Lost - need some help please

[Brenda_2011]

My husband has had problems with CAD since 2003. His angio reports are as follows:
2003
- RCA acute marginal severly diseased in the proximal third (80%-90%)
- distal RCA including the RPDA with mild difuse plaque (30%)
- proximal third 90% stenosis
- LDA mildly calcified in the proximal and mid segments
- large early branching diagonal has 80% stenosis just after the bifurcation point
- OM1 at 80%-90% stenosis in the proximal segment

2009
- RCA with 20% instent narrowing
- acute marginal has subtotal stenosis with competitive flow
- RPDA has mild luminal disease descending
- LAD with mid subtotal hazy 99% stenosis
- large diagonal (extending laterally) had luminal disease
- Cx with mid 90% stenosis
- OM1 with long proximal occlusion (healthy left to left collaterals to this bifurcating marginal directly from the diagonal)
- OM2 small with marginal disease
- 1st left posterolateral branch is occluded
- distal left posterolateral branch has luminal disease

2014
- LAD with 99% distal stenosis (patent mid vessel stent)
- 1st diagonal with 90% proximal stenosis
- OM1 with 100% stenosis (chronic total occlusion with distal vessel filling via left to left collaterals)
- OM2 with 95% proximal lesion
- RCA has a 50% ostial lesion, 40% instent stenosis, 90% distal stenosis
- RPDA - 50% mid stenosis
- Cx has mild luminal irregularities

We were told that he had to undergo a quadruple bypass and this was done 2 days after the catherization (April 2014). The doctor performed the CABG on RPDA, OM1, OM2, and the 1st diagonal.

We did not get the information on the catherization results or the arteries that were bypassed during CABG until a week ago. I finally got around to read these records  couple of nights ago and I'm very concerned about the other areas that show blockages (distal RCA and LAD) that were not addressed. What should we expect? My husband also thinks now that he shouldn't have done the surgery as the recovery process is very slow, he's lost 13 lbs (was already super skinny) and his hemoglobin dropped considerably due to the surgery (7.3 vs previous 15). Thanks for the help!

[Brenda_2011]

I don't disagree with you at all. I've seen what diet changes did to the people of my native country. My husband was shocked to see how skinny people were 20 years ago. The size large was more like the equivalent of medium in the US and you would not find any XL clothes. Now, thanks to Monsanto and others like them, the obesity is rampant there too.
Statins may have some role and certainly have helped some people, but they are not the end all be all.
Good luck with the diet. Try to buy the produce from farmers markets as they are better than what you would get in the grocery stores.

[ed34]

I have seen many trend changes which seemed to be associated with diet. For example, the old English empire has made the UK and India quite close. We have a fair number of Indian people living in the UK and they are a lovely people. When they first started moving to the UK, they were reduced in stress having come from a poor background, yet their diseases increased. It was explained that their diet was to blame. We had lots of foods sprayed with chemicals etc, whereas in India they go straight from the fields to the market and are a lot fresher/natural. Now after years, they've set up a lot of their own food chains where they import from their own country. Since that time their disease levels have started to decrease again. For many years we had to so called French paradox. French people were eating many high fat foods, they have cheese in nearly everything. They love red meat and yet have much less heart disease than the UK. They first believed it was the huge amount of wine they consumed, so wine sales in the UK boomed. Grapes were stripped down into single molecules and nothing really substantial was found. Now, the French do use much fresher ingredients than the UK and there are far more French people who know how to cook than British. The average British girl has no idea how to cook anything now, they don't spend time watching Mom and learning. It used to be traditional here for girls to learn cooking and baking. If I asked 100 girls on the street how you make bread, I can promise you that ONE would be able to answer me on a good day. The French also eat during a long lunch break, sometimes accompanied by a little sleep. We British eat while walking or working most of the time, or if lucky, get 15-20 mins to scoff it down in a restaurant. When I look at primates, cats or other mammals, they eat for however long it takes, then lay down and sleep it off. Maybe humans need this too, I don't know. What I do know is that giving statins to everyone in a population as a safe measure will not cure it. I also know if they don't get answers soon, going by trends, everyone will end up with heart disease by their mid 30's.

[Brenda_2011]

I agree that genetics is just an escape explanation which may keep many people from asking additional questions.

Not sure what the answer is but I also think that stress, diet, the fact that most (if not all) food is genetically modified and full of pesticide, along with all the other chemicals that are sprayed every day, contribute to the whole situation.

5 years after I moved to US I developed resistance to many antibiotics; 10 years later I was diagnosed with rheumatoid arthritis. In my heart I totally believe that my body got shocked when I changed my diet from natural food to God knows what we're even eating here. They even put antibiotics in veggies.

But then I ask myself how come some of us get these diseases while others under same conditions don't.

I wish that instead of depending on a small study her and there, the scientific community would use the unbelievable amount of data that's  collected on a regular basis and would look for some common patterns instead of just taking the easy road and put everyone in the same category.  When I asked my GP if they look at this sort of thing he said no, they just analyze the payment segmentation.

Let me know how the new diet works out.

For us right now we're still dealing with the weight loss issue. When we went to another cardiologist a coupe of days ago, he sent my hubby to do some blood test. He said it could be many things including cancer. I couldn't believe that guy - why not wait until you get the results instead of scaring your patient unnecessary.  I heard that some patients do lose a lot of weight due to certain hormones that will increase your metabolism. Hope he'll be okay.

[ed34]

I'm not sure I find genetics a sensible reason. It's like saying millions of people in the civilised world have suddenly inherited bad genes. My grandparents all lived to be over 90, my parents over 80 and my 2 brothers are older than me with no heart issues. Up until the age of 40 I was the fittest one in our family by far, I did incredible levels of exercise every day and loved it. I still think it's something to do with diet. I was a great sugar eater from my teens. I would skip dinner and live off chocolate.

[Brenda_2011]

Thanks for sharing your experiences and sorry you've had such a hard time.
I'm amazed how with all the data we collect from everyone this is he best we can do.

My husband didn't have high blood pressure, no high cholesterol, no smoking, no junk food and he was already very skinny. The doctors told us is genetics, but his family doesn't have CAD.

Good luck with the new diet! I'm sure you'll be okay because we need you on this site.

[ed34]

From what I know about the disease itself and what happens. It all begins with the breakdown of the endothelium cells in the artery. The lining of an artery is as smooth as glass but the cells do become damaged from time to time. No matter how great your diet, how fit you are, this will always happen. Cells simply wear out and die. In a healthy person, the damage is repaired very quickly before any real harm can occur. However, in some individuals, the damage is much slower to be repaired. So slow in fact, that tiny fissures appear in the lining. Now the immune system detects those fissures and comes to the area to aid repair. This causes inflammation because the immune system tries to remove trapped blood cells from the tiny cracks. Huge white cells (Macrophages) gobble up the cells and this includes any trapped cholesterol which is pure fat inside a membrane. The macrophages die and the body would normally get rid of the waste, but we now have pure fat to deal with. Our blood is mostly water and no matter how hard you try, you will never get fat to mix with it. You can stir as fast as you like and you just end up with a sticky mess. This fat is smeared along the artery and some is still inside the wall. The smeared fat eventually gets oxidised and becomes a plaque. This seals off the fat inside the artery wall and can cause a restriction to blood flow. If the plaque is weak enough, it can crack and rupture. The free plaque can flow along in the blood stream and end up being lodged in a smaller vessel, either in the Heart or brain. If we are lucky, it breaks down even further when bouncing along and never gets trapped. Sometimes when it gets trapped, the pressure of the blood is just enough to break it down further. This gives a temporary heart attack. This is the usual explanation when they do an angiogram and find nothing there. The area of an artery which loses the plaque is now another problem. The fat inside the wall is free to bulge out, blocking the vessel or being pushed down stream. This can cause another blockage. This still isn't the end of it. Now the body detects the rupture and signals platelets to become sticky. Your body thinks the damage is causing you to bleed out and wants to stop that. You form a blood clot around the rupture site and bingo, another blockage. This is why we take aspirin to help inhibit this problem and give more time to get to the hospital before permanent damage occurs. Once in hospital they will inject a stronger anti coagulant to break the clot down.
I don't know if you have a procedure in your home if a heart attack occurs? but I've given strict instructions to my 3 children. When I had my last attack I felt lots of palpitations and I started to blackout. I honesty believe I would have died if my youngest Son didn't take action. He squirted 2 doses of Nitrates under my tongue and gave me 6 baby aspirin to swallow. He then phoned the ambulance service. After 2 minutes I was still in bad shape so he gave me 2 more squirts of Nitrates (these force arteries to fully open). After 30 seconds I started to feel better. By the time I got to hospital I felt fine and blood tests revealed it was an attack, a bad one. They did an emergency angiogram and found nothing there. They said the Aspirin and Nitrates did the trick. I keep the Nitrate spray and a packet of Aspirin in a place where everyone knows, so there is no delay. When I go out of the house I always take the spray with me. It really can be a life saver.

[ed34]

The problem is, there are a lot of sources but most of them are just plain nonsense. The truth is, believe it or not, there is still no real idea as to why we get this disease. My journey began in 2007 when I was 46 years old. I was thin and athletic doing loads of exercises every single day. Suddenly BANG a heart attack. I was so shocked in the angio-suite to see how calcified my arteries are. My left artery was completely blocked at the top and had been for years but I grew collaterals at the bottom which fed into the vessel. I had no idea that this was even going on. My heart attack was due to a clot in the vessel which was feeding across to the left one. I've had 3 attacks in total and survived but have no idea why. Every day I read or hear of someone else who has died from an attack, yet here I am having survived 3. Luckily fast hospital intervention has saved my muscle (so far) and my EF is still 70%. You won't believe the confusion I got when I started my journey. My cholesterol was off the chart, I had hypercholesterolemia. Basically, even if I eat nothing, my Liver works overtime making the stuff. I was given high doses of Statins and my levels dropped well below the national average. I was then told things will improve. WRONG. With very low cholesterol I still developed more blockages and had a further 2 attacks. I then wondered about stress which seems to play a huge role. It seemed that each time I got stressed my angina worsened, so it made perfect sense. I then examined my life and removed the stress. I basically talked to myself for many months, explaining to myself that things happen if I worry about it or not. I am so laid back now you wouldn't believe it. Did it work? not really, I still had my third attack. So what is it? Well, I now firmly believe it's the only thing left, diet. I've looked at human anatomy and it just doesn't seem that we are geared to be meat eaters. We are fruit, veg and grain consumers. We weren't hunters, we were gatherers of berries and things. So now I am experimenting with diets. I tried a high starch diet which is basically long simple sugar chains, but this has messed up my blood chemistry somehow. My red cells are larger than they should be and my immune system is going nuts. My triglycerides are also WELL high. One thing thou, my LDL is the lowest it has ever been. I am now switched to a fruit and veg diet with no meat. I saw my Doctor yesterday to go over my blood tests in much more detail. I do seem to be developing some deficiencies. I am low in B12, folic acid and probably Iron. Now, there is another cause which can affect my red cells this way, and that is cancer. So she wants me to continue as I am, on the recent diet change and have another test in one month. If the problem has not worsened then it's not likely to be cancer. If it is the same then she will prescribe supplements. If it it better then the diet has resolved the issue. I have to admit I felt better at first on the starch diet but after a week I felt a lot worse. I felt lethargic and couldn't be bothered to do anything. Now on the fruit and veg diet, I feel much more lively. I think this is the right diet and there is another good reason to get meat out of your diet too. We have many different types of bacteria in our digestive system. Different bacteria digest different foods. The bacteria which helps with meat has recently been reported as giving out toxins as a byproduct, which get into the blood, and help to start artery disease. This includes fish by the way. Vegans in a study showed none of this toxin or bacteria. The problem with being vegan is vitamin B12. As humans, we use very little of this but it is very important. We have the ability to store enough in our body to last about a year. Just one teaspoon of crushed flax seeds will give enough B12 to last at least 3 weeks. We have to crush the seeds first because the shell prevents us from digesting them to obtain the vitamin. I have really been looking into meats. What we buy from the supermarket chains is far from pure meat. They add stuff to the meat to preserve it and make it into a higher volume. The animals are fed very odd food (even containing meat products) to fatten them up. They are given lots of antibiotics and steroids. With so many chemical changes in the animals, maybe the molecular structure of the meat is not so different that we can't digest it safely anyway. The trouble is we need mass farming techniques because of the population size to feed. It has been revealed in the UK that our chicken goes to germany where it gets pumped full of liquids to make it weigh more. It also has a chemical called X injected into it and they won't reveal just what this is. We have no idea what we are eating. Now the summer has arrived, I am making a vegetable patch in the garden. I am planting my own vegetables including tomatoes and cucumbers. It's back to nature for me as much as possible.

[Brenda_2011]

Once again, Ed, thank you so very much for your help! My husband and I are very appreciative.
We do have laws regulating patient records in the US, but you wouldn't know it by the way the doctors and hospitals refuse to provide this documentation.
Both federal and state law require the providers to release the records within 30 days of patient request they need to keep the records on file for at least 7 years. Today we finally received some information - 1 printed page (we asked for the CD) with what it supposed to be images from his stress test in April 2014. He also did a stress test in 2012, but we were told today - after almost 7 weeks - that they no longer have these records because they "changed the system." I thought that the EF rate should show up in the system, but this was also handwritten. We still didn't get the ECG record. The whole situation seems really suspicious to us.

By the way you seem to know so much about this whole area, any good sources that you cold share? I'm interested in learning as much as I can about this disease.

[ed34]

Hi. Yes I certainly did have very odd sensations in my chest wound for months. Sometimes it felt like someone was stabbing me with pins, sometimes I felt a heat there while other times it felt cold. Sometimes it itched and sometimes it even felt numb. This is due to the nerves healing and I think the brain gets a bit confused with the signals as the nerves repair. That's all I could put it down to, that my brain was used to a certain signal meaning heat but it interpreted now as pain etc. Over months, it seemed to sort it out, re-learning what the signals are. With regards to Angiogram images I had a lot of trouble getting copies of mine. They hate giving these up. However, I realised that they are digital information on a computer in the Hospital records, and we have something called data protection. I have a right by law to demand a copy and as soon as I mentioned data protection to the Cardiologist he went and got a copy immediately. The reasons you give can also make a difference. If you say its for a second opinion, then they are very reluctant and even under data protection they will delay you getting copies. A good excuse is "If we are away on holiday or a trip, a long way from this hospital, I think it will save a lot of time and risky procedures to carry the valuable information with me".

[Brenda_2011]

Hi, Ed
I have one more question. Sometimes my husband experiences pain around the chest cut and today he said that's like a sharp pinching pain that comes an goes. Have you had anything like this when you were recovering from the bypass? He also keeps losing weight - is at 16lbs in 7 weeks and he was already very slim.
The hospital and the cardiologist that referred him for the procedure refuse to provide us with any images from the stress tests or catherization, which is absolutely incredible and makes us think that something is not right at all.
I scheduled him for an appointment with another cardiologist - hopefully we can get some answers, but this guy would have to fly a bit blind since we don't have the records. We are so frustrated!
Thanks so much.

[Brenda_2011]

Thanks again for all your help!

[ed34]

Not that I've seen, but from my experiences it has tended to be the LAD first, then Circumflex, then RCA. I guess because these are the major vessels and tend to develop problems first.

[Brenda_2011]

You're exactly right. There is a lot of mediocrity in our societies nowadays and unfortunately that extends to the medical profession. But everyone in a while you find that diamond in the rough that does the right thing.

One other thing that I can't stand in this whole healthcare industry is the secrecy they surround themselves by. I just started to do some research in this area and have been trying to see if I could get statistics on which arteries are bypassed the most, but couldn't find that much. You would think that with such a popular surgery in addition to all this technology that gathers a lot of useful information this would be available to the public. Do you guys have anything like this in the UK?

[ed34]

I think the same as you. My opinion is, if angio is a possibility, then do it. If the stents don't remain patent, at least there is still the possibility of bypass surgery because you end up with the same blockage you started with anyway. Angio is much quicker for recovery, days instead of months, and there is virtually no risk of infection. I personally think there is a lack of highly trained cardiologists in angioplasty. Sure there are a good number who can put the average stent in, but when it comes to shaving away plaque or doing anything slightly more difficult then they become full of excuses. I was told that my LAD blockage was impossible to remove, by 9 cardiologists across 3 different hospitals. Then at a teaching hospital a cardiologist laughed and said "if you want it done right now, I'll do it with my eyes shut". This was an outpatient appt. and I had it done there and then.

[Brenda_2011]

Hi,
Sorry you've had such a hard time.
In the US they just tell you to take pills; diet is not discussed that much and if it that's not real diet.
I'm originally from Europe myself and I've been fortunate enough to have grown up on natural food (not organic non-sense). When I came to the states, I've had a terrible time adjusting to the food because it was/is full of GMOs - I called it plastic food at the time.
Unfortunately in Europe is pretty much the same nowadays.
In the US we go to farms to purchase produce and meat. We think its a bit better than what you find in the stores, but when you know that they spray all sorts of nasty things in the air (e.g., chemtrails) I don't think you can get away from it.
I hope that you will feel better!

[Brenda_2011]

Hi, there

First of all, thanks for your comment.
I have to say that if it would've been me I would've want to have more information before agreeing to a major surgery. My husband is different and I think that he got scared when he was told that it was urgent.
I'm not a health professional either, but looking at the arteries they bypassed (RPDA at 50% stenosis) and the OM1 with collaterals in place long time ago I have to wonder. In addition, the doctors involved, to me, they seem a bit shady. It is well documented that in the US we have many unnecessary procedures: some for money and others to increase the prestige of an institution.
The cardiologist who referred my husband to do the cath insisted on a specific interventionalist and when I said we were thinking of going to the one that did his stents in 2009, he kind of flipped and said that now he would have to go back to the one he knew and cancel an twice he mentioned that there were no money involved between him and this guy. I wasn't even thinking about that but he mentioned it gave me a bit of a pause. He also became aggressive when I asked more questions about which areas he thought were affected ) based on the stress test). After the surgery when we tried to make an appointment for follow up he made himself unavailable.
After reading the hospital records, which are not more than a few paragraphs with very little information, I called the surgeon office to ask some questions about the distal blockages. The nurse practitioner I spoke with was trying to tell me that the RPDA was probably before the distal RCA and that is why they just did the bypass on the RPDA instead. Based on the artery segmentations I've seen in reputable journals this is non-sense. Then she was trying to tell me that they don't do bypasses on 50% (which I didn't even ask for; I asked if the interventionalist couldn't stent the ostial RCA, which I know it's difficult to do); then again they did the bypass on the RPDA which was 50% blocked. Even this person said that the OM1 could have gone either way.
Most doctors in the US are quick to cut you open regardless of consequences. I think this is plain wrong.

[ed34]

Hi, yes I did have a triple bypass in Sept 2007 and by Dec 2007 it had failed I was still recovering. I would say that the worse part of recovery is the first 3 months, then things start to improve faster. I've been offered another bypass but I told them there is no way I will have it done. A nuclear stress test is often used in conjunction with bypass decisions to give an indication where the blood supply is at its weakest.
The biggest thing which is not discussed properly with patients is diet. I recently called my cardiac rehab centre and they are still educating patients the same way as they did 20 years ago. This is unbelievable because a lot of research has been carried out with diet, yet the information never reaches the patient. There is substantial evidence out there, including angiograms, which show there are diets which can stop or even reverse the disease. Will Doctors take this information seriously? no, because it is free to commit yourself to a diet. Cancer cures made from herbs have been removed by the FDA and other organizations around the world because herbs can be grown for free. We live in a society where "if you don't pay for it, you can't have it". I have just finished looking into all this after spending months of digging deep into the research. We humans are meant to eat whole grains, vegetables and fruits. We are not meant to eat oils, fish, meat or cakes etc. We are not meant meant to consume dairy either, but we consume tonnes of it. Our brains didn't evolve through turning into meat eaters, this has been proved nonsense time and time again. Taking statins isn't a bad thing, they lower the cholesterol, but through an aggressive diet we can lower our cholesterol even further. I have recently started a very strict diet and will never eat meat, fish, dairy again. I still take statins and my other meds, but to be honest I seem to have so much more energy than I did last week. I'm having no reflux issues or heartburn either. From 2007 I did exactly as the experts told me. I had one stent in 2007 but by last year I had received a triple bypass which diseased within 3 months, plus 9 further stents of which 5 re-blocked quickly. I'm disgusted that it has taken me 7 years to wake up and realise there is more to it than meds. We are what we eat.

[Flycaster305]

I sure would have wanted, even begged for bypass with the last report.  I'm not a health professional, but have had a bypass procedure, 10 stents, a pacemaker, so I've seen a lot of reports.
Images from a stress test are frankly useless unless one is trained to read them.  
Certain terms are important.  Ostial refers a blockage at a  'Y' and are very difficult to stent.  Blockages over 70% are a concern.  Distal refers to blockages about in the middle of the artery.  10% of bypass procedure fail within the first year, not all veins seem to work as arteries.  If your husband doesn't perk up soon, I'd ask for another stress test.
It took me about two months before I could go back to part time work.  I was in pretty good physical shape before the procedure with daily exercise.  

[Brenda_2011]

Ed, thank you so much for your reply. It's very hard when you don't know much about this area and you're left out in the cold by the "professionals."
I felt uneasy about this whole situation, but the cardiologist told us that this was urgent and insisted on a specific interventionalist, who after a very short catherization (10 minutes) said he needed urgent bypass. We weren't told much but figured that we were in good hands. After reading this latest report I have to wonder why this was done in the first place.

My husband who is on his 6th week past surgery is still pretty weak.
The reason why he went to the cardiologist in the first place was that one evening he experienced dyspnea while carrying some water up the stairs, but then it went away and he was okay.

I've noticed that you had a triple bypass - how long did it take you to recover?

Also, my husband has had a nuclear stress test before the catherization and I asked for the images, but didn't get it. From what I've read there are images involved with this sort of test. Do you know if that's the case?

Thanks again for all your help.

[ed34]

The distal LAD and RCA are always a bit tricky to bypass because a long section is normally diseased and very sticky and nasty inside. It could be that there wasn't a clean enough area to graft onto. However, distal LAD and RCA usually get pretty good collateral feeds to assist them and these are too small to be seen on angiograms most of the time in those areas. This would take a nuclear scan. So the vessels in question remain to be the OM1 OM2 D1 and RPDA. Now comes my confusion. The RPDA is 50% blocked which is not a concern yet. Obtuse Marginal 1 is blocked but getting a good feed from Diagonal 1, which is now blocking severely. So OM1 didn't need grafting at all, just D1 so it could continue feeding it. The more I look at this the more I think just OM2 and D1 needed a stent?