UNSURE if I should get stent...

I am UNSURE as what to do.... I mad a previous post... I will start from beginning if that is OK, by doing so mayb I can sort this out in my head some as I go along...
about 2 weeks ago I went to ER because of high BP... The EKG was not normal, the calcium score xray was 0... they asked who my cardiologist was, he was out of town so his partner did an angiogram the following day. It showed a 90% blockage in a branch off the LAD... He told me I also had another 40% blockagein LAD, but seemed unconcerned about it. He said he thot treating me with medication would be the way to go because the blockage was SOFT plaque and he was afraid to mess with the 90% blockage because it could make the LAD WORSE(???) I spent 2 nights and was sent home. ( I have no Insurance)... The meds made my BP fall to 83/48 and slow pulse in the 40s.. so I called my reg Cardioloigist (who I had seen in the past for PVCs) They had me come in. He looked at the pictures of the angiogram and said he wanted to stent the 90% blockage, but it was risky because of location, but that he thot he could do it...and that my pain would be gone. I said "I dont have pain"... He wasnt feeling good that day and told me so... he said }"You are going to give me a heart attack!" I guess because I was questioning him too much for his liking??...He then said he wanted to look at the VIDEO of the angiogram which was aat the hospital. His nurse called me in a few days and said" The Doctor wants to do an angiogram on your other leg on Tuesday"... I quesstioned her WHY? She said hold on... she came back and said he wanted to do a stent, she said the Doctor that did your angiogram did not do one because he was not your regular doctor" I told her I wanted to VISIT with my doctor b4 coming in for a stent. I went in to see him the next day I think it was... this was wednesday of last week I think. He said I have a 60% blockage in the LAD besides the 90% in the branch. He said he wanted to balloon the branch and stent the 60%. He said this is not for the pain, but to keep it from flaking off and possibly causing a heart attack. He said he was NOT concerned at all about the 90% blockage... he said in the old days they would just block it completely off. He said if that was my only problem he would not do ANYTHING except the meds. He said he would feel better stenting the LAD.

I am suppose to go in the morning for the stent and the balloon... I feel so uncertain about all this... I wonder WHY the first Doc opted for meds... THEN the second doc AT FIRST WANTED to stent the 90% blockage, then said it was NOTHING to worry about... but wanted to stent the blockage NOONE seemed concerned about at first. He mention that he noticed someething happened on the EKG while I was having the angiogram... I didnt  understand.. but he quickly said that will heal though, and brushed it off changing the subject, so I forgot to ask more questions about what he had just said.... I wish I knew WHAT it was he was talking about.

I have noticed how well informed many of you are. I am not, but have read enough to know whether to stent or not is sometimes a very difficult call. I hope I may gain some peace of mind, or further insight as to whether to go ahead  with this. What do you feel you might do in my situation? Thanks so much for reading, I hope I made sense.

[woogie50]

I forgot to add... We carried health insurance for years and years... but had to drop it about a year ago... The doc asked about this... He said he could help us out by getting the stent& balloon  from a friend... he also said he wasnt worried about his payment, but tha the hospital would have to have some payment ... The hospital called us to say it would be 3,800.00 for an angiogram. The doctor had not told the hospital he was doing a stent also... I assume the doctor is trying to do us a favor... I feel fortunate that I found a doc that would do this since I dont have insurance.

[ed34]

I'm confused about the remarks from both your cardiologists, but the first one does seem to make more sense in a way. To not be concerned about a diagonal vessel off the LAD becoming completely blocked is a bit nuts to me. This can cause all kinds of problems and your EKG is abnormal, along with your BP. I personally think it's likely because of the 90% blockage. We don't live in the 'old days' and that's irrelevant. Besides, he doesn't say how much those patients suffered in the form of angina. The blockage is probably right where the diagonal vessel joins onto your LAD which makes your first cardiologist correct. It is risky to play around with this blockage. If this was my body, and that's all I can go by, I would probably have the ballooning to the 90% blockage but tell them to leave the 60% alone. Ballooning is not very successful, which is why stents were designed. You have around a 40% chance that ballooning will keep the vessel open. It could collapse very shortly after ballooning, even to 100%. However, in the near future this vessel could very easily become totally blocked as the plaque continues to build up. So I would take the 40% chance and have it ballooned. They will probably have to balloon it more than once anyway. The 60% blockage is something I would tell them to leave alone. The first cardiologist estimated this at 40% and the second at 60%. It's probably somewhere in the middle, 50% which is fine for blood supply. If in the future you start to get angina symptoms, this can be addressed, but with good lifestyle changes you should be able to stop this blockage from worsening, maybe even develop good collaterals which are natural bypasses to give extra flow. So, to summarise, if this was my heart, I would opt for the ballooning on the diagonal branch (90%) but leave the 40-60% in the LAD. I know it sounds nuts, you are probably wondering why you would leave a blockage when it can be treated, but trust me, stents can make things worse. The blockage you have is not that serious yet. We would all probably make different decisions with our bodies, so I hope others will put their opinions forward for you too. Good luck and I'm sure you will be just fine :)

[kenkeith]

Quote: "The hospital called us to say it would be 3,800.00 for an angiogram. The doctor had not told the hospital he was doing a stent also... I assume the doctor is trying to do us a favor... I feel fortunate that I found a doc that would do this since I dont have insurance."

Your doctor may be relying on a social network that helps patients who have a financial need and need medication attention.  It seems strange the doctor is taking what seems to be something for granted.  If there was an emergency, that would be a different perspective, but for a doctor to go ahead without clearing it with the underwriter or provider may come back and bite you!

To submit the costs to you would the first step required for financial assistance. Then a sworn statement from you that you can not meet the the financial burden.  

Thanks for sharing.  Take care,

Ken.

[woogie50]

YaY Its over and Im home !! He ballooned th 90% and stented the 60-70%.... Although I logically understand that treating the 60% with meds would perhaps be just as good, psychologically, I feel better knowing there is a stent, because the doctor felt the plaque would be less likely to flake off if a stent were in place there compacting it.

Ed, Thank you ... I didnt get to read your post until After it was all over... but you made excellent points.. and you must be very wise, making any sense at all of my post... you "got it"... :)

Ken, I guess we will see how the financial end all plays out.... But I found it so refreshing that the Doctor and the hospital was willing to work with us. For now, we paid the hospital 3,800.00... they said that is all we will owe them. They said usually it is usually 10,000.00 for an angiogram... not including a stent ! So I feel blessed right now in more ways than one.
I so appreciate the knowledge & support of this forum....

Wishing everyone one here healing and blessings!!

<3