I am very surprised that a dissolving agent hasn't been developed for this. Imagine having a cath done, but instead of applying contrast, a powerful dissolving agent is put into the coronary arteries. This would clear not only the major coronary arteries, but work its way down into capillary level. However, the danger is what's left behind, the soft mess hidden under the plaque. This is a mixture of pure fat and several other cells which have become stuck. This is the really dangerous stuff to the system. So, stage two would be some kind of powerful emulsifyer to dilute the fat into the blood. I wouldn't fancy the idea of this diluted fat going through the rest of my body, it could end up making a mess somewhere. I would have thought this process would require a rinse and quick removal using suction. Of course there then follows another problem. The lining of the artery will be a real mess, all humps and bumps where the disease was. Of course this would heal over time, but good anticoagulant will be needed to stop further clotting. Will other cholesterol lipids get stuck into the damaged wall and start atheroscerosis all over again? probably.
So no matter how you aim at it, the problem looks as though it will return.
"The lining of the artery will be a real mess, all humps and bumps where the disease was. Of course this would heal over time, but good anticoagulant will be needed to stop further clotting."
It is interesting how the thought patterns of two people who don't know each other from Adam will sometimes match purely at random. I was performing a thought experiment (i.e. woolgathering) about this exact scenario just the other day. It seems to me that the result of merely dissolving the cholesterol, plaque and whatnot from the inside of arteries would be markedly similar to what happens when you clear a clog out of old PVC drain pipe. I've worked with the stuff for years, and have noticed that old pipe is scored and pitted on the inside by impurities caused by whatever gets washed down the drain over the years. Merely clearing out the clog wouldn't remove these imperfections, and in the case of your arteries, they would become an attractant for clots and provide a perfect base surface for further deposition of material.
I suspect that nanotechnology will eventually become part of the treatment of choice for this issue. After a good dosing with some sort of X-factor "unobtainium"-based flushing agent to remove plaque, nanites could be released that would travel in the bloodstream to the site of arterial imperfections and smooth them, much like a sander.smooths a rough piece of wood. And being on a microscopic level, the "sawdust" left over from this would easily be absorbed by the body just as it would any other small foreign object, and not create an additional danger of stroke.
While such technology won't happen in my lifetime, perhaps my family's spotty history of heart health or lack thereof won't be an automatic given for my descendants.
A bit of a basic description :) but not really practical. The problem is, the lining is made from living cells and you can't just split a cell in half to align it to the cell, or missing cell, next door.
I think maybe a better solution would be to use the bio degradeable stents which are coming up. A long stent could be inserted into the rough artery, the longer the better because it would require less pressure to hold it in place, it would be less likely to slip.
After three months or so, a nice smooth lumen should have grown and the stent will have dissolved. Eh Voila, a nice new smooth lining.
This is the way stenting is supposed to be aiming in the near future, but I think it will require many cardiologists to alter their methods of practice. Let me explain...
My first stent was due to a clot which was ruptured plaque in my obtuse marginal (OM1).
The cardiologist removed the plaque and most of the clot, leaving only a small amount of soft fat. The stent was then inserted and it only had to squeeze against a small amount of soft material. The same happened with my LAD in September 09. The cardiologist obliterated the plaque using different tools, leaving only the smallest amount of fat in a few areas. 5 long stents were implanted which again ended up having to only squeeze a small amount of fat. My stents are concentric in the arteries and are not causing untold damage to the lining. Now this, from what I have been reading, is not always the way of practice. It would appear some cardiologists simply squeeze a stent against the hard plaque, forcing it into the artery lining. Some plaque can be like soft chalk, but it can also be much much harder. Imagine what it must be like when a Cardiologist squeezes rock hard plaque which is irregular in shape, into the artery lining. It will not squash down, it will put a lot of extra strain on the artery, forcing the wall outwards and the plaque will probably cut into it. Also, the stent will unlikely be concentric in the artery.
If bio degradeable stents are to be of useful benefit, then all the plaque will have to be removed and a good portion of the fat. Maybe this is why they are taking so long to come into play, because I know the stents have existed for some time now.
"A bit of a basic description :) but not really practical. The problem is, the lining is made from living cells and you can't just split a cell in half to align it to the cell, or missing cell, next door."
Meh. Good thing I'm an amateur plumber and not a cardiologist. I guess the Tim The Tool Man Taylor wing of the Mayo Clinic I'd planned to leave some of my millions of virtual dollars to build is out of the question now ... ;)
Your observation that current stenting technology can place additional strain on an artery seems to be a sound one. All that plaque and corruption and rough material has to go somewhere, and in the case of stenting, it simply gets crushed outward into the walls of the artery the stent is presumably designed to protect. That couldn't be good in the long term because any stent by design narrows and compromises the artery in which it is placed.
I will say I've never been comfortable with the whole idea of non-biodegradable stents in the first place. In their current form, much like your chronically unemployed brother-in-law, stents remain there forever, drinking your last beer and leaving disgusting smells in your living room couch as they eat Chee-tos and watch Youtube videos all day long. The idea of a biodegradable stent that does its job then goes away is much more attractive to me from an engineering and a medical standpoint.
Even bio degradeable stents pose a problem, well, one that I can see anyway. A lot of the fat is actually under the natural Lumen of the artery. How can you possibly remove this? I was given an option by a cardiac surgeon to treat my LAD other than a redo-bypass/stenting. He proposed to perform a complete 'open end type arterectomy' on the vessel. This involves making a small incision at the base of the artery and pulling out the entire Lumen layer. It can be very tricky and was a VERY risky option. The only bonus would have been to remove ALL the fats and disease, including that under the lumen hidden away. From what I can gather, and even then there are many different opinions, the fats under the Lumen will eventually be removed by the body. However this takes lifestyle changes and medication to ensure you keep your blood chemistry well balanced. So, maybe in retrospect, if an artery has the obvious plaque removed, is stented with a bio degradeable stent, the body will do the rest. I have a feeling it will be one of those things where only time will tell when it hits the public.
What is the overall credibility of chelation therapy?
I have been kicking myself since responding to this on another post. I have no idea why, but I confused chelation with eecp. Chelation in my opinion is just a nonsense therapy which clinics are making a lot of money from. A bit like waving a magic crystal over your body to cure cancer.
However, EECP, does look very promising. Many patients who experience angina for no explanation (even with no seen blockages) seem to benefit a lot from the treatment. It does seem to require top ups though.
Just a personal opinion. I don’t trust chelation, and I think that EECP is acting more like a placebo in patients with unexplained angina, for the simple reason that unexplained angina has no apparent cause, and logically nothing can be solved if the cause is unknown.
The only positive and decisive work on this subject that i've found, which appears safe and may allow the body to reverse the build up of plaque is the dietary approach put forward by Dr Caldwell Esselstyn.
What do other authorities say about this treatment?
Food and Drug Administration: In the absence of evidence of safety and effectiveness, the use of this treatment for atherosclerosis is investigational. To date, no physician or sponsor has filed a plan or protocol to study its (EDTA’s) use in such treatment.
No party has ever provided us with an organized submission attempting to show that it is an effective therapy in atherosclerosis; instead, we have been handed unorganized data without any attempt to describe a formal study.
Under the circumstances, we have had no choice but to attempt to prevent improper promotion of the drug and to point out its unproven status.
American College of Physicians: Chelation therapy with EDTA has been used in the treatment and prevention of atherosclerosis. Because of the risk of severe renal (kidney) toxicity and lack of objective evidence suggesting therapeutic benefit from EDTA therapy … such therapy should be regarded as investigational and (should be) conducted under carefully controlled conditions in an academic institution by experienced investigators.
National Heart, Lung, and Blood Institute, National Institutes of Health: There is no reason to expect benefit from chelation in the management of arteriosclerosis. More importantly, there has been no scientific evidence of such benefit — and there is scientific evidence of no benefit.
American Medical Association: The AMA believes that chelation therapy for atherosclerosis is an experimental process without proven efficacy. They have also reaffirmed their 1984 House of Delegates Resolution stating:
"…there is no scientific documentation that the use of chelation therapy is effective in the treatment of cardiovascular disease, atherosclerosis, rheumatoid arthritis, and cancer;
"…if chelation therapy is to be considered a useful medical treatment for anything other than heavy metal poisoning, hypercalcemia, or digitalis toxicity, it is the responsibility of its proponents to (a) conduct properly controlled scientific studies, (b) adhere to Food and Drug Administration (FDA) guidelines for the investigation of drugs, and (c) disseminate results of scientific studies in the usually accepted channels."
American College of Cardiology: There is insufficient scientific evidence to justify the application of chelation therapy for atherosclerosis on a clinical basis. At the present time, therefore, chelation therapy should be applied only under an investigational protocol.
Isn’t it true that practicing physicians and medical organizations oppose chelation therapy because widespread use of this procedure would mean a loss of income to cardiovascular specialists, particularly surgeons?
No. Organized medicine opposes chelation therapy because it’s an unproven procedure and it involves extreme risks to patients who receive it.
The truth is that physicians who treat cardiovascular diseases could significantly increase their income if chelation therapy was a scientifically proven treatment procedure. Many people have atherosclerosis, but only a relatively small percentage develop problems severe enough to require surgery. If chelation were scientifically proven, EDTA could be administered to everyone who had atherosclerosis. Surgery can be done on only one patient at a time. With chelation, the number of patients who can be treated is limited only by the amount of room in the practitioner’s office.
I suppose it depends on which source you read. I have read that eecp actually seems to promote the formation of collateral vessels. However, I agree that the placebo effect can cause a huge problem in results for research. I remember watching a test where a Doctor asked 6 patients with sleeping disorders to take part. These participants were lucky to get one hour sleep per night. She told them there was a break through with a new drug which would help them to sleep through the night and each person was given 7 days worth of pills.
After the week was up, the Doctor met all the patients. Guess what, every single patient was sleeping through the night without waking up. What was the new fantastic medication? sugar pills.
The power in belief is amazing. I wish a Doctor would give me a sugar pill and say its a new drug that stops angina. Maybe it would cure me.
I don't have any information on unexplained angina studies with EECP therapy, but my research indictates EECP is effective in about 65% of the EECP procedure population by developing collateral vessels. A placebo can't develop vasculargenesis as a placebo is psychophysiological in application and no pharmacological effects.
An experimental treatment must show better results than the placebo effect to be considered effective. If EECP is 65% effective, the results are self-evident for efficacy Also, conservative insurance policies cover EECP.
"If EECP is 65% effective, the results are self-evident for efficacy "
I think one has to be very wise here because many clinics state different research results. I have actually seen a range between 31-75% success rates and none have stated where the research was done and by whom. EECP is not a long term solution either, but again it depends who you believe. I have read ranges between 1-5 years before the effects die off. I believe that the FDA has approved this system and a report stated "With this new indication, we estimate that the percentage of eligible patients within the average medical practice who would likely benefit from EECP could grow from 2% to upwards of 15% to 20%," said D. Michael Deignan, President and Chief Executive Officer of Vasomedical". "These patient volumes would translate into a market opportunity for our cleared indications of an estimated $2 billion in sales and services over the next several years in the United States alone".
"Congestive heart failure afflicts more than 5 million people in the United States alone, with more than 550,000 new patients diagnosed every year. It is the single most expensive disease state in the nation, accounting for more than $40 billion in direct and indirect medical costs"
There is a list of conditions which eecp treatment will be denied. Example of which are recently inserted stents and valve defects.
This is a video showing the treatment in action. As you can see, it does make the patient move around on the bed and I have read it has been uncomfortable for some.
A meaningful statistic for evaluation alludes conclusions as a control group is not blinded to randomization. Also, there are 4 different categories of NYHA functional classification, etc. and what condition is being evaluated (tolerance for work, angina, V02 level)etc.
"Enhanced external counterpulsation (EECP) treatment can improve exercise tolerance in patients with ischemic heart disease; however, the possible benefits of EECP in patients with stable heart failure (HF) and left ventricular dysfunction (LVD) are unclear. An open pilot study showed significant increases in exercise tolerance in HF patients undergoing EECP. Thus a larger, controlled study of EECP in patients with stable HF (New York Heart Association [NYHA] classes II and III) and LVD was undertaken.
Methods and ResultsThe PEECH trial is a controlled, randomized, single-blind, parallel-group, multicenter study of 187 patients with symptomatic but stable HF (NYHA classes II and III) and an LV ejection fraction ≤35% was designed to assess the efficiency of EECP in patients with stable HF. Medical therapy is optimized in all patients based on the recommendations of the Heart Failure Society of America (“Usual Care”), and then randomized between 2 treatment groups; UC or EECP (35 hours over 7 weeks).
ConclusionEfficacy measures include standard exercise tolerance tests on a treadmill (modified Naughton protocol), with measurements of peak oxygen uptake and exercise duration time; quality of life questionnaires; NYHA classification; and neurohormonal markers of HF".
EECO therapy involves 35 weeks (1 hour) of treatment. It is counter pulsation with pressure cuffs on the calves thighs and buttocks and monitored with an EKG. It increases the blood supply to arteries feeding the heart muscle. Just before the next heart beat, all the cuffs deflate at the same time, which decreases the amount of work the heart has to do.
Strain on the vessels may not be an issue with EECP. Enhanced external counterpulsation (EECP) has been demonstrated to be an effective method for the treatment of atherosclerotic vascular disease. However, the exact mechanism underlying the beneficial effects of EECP is not completely clear. We hypothesized that EECP leads to improvement in ENDOTHELIUM function, contributing to its clinical benefits. .
The computational results show that when EECP is applied, the blood flow rate and the wall shear stress level of the artery are increased in a cadiac cycle, as well as the pulsatile character of blood flow and wall shear stress. Which are possibly the hemodynamic actors that lead to the improving of the endothelial function which is thought to be directly relating to the atherosclerosis
So what we need to wait for is the cheap home version to be released so we can all plug in at night for an hour.
What would be interesting is to know if it prevents disease from occurring in people with a strong family history of heart disease. I suppose that kind of research is very difficult because how would you know if they were going to develop disease in the first place.
Do you think it benefits other organs, such as the liver and kidneys?
I wish to add on the subject of EECP's efficacy , in continuation of ed34's
comments on 17th Feb. to this column.
I am a patient of PAD as also CAD aged 69, and had CABG 13 years back and continue even today heart medications following the heart bypass surgery. My vascular surgeons ruled out surgical interventions
for my PAD and CAD. Besides medicines for PAD, he advised me to try
any alternative therapy like EECP, if I so desire. I did opt for EECP.
The point I wish to make is, that artheriosclorosis is a silent killer, by
slowly reducing blood supplies to my brain cells, eye nerves, ear nerves
as I saw it myself by the doppler test of my Carotid arteries in neck zone.
When my vascular surgeon suggested an abdominal ultrasound, I got the shock when it revealed that my kidneys are having symptoms of damages. A scan of kidneys revealed that because of poor blood circulation, both the kidneys are performing below normal efficiency for
quite sometime and thus damages to kidney cells are evident.
You see the dangers,how arterial b lockages are causing undue harm all over our body. No surgery can remedy this, except diet, exercise and
EECP. EECP certainly helps blood circulation with added force and
floods the starved-cells with oxygen. By this they stop the decay at
cell level in different parts like, kidney, prostrate, eye, brain cells etc.
Beyond doubt, EECP is a welcome boon to any old person to keep in
better health all round. My own experience proves it.
But is eecp a cure? From what I've read, most people have to have the treatment repeated at regular intervals. All we are doing is creating natural bypasses in the form of collaterals, but we still know very little about them in reality. Do these vessels disease over time? how many can we form?
I was the same. I was told it's because when you have heart problems there is a tendency to store more body fluid. I remember when my LAD was opened, I sweated much than usual for about 3 months, and my weight dropped to its original, around 66.5kg
I don't think so. I remember reading somewhere that if you want to lose weight with exercise, you have to do it alternate days. It was found that you burn more body fat on your rest days, because during exercise you burn carbs, instant energy. Fat is a slow energy provider.
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