Amish Paradox

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Background

Marc is a very pleasant 50-year old gentleman who came to speak to the class concerning his history of unstable angina, myocardial infarction, and the treatment and care he was given during his stay in hospital. Accompanied by his brother-in-law, David, they were driven from their Amish Community approximately 80km from London to speak with us.

Marc was born in Ohio, and moved to Canada at 11 months of age. He lived in South-Western Ontario until he was 16, and then stayed 10 years in Honduras. At 26, he came back to Ontario where he owns a farm and is currently growing produce – peppers and watermelons. During the winter he sells cooking stoves.

In February 1997, age 43, he woke up with an upset stomach. He was not feeling well the entire day and could not work. This was unusual for him. After a few days he decided to go to a walk-in clinic where they recommended going to the hospital. At the St. Thomas hospital, the doctor reassured him that it was nothing serious, however the results of the blood sample showed elevated enzymes suggesting a serious heart attack. They continued to monitor him, hoping to stabilize him before transferring him to Victoria hospital. He had ongoing pain during his stay, which he described as a dull ache (clenches his fist). He became weaker while in hospital and he was experiencing ongoing pain while the doctors "juggled" pills. The physicians wanted his pain to be at “0� on the scale of 0-10, but this was never really achieved. However, it was mentioned that Marc, and most Amish, have a high threshold for pain. At day 5 Marc firmly requested to be transferred to London.

Marc was now under the care of Doctor Malendas who was very concerned and began to ask questions "why had such a young, healthy 43-year old man come in with a heart attack?" Marc was offered angioplasty (he wouldn't have been a candidate for bypass due to his young age). He felt very relaxed when undergoing angioplasty as he watched the x-ray screen. But he still had this pain. On the second try, the team managed to open it, and a stent was put in. A branch of the left coronary had shown a 99% blockage. Suddenly, Marc’s pain was gone.

He is now working on his farm as hard as any other 52-year old.

Family history

  • 11 siblings (7 boys, 4 girls).
  • Father died of MI at 59. Brother was killed at 35, so 6 boys alive. 3 have had open heart surgery (of which 1 multiple times), 1 brother had a stroke, and another had a sudden MI. One sister has a pacemaker, and another had a stent put in. Only 2 sisters are not known to have heart problems.
  • There is also a family history of Type II diabetes and high cholesterol. There is no smoking or drinking in the Amish community. Marc was sent to a dietician where he was told that he was doing everything right. He is currently taking 1/2 pill Atenolol and 1 Nesinopril a day.


Objectives

  • Identify risk factors.
  • Culture and lifestyle of the Amish (and how this may relate to medical issues). Expand this to other ethnic groups.
  • What are various possibilities concerning the etiology of Marc's heart attack?
    • how can we explain the family history? Let's try to be specific.
  • The manner and approach of the physician.
    • how do the Amish pay for their medical bills?
    • should the doctor's manner be different when treating a different ethnic or community group? If so, how?
  • What is Dr. Silcox's favourite colour? is this a joke?
  • Are there any new cholesterol-lowering drugs/treatments/diets on the horizon? Any gimics/hoaxes promising to lower cholesterol?
  • Feel free to research any topic of interest not aforementioned.

Bonus point: What was the "Amish walking study" (published early 2004) trying to prove?

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