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BY-PASS SURGERY


  I AM A 42, INSULIN-DIABETIC FOR 35YRS.
  ANGINA(PRE-INFARCTION)           DIABETES MELLITUS- W/RETINOPATHY
  MID-CAB 4/97                     """""""""""""""""- W/PERIPHERAL NEUROPATHY
  PERICARDITIS-ADHESIVE            """""""""""""""""- W/NEROPATHY-KIDNEY
  SURGERY-AORTOCORONARY BY-PASS GRAFTING 11/97
  CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY
  PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY STATUS
  FAMILY HISTORY- ISCHEMIC HEAART DISEASE
  COLLAGEN VASCULAR DISEASE-ELAVATED ANA (LUPUS?)
  SMOKER 25 YRS., HAD QUIT 1/97
  4-18-97 CARDIAC CATH
  SEVERE PROXIMAL STENOSIS - LAD W/HIGH GRADE LESIONS IIN VERY DISTAL
  PORTIONS OF 2 TINY CIRCUMFLES BRANCHES AND AN OCCLUDED NON-DOMINANT
  RT CORNARY ARTERY. LEFT VENTRICULAR FUNCTIONS WELL PRESERVED
  4-21-97 MIDCAB
  FEFT IMA ANASTOMOSIS TO LAD. WAS THIRD PATIENT TO HAVE THIS DONE BY
  SURGEON. LAD WAS 2.75mm VESSEL
  6-3-97 CARDIAC CATH W/BALOON
  LAD SHOWS LONG SEGMENT OF 90% STENOSIS PROXIMALLY ALSO SOME STENOSIS
  IN MAIN TRUNK OF LAD AT INSERTION SITE OF LIMA GRAFT
  LIMA GRAFT SHOWS  A HIGH 95% STENOSIS OVER A LONG  SEGMENT JUST PRIOR
  TO INSERTION SITE AFTER ANGIO REDUCE TO 0.
  6-6-97 CARDIAC CATH W/BALOON
  70% STENOSIS WAS AGAIN ANGIOPLASTY TO 0 WITH A HIGH PRESSURE BALOON UP
  TO 20 ATMS
  6-13-97 EMERGENCY ROOM CHEST PAIN
  6-16-97 HOLTER MONITOR AND BACK TO WORK WIH CHEST PAIN AND SHORT OF BREATH
  6-19-97 CARDIOLITE TREADMILL- DOCTOR WAS THERE FOR MOST OF PROCEDURE, SAID
  I WAS FINE TO LEAVE FOR VACATION, WHEN I GOT HOME HIS NURSE CALLED AND
  SAID I DIDN'T PASS TREADMILL AND TO MAKE SURE I NEW WHERE THE EMERGENCY
  ROOM WAS IN LAS VEGAS AND CALL WHEN I GOT HOME. WAS UNABLE TO CROSS A
  STREET AT THIS TIME. I ALWAYS HAVE A HARD TIME GETTING DOCTOR TO BELIEVE
  THAT I AM FEELING BAD.
  6-20-97 ANGIOPLASTY
  LAD SHOWED SEVERE DISEASE PROXIMALLY WITH HIGH GRADE STENOSIS AND HIGH
  GRADE STENOSIS RIGHT AT THE INSERTION SITE OF THE LIMA GRAFT. THE LIMA
  GRAFT SHOWS LUMINA IRREGULARITIES OF THE PREVIOUS LONG STENOSIS JUST  
  PRIOR TO THE INSERTION SITE  INTO THE LEFT ANTERIOR DESCENDING AND RIGHT
  AT THE INSERTION SITE THERE IS A 90% STENOSIS. AFTER ANGIOPLASTY THIS IS
  TOTALLY RELIEVED BUT LUMINA IRREGULARITIES REMAIN MORE PROXIMALLY IN THE
  LIMA.
  7-2-97 RETURNED TO DOCTOR WITH SAME SYMTONS AS ALWAYS HE HAD NO
  ANSWERS FOR ME.
  7-24-97 WAS ADMITTED TO ANOTHER HOSPITAL, WITH DIFFERENT DOCTORS.
  ANGIOPLASTY-
  SIGNIFICANT PROXIMAL LAD STENOSIS AND A GRAINY APPEARANCE AT THE SITE
  OF PREVIOUS DILALATION THROUGH THE LIMA. THERE WAS RETROGRADE FLOW THROUGH
  THE LIMA GRAFT. ANGIOPLASTY AND STENTING USING A 3.0mm.GR-II STENT IN THR
  AREADISTAL TO THE LIMA GRAFT, AND A 3.5mm.GR-II STENT IN THE PROXIMAL
  LAD.
  HAD OTHER NUMEROUS CHEST PAINS AND SHORTNESS OF BREATH,THROUGH
  THE FALL OF 97.
  10-30-97 BY-PASS SURGERY
  FIVE VESSEL CORONARY ARTERY BYPASS W/OPEN LONGITIUDINAL ENDARTERCTOMY
  OF THE PROXIMAL TWO THIRDS OF THE LEFT ANTERIOR DESCENDIING CORONARY
  REPAIRING THE LEFT ANTERIOR  DESCENDING WITH THE FREE RIGHT INTERNAL
  MAMMARY ARTERY GRAFT AS AN ONLAY PATCH ANGIOPLASTY, CONSTRUCTION OF A
  SEQUENTIAL REVERSED SAPHENOUS VEIN GRAFT TO THE MID RIGHT CORONARY
  ARTERY ENDING ON THE POSTEROLATERAL BRANCH OF THE LEFT CIRCUMFLEX
  CORONARY ARTERY, CONSTRUCTION OFF SEQUENTIAL REVERSED SAPHENOUS VEIN
  GRAFT TO THE INTERMEDIATE VENRICULAR AND OBTUSE MARGINAL BRANCH OF THE
  CIRCUMFLEX CORONARY ARTERY.
  DISCHARGED 11-3-97
  WAS TO RETURN TO WORK FIRST OF YEAR. WAS A HISTOLOGIST AT HOSPITAL
  WHERE I HAD MIDCAB FOR EIGHT YEARS, DID NOT USE MY SICK DAYS THE
  PREVIOUS YEAR, WORKED IN BETWEEN ALL PROCEDURES.
  RECIEVED A LETTER ON CHRISTMAS EVE THAT I WAS FIRED. GOOD CHRISTIAN
  VALUES FOR A CATHOLIC HOSPITAL.
  FILED LAW SUIT AND RETURNED TO WORK IN MID JAN 1998 AND DID GOOD FOR
  A FEW MONTHS AND THEN QUIT IN MID MARCH DUE TO STRESS OF PRESSURE
  FROM SUPERVISORS.
  4-30-98 ANGIOPLASTY
  95% STENOSIS IN THE LEFT POSTEROLATERAL BRANCH OF THE CIRCUMFLEX VIA
  THE SAPHENOUS VEIN GRAFT, WAS REDUCE TO 25%.
  6-11-97 POSICOR
  FOUND OUT SOME OF MY PROPLEMS RELATED TO POSICOR, OR SO THEY SAY
  5-12-98 DIPYRIDAMOLE MYOVIEW
  1.ABNORMAL PERFUSION SCAN
  2.RESULTS CONSISTENT W/EQUIVOCAL ANTERIOR INFARCTION
  TOLD TO GO HOME NOTHING WRONG AND TO GIVE IT TIME
  8-?-98 TREADMILL
  WAS TOLD I DIDN'T PASS AND SCEDULED FOR ANGIO
  AFTER ANGIO WAS TOLD EVERYTHING WAS FINE BUT I DO HAVE SOME HEART
  DAMAGE THAT I DIDN'T HAVE BEFORE. DO NOT HAVE THE RECORDS FROM THESE
  PROCEDURES.
  QUESTIONS????
  1.WAS TOLD IN 4/97 THAT THE MID CAB WAS MY ONLY CHOICE THAT STENTS
    WOULD NOT HELP, WHY?
  2.WHY DIDN'T MIDCAB WORK?
  3.COULD DIABETES SMALL VESSEL DISEASE BE A CAUSE OF MIDCAB NOT WORKING?
  4.DOCTOR STATED AFTER ANGIO OF MICAB THAT "FOR REASONS UNKNOWN,THE
    PATIENT HAD A MARKED REACTION IN THE INTERNAL MAMMARY GRAFT ITSELF
    WITH A LONG AREA OF STENOSIS AT THE INSERTION SITE." ANY GUESSES
    WHY?
  5.HOW OFTEN AFTER BYPASS SURGERY DO SOME PATIENTS HAVE STENOSIS AND
    IS THERE ANY REASON? IS THIS A COMMON THING?
  6.I WALK 4/10 OF A MILE IN 7 MINUTES WITH BAD CRAMPING IN MY LEGS
    AFTER THE FIRST MINUTE, SOME DAYS I HAVE HEART CRAMPING AND SHORTNESS
    OF BREATH. WILL THIS STOP SO THAT I CAN GO LONGER AND WHY THE LEG
    CRAMPS?
  7.IS THERE A CHANCE THAT WITH TIME I MIGHT FEEL BETTER AND BE BACK TO
    MY OLD SELF?
  8.IS THERE A WAY THAT I CAN SEND ALL OF MY MEDICAL RECORDS AND TAPES
    TO THE CLEVELAND CLINIC AND GET A OPINION W/O HAVING TO COME THERE
    FROM INDIANA?
1 Responses
Avatar universal



Dear Tina,
Unfortunately, you are in one of the highest risk groups there are for development of coronary
disease, as well as the most likely not to do well after revascularizations.  This is completley due
to your having diabetes- a terrible disease that we as physicians do not have a great handle on(especially
on preventing the progression of the disease.)  It has been shown in a few studies that diabetics with multiple
vessel coronary artery disease do better with bypass than with angioplasty and stenting.
When your vessels and grafts reacted so quicky with more and more stenosis following the bypass, the only
thing to do at that point was try angioplasy and stent, because actually when patients get stenosis of their
bypass grafts that quickly following surgery, it often will respond to an angioplasty alone(without stent.)
Unfortunately, you did not respond and your body continued to lay down plaque in the bypasses and coronaries
at a very brisk pace-this more than likely is related to your diabetic metabolism.  Not only can we not explain
why a diabetic is more likely to do worse, we currently have no specific therapy for it, except to do as much as
you can to prevent the heart function from decreasing (i.e. damage from occuring)
We have known about "small vessel disease" for quite some time and because we simply have no therapy for such small vessels,
other than medical therapy (nitrates, cholesterol lowering drugs, and aggressive sugar management), it presents a very difficult
situation for a patient such as yourself.  
The cramping in your legs could very well be secondary to decreased blood flow to your muscles(due to blockages in the arteries that feed
the legs.)  This is best dealt with (evaluation and treatment) by a vascular doctor.  
The Cleveland Clinic will not give second opinions so to speak until it has the patient and the records at hand, granted it may only be
one visit, however, the patient must present for a history and physical as part of the evaluation.  If you are still interested, you can
call 1-800-CCF-CARE and ask for an appointment with one of the cardiologists at desk F25.
It really sounds as if the cardiologists have done as much as possible to help keep your
heart strong, however, a second opinion is always a good idea.  Good luck and write back with any further questions.
I apologize if I seem very blunt, however you have a very bad disease that is progressive, making it unlikely that you will
ever feel "back to normal" so to speak.  A patient in your situation needs to be his/her own advocate(which you are) and
needs to find the good in a potentially bad situation, or better said, look on the bright side and really enjoy all those days
that you are not spending in the hospital for your heart or diabetes appointments and procedures.
Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment
can only be made by your physician(s).



  
    THANK YOU FOR READING THIS LONG LETTER. I HAVE A PROBLEM WITH GETTING
    ANSWERS FROM DOCTORS AND NO EXPLANATIONS. I ALSO HAVE BEEN TOLD
    TO MANY TIMES THAT I LOOK GREAT AND GO HOME AND WAIT. WELL I,M
    STILL WAITING.
    I RECENTLY REPLIED FOR  SOCIAL SECURITY AND WAS JUST TOLD THAT
    I WILL RECIEVE IT, THIS HELPED ME TO ACCEPT THAT I'M SICK BUT
    I HATE IT AND WANT TO WORK, DO YOU THINK THERE IS HOPE?
                             THANK YOU SO MUCH
                                TINA




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