Wednesday, July 03, 2013
Here is a quick overview of the key facts in my heart disease: I am 63, 6’2” and 220 pounds, I had my first angina attack a week ago. Within the first 24 hours of being admitted to the emergency cardiology unit, my triponin levels rose from .00 to .08, then went back down to .00. Although two ultrasounds (echocardiogram and bubble stress test) showed my heart to be functioning at near normal levels with only minor issues and no heart muscle/cell damage, an angiogram showed four 60-80% blockages. Doctors immediately recommended bypass surgery, and said I was not a candidate for stents due to intersecting arteries near the blockages (later, other cardiologists disagreed with this conclusion). While I clearly have heart disease that needs immediate treatment, my family and I have researched and decided to take a route that is up-and-coming with promise of even more success than the previous ones advised to us. Leaving the hospital was a very, very tough decision.
Bottom line, our research has shown that I am actually at less risk of complications and have longer term survival odds through a plant-based diet with medication versus open-heart surgery. My brother, daughter, and I are all going to follow Dr. Caldwell Esselstyn’s nutrition/reversal program. I found a FABULOUS cardiologist (Dr. Rex Outtrim) who will help me monitor my progress. I go back in a month for a PET scan to measure my progress and make a decision whether to stent only one of the most problematic arteries or not. If I have made significant progress on the flow %s in my three main heart arteries, we hope to avoid any surgical procedure at all.
If you or anyone you know has heart disease, I strongly recommend reading Dr. Caldwell Esseltyn's and Dr. Dean Ornish’s reversal program books. Do not just trust your doctors. YOU must be your own advocate and OWN your own recovery program. You must also be committed to serious life changes or you will NOT get better, surgery or not. Most doctors automatically recommend bypass and other invasive procedures because most people do not change their ways, and bypass is the best option for those who don’t take control of their health. This is a very skewed system, as doctors just assume you are one of the “lazy” or “set in your diet ways” majority. And, most doctors are not up on the research, Nobel Prize winning discoveries, and FDA-approved programs of Esselstyn and Ornish. Very sad that this is the state of our healthcare system!
My hopeful goal: With a careful course of medication, I hope to avoid surgery with strict diet, meditation, yoga and aerobic exercise. I have read Dr. Dean Ornish's and Dr. Caldwell Esselstyn’s books and am extremely encouraged by their research and patient outcomes. I am currently following Dr. Esselstyn’s plant-based, no-oil-dairy-meat reversal plan…and Dr. Dean Ornish’s exercise/mindfulness plan. (And feel better than I have in a long time!) I would also like to explore working with other treatments I have read about, or any other recommendations my followers have for me. Please leave a comment!
Here's a little background so you can hopefully avoid the same life or death question. Believe me, you don't want to be sick in the hospital, hooked up to machines, tired, stressed to the max, doctors telling you that you need a bypass asap...and this is when you have to assess the big question: Am I really a “must have surgery now” case or not? This is not the best time to make this life or death decision--with limited information at that!
With the help of my support team, we came to this conclusion: with no other symptoms prior or since, and some out-of-the-ordinary bad choices leading up to the event last week, we think I constricted/stressed my arteries into sounding the alarm that I have serious blockages – yet I had time to “change my ways” with a reasonable amount of risk. Later, Dr. Outtrim confirmed this is a very reasonable probability, especially since I over-constricted my blood vessels the day prior to my angina attack by smoking strong pipe tobacco. (Unfortunately, I found my old pipe collection from 30 years ago on Friday and smoked 3 bowls to remember the "good old days.")
If you can believe it, I actually feel "lucky" it set off a warning alarm that probably saved my life and prompted me to change my ways before I caused irreversible damage! See, good can come from bad! Ha!
But the main factor in my artery disease: I haven't had the best diet and exercise program prior to my “angina attack”. Adding to that, I have piled on the decadent foods this past year after retirement, from my "dream retirement" Italy trip in May to my sedentary "relaxed" life with far less movement. (Teaching forced me to keep moving!) With all this extra oil, cholesterol, etc. it only added to my blockage issues and pushed me over the edge. Finally, on June 22 at 2 a.m. my body sent up the first red flag: I started having chest pains and shortness of breath. While I thought it was just indigestion from the two portions of spaghetti dinner, once in the emergency room, I realized how serious my condition really was. It was the shock I needed to change my ways, and I was lucky to suffer no heart damage and have the option of choosing a diet program vs. surgery.
Here are the key findings in my diagnostic tests so far:
1 – 6/22 Angiogram/cardiac diagnostic report: Found four main blockages, 60-80%. Determined "unable to stent" due to intersecting arteries. Based on findings, cardiologists at the U of U recommended triple bypass surgery asap.
Key within my labs: within the first 24 hours after admittance, my troponin levels went from .00 up to .08…then back down to .00, and were still at .00 when I left the hospital on 6/26. Very good indicator there was no “permanent damage” to my heart--a huge relief to family and me!
2 – 6/22 Echocardiorgram (ultrasound) report: I was told my heart looked healthy and appeared to have “good blood flow/function” normal for my age. Doctors say they only found “minor issues.” The two most concerning things I read on this report: “Hypokinetic inferior wall, entire inferior wall is abnormal” and “findings are consistent with ischemic heart disease.” Basically, one of my main blockages is effecting how the bottom part of my heart is pumping. Although I have near normal “ejection” and “function”, the bottom muscle in my heart is weak. Much research shows, and my current doctor feels we can reverse this with diet and exercise.
3 – 6/26 Bubble Echocardiogram/Echo Doppler (with contrast) stress test report: This test reaffirmed it was reasonable to delay the bypass so we could have time to do our homework and get a second opinion. U of U doctor’s advised this stress test to show us how “severe” I was, and the risk of waiting on bypass surgery.
When the ultrasound showed near-normal function of my heart and I met my targets without any irregularities, the doctor who had previously insisted on bypass surgery told us that he was surprised, and said, “I sure did not expect him to do so well.” Based on this test, doctors felt it was “reasonably” safe to release me (on meds) to get a second opinion, but advised us to move quickly. So far, our second opinions from Dr. Outtrim and a very sharp cardiologist at the Mayo Clinic have affirmed we are on a reasonable track that is no more risky, and probably LESS risky than surgery. Surgery is not a cure. It’s a temporary fix!!
Concerning language in this report to note:
• Anterior ECG leads with stress demonstrated significant depression.
• New segmental wall abnormalities were seen with stress.
• Inferolateral ECG leads with stress demonstrated marked depression and horizontal ST segments.
• The entire inferior wall is severely hypokinetic.
• Symptoms were not suggestive of ischemia, ECG findings are, high probability of obstructive coronary artery disease.
I went home with the following course of medication, with the following understanding of what they are doing for me:
1) Baby aspirin (Blood thinner)
2) Lisinopril (BP lowering Ace inhibitor. Discontinued by doctor’s orders because my blood pressure was too low.)
3) Atorvastatin (Cholesterol lowering, generic Lipitor)
4) Plavix (Blood thinner, anti-clotter)
5) Carvedilol (Beta blocker to slow my heart rate)
6) Nitro (Just in case!)
Dr. Rex put me on a pared down course of the above since this course has kept my blood pressure too low, and changed my Carvedilol to the lesser side-effects Metropal (Toparal) that does not slow my heart rate to “control angina,” plus a supplement of Q10.
Next steps and our (researched) thoughts:
1) No collateral flow was ever discussed or measured during the time I was in the hospital. How can we tell if my heart has performed (angiogenesis?) and my “secondary arteries” are actually compensating? In essence, has my body created its own “bypass system” that may be delivering blood flow to the needed areas which could make it “less risky” to work on stopping/repairing my heart disease through non-invasive treatments? Research and our current medical advisors say yes, completely possible!
2) PET Scan: would this be a “better” test to perform to measure actual blood flow and the risks of my blockages? We have read and also heard from a technician, “Don’t get caught up on the scary blockage % numbers from your angiogram, there are limitations to how it shows the actual blockage depending on scope angle, etc. What you need to be concerned about is blood flow %.”
So, the very important question based on 1 and 2: Since the echocardiograms have shown us hard evidence that my heart is performing at mostly normal levels, could flow numbers from PET scans be a safe indicator of my actual risk? This gives us a lot of hope that we can at least stop further progression and even repair some of my diseased artery (endothelial) cells (according to Nobel Prize winning researchers and case studies). We are hoping the PET scans can give us a baseline test plus tests we can repeat to measure my progress. This is key in our “self prognosis” that our current doctors have confirmed. I go in for my first PET scan in a month as I said before.
3) EECP Is this used mostly in older, inactive patients, or could I benefit from it, too? We’re looking into this as well.
4) One of my main blockages appeared in a place where it could be stented (while the others did not due to intersecting arteries--according to U of U cardiologists). If I don’t progress at a reasonable rate, we may just stent one blockage to increase flow in combination with diet and medication. This is the main blockage causing the muscle in the bottom of my heart to have impaired function. This was a big "AH HA!" moment when we met with Dr. Rex Outtrim as he reviewed my diagnostic tests. This stent is far less risky than open heart bypass surgery, and is a viable option on the table right now. We'll know more in 4 weeks when I go in for my PET scan (measures flow) as to what my decision will be on stenting. Less than 5% of patients have issues with stenting, but there is always a risk. Especially when you are cutting off flow in that artery to place the stent! But the doctors we are hooked up with now at Intermountain Healthcare (The Utah Heart Institute) are very good and are up on the latest and greatest procedures and advances in stent technology. They, unlike U of U, claim you can even stent in and around intersecting vessel locations. (A stent is an expanding mesh tube that opens your blocked artery and can stay in place with no issues for the rest of your life. IF you change diet and don't fill it up with plaque again!)
I hope this synopsis was helpful to friends and family following my case. I will keep you up to date on my progress in this blog.