drugs, management is much easier; and the ARBs are showing signs of having positive pleiotropic effects as well, although it is too soon to tell for sure.

A technology I’ve started to evaluate and which I’m surprisingly impressed with is the InterCure RespRate system (http://www.resperate.com/us/pages/about_overview.aspx ) for reducing BP. When I first saw this thing I thought it was pure hokum. However, it does let many patients reduce their BP medication – most particularly beta blockers – which some patients find intolerable. It is a bloody expensive thing for what it is (~ $400), but since it is FDA approved, Medicare or private insurance will cover it. It is only for those patients who are patient, like the touch-feely approach, or who won’t or can’t take medication. It works for all kinds, but most patients do not have the time, discipline and patience to use the device as prescribed.

Beyond the above, the next most important things is enhanced external counterpulsation therapy (EECP) http://www.ghc.org/all-sites/clinical/criteria/pdf/eecp.pdf. I am a huge advocate of this non-invasive Tx. It is positively miraculous in many patients who have burned through 2 or 3 CABGs and are out of options. The Tx consists of the patient donning a pair of pneumatic trousers with multiples cuffs that inflate at the beginning of diastole and deflate at the beginning of systole. During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs and finally, the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg. The patient’s ECG is used as the trigger for inflation/deflation cycles.

In patients with multi-vessel or serious single vessel disease, it comes down to how long do you want to live and how do you want to die? CABG, done at centers of excellence here in the US, is now so good it is incredible. As a cryonicist, I wouldn’t even think of walking around with serious CAD whilst fooling around with medical management. That’s saying something, because I’d be the first to tell you that virtually nobody comes off the pump, even today, with the cognitive reserves they had when they went on. Again, your mileage may vary.

Because there is no NHS people buy their own medical services. As long as that was affordable it was great! [ It no longer is,] People were very picky about their primary care docs, and if you trust your PCD, then you are likely to be comfortable with his referrals (consults in the UK). Your final triage was also your pocketbook, so you knew where you stood. With NHS, all sorts of necessary decision making comes into play with the associated bureaucracy. And everybody knows that in THAT situation things will inequitable in a way you can’t see. Also, your doc doesn’t work for you, he works for the NHS. I’ve known many a competent doc that was an arsehole, and in private practice they flop. Even the HMOs don’t want them because of the headaches they cause the other docs in the system. In the NHS, you have to take what is offered. And please note, I’m not knocking the NHS. It’s a tradeoff, that’s all.

My children receive quality education, we have Internet and cable for documentaries, learning and social networking. My teen has an iPhone, each child has a laptop. We are able to travel a few times a year. My children know how to shop frugally, balancing cost with health and nutritional needs. They know how to find the latest styles at thrift shops, I place importance on being able to donate to causes that give back to society–rather than on material or “brand name” things. I take my kids to volunteer locally at food banks, and groups like the Ronald Mc.Donald house–whatever is is the area we are living. I’ve taken them to see difficult living conditions in other countries, and raised them with documentaries–so they will have appreciation about where and when they were born, all the things they have–and their obligation to give some of that back.

Why do I want another baby? I love teaching them when they are babies, having them reading at age 2–breastfeeding till age 4 1/2 years, giving them an expanded awareness about the world. I may adopt if I don’t conceive, there are so many children needing homes-and I can easily re-lactate to breastfeed an adopted baby.

I think another reason people don’t choose cryonics that was not touched upon, is that it is “selfish” -people have guilt about how much suffering there is in the world. The assuage that guilt by being green, or being religious –and also by not wanting to take more resources than their time allows for. This being said while they daily, while alive, take more resources than billions of people in the world–while 17,000.00 children die of hunger a day. Where 30% of the world lives in extreme poverty, under $1.25 a day–not even “relative” poverty.

Humans have a hard time living when they have more wealth than others, at least balancing their guilt.

For me, I’ve developed a way to cope, since I was in my late teens–I can give back a fair amount in my life from what I got by luck, of where and when I was born. I can give back more, the longer I live–period. If cryonics works, then I can help with problems at that time. A. I don’t think cryonics has a high chance of working due to societal problems, not the science- and B. I don’t think there would be a “utopic” situation 500, or a 1000 years hence.

Religious people can do more good for their religion, or if you are inclined to social action or social work, you can find ways to fit in if cryonics worked. If you are desperately poor, due to society in the future, well you can appreciate how most the world lived in your time–and do what you can to work your way out of it. If you actually find life to be too hard to live for whatever reason, you have the same option to check out that you do now. People don’t often choose suicide (statistically, of course there are those that do) –because they see things worth living for in life. A reason I’ve seen people be positive about with cryonics, they’d get more time in life.

I’ve never had people refuse money I’ve given to them on the street, but the largest sum I’ve given is two hundred. I’ve never had people say they wouldn’t want more of life because life is so hard (I have heard the decrepit/bad health argument, which is countered by rejuvination) It is my experience that people are mostly optimistic and happy. That there is more good in humanity than selfishness.

I don’t have the view that children are a detriment due to their selfish nature–I see acts of altruism that are unbidden in my own children. Even though I feel a lot has to do with how parents raise them, I know there is an enormous amount that is genetic–but even then one can turn to studies showing other apes, such as Chimpanzees have altruism innately.

I don’t fault Alcor for not having a press release ready for Robert Ettinger’s death. I feel that is Cryonic Institute’s job, and Robert’s son did an excellent job giving interviews and information. The news spread globally, and brought new interest into cryonics.

Life is hard, but I can’t justify saying my life is “hard” when so many others have have it worse. I’ve met people who have it “worse” and they are happy.

Most people are happy with what they have in life, whether that be a small amount or a large amount –most everyone still has goals they are working for.

Promoting cryonics would be better if there was a revived mammal of course. There is science to support it working someday, but it can’t be proved to “work” yet. Beyond the science of it though the psychological factors must be addressed. A major point is how one can be helping the Earth, giving back to humanity if it works. Cryonics has to lose its selfish image, and show how it gives back to the community now as well (research into organ preservation and transportation, taxes, employee incomes, building expenses). Cryonics needs to show how it benefits the future as well as now.

http://www.overcomingbias.com/2011/07/expats-like-cryonics.html

http://content.healthaffairs.org/content/early/2011/07/27/hlthaff.2011.0662.full