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Problems After Coronary Artery Bypass Graft (CABG)

Post problems or concerns you may have after bypass surgery.

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Current Postings on This Page (17):

• Ray -- Maybe we're going to have to start a new topic on EDTA, a.k.a. chelation therapy, Artery Clearance Therapy (ACT) etc. since we're getting a number of queries. As far as we know, there are no randomized clinical trials or peer-reviewed articles in major cardiology journals showing efficacy of these therapies. However, an NIH-sponsored study was begun back in 2002 and is still recruiting. The Trial to Assess Chelation Therapy (TACT) won't be finished recruiting until 2009 (they have 163 centers). We look forward to the results, but as of now, there's no real data to show this therapy is valid. The danger is that patients will self-treat (and spend money on the drugs) and avoid the proven therapies.

As for Ascorsine-9, we don't know much about it, except that it seems to be a formulation of essential vitamins and some other ingredients. But we did note on a supplier's website the following: "WARNINGS: Anyone taking anti-coagulation drugs should not take this product", so we would be very wary of Ascorsine-9 for heart patients who may well be taking anti-coagulation or anti-platelet drugs. Talk to your cardiologist about this.
Forum Editor, Angioplasty.Org, February 28, 2008

• May I have comments on the use of artery cleaners EDTA ethylenediaminetetraacetic acid and/or Ascorsine-9 nine months after double bypass surgery.
Ray G., Georgia, USA, February 10, 2008

• My brother had 4x CABG 1 year ago. He had a very hard time healing and his angina is back at 6 months from smoking (we think) and had an angiogram at 6 months that was clean. Of course, he took it from that that he could keep smoking. As it turns out, we just find out he has not been taking an aspirin a day or his blood pressure meds. His blood pressure is good though at 120/70. Surprising but true. I am very concerned that the longer he doesn't take the prescribed drugs, the faster he will need additional treatment. He really thinks that the meds were making him worse because now his BP is good! However he is taking Protonix and 4 tums a day to try to help the burning under his sternum. The doctor just keeps saying, your pictures at 6 months were clean, so you are in good shape. The dr is ignoring the burning under the sternum - knowing he has stopped meds. HELP!! Any suggestions? He is only 50 years old and has lost his desire to keep fighting.
K.R., New York, USA, October 15, 2007

• Russana -- look up our Forum Topic on EECP for more info.
Name, State, USA, October 13, 2007

• Can someone please help. My father who is 69 years old had a bypass 6 months ago and has been in an out of hospital since the operation, which has seen no positive result. He is currently in hospital and having ongoing angina attacks, up to 3 per day, often when he is asleep. I have read about EECP on the internet and am very interested in this treatment for him. We live in Sydney Australia, does anyone know whether this treatment in offered in Australia?
Russana, Sydney, Australia, October 10, 2007

• Hi, i am a 52 year old male and weigh 128 kg.have had 2 stents, a by-pass in 1995 and 2006. I will be contacting my cardiologist monday next week for an appointment as i am experiencing swelling of my feet which never happened before, heart beating irregular and wonder if i am nor in the early stages of heart failure as the swelling is excessive. I do cardio exercise each day for 1 hour and drink 2 litres of water whilst exercising... Is the fluid intake to rapid in that period...? I am a very active person working my 14 hours per day up and down and wonder if the fact that i am so active, also be the cause. Would appreciate your comment.
Johan Stapelberg, Brooklyn Holdings, South Africa, August 25, 2007

• Gerald -- you certainly are an EECP evangelist (by the way, Angioplasty.Org's Forum has a topic devoted to EECP). And the treatment has been shown to help some patients who still experience chest pain if it is not relieved by drugs, angioplasty or surgery. And this is not a small number: the recent COURAGE trial showed that 1 in 4 patients still had chest pain after 5 years. The general theory that vascular disease and blockages are at least partially a result of endothelial dysfunction is pretty well accepted. The big question is what causes this and how best to treat it. You're correct in saying that interventional procedures don't improve this dysfunction systemically. We (and the physicians who pioneered this field) always say, angioplasty is a mechanical solution to a biological problem. One of the positive aspects of the COURAGE trial was that modern medical therapy (statins, beta-blockers, etc.) seemed to have a definite systemic effect and low-risk stable patients did very well without any intervention. There is much research going on into how best to restore endothelial function. EECP has had several clinical trials which have shown some benefit in certain patients -- and you and your friend are definitely in that category. But overall, the trials have not shown EECP to be "the cure" we're all waiting for. Which is not to say it's not valuable and most definitely under-utilized. The Minneapolis Heart Institute at Abbott Northwestern has a whole program to treat patients who have not responded to the mainstream therapies. Called OPTIMIST, it offers a range of solutions, one of which is EECP.
Forum Editor, Angioplasty.Org, May 4, 2007

• John S, patient, Brisbane, Australia: John, many of your questions and concerns can be answered by reading my post to Jack D. but let me personally address these: "You mention some going 3-5 years without need for re-treatment. Are these people you know or have you just been told this?" I was told this by technicians and cardiologists at the two different provider sites I attended to receive my 4 x 35 hour courses of treatment. One EECP patient Tom is now about 87 years old. I made his acquaintance on a financial message board. He is a highly intelligent man and is in very good health today, probably in BETTER HEALTH today than he was 10-15 years ago when he was receiving repeat angioplasties and major CABG procedures. He swims and works out almost daily at their local YMCA's gym and pool. He will easily swim the length of their pool underwater regularly. We email one another weekly, often exchanging information which helps us better understand all of EECP's mechanisms of action which, by the way, are still highly misunderstood by many/most cardiologists. I am proud to regard Tom as a good friend although we have never personally met.

"Also I am concerned that in some instances EECP does not work - why is this do you think?" A very fine cardiologist once explained to me that he believed those 20-25% patients who have not responded to 35 hours of EECP treatment do so simply because they require many more hours. The differences between individual patients are just too great to expect them all to respond the same. Some patients require 45 hours, 60 hours or even 75 hours. Treated in this manner, you will see over 95% of the patients regularly improve by one or more class. Patients who receive EECP for Class III or IV angina caused by ischemic heart disease will almost always have a pre-existing state of endothelial dysfunction and a loss of vascular homeostasis. In this disease state (which cardiologists seem to ignore), the vascular system has become inflamed and constricted. This seems to be a precursor to full blown atherosclerosis which will then accelerate the progression of ischemic cardiovascular disease. In this inflamed and constricted state, vascular lesions will develop throughout the entire vascular tree. As the body attempts to heal these vascular lesions they may become covered with something very similar to a scab or a sore on, for example, your arm or leg. In endothelial dysfunction, the vascular wall, being very constricted, makes those lesions more susceptible to rupture. Patients in this condition are often rushed to the hospital and DESed with off label use of a $30,000.00 stent. Their symptoms may be quickly improved but the underlying endothelial dysfunction which caused the inflammation, the constriction, the lesions and the ruptured lesions will remain a threat because, to my knowledge, invasive procedures will do nothing to treat the underlying endothelial dysfunction and the loss of vascular homeostasis. But now get this! EECP treatment will not only improve the the symptoms of angina and ischemic heart disease but it has also been shown in multiple studies to REVERSE ENDOTHELIAL DYSFUNCTION and to the degree that it does this IT WILL ALSO RESTORE VASCULAR HOMEOSTASIS. This means that EECP may decrease pro-inflammatory cytokines while increasing anti-inflammatory cytokines which means less vascular inflammation, less constriction and a more stable vascular system. Following this cascade of vascular events, we can by logical extension, expect then, to see FEWER ruptured lesions. With FEWER lesions rupturing, we should expect to see FEWER new blockages, FEWER embolisms, FEWER strokes, FEWER MIs, FEWER hospitalizations and yes, even a REDUCED mortality rate. All of this should proceed from EECP's effect of REVERSING ENDOTHELIAL DYSFUNCTION. And again, this is something that invasive procedures, by themselves cannot do. If you still have questions, I would be happy to help you. Please email me at postman23_2000@yahoo.com. [Note: posting has been edited for length]
Gerald Oros, Collinsville IL, May 3, 2007

• Sorry I should have said 14 stents, ex-smoker, quadruple bypass (she quit 1 year ago) but that does not make her an official "non-smoker" yet. I believe you have to be clean for a while before you get that label.
Jack D., New York, USA, May 1, 2007

• Jack D: Geeze Jack! Don't you think it's high time you and your wife stood your ground and made some some of these decisions yourselves? You're going to get nothing but more of the same from your doctor. So what other treatment options does your wife have? Your doctor, if he is responsible, should have already told you. There is the FDA approved, Medicare reimbursed, NON-INVASIVE treatment option called Enhanced External Counterpulsation also referred to as EECP or ECP.

You can learn everything you need to know about this in the next 15 minutes by going to www.vasomedical.com and clicking on the DVD for patients to immediately view what, how and why this therapy is so safe and effective for relieving angina. At this late stage of treatment, it was very, very wrong of your cardiologist to not inform your wife of this option but instead -- continue to inflict more and more invasive procedures upon her which obviously are not helping her but which is making him very, very wealthy. But don't be too hard on your doctor because as I estimate it more than 95% of the other invasive cardiologi$t$ are doing the $ame thing. Now, don't misunderstand me, most of these invasive procedures produce good results right away and the patients will receive good symptomatic relief. But no one should be subjected to 14 stents, a CABG and then still want to do another damned angiogram!!! Jack, believe me please! Sit down with your wife and watch the DVD called "Straight From the Heart" ASAP! If, after watching that film and you feel that your wife wants to try it. Ask your cardiologist to arrange for the 7 or the 3 1/2 week course of treatment. If he tries to discourage you from trying it, get another doctor! You see the cost for a course of EECP treatment, more often than not, runs less than the sales tax for a single bypass surgery. Prescribing EECP is not as profitable as sawing open a patient's chest. I'm sure you both get the picture!

If, after viewing the film, you still have questions, I would be happy to help you. Please email me at postman23_2000@yahoo.com. BTW, I am an angina patient with ischemic heart disease. I had my first course of EECP 4 years ago and the results were so good I chose to have it repeated for the next 3 years. I will take my 5th course of treatment this Summer ---- so I think I know a little something about EECP and I can give you some tips of how to get even better results from it if you're interested.
Gerald Oros, Collinsville, Illinois, USA, May 1, 2007

• Gerald O., Illinois. You mention having had EECP, as an alternative to CABG. I am at the stage of considering my options and this treatment a possibility. Can you tell us your condition (angina, number of blockages and symptoms) which led to the treatment and how soon after starting you saw some improvement? You mention some going 3-5 years without need for re-treatment. Are these people you know or have you just been told this? Also I am concerned that in some instances EECP does not work - why is this do you think? Best Regards.
John S., patient, Brisbane, Australia, May 1, 2007

• To Jack D. in NY: several months after just one stent, I observed pain whenever inhaling a cigarette. Ok, the solution was a no brainer, I quit smoking and the pain went away. Done. You write that your wife had 14 stents, quadruple bypass, but she continues to smoke and she is (even otherwise) resisting her doctor? Hello? Please show your wife all the warnings on those cigarette packages, they are serious.
Tom, Encinitas, California, USA, April 30, 2007

• My wife, 43 yrs old, diabetic, smoker had a quadruple bypass 5 mos ago. This was after 14 stents to the RCA in an 18 mos period and during that time span an MI from a clot. 3 mos after the CABG, her angina pains slowly returned and at 5 mos they are in full swing. She gets pressure with exertion and without. When her blood sugars are low she gets intense chest pressure as well as a burning pain directly under her sternum. The Dr says an angiogram is indicated. She is resisting. Anyone else had these issues?
Jack D., New York, USA, April 29, 2007

• I would suggest looking into the possibility of having a blood sugar problem and not knowing about it. My wife, age 43, after experiencing severe unstable angina, was given 4 DES in Nov. 05. She continued having angina, although less severe, and was very dissatisfied with the doctors telling her that her case was so exceptional that they could not explain it, only stating that she may be having coronary artery spasms. Since than she has had 5 heart caths done and 4 more stents inserted inside of the ordinal stents because of restenosis and also had a blood clot form that required a balloon to clear her stent that resulted in the stent becoming fractured. Her family doctor decided to test her for insulin resistance and we were quite surprised to learn that, yes, she does have this syndrome. It is also known as Metabolic Syndrome or Syndrome X. It has the tendencies for forming clots and causing plaque to build up in the coronary arteries. We recommend the book "Syndrome X The silent killer". We have just started her diet change so we cannot report any success yet but are very hopeful that this is the cause of her continuing problems. Good luck and we hope that this may give you another avenue to explore.
Paul S., Michigan, USA, February 15, 2007

• Pam, Lafayette, Louisiana Pam, there is a very safe, non-invasive procedure which is FDA approved for the treatment of Class III and IV angina pain. Medicare will reimburse for it and it is covered by most, but not all, insurance companies. It is presently reserved in most cases for patients who fail to respond properly to the invasive surgeries and angioplasties/stents. The name of this treatment is Enhanced External Counterpulsation or EECP and/or ECP. If you will go to www.vasomedical.com and watch their video tape, you will learn how and why it works. It does require some commitment from the patient as they have to receive this treatment 5 hours a day for 7 weeks. The treatment is comfortable enough to tolerate and has a success rate of about 80% with 35 hours treatment. I have received this treatment for my shortness of breath and angina pain with good results but because my arthritic knees inhibit my ability to exercise, my symptoms begin to return after about a year. So, I have chosen to get the treatment yearly and have done so for the past 4 years. Most patients, however, are able to go 3-5 years or more with just one course of treatment. Despite its success record, physicians are not too quick to recommend it because at the present rate of reimbursement (shamefully low), doctors find that is is not very profitable and therefore, quite understandably, prefer to keep using invasive procedures. The cost of a course of EECP is often less than the sales tax for a single bypass surgery.... Stent placements run 5-6 times the cost of a course of EECP.... If he wants the EECP treatment, he's going to have ask for it and then not be dissuaded if the doctors then try to change his mind. He must be adamant yet respectful. If he can do this most doctors will be glad to prescribe the treatment for him.
Gerald O., Illinois, USA, February 14, 2007

• My brother is 49 years old and has had triple bypass about 8 months ago. He has seen very little improvement. Still very short of breath and takes nitro several times a day. The doctors are just beginning to figure out what's going on. Any similar cases out there?
Pam, Lafayette, Louisiana, USA, February 5, 2007

• J Norman-- Looks like you have been though an ordeal... I am a clinical educator in a cath lab and I hope I can help. It really is not quantifiable, your prognosis, from your story. You need to take into account your symptoms and how often, how severe, etc. Regardless of the number of blocked arteries, it is the heart muscles response and amount of damage that is the important factor. Do you know the state of your heart muscle (this can normally be diagnosed by a heart scan or during cath). If your heart muscle is reasonable, then you need to continue with your life, taking one step at a time, always being aware of your symptoms and never ever stressing yourself physically. However, you need to stay positive and mentally active. Your physician was perhaps slightly inaccurate to tell you this was worse than cancer and I feel you have been given inadequate information. You need to know what all this means in real terms and how it will affect your life? There are new advances in cardiology all the time, pharmacological and medical interventions such as cath lab things and you have the right to be know if these will apply to you. I hope I have helped ...and not confused you. You should know that I have seen many patients in your position and they have developed a good relationship with their cardiologist and have learned to live within their means ....and enjoy it!!
Andrina, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia, February 10, 2002

• 58 Female -- had triple bypass Oct 18, 2001. All attending physicians stated my surgery was a success and I went home in 2 days. On Jan 18, 2002 I experienced severe chest pain and went to the emergency room. The ER doctor conferred with my cardiologist and decided I should undergo a cardiac cath to see what was going on. On Jan 19 after the procedure my cardiologist reported to my family and I that 1 graft has completely blown, graft 2 had 90% blockage in which he placed a stent, graft 3 had approx. 95% blockage and a balloon procedure was done. It was explained to my family and I that my arteriosclerosis was so severe that it caused this all to occur (in 3 months time) and that my prognosis was very poor. He even stated that it was worse than that of cancer. My physician has left us with no hope and no options to explore. I am taking it upon myself to find other avenues of treatment. If anyone has experienced this and has any advice or encouragement let me know.
posted by J. Norman, Loudon, Tennessee, USA, January 20, 2002

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