My MD says atypical case.

My MD has said there has been nothing typical about my case.  I'm 55yo male,NS,ND, walks regularly who had 2 failed stents in '99 follwed by CABG 2 months later. My original presenting problem was right arm pain on exertion. The angioplasties resulted fron an abnormal stress echo. After bypass the pain never really went away. I've had caths since that showed narrowing below the grafts but not appropriate for repair because they were diffuse and in smaller vessels. I follow the Ornish program and did 7 weeks of EECP the end of 2002.

Near the end of the counterpulsation the character of the pain changed from only r. arm (bicep) pain on exertion to additional broader chest discomfort and burning across the upper chest and down the center on exertion. As a result I had a cath in 1/03 that showed considerable improvement in the area below the grafts as well as some new small collaterals, but it also showed narrowing around 40% where the graft joins the native vessel (as well as some where the graft attaches at the upper end). My lipids other than HDL of 31 are good as are CRP and LPa. I take lotensin, norvasc, plavix, metoprolol, zocor, niaspan,levoxyl and prevacid. I just had a stress echo that showed a problem in the bottom of the heart and they recommend another cath. I wish I could make better progress and am looking for help. 1)Are there other diagnostic or therapeutic alternatives I should consider? 2)What is the best way to monitor my cardiac health on a routine basis (I have LBBB)? 3)Any suggestions for raising HDL?
4) How good are the new stents? Thank you very muc

[CCF-M.D.-RCJ]

Kiwi01,

Thanks for the post.

Unfortunately, many Americans suffer from this same type of aggressive coronary disease that you describe.  Despite the relative lack of cardiac risk factors, many still have very significant atherosclerosis.

(1, 2) The one thing in your story that stands out is the fact that your pain mat have been totally unrelated to your blockages.  This makes your care tricky because now it is difficult to follow you.  One suggestion is to undergo a gold-standard functional study, like PET scanning, to help determine if the pain you experience is really from the blockages.

(3) You are on a good regimen, with the notable exception of the lack of aspirin.  Two drugs that may or may not be useful would be ezetimibe (zetia) and fenofibrate (tricor).  Talk to your doctor.

(4)  For the right stenoses, the preliminary evidence is that the new stents are exceptional.  However, what constitues the "right stenosis" is very specific.

Good luck.

[carisue]

Hi, sorry to hear about all your troubles.  I have had great succsess with Flax seed oil.  Not only did it raise my good cholesterol but it lowered my bad as well.  Mine were quite hi 270/300 triglicerides (triglycerides) where over 400.  Hope that helps.  Good luck.  CariSue

[Kiwi01]

Thanks for your post.  I do take 3 grams a day of omega3 fish oil which is recommended for men by Dean Ornish.  For women he recommends flax. Apparently he has some concern that flax seed may contribute to prostate problems.

[4ZBirds]

My husband, now age 52, had 2 CABG surgeries in 2001 (a 4 vessel then a 3 vessel), is on similar meds but even more as he has familial coagulation issues. We had problems getting his HDL up on Ornish diet, in fact it went down along w/his LDL. We then switched to Mediterranean diet (as described in Dr. Yannios' book)  and as of this July his HDL has gone from 32 to 45. (He gets fish oil too.) Did not change or increase statins but have added Niaspan at 500 mg/day. About stents: In May of this year he had chest pain & got one of the new Cypher stents placed in his circumflex and so far so good. (before the 2nd CABG a regular stent was placed & occluded before the doc's eyes in the cath lab)
Good luck to you!

[Kiwi01]

I appreciate the doctors response. One thing I didn't understand - the doctor said the new stents work well for the right stenosis and the right stenosis is very specific. Do we know what the right stenosis is or which ones respond best to the new stents? Thanks for any information anyone has.