Tag Archive for: breathing

Finding the Cause of Death

/in /by

Last week, I left you with a question about a hypothetical situation: What if my grandmother’s bedsores had become infected to the degree that it spread throughout her body; she still had congestive heart failure but didn’t have pulmonary effusion at that time. What would be the primary cause of death?

With so many health experts and influencers that get a lot of attention in social media, causes of death appear to be misunderstood. Let’s cover it as simply as I can, based on the definitions from the CDC, WHO, and other agencies around the world.

  • The primary cause of death is the situation or condition that started the chain of events resulting in death.
  • The secondary cause(s) of death are any conditions that may have contributed to the death.

In the case of the hypothetical situation, the cause of death was the systemic infection from the bedsores. The congestive heart failure was a secondary cause of death. We can’t know for certain, but the infection probably took away the ability to fight back due to the weakened condition of the cardiovascular system.

I’ll give some examples of misinformation in Saturday’s Memo—which is May 10. Long time readers will understand the significance of that day.

What are you prepared to do today?

        Dr. Chet

Why My Grandmother Died

/in /by

You may be wondering why the TAP-IT study created that stop-in-my-tracks moment. In the mid-1980s, my grandmother Frances was 80 years old and was always my biggest fan. She had congestive heart failure, so doctors tried the needle procedure, which drained close to 20 lbs. of fluid from around her lungs; you can imagine the pressure that caused on her heart. But congestive heart failure is an unforgiving disease—at least it was back then. Without a real treatment other than thoracentesis, there’s no cure.

Months later, the pulmonary effusion happened again, but she refused treatment because the procedure had hurt too much the first time. She died a couple of weeks later. The study prompted my realization that a medication like a diuretic might have prevented a rather difficult death with multiple bedsores.

The fact that there was never a randomized controlled trial to compare the two approaches until 45 years later just absolutely astounds me. At least now there are treatment options for people with the same condition without the same type of complications.

Just to be clear: there was no coming back from advanced congestive heart failure as my grandmother had. Using either procedure would not have cured her—it would have eventually killed her anyway. But the difference was really in her quality of life. She may have lived longer and certainly less painfully using the diuretic, which as I said was available even back then. But there was no research to support it.

What Was the Cause of Death?

There appears to be a lot of misinformation today about cause of death. I’m going to use my grandmother as an example. I mentioned that she had severe pulmonary effusion due to the congestive heart failure. But she also had bedsores. If they had gone septic, resulting in a whole-body infection, what would have been the official cause of death? That’s what we’ll explore next week. Please share your thoughts.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161

TAP-IT to Stop It

/in /by

Have you ever had a moment where you were reading something, listening to an audio, or watching a video where you just had a moment of realization and absolutely stopped in your tracks? The reason is that you got hit with a discovery of some fact that you didn’t know. More than that, you realized what it meant. That’s what happened to me while listening to a podcast from a cardiologist about pulmonary effusion and how to treat it.  Let’s start there.

Pulmonary effusion (PE) is the buildup of fluids in the connective tissue surrounding the lungs and the chest cavity.  If enough fluid builds, it’s going to push on the lungs and ultimately push on the heart and make it very hard to breathe. To restore function, the fluid has to be removed. This happens to people who have congestive heart failure.

The TAP-IT study, formally called Thoracentesis to Alleviate Cardiac Pleural Effusion–Interventional Trial, was recently published in a leading heart journal. The researchers selected subjects who were 80+ years of age with less than a 25% ejection fraction. This population was chosen because they are the ones most likely to suffer from pleural effusion. They compared subjects who took diuretics to alleviate the fluid with subjects who got thoracentesis. The goal was to determine if there were any differences in outcomes as assessed by the number of days lived after beginning treatment.

The results? There were no differences in outcomes between the two groups. That’s amazing! Both reduced the pleural effusion, but there were differences in patient comfort and quality of life. As you might imagine, sticking a 2- to 5-inch needle through the rib space and into the pleural cavity to drain the fluid is going to be uncomfortable if not downright painful. There were also 20 out of 80 pneumothoraxes with the needle approach, while there were no complications noted in the group that took the medication.

The realization? This was the first randomized controlled trial that compared thoracentesis with diuretics, even though diuretics have been available for 75 years and thoracentesis for 175 years! Why did that matter to me? I’ll tell you on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Circulation. 2025 Apr 1;151(16):1150–1161

COVID-19 and Obesity

/in /by

Obesity may be a contributing factor to the severity of symptoms for those who get COVID-19. The best explanation I’ve found why that may be true is in a paper in Nature Reviews Endocrinology published in April. There are several reasons in addition to the cardiovascular and endocrinological co-morbidities associated with obesity.

Just a reminder, by definition obesity is a Body Mass Index (BMI) greater than or equal to 30.0 kg/meters squared; it’s a measure of surface area. You can check yours at the Health Info page on the Dr. Chet website; it also includes the info to determine if you’re really big boned, because that has an impact.

The increased risks associated with obesity are driven by the respiratory system:

  • Impaired respiratory mechanisms
  • Increased airway resistance
  • Impaired gas exchange
  • Low lung volume
  • Low muscle strength

In effect, the greater the obesity, the more difficult it is to breathe deeply and when deep breaths are taken, the resistance within the airway and the actual exchange of oxygen and carbon dioxide are impaired. If required, intubation is more difficult. The greater the degree of obesity, the more difficult it is to provide regular patient care if someone is hospitalized with the virus. Add to all that the co-morbidities of the cardiovascular and endocrinological systems, and it makes recovery very difficult. More research is needed, but it’s a serious issue in a country where over 40% of all adults are obese.

I’ll wrap this up on Saturday with some thoughts about what we don’t know that could be impacting the development of treatments for the COVID-19 virus.

Facebook Messenger

I try to make myself as accessible as possible, and Insiders and Members have quicker access. My website contains a way to email me if you have a question. One way I’m no longer going to accept questions is via Facebook Messenger, so please use one of the other avenues.

What are you prepared to do today?

        Dr. Chet

Reference: Nature Reviews Endocrinology volume 16, pages341–342. (2020)

Observations from the Road: The Mile-High City

/in /by

Whenever I travel, I observe people and especially what they do. This past weekend was no different as I traveled to Denver to do a seminar. Because Denver is called The Mile-High City, I thought altitude was a great place to begin.

There are at least two things that happen when you move from sea level to 5,000 feet: the oxygen level of the air drops about 3%, and the density of the air decreases. The net effect to the body is that it’s more difficult for the hemoglobin of your blood to saturate with oxygen and . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.