Failed grafts

[Peter Pan]

I had a bypass operation involving 6 arteries (using all leg veins) in July 2000.  A January 2001 angiogram found 2 jump grafts had failed and 3 additional native arteries are clogged. I am told know that an angioplasty and.or bypass are no longer possible (diffuse). I am being treated medically.

I had the following questions:

1. Would you confirm that "treating medically" attempts to stop the progression of the problem and not clear existing blockages ?

2. What sort of problems (other than the obvious - heart attack) could occur over time with 5 arteries clogged ?

3. Can anything be done to slow this down.  I exercise everyday (bike-walk-weights) and I have lost nearly 50 lbs (down to 165)since the bypass. I am now a vegetarian (mostly). Test results cholosterol-liver etc. are all excellent with the exception of a slightly lowered HDL. It just seems to keep going.

4. I am 40 years old. Can you give me an honest-educated, long term prognosis ?

[CCF-M.D.-CRC]

Dear peter,

1. Would you confirm that "treating medically" attempts to stop the progression of the problem and not clear existing blockages ?
A: Medical management of coronary artery disease is an important part of therapy and should be used regardless of surgical/angioplasty therapy.  The question of if surgical/angioplasty should be performed will depend on several factors including the legree of symptoms, the target vessels and the overall health of the patient.

     2. What sort of problems (other than the obvious - heart attack) could occur over time with 5 arteries clogged ?
A: Other problems could include angina and loss of heart function.

     3. Can anything be done to slow this down. I exercise everyday (bike-walk-weights) and I have lost nearly 50 lbs
     (down to 165)since the bypass. I am now a vegetarian (mostly). Test results cholosterol-liver etc. are all excellent
     with the exception of a slightly lowered HDL. It just seems to keep going.
A: In addition to the above you should also have a homocystine level and a hemaglobin H1C checked. If these are elevated they need to be treated.  Also you should be taking maximum doses of a lipid lowering drug and a beta-blocker.

     4. I am 40 years old. Can you give me an honest-educated, long term prognosis ?
A: I wish I had a crystal ball.  With the changes you are making and proper medical treatment you could live a normal lifespan.

[WJS]

The first thing that you should do is ask for your money back.  That should get a good laugh - these guys get paid whether they help you or hurt you.  Perhaps you should sue them for hosing you up like that at age 40.

This is why I have never given in to the scare tactics used to sell me on bypass surgery after the two failed attempts to do angioplasty on me.  I am living just fine with a 100% occluded RCA, a 70%+ occlusion at the entrance to the circumflex, and a large "cratered" plaque in my left main.  I left the hospital, after it was discovered, with the attending cardiologist telling me that I had a 40% chance of sudden death within 5 years.  

I saw the fact that my left main had ruptured as progress in Lipid control - not that sudden death was imminent.  When you take the lipids out of the wall of the left main, given the tremendous hydraulic stresses, it's bound to rupture.  The next task is to erode the remaining shoulders of that plaque and return the artery to health.

Like you, I do a lot of physical exercise.  I know my limitations and stay under the angina threshold.  I don't do serious exercise after I eat.  All of my exercise is low intensity, except I run a couple of hundred yards in one of my daily walks.  I walk a hilly course 2 to three times a day.  I hike on the weekends.

I have just completed a 50 mile trek on the Cascade Crest Trail in Washinton State's North Cascades mountains.  I was carrying 55 lbs because my hiking partner has a knee brace and can carry very little.  It was 6 days of very strenous low intensity exercise a long way from a hospital or medical help.  The Crest trail does a lot of ups and downs between 4,000' and 6,500'.  This was my second trek in the month of July.

The scary thing is that I now feel 100% healthy - I certainly don't feel like a heart patient or someone who will die within a couple of years, although the cardiologist could be right.  Anyway I have a lot of hiking and climbing to do this summer yet and hope to continue getting stonger.

From my experience the trick is to get your LDL way down.  I have had fantastic results with a low dose of Liptior + Welchol (new bile binder).  

Also you should have good BP control.  An ACE inhibitor is the way to go if you can tolerate it.  I take low doses of the ACE inhibitor Altace + the calcium channel blocker Norvasc.

My experience with Beta Blockers is that they are good for old people sitting in chairs waiting to die, but counterproductive for young active people.

Also, if you can avoid blood thinners and Plavix, stay away from all of that ****.  The key to recovery is having healthy blood and a healthy endothelium.  If you can tolerate an aspirin, it may be ok.

Also you might consider how your arteries got so hosed up at such an early age.  In some cases it might be bacterial.  I went on a 1 month round of Zythromax, just in case.  If I could do it again, I would recommend 3 months.  There is no literature on what the ideal course of treatment might be - it's pretty much theory right now.

Also watch the amount of Iron that you take in.  Most people have way too much.  Don't take iron supplements or eat foods high in iron, such a liver.  I gave the maximum amount of blood that I could to the Red Cross before they denied me because I admitted to having angina after eating and doing strenous exercise.  Now I have to find someone else to bleed me.

Then you might consider supplements.  Definite do the following:

Good MultVitamin (non of that Centrex ****)
B Complex
E (at least 800 IU)
Folic Acid
Salmon Oil (2 Grams)
Garlic Pills (4 Grams)

I also take about 15 other antioxidants, amino acids, and other supplements every day, but those are the basics.

Also you might drink some dark juices (not the artificial and sugared **** that you buy in the supermarket).  I drink a quart of Trader Joe's blueberry juice every day.

Also, don't let the tail wag the dog - see what that has got you so far.  Do your own research and create your own plan for living with the disease and getting healthier.  Three of the 4 pills that I am on are because of my research, not the doctor's choice.