Diminishing Options

Posted By Edward MacAlmon on October 25, 1997 at 09:56:26:









I am a 50 year-old male who had an "incomplete" heart attack in October '96 followed by quintuple CABG.  Over the course of this year, 4 of the 5 grafts have closed, even  though an additional angioplasty and stent placement were effected at about 7 months.  The only graft remaining open is the internal mammary which apparently was rerouted as one of the 5 new grafts.  My internist working in conjunction with my cardiologist (MCOs--you know) believes that the risk of an additional by-pass is greater than trying to keep the internal mammary open via medication (in addition to Metropolol and Zestril, he has started me on Lipitor 80mg/day + Ticlid 500mg/day + aspirin).  He also believes that the amount of small vessel damage suggests that there is not much point in attempting another by-pass as there is not much to connect to.  This leaves no "fall-back" position as he believes that if the internal mammary closes, a fatal event will occur.  He discussed the only other possibility as a transplant, but states that the condition of my heart does not make me an appropriate candidate (apparently funcitioning too well at this point).  Of course this news (received two weeks ago following a 4th cardiac cath conducted to try to figure out the cause of continuing angina) has generated uncertainty and fear for myself and my wife.  Are there additional options?  Should I be seeking a second opinion from my MCO? Any help would be appreciated.  Thanks very much for this wonderful public service.