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How Possible to open 100% LAD Blockage
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How Possible to open 100% LAD Blockage

I have been diagnosed with 100% blockage in LAD. Is it possible to have it opened using catheter and placing a stent.
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367994_tn?1304957193
Consideration would be given on how long the vessel has been totally occluded, how hard the plaque is, it MAY be possible for an interventional cardiologist to pass a wire through the occlusion and rotorblade with a catheter. Even when intervention is done, it is usually less than 30% successful for more than 3 months and even less at 1 year.  If there is 100% blockage and no signs of a deficit supply of blood to the area normally served by the LAD, an assumption would be there is a natural bypass (collateral vessels)...you have developed collateral vessels.  It is possible if the 100% LAD is opened, the lower resistance of blood flow through the LAD can take away the blood flow through the collaterals.

If you are not having angina (chest pain) or heart failure, a cardiologist may take the option to manage with medical therapy and risk factor modification (lipids, stop smoking, exercise.

I have known to have a 100% blockage of the LAD for the past 6 years, and I am medically managed...no symtoms (symptoms) and little or no progression of coronary artery disease.

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1262435_tn?1270315459
Thanks Ken. So what options or alternatives do I have. among medication, intervention and heart surgury. Doctors I have seen gave me conflicting advices to say the least. I am 52 male and a smoker.
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976897_tn?1379171202
It isn't very common for a blockage in the LAD to be opened using stenting, especially near the top of the vessel. In the UK it took me 2 years to find a cardiologist willing to perform the procedure. I don't think there is any fixed percentage rates on success from what I could gather because the procedure is so rare. My procedure was done in a research college in London and several cardiologists attended to see how it was done. My plaque was very hard, so hard the catheter twisted and nearly penetrated the artery wall. It took a lot of 'chipping' but eventually he reached the soft material. The cardiologist who did the procedure has 30 years experience under his belt and in my outpatients appointment with him (5 months after the procedure) he feels sure the stents will not pose a problem. I do know that this cardiologist will not do the procedure on a smoker, he feels that people who want to deliberately kill themselves are not worthy of his pioneering approach (his words not mine). I was a smoker until 2007 and because I had given up for over 2 years he agreed.
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367994_tn?1304957193
Medication, stent, and bypass therapy only treat the symptoms of coronary artery disease.  There is no cure nor regression of the malady.  The medication would be an ACE inhibitor, beta blocker to reduce the heart's workload...med to reduce cholestoral, and if there is chest pain (angina) a nitrate provides relief.  You may want to google the COURAGE study that explains the result of a study that evaluated the different therapy available. The result is there was no difference in the therapy as it relates to a longer or better life span.  The different treatments only deal with the symptoms.
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Avatar_m_tn
I had a lower 100% LAD block that couldn’t be opened by a doctor in July 2008.  He informed me that 100% blocked arteries can sometimes not be opened because the block becomes very hard.
On 2/23/10 I had another Interventional Cardiologist open the same 100% block I about 1 minute.
He never even had to get to the rotoblade technique and did it with regular balloon angioplasty.
As I keep saying to most people on here.  Find the closest Major Hospital in your area that specializes in Heart problems and try to see the Director of their Interventional Cardiology program.
So the answer is “YES” a 100% blocked LAD can be opened.    
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159619_tn?1318997813
Fortunately, (knock on wood) I have not had to deal with an artery that is blocked at 100%, but I would think that each case is unique. I don't think that one can say that all arteries that are blocked 100% can be opened. I know of aggressive treatment options that have been explained to me at the Cardiac Care Unit I am associated with, but one thing I have learned is that each case has special considerations.

Wish it were easier, good luck.

Jon
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976897_tn?1379171202
From my experience of talking to lots of different cardiologists to try and find someone to remove my 100% blockage I had the distinct impression it was down to two factors. The Cardiologists experience and the Cardiologists confidence. This was reinforced by a cardiac surgeon telling me the very same thing when I met him to discuss the options of an open end type arterectomy. No surgeon wants a death on their hands and when the option of bypass surgery is available to remove that fear, nearly all of them will jump at that chance where possible. My cardiologist is Australian and comes across almost cocky with his attitude. I suppose this cocky attitude built up over his 30 years angioplasty experience. He definitely likes a challenge and doesn't do the standard stenting procedures, he said he finds them too boring now.
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976897_tn?1379171202
"Medication, stent, and bypass therapy only treat the symptoms of coronary artery disease.  There is no cure nor regression of the malady"

Do you believe that to be so in all cases? I mean, if a person has just one tiny area of disease which is treated by shaving or rotablation, followed by stenting and the disease never returns, is that still a treatment or a cure? I witnessed many patients returning from the cath lab with reports saying "one area of disease, successfully stented". If those people make lifestyle changes which are causing their disease, are they cured?
I suppose it depends on how you look at it.
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367994_tn?1304957193
QUOTE:: "So the answer is “YES” a 100% blocked LAD can be opened".

A: The point is whether or not it advisable to open a totally blocked artery, not having the ability to do so...  Opening arteries that are 100 percent blocked in the first 12 hours after a heart attack with angioplasty can quickly restore vital blood flow to the heart, and is considered optimal treatment for almost all patients. However physicians in the United States often open blocked coronary arteries with angioplasty in stable patients who are beyond this treatment window, although there aren't any definitive clinical trials addressing this practice.


The following study supports the risk NOT  to open and stent a100% ocduded artery:

>>> The OAT study involved 217 sites on five continents. It enrolled 2,166 patients who had a completely blocked coronary artery causing their heart attack, which was identified after the early phase of the heart attack. All of the patients were in stable condition. They were randomly assigned by computer to receive balloon angioplasty and stents plus medical therapy or medical therapy alone three to 28 days after their heart attack. Researchers tracked their health for an average of three years after the heart attack.

There was no statistically significant difference between the two groups in the occurrence of death, heart attacks, or heart failure in up to five years of follow up, according to the study. The researchers also observed a "worrisome" trend toward excess rates of repeat heart attack in the group receiving the angioplasty and stents. Dr. Hochman said that further analysis and longer follow up is necessary to understand this observation, which did not reach the level of statistical significance, so it could have been due to chance alone.

Dr. Hochman speculated that opening a totally blocked artery in a patient who has collateral blood flow may interfere with the ability of the collateral vessels to rapidly supply blood if the opened (stented) artery re-closes. "It seems that total occlusion is a stable situation and this may be converted to a potential risk for recurrent heart attack if the artery is opened and then re-occludes," she said. In addition, it is possible that some heart muscle may be damaged due to dislodging of clots and plaque at the time of the angioplasty procedure, counteracting other potential long-term benefits".

I personally agree with the above assessment, and I would not consider opening and stenting my 100% blocked LAD that has been blocked for at least 6 years.  I can provide documentation that an opened totally blocked artery and stented has a high risk of restenosis.
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367994_tn?1304957193
Q: Do you believe that to be so in all cases? I mean, if a person has just one tiny area of disease which is treated by shaving or rotablation, followed by stenting and the disease never returns, is that still a treatment or a cure? I witnessed many patients returning from the cath lab with reports saying "one area of disease, successfully stented". If those people make lifestyle changes which are causing their disease, are they cured?

If medication dilates the vessel sufficiently to remedy angina, is that a cure?  I don't believe someone would say "one area of disease successfully stented." sounds follish to me.

The various teatment remedies symptoms and the disease whether it is genetic, etc. does not cure the disease. That is the view of the professionals...treatment, no cure.  Better said the treatment relieved the symptom...not one area of disease successfully stented...whether the stent is a success to relieve angina would take weeks, months.  If there is restenosis, then the stent failed.

Hopefully some day CAD can be reversed and cured.
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976897_tn?1379171202
"The various teatment remedies symptoms and the disease whether it is genetic, etc. does not cure the disease. That is the view of the professionals...treatment, no cure. "

But surely genetics is not the cause with everyone. If it were the case, then the human genome is in serious demise as CAD is continually increasing and this would suggest rogue genes are flooding through the whole population of the planet. It would also suggest this has happened in a few decades which I find highly unlikely. So, we are left with general lifestyle as the only other alternative.
'disease' in a dictionary online gave the definition as "illness of people, animals, plants, etc., caused by infection or a failure of health rather than by an accident ".
So, is it not fair to say that if a person develops CAD through bad diet or high stress levels, and they remove that factor from their lifestyle showing the CAD as no longer progressing, the disease is cured? If the disease is no longer developing due to the cause being identified and being removed, then this surely is a cure? I agree damage from the disease will always be present, but the disease itself is no longer progressing.
Again, I think it depends on how you define 'cure'.
Another way to look at it is, if the disease is stopped in its tracks by lifestyle changes (which does happen, it happened to me), and a person no longer has their health affected, then this surely can no longer be classed as a disease?
I have seen some very good online videos of angioplasty procedures over the years, performed by very good cardiologists in the USA. Some have actually used the word 'cured' at the end of the procedure. Does this mean it's just simply a choice of words?
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1262435_tn?1270315459
In my case, it seems, LAD was blocked during the month of November 09. During which I suffered chest pain even after short walks on a slopy roads. Now, things are overturned and no suffering from pain similar to the previous ones. As to professionals, I have consulted 10 Doctors so far. I am overwhelmed with the variations in their views. Thier views are as follows:
- Firs surgen : Beating heart surgeory.
- Second surgeon: Conventional heart surgeory.
- Third surgeon: Medication with three months monitoring.
- First Cardiologist (Same one who performed the angioplastry): Stopped short of placing a stint. and reffered me to a surgeon.
- Second, third, &Cardiologist : Prepared to perform angioplastry with estimated success rate of 70%, 95% and third will put me on medication.
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976897_tn?1379171202
I too had various opinions. I was first to have the blockage rotablated but the cardiologist was overruled and a bypass was performed. This lasted 3 months which embarrassed the overruling cardiologists. I was then offered a redo-bypass which I refused and the surgeon agreed saying "Your best option is angioplasty, but good luck in finding one with the right level of confidence and experience for such a blockage". I was then recommended to have a transplant which I also refused. With an EF of 70% and no problems apart from a few restrictions, why the heck would I want a transplant? bit extreme. Anyway, the blockage is gone now.
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367994_tn?1304957193
QUOTE: "I think it depends on how you define 'cure'".  Which therapy medication, stent or bypass is a cure for CAD? None, the available treatment only treats the symptoms. When you have time go the expert forum for a reference.

You are merely dancing around the subject of cure and needlessly parsing and picking at the definition of cure.!  What's the point?.  
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976897_tn?1379171202
The point is very clear. The point is the way it's portrayed to people with the disease, the term 'no cure' is neither 100% accurate neither is it something people need to hear if it isn't accurate. If someone smokes 60 cigarettes a day and eats nothing but high fatty takeaway meals every day, you will likely find the disease will no longer progress if those factors are removed. What I'm saying is, the cause for the disease is found in many people and can be stopped and in my opinion this is 'cured'. If playing with words is going to happen on both sides of the coin, I think it should at least be accurate.
In the last two years no disease progression has been observed in my angiograms. Why did it suddenly stop? If it was genetic then this wouldn't have occurred. Other factors were obviously the cause and have no been removed through personal changes. If a disease stops, is it not cured?
Your viewpoint on me dancing around on this topic is a strange opinion and it should seem obvious that I'm only trying to point out to people that the disease can be brought under control.
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367994_tn?1304957193
____The different opinions are probably due to the doctors' bias for their specialty.  Most doctors would not recommend any serious intervention for CAD unless there are symptoms and there are exceptions, but if there are exceptions, then it would be your responsbility to understand with consultation what are the benefits and what are the risks.  From your post you are symptom free, can intervention guarantee no symptoms?

When there is angina (symptom of occluded artery) the option of medication will dilate the vessels (not a cure) and increase the size of coronary lumen (channel) and relieve any stenosis that is causing pain.

A stent mechanically opens (dilates, not a cure) the vessel  and hopefully the risks of restenosis, heart attack from a blood clot or collapse of an ill fitting stent, possible serious problem from the doctor's error and casue a rupture, system malfunction that rutures a vessel, etc.  Your doctor gave a 70% success from no serious affect. (presently no symptoms vs. 30% possibility).

A bypass does not provide a cure, if it did I would be the first to have the procedure.  Bypass with native veins are sstill vulnerable for occlusion,  limited number of vessels available.  My brother-in-law had bypasses and has been told there are no more vessels available for another bypass.

If you had 100% blockage of the LAD, unless it was at the distal end, you would not survive without immediate help.  But it is possible that you gradually grew collaterals as the vessel was becoming occluded.  Also, there is some evidence in acute heart attacks there is collateral growth.

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367994_tn?1304957193
"What I'm saying is, the cause for the disease is found in many people and can be stopped and in my opinion this is 'cured'. If playing with words is going to happen on both sides of the coin, I think it should at least be accurate".

If you cannot provide a professional source that refers to a stent being a cure, your postion is merley your personal opinion and a misunderstanding of the procedures available.  I can provide doctor's opinion from the expert forum.  You want to argue, but  I'm not going to waste my time.   We can agree to disagree on the meaning of cure, but I don't believe a professional according to you refers to a stent implant to be an overall cure. Its the overall CAD that is the reference  not the individual remedy of a specific occlusion.  
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1262435_tn?1270315459
In the mean time, I am taking 20 of lipitor, 5 of concor, and aspirin daily. Does it sound normal and right medication for my situation. I am eager to find out any other suggestions to discuss with my doctor.
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367994_tn?1304957193
I can understand your concern with serious choices that involve your health.  I suggest you post your question of concern with the cardiac experts' forum.  If you page down and to right you will see the appropriate link.  Unfortunately there doesn't seem to be any response to followup questions so may want to draft your question with that in mind.  Good luck and take care.
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976897_tn?1379171202
"We can agree to disagree on the meaning of cure"

Yes, I think we should end it here because I don't think you've grasped anything I''ve tried to say.
Amen
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976897_tn?1379171202
A Cardiologist will give his opinion on what benefits you should receive when a procedure is performed, but this doesn't mean this will be the outcome. To be honest I think there is much still to be learned about the problems with angina. I was told by lots of cardiologists over a two year period that my blocked LAD was the big problem, if that was treated then I would be running around again. Well the blockage has been removed and to be honest with you, there's not much difference at all. I witnessed the huge increase of blood flow into my LAD when he broke through the blockage, I even witnessed my ECG suddenly change. Everyone was excited, thinking I would now have no physical restrictions. How wrong everyone was. So, before you have any procedure, don't assume it will be a magical solution to your symptoms because that isn't reality. Some people obviously feel great after a blockage is treated, but many do not.
Now cardiologists are stumped because they can see no reason for my angina on any scans and my EF is 70%.
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367994_tn?1304957193
Yes, I think we should end it here because I don't think you've grasped anything I''ve tried to say.
Amen"
You can stop the argumentative dialog because you are not offering  any insight. You have an extensive record for arguing and insulting, and it is disruptive.  I understand, so please...
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Avatar_m_tn
My recent report says , Occlusion of Proximal segment of LAD with poor opacification of mid &distal LAD....,while my 2d echo report says - Ejection Fraction is 60 percent...What do I make of it?
And my CT angiography says - Significant stenosis (>70%) of distal RCA & mild stenosis of mid RCA. That was the impression from my CT . Would someone analyse this for me. Should I ignore the LAD and go for a stent in RCA . The rest of the report is normal except for some calcification which is quite high. 208.5 (Normal being up to 100)
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976897_tn?1379171202
what are your symptoms?
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Avatar_m_tn
Reading what is here has showed me that there is no right answer. Each case will be different, each doctor will have his own opinions. Im 53, I had a heart attack on thanksgiving day, went to the emergency room and was told my lad was 100% blocked. Half an hour later a full metal stent was put in and the pain went away immediately. Its now going on Jan. 1, so far so good. I have type 2 diabetes that im controlling with diet and meds, plavix and asprin for the blood, 30 min. of walking a day, had my last cigarette on thanksgiving day. I wake up every day wondering if it will be my last. I came here trying to find out if my time is limited or if I keep doing what Im doing will I live to a ripe old age, I guess I will have to keep looking.
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Avatar_m_tn
Of course, you can keep on looking, but I doubt that you will find an answer. I had a Calcium Score of 1242 with the LAD at 782, no Angiogram and no Angina. But, there has to be considerable blockage just how much I don't know. The cardiologist said, you'll live another 30 years which would really be an accomplishment as I am already 75, so I dismissed it and stopped looking for answers.
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1262435_tn?1270315459
I too was looking for the "right answr". I was getting increasingly confused. Doctors giving me different opinion s. I had my surgery on 25/6/2010. A year & a half later, I feel that one can never the find the right answer.
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Avatar_m_tn
I don`t see any comment about chelation therapy. Why?
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976897_tn?1379171202
Chelation hasn't been proved to work. If you imagine chelation removing calcium from the arteries, then this would make a diseased vessel much more risky for causing deadly blockages. Calcified plaque is often in the form of a 'cap', holding back the soft plaque inside the artery wall. The whole idea is to hope this cap doesn't break. If chelation makes the caps weak, lots of soft plaque will leak into the artery, causing a clot further down the vessel. The artery lining will then signal passing platelets to stick to the damaged area, where the cap was, and form a second clot. Very rarely do people survive from a double whammy.
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Avatar_m_tn
try this    http://www.trackyourplaque.com/
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Avatar_f_tn
Thumbs up for all the good information you have given 100LAD.  I'm someone with a 100% blocked LAD.  I am on a medical regimen.  Drs. Samin Sharma and A. Kini at Mt. Sinai in NYC were unable to open my totally occluded artery.
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Avatar_m_tn
hi Kenkeith

I agree with your  comments

My question before you is the following

My dad has 100% blocked LAD. He has blockages in other 8 areas as well. He is stable and doesn't have any chest pain as such.

He suffered an attack 3 years ago and since then he was on medication. it is only 6 months back that he went for an angiography. It was just routine. He didn't have any chest pain or other problems when he decided to go for an angioplasty.

The angioplasty showed blockages at 6 to 7 years with LAD blocked 100%. The doctor advised us to go for an bypass immediately.

Now if he is not facing any problem then why does he need to go for an bypass?

He can walk for 40 minutes. now we are in a dilemma whether to go for an bypass or not?

Pls mark a copy of yoru reply to my email id ***@****

Thanks
Dhiraj

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Avatar_m_tn
You are a little late in agreeing with Kenkeith's comments. He hasn't been on this forum for a long time. However, my thoughts on this are: if your dad's LAD is blocked 100% he has to have developed collaterals. If you bypass the LAD chances are the collaterals will close and if the bypass subsequently closes up on him again, they might not open up again - end of the line. Did your dad have a Nuclear Stress test to determine if the blood supply to the heart is ok otherwise and no damage to heart tissue has occurred?
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976897_tn?1379171202
Be very careful when making your decision. You have to take many things into account and weigh up the odds. Firstly it is very obvious that collateral vessels are feeding into the LAD, else he would be in a far worse condition, probably heart failure or worse. You say that there are other blockages, apart from the LAD, and what you need to determine is which vessel is giving blood to the collaterals to feed the LAD. If that vessel becomes restricted too much, then the collaterals will give much less feed or even close. My Left circumflex has been my life line for years, and this is the vessel feeding collaterals. So far this vessel has received 3 stents and it is still wide open. Cardiologists fight to keep this vessel healthy and open so my LAD gets fed. I had a bypass in 2007, and after 3 months I suddenly dropped to my knees fighting for air. After less than 2 minutes I felt fine. An angiogram revealed that my bypass had failed to the LAD and after 2 minutes my collaterals from the left circumflex vessel re-opened making me feel much better. You are right to wonder why surgery would be recommended if there are no symptoms, but you need to establish where the LAD is currently getting its feed from.
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Avatar_m_tn
Hi Kenkeith,

In the angiography report of my father, doctors diagnosed 100% blockage in LAD (although this was not the cause of his recent heart attack). There was another blockage of 60% in right coronary artery and the clot got stuck there which caused the heart attack.

The LAD had total occlusion and has been calcified because of which they are not doing PTCA (angioplasty) in that and suggesting bypass surgery.

My questions :

1. This LAD seems to be blocked for more than 5 years and the collateral vessels are formed which are supplying enough blood supply to the muscles. Do you think this is good enough and can be managed with medication

2. Should we try angioplasty (stent) in this artery although doctors dont suggest that as forceful angioplasty might rupture the vessel

3. Can we go ahead with the medication only and how feasible this is.


Current Medication he is undergoing:

1. tab. Clopilet-A    [0-1-0]  (to be stopped 5 days prior to surgery)
2.tab. CAAT 40mg (Atorvastatin)    [0-0-1] (till review)
3. TAB. MEt-XL 25 mg (1-0-0)
4. TAB Hopace 2.5 mg (0-0-1)

Link to Angiogram report :

https://www.dropbox.com/sh/snalmz9wovpu3rp/vbN2wxrpYO
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976897_tn?1379171202
kenkeith isnt here anymore.

1. A nuclear scan will establish the answer but also the angiogram will show the retrograde fill of the LAD and the vessel size. The vessel size will be a good indication of how well the blood feed from collaterals is compensating.

2. To remove a total blockage heavily calcified is very risky indeed. There is a huge chance of the catheter going through the artery wall, causing an internal bleed. If pierced, the artery can also start to break up with the blood pressure.

3. This will depend on important factors. Firstly where are the collaterals getting their feed from? probably the RCA. If this vessel is clear and maintained in the future, then yes medication alone is possible. It depends also on symptoms.
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Avatar_m_tn
Thanks a lot for a quick reply ed

Doctors suggested MPS test (I assume this is called nuclear scan that you mentioned in your ans too). I think this test will give the indication about the amount of blood feed from collaterals and the total amount of blood reaching different muscle.

Just to inform you His LVEF in echo came out to be 55% which seems to be good and he is not having any chest pain or any other problem
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976897_tn?1379171202
Then the collaterals are probably doing a good job. However, if they are being supplied by the right artery, this must be well maintained.If the right artery blocks, it will effectively cut off the supply to both the right and the left.
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Avatar_f_tn
I have 3 stents in the every end of the LAD. 3 cardiologists have said they would have never stented.  This was in 2007 and now I am having chest pain and ischemic changes to that area. The cardiologist is saying I need to live with it and maybe it will occlude and I would have no more issues. Said it will not kill me. I am not sure I am okay with that. Should I get a Cardiac Vascular Surgeons opinion?
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