My fathers heart problem

[f2008]

my father is a heart patient and diabetic, had bypass surgery in 1997 june, now 1 month back his ecg was very disturbed and was admitted by his cardiologist, angio performed, the results are:
Left Main CA: Normal
LAD: Mid LAD with 100% stenosis,calcified. LIMA to LAD is patent, severe stenosis of LAD after graft insertion.
CIRCUMFLEX: Proximal circumflex artery with 95% diffuse stenosis, calcified. SVG to OM and Ramus(Sequential) totally occluded.
RIGHT CA: Proximal right coronary artery with 99% stenosis. SVG to RCA totally occluded.
recommendation: Medical follow up.
We went to almost 3/4 cardiologists but all said that no by pass surgery is possible now because veins are weak, i can send the angiography and thalium scan tests if needed. my father is 53 and now a days he have this pain in his back (cardiac). we live on 4th floor and we dont have any elevator in our building, my father go to office daily and drive car.
is there anything we can do or shall i send total documents and the cd?

[kenkeith]

Insurance usually pays for a second opinion.  You're not serious when expect something to be free are you?!

[f2008]

thats so expensive, cant they give second opinion free?

[kenkeith]

The doctors on the expert forum are associated with the Cleveland Clinic...the clinic competes with the Mayo Clinic for number one sdpot for the best doctors and hospital.  An individual can get a second opinion by submitting documents and cd.  

If you can't get an answer by posting on expert forum, or you can communicate by E-mail with the Cleveland Clinic for a second opinion.  If I remember correctly the cost is $500.00.

[sarashah]

yes the doctor told us that a natural bypass is created but one cannot depend on it because of its weakness and size of the vessels. doctor says that bypass surgery or angioplasty not possible. Why his veins or arteries are weak, were they weak when he had his bypass surgery back in 1997?
Doctors say that his surgery is not possible in pakistan, consult with western doctors and take him there... is the surgery possible anywhere in the world, which assures health...?

[kenkeith]

Your father has occluded vessels for a period of time, and he seems to manage well under the circumstances.  It is possible occluded vessels have developed a natural bypass with angiogenesis (formation of blood vessels) or the opening of collateral vessels.  

I have complete blockage of the LAD and vessels have bypassed the occlusion.  Veins are normally small and weak as they would be with angiogenesis.  It is possible the pain in the back is not associated with ischemia (lack of blood flow to the heart).
All the blockages relate to coronary arteries and for the doctor to refer to veins (weak) is puzzling.

I'm not trying to diminish the seriousness of the blockage, but there has to be some natural bypass or genearation of another circulatory system to supply blood/oxygen to the deficit area.

EKG is not a very reliable source other than for rhythm disturbances.  The EKG probably shows a depressed ST segment, and that can be something else or due artefact.

[f2008]

well he was diabetic when he had his first surgery, but his sugar level remains under control. he never have used insulin. he was taking lipiget some days ago but now the cardiologist has changed it to Rolip.

[Encephalomalcia]

The answer regarding no bypass surgery is most likely because he is diabetic and diabetics do not heal well.  If he had surgery, he probably would not heal.  If his veins are all weak, then there are no good veins to use for the bypass surgery.  If the arteries in his heart are weak, a stent most likely would not work.  Medication would most likely be his best option.  Cholesterol medication such as Lipitor.  Discuss medication with his doctor medication that studies show reduces cholesterol blockage in the arteries.