Problem after 2nd bypass.

[guyinla]

I am a 40 years old unfortunate male with severe CAD, diabetes and narrow coronary atreies. I have
been living in California last 21 years and finished graduate school here.
Originally from Bangladesh. Father had CABG X2 when he was 65 and living.
Both parents have diabetes. I am 5-5 and 135lb. Very bad coronary arteries
but very good heart (relatively speaking)

My events:

9/97 MI, CABG X 3 at St.Joseph Burbank, CA. Dr. Taro Yokoyama
9/02 Stent in one of the vein graft at St. Vincent Hospital
11/03 Another stent on the same graft. Valley Preb Hospital
04/06 Mild MI
05/06 RE-DO CABG X 5 at UCLA, Dr. Hillel Laks
08/06 Ecocardiogram Result - Good. LVF 60% very minor wall thickening from previous MI
08/06 CT Angiogram - 1 closed off, 2 to the right sends very low amt blood and 2 to the left are good.

Complain: Mild chest discomfort. Aching in Chin (not the jaws) usually
caused by exertions (emotional or physical) . Middle of the night weakup
with blood pressure usally 155/100. However usual blood pressure <120/<80
65-70 Heart beat. Medications: (glucophaz, glipozide, isosobride, atelenol,
plavix, asprine).

Can anyone help me why I am having this discomfort, and if re-do cabg closed
off, then what do I do?

PS. I have only Left arm artery left.

[guyinla]

Hi asked my Primary Care about TMR, and he didn't know much about it. He told me he will speak with the Cardiac Surgeon. I had my surgery 4 months. Untill three months I felt I was going great. Now I feel I am going backward. Especially after finding out 2 grafts to LCA hardly sending any blood, Ramus graft already closed off and 2 on RCA is ok. I am planning to go back to work tomoroow (Monday) wish me luck.

[heartdoc]

I am surprised that no one has mentioned TMR (Transmyocardial Myocardial Revascularization).  It is an FDA approved and insurance-covered laser treatment to the heart that has been documented to durably (5 years +) and significantly improve angina in patients with refractory angina, typically after multiple CABG and stent procedures.

[AustinCAD]

You might want to try and find the book by Dr. Enas Enas:  "How to beat the heart Disease Epidemic among South Asians...."   This has a lot of information about premature CAD in South Asians and specifically adresses high Lp(a) as one of the risk factors that contributes to it.  This also leads to restenosis etc and the agressive spread of the disease.  One of the ways to adress it is to use Niacin (unfortunately at very high doses).  The book has a lot of general information and would be a good buy  for everybody (i.e. not only Indian). This forum also has good info about Lp(a) - it suggests that no clear evidence exists for treating for it (elevated levels may be reporting a diseased conditions and not causing it like fever reports infection and is not the cause).   Balancing both opinions you might still choose to try and reduce Lp(a) if you can tolerate niacin under medical supervision (usually contraindicated for diabetics I believe but your physician may be able to guide you better).

[guyinla]

I can definitely understand about the nitro. I get so paranoid about everything. I use pop nitro pill and spray like there is no tomorrow. Bad part - my body is becoming resistant to it. Before my surgery (4 mo) ago, they asked "So how many times do you spray nitro or take the pill a day?" - I replied "Umm. between 30 to 40 times." Next thing I knew they admitted me to the Hospital (lol).

PS. After 2nd CABGX5 - Now I use few times a day. Last month result. Ramis graft blocked off, 2 LCA grafts moderate flow and 2 RCA grafts great flow. I just got the CT Angio CD but can't make it work on home PC.

[NitroOnTap]

The above message was for you. Sorry for the mixup.

[NitroOnTap]

Man, I hope you enjoyed that cheeseburger. I wish I had one. I get one about every six months. It is a real pain to have to choose between a good burger or fried chicken. I am on a diet of "if it is processed by man, I cannot have it." I prepare everything from a raw state (nothing fried), so eating out once every six months is a real treat.

My Cardio, Dr. Martin was the one who recommended Chelation Therapy. She probably did that because of my condition. They cannot redo my bypass so the only options I have left are alternative treatments. I suck down a lot of Nitro hence my user name. lol

[guyinla]

I saw my doc today, asked him about Chelation Therapy and his opinion was negative. By the way my PCP happens to be the director of the medical center, so I don't think he will pay for any Chelaton Therapy. I saw my Lab result today. (However it was done non-fasting) Total CHL 148, LDL 39, HDL 39 (darn), Trig 343 (holly * - Honestly, I had an ultimate cheese burger 1st time in a month a my doc decides to do a surprise lipid work 1 hour later) but my Lp(a) was 68. I started back on Cardio-C - The Pauling therapy. If you guys know anything about Lp(a) please post here.

[chrisr]

From my first discussion with the chelation doc, it appears that the processs itself removes alot of minerals and vitamins from the body so it is essential that these be replaced hence the high vitamin treatment. Most of the material removed is excreted via the kidneys so these must be in good shape and some people apparently do suffer some kidney damage. I have just received some hopeful news that I may be included in the NIH trial here in Tampa but must have all the necessary blood and kidney tests. I have obtained alot of info on chelation and arteriosclerosis and natural treatments from a website: Afibbers.org. Although dedicated to people with Atrial fibulation you can search chelation/arteriosclerosis and get alot of info. Will keep in touch. Chris.

[guyinla]

Thanks for your post. I read up on EDTA whic never talks about Vitamin-C / Lysine therapy or LP(a). And Vit C people never talk about Calcium. I am so confussed.

[chrisr]

Guyinla,Thanks for the info and address. Have seen the Cardio-C but never used it. May try it. Like you said its unfortunate with folks of E Indian origin like myself also we do have small arteries and the diabetes makes it even worse. Luckily I am over 50 and may try the chelation if I can be included in the trial. Its quite expensive and insurance does not cover it. Will keep in touch by email.

NitroOnTap, I have just transferred to the Tampa area after doing my last surgery and followup in CCF, Cleveland. If you don't mind I will like to get references to a good cardio or 2 in Tampa . I am in the Odessa area so close to the Pepin Heart Institute. Will also try to get in to the chelation research trial which I just read about. Hope I am not too late. Will appreciate your kind assistance.
Thanks,
ChrisR.

[guyinla]

I honestly can not say Cardio-C made me feel any better; except psychologically initially. I have few cans sitting in kitchen shelf that I don't even feel like taking it.

[STUARTCBRANDT]

My mother and her husband have had over 50 IV Chelation treatments and are doing great.
She lives in Homestead Florida.
My mom said she is feeling much better after the Chelation,
She keeps talking about some NIH study in Miami that the seem to be working on.
I guess they are trying to find out it really works and how well.

IS THE CARDIO C WORKING FOR YOU AND HOW WELL.

Stuart Brandt

[STUARTCBRANDT]

To guyinla,

I think the Cardio-C cant hurt if it helps great if not oh well,
I have been reading up on Vit C and it does seem to help some with heart problems.
I really hope you get better I am 42 and want to live a long life, plus my Six kids need me to be around much longer.
Look up Dr Linus Pauling PHD he is dead but his work is still in lots of places.


Stuart Brandt

[NitroOnTap]

I did quit for about 6 months and I still had the pain because of the grafts that had closed down. My Cardios do not want me to drive over 50 miles per week and NO driving in rush hour traffic. This allows me enough miles to make doctor appointments and chow/med runs.

[SeanS]

You may find, Nitro, that after quitting smoking your chest pain may subside...mine sure did. I had a bypass 3.5 years ago. I had my last cigarette on the way to the hospital.

[guyinla]

There is a Jenny Craig ad

[chrisr]

After reading up on chelation I am also considering this route but want to do some more research because of my particular heart condition (AVR with Dacron patch). I have also seen the ad for the NIH research trial and hope to enroll if accepted. I do have regular dreams but they wake me up with heavy palpitations and almost always with high BP. I am now considering CPAP since a sleep test indicated mild to moderate sleep apnea with little or no REM sleep. I would welcome input from anyone who have done chelation therapy and what were their results one way or the other. Also whether CPAP helps with the night waking spells, palps and high BP?

[NitroOnTap]

I had a Quad bypass in Sept 04 at the age of 55, the day after Pres. Clinton had his bypass. When he says "I feel your pain", he is telling the truth. In Nov 04, my bypass failed. I have one and a half open. They cannot use anymore veins since they are too small. Attempt to stent failed also. So I live on Nitro. I would get chest pains every night so they changed my Nitro patch to night use.

Even then, I can get chest pains if I have a physical dream. I dreamed one night that I was a Templar Knight and in a sword fight. My oponent pressed my sword into my chest and I had chest pain. Then I woke up and sure enough, I was in a full blown angina attack. I have to sleep in my recliner since I get chest pains when sleeping flat.

My meds include Metoprolol, Plavix, Ecotrin, Cozaar, Pravistatin, Niaspan, Protonix, Darvoset, Amitriptyline, Combivent, and Nitro Tab/Spray PRN.

Over time, you will learn by the way your chest feels when to pop a Nitro. I do not know what else we can do in these situation. My Cardio will not let me work. I cannot walk far to exercise due to Spinal Stenosis. I know what it is like to get chest pains just from taking a shower, making dinner, or cleaning house.

I quit smoking 2 months ago. One more month and I can get into a Chelation Therapy Study they have going here. I hope that helps providing I do not get the Placebo.

My CABG was done by the Pepin Heart Institute. I have 2 Cardios at the Cardiovascular Center of Tampa, so I always have a 2nd opinion. It never hurts to have a second opinion.

[chrisr]

What a coincidence! Ihave an almost exact replica of your CAD history and procedures. 2 CABGs, stent implants in between with last OHS just last September and now still having chest discomfort but with nausea on exertion. I am also diabetic, hypertensive with high TG, VLDL and low HDL. I had a stress Echo in May 06 which showed EF of 55% but with Stage I dyastolic dysfunction. An Adenosine stress test last month also indicated some stenosis in the apical and inferolateral areas of the heart. My meds include Glucotrol, Coreg, Diovan, Zetia and Coumadin since I did have a Bicuspid Aortic valve replaced with a St.Jude mechanical. I am concerned about another Angiogram since I had 5 Catheterizations done last year including the 3 stent implants. The cardios have me off Aspirin/Plavix since they said that they bypassed the stents in my last CABG but I notice you are still on these meds. Fortunately I have never smoked but still afflicted with this severe CAD. And since my last CABG done at CCF I have done all followups at CCF. My chest discomforts usually suside with application of Nitro patch which may help you out. If you don't mind because of our very similar conditions I would like to keep in touch with you. My email is: ***@****.
Thanks, Chris R.

[CCF-M.D.-MJM]

Very good points.  If you are reading this, have coronary disease and still smoke, it is NEVER too late to stop!  There is no medication that can fight the negative effects of smoking, the only thing you can do is stop smoking.

[guyinla]

Thank you for your time. My apology, I am on Lipitor (40mg/day) Yesterday we (my doctor and I) decided to increase it to 80mg, since my Triglyceride was little higher and HDL is lower. For anyone reading this, I was a smoker since I was 20. At the age of 30 I had first MI and CABG X3, and I was not over weight. Please listen, CABG is not a fix for our condition; it is merely keeping us alive. I went on smoking even after my first CABG in 97. Now at the age of actually 39, I had second MI and re-do cabg x5 by one of the best surgeon in the country, I realized - CABG is a temporary fix. And I did quit cigarettes 5 months ago. So can you.

[CCF-M.D.-MJM]

Hello,

I am very sorry to hear about your premature coronary artery disease.  Just about everyone with coronary artery disease should be on:

aspirin
statin (lipator, zocor, crestor, etc)
beta blocker
ace inhibitor

I notice you are not a statin -- do you know why?  If you had muscle aches, we usually try another statin.  If that still doesn't work, we will at least use Zetia unless your LDL is already rock bottom.  Even if your LDL is less than 100, we still use statin medications in everyone with out an absolute contraindication.

Make sure you have very tight control of your diabetes.  Glucaphage is a great diabetic medication that we like to use at maximum doses (assuming normal kidney function) before starting another agent.

NO SMOKING (your probably don't but we can never say this enough).

Consider a second opinion at a major medical center if you haven't already had one.  If you do this, take with you your echocardiogram, lab work if you have it and the catheterization films probably on  CD.

I hope this helps.  Good luck and thanks for posting.