It’s really difficult to get this message to people who already have had a coronary artery bypass. They are convinced their cardiologist is a saint and if it were not for him, they would have been dead a long time ago. Right, and the tooth fairy takes dentures. I am tired of pussy footing around the subject. If you did not get a second opinion from a noninvasive cardiologist when your interventional cardiologist told you you would have a heart attack or die if you didn’t immediately have a bypass, you are a fool.
I started my blog nearly three years ago, after being told by a cardiologist, cardio-thoracic surgeon, and my own primary care physician, that I needed to have a quintuple coronary artery bypass within a day or I could be dead or have a heart attack. “Your heart is great,” I was told, “but your coronary arteries are bad, very bad. You are a walking time bomb.”
I thought that assessment rather strange. I had been walking this earth for the previous six months with frequent symptoms of angina that occurred each time I engaged in physically stressful activities. When I would rest, they would go away, troubling occurences I realized were cardiac in nature, but not so much that I worried about them.
“But doctor, if I have two coronary arteries that are 100% blocked and three that are 85% or more blocked, why is it my heart is in such great shape? Isn’t it the job of the coronary arteries to keep my heart working by bringing oxygen? My heart must be getting oxygen from somewhere, right?” I asked.
Not one of these paragons of American medicine was able to answer my questions, or perhaps, they were able to, but unwilling. As I learned later, that was probably the case. I told my family doctor and the two consultants I hardly knew, no thank you, I do not want my chest cracked open this week, nor do I want to be on an operating table next week. In fact, so adverse am I to scapels, I think I’ll get a second opinion. Despite their strong protestations, that’s exactly what I did.
I found Dr. Howard Wayne on the Internet. He ran the NonInvasive Heart Clinic of San Diego and he personally answered my email within a few hours and by that evening we were talking on the phone. He told me not to let anyone cut on me and we set up an appointment for the folling month in his San Diego office. The visit cost me $1600 out of pocket expense that my insurance would not cover. Far less costly than the quintuple bypass Indiana doctors wanted me to receive.
When I arrived at Dr. Wayne’s office, I found a man who looked 15 years younger than his 81 years. In fact, it was only after his death while on vacation at Lake Tahoe this last October 23, that I learned Dr. Wayne’s true age. He ran his clinic without a receptionist or nurse. But he did have medical equipment that must have cost a fortune. He didn’t have a medical technician to do the tests, Dr. Wayne was a one man show.
After around two and a half hours of poking and prodding my chest with doppler devices and microphone looking gizmos, and listening very carefully to many areas of my heart through earphones, he announced, “Yeah, your coronary arteries are pretty useless. But that’s not causing your angina.”
“It’s not?” I replied, surprised. “Nope. You’ve got high blood pressure,” he said confidently without having yet measured my blood pressure.
“I’ve never had high blood pressure doctor,” I politely responded. “It’s always 120/70 or thereabouts.”
“You don’t know it, but every time you get angina pain, it is caused by hypertension,” he said flatly.
Then he had me lay on the examining table and he put a blood pressure cuff on my left arm. He carefully put the stethescope bell on my arm and gently pumped the cuff up. He released the air slowly and then announced, “120/70.”
“See, I told you,” I said, a bit too smugly. “Now take this instrument and hold it in your right hand and squeeze it as hard as you can while holding your right arm up in the air. I took the grip-measuring device and did as I was told. A minute into the exercise, he took my blood pressure. It was 230/130. I was dumbfounded. He was right.
Dr. Wayne started me on a medication regimen and the angina went away. I won’t get into what the drugs are, they are found in other threads on this blogsite. I will tell you why Dr. Wayne wasn’t worried about my coronary artery disease.
Males, over 50, have a remarkable ability to generate new blood vessels whenever the ones they were born with are compromised by injury, or in my case, by the normal aging process. Yes, coronary artery disease is not really a disease. Often bypasses damage the new vessels a body is creating, doing more damage in the long run.
Let’s look at what the American Heart Association says about angiogenesis, the creation of new blood vessels:
Angiogenesis is a natural process in the body that involves the growth of new blood vessels. It can occur during coronary artery disease, peripheral artery disease and stroke when there’s insufficient blood supply and oxygen to the tissues, a condition known as ischemia. The body’s first response to less blood flow to the heart is to grow tiny new “collateral” vessels to help blood flow around the blockage. For unknown reasons, the process eventually switches off. Some proteins in the body can help trigger new blood vessl growth and so increase the oxygen supply to the ischemic tissue. Such angiogenic proteins include the endothelial growth factor, vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF).
Scientists are using gene therapy to copy this natural process by delivering angiogenic genes to ischemic tissue. For example, let’s say the goal is to create or improve blood flow in peripheral (leg) or coronary (heart) arteries damaged by vascular disease. Then, the ability to “turn on” the angiogenesis gene could be a potentially powerful way to “grow” new blood vessels.
Several scientific studies involving gene therapy trials for cardiovascular disease in humans are under way and look very promising. However, gene therapy still needs many improvements before it becomes routine treatment for cardiovascular disease in the clinic.
Yes, my body was building its own bypasses around the blocked arteries and Dr. Wayne said the medication will help nature take its course. He said within a year or so, my collateral vessels will replace the blocked arteries. Again, lets see what the American Heart Association says about collateral circulation:
What is collateral circulation?This is a process in which small (normally closed) arteries open up and connect two larger arteries or different parts of the same artery. They can serve as alternate routes of blood supply.
Everyone has collateral vessels, at least in microscopic form. These vessels normally aren’t open. However, they grow and enlarge in some people with coronary heart disease or other blood vessel disease. While everyone has collateral vessels, they don’t open in all people.
How does collateral circulation help people with heart disease?
When a collateral vessel on the heart enlarges, it lets blood flow from an open coronary artery to an adjacent one or further downstream on the same artery. In this way, collateral vessels grow and form a kind of “detour” around a blockage. This collateral circulation provides alternate routes of blood flow to the heart in cases when the heart isn’t getting the blood supply it needs (myocardial ischemia) (mi”o-KAR’de-al is-KE’me-ah).
These are things your cardiologist doesn’t want you to know. If you did, their scare tactics and coercion would be obvious. The Coronary Artery Bypass Graft is the most over-prescribed surgery in America and doctors should be ashamed that they violate their Hyppocratic Oaths with 95% of the CABGs they perform.
11 users commented in " Hard Facts for Potential Coronary Bypass Victims "
Follow-up comment rss or Leave a TrackbackSHHH…we docs know about angiogenesis. And if we could be sure that it would happen in our patients, we could spare the bypass surgery.
You see, I’ve been in medicine before they did bypasses, and you know what? Some people with stable angina lived for years, although many were misearable. Some got better. The only “treatment” was diet and exercize and nitroglycerin back then.
Similarly, we knew that a vegetarian low cal diet combined with a gradual increased exercize program would result in improvement almost as much as surgery. We’ve known that since 1970 (maybe before, but I graduated 1971).
Alas, it doesn’t work in the real world. You try telling grandma she needs to stop eating cannoli.
When they did a comparison study of diet/exercize/medicine vs bypass in the VA, they found the first group ended up having more heart attacks or having so many symptoms the guys insisted on the bypass.
You see, in the real world our patients don’t eat correctly, don’t exercize, and want a quick fix.
Now we have a third choice, stents, but they work better for one or two blockages, not someone with arteries that are full of junk.(i.e. diffuse arteriosclerotic placques).
Now, if these new stem cell injections work, maybe we can stop doing bypasses. Then I’ll agree with you.
In the meanwhile, continue what you’re doing. I love it when patients actually take care of their own health.
Dr. Reyes, I don’t know if you are a cardiologist, but as a physician, you should know that the American Heart Association and the American College of Cardiologists, in their own standards, state CABGs should not be performed as the treatment of choice for CAD, except on the occassion of three specific locations of blockages, that are fairly rare, or when certain compromises of heart function have occurred. Yet for many America cardiologists, it is the treatment of choice.
My heart was healthy, according to the interventionalist. It was receiving oxygen. It was not eschemeic. Why then did he think a CABG would cure my angina? Didn’t he know about angiogenesis and collateral vessels? Why couldn’t he answer my questions about that then?
Don’t answer. Obviously he was more interested in the fee for the CABG he was going to assist on two days later than treating me appropriately with medication.
What did my noninvasive cardiologist do? He didn’t put me on a special diet. He took me off the Lipitor the interventionalist started and told me to never take it again. In fact, he told me to forget about cholesterol all together. He said he hadn’t had his cholesterol levels checked since he was in medical school and he attended long before you did.
One question doctor, If I was a walking time bomb in the spring of 2004 and I am still walking around the end of 2006, am I a dud of a walking time bomb or is my interventionalist cardiologist a dud?
Oh, and Dr. Reyes,
Regarding the VA study you cited. How do you like this one?
Twenty-two Year Follow-up in the VA Cooperative Study of Coronary artery bypass surgery for Stable Angina. Peduzzi, P, Kamina A, Detrie, K, American Journal of Cardiology. 1998; 81; 1393-1399.
Between 1972 and 1974 354 patients with symptomatic coronary artery disease were assigned to conservative medical treatment and 332 with similar symptomatic coronary artery disease were assigned to surgical revascularization. [b]The overall 22 year cumulative survival rate for the medically treated group was 25% while it was 20% in the surgically treated group. The probability of being free of heart attack was significantly higher in the medically treated group (57% vs. 41%). The authors conclude that the trial “provides strong evidence” that initial bypass surgery does not improve survival or reduce the overall risk of a future heart attack. On the contrary, invasively treated patients were much more likely to suffer a heart attack or die compared to patients who are not treated surgically.[/b]
Jeff,
I think Dr. Reyes probably is well-meant, but maybe she hasn´t had enough information.
My father is a Cardiologist, he is 81 y.o. and is retired. He keeps reading and learning about new techniques in Cardiology, and he is still a teacher. As Dr. Reyes, he was a Cardiologist before CABG was a common practice. When we told him about Dr. Wayne’s points of view he was very reluctant. For decades doctors had been told that bypass surgery was safe and the better option. Then he read and re-read most of the studies posted in Dr. Wayne’s site from their original sources. Finally, he was truly convinced that CABG (and agioplasty/angiograms)is absolutely over-prescribed, and that Dr. Wayne’s philosophy was right.
Today, he is still reluctant to Dr. Wayne’s medication dosages and a few other points, but at least there is one doctor telling new Cardiologists that CABG is not necessarily the best.
Maybe Dr. Reyes would want to check deeper on mortality statistics and studies.
Thanks for posting this article.
Thanks for the comment Maria. I sometimes get wrapped up in this issue so much that I need to step back and be more tolerant and understanding. Most ignorance is not the fault of the ignorant, but of those who taught them. I had a really hard time convincing my pharmacist that indeed, my cardiologist did want me to take the doses of the medications he put me on and to dispense them exactly as written. I even paid for the extra tablets for a while until my pharmacy finally gave in and began charging it to my insurance.
Dear Dr. Reyes,
I am in highschool,and our senior project is to talk about what we want to do when we grow up… One of the requirements of my report is that I have t o interview someone in the following profession.My dream career is to be a Cardiologist. I know you are a very busy person but I was wondering if at all possible I could interview you through online.If you are not able to do this I completely understand……
Sincerely,
Miken Hickman
Help I am a former Dr Wayne success story who is again suffering from severe angina. My Cardiologist insists that an angioplasty is my only option. What do I do?
1 year ago this month I had a heart attack. 3 ECG’s said everything was fine…blood oxygen levels were 99%…blood pressure tends to be low rather than high 115/55…after almost 12 hours wait to be seen by a doctor, blood tests were done…the only indicator of a heart attack…other than severe chest and arm pain…was the enzyme in my blood.The angiogram revealed that I had a single 100% blockage but my body had done its own bypass…other than that blockage my veins are exceptionally clean..only 2 other areas with less than 30% blockage…I cannot get or find very much information…I cannot get any real answers or explanations…my cardiologist has seen me twice in that year and says I’m fine…I don’t feel fine yet…I still get very tired…I saw the new artery…it is quite small in comparison…will this change? Are there medications to encourage growth? Should I be doing anything differently from other heart attack patients? Where can I get more information?
So there have been a number of studies looking at patients like you (i.e. stable angina) and evaluating a medical vs. surgical option. If you’re interested a nice meta-analysis that includes ~2600 patients (comprising 7 randomized controlled trials) found that a strategy of initial CABG resulted in lower mortality at 5 (10 vs. 15%), 7 (15 vs. 21%)and 10 (26 vs. 30%) years. To be clear – that means 10% mortality at 5 years in the inital CABG arm, and 15% mortality in the medical arm. So note that 85% of folks were still alive in the medical arm at 5 years. However, an extra 5% were alive with an initial CABG approach. Now, an examination of subgroups demonstrated that higher risk folks benefited the most, while lower risk folks didn’t benefit at all, and had a trend towards worse outcomes with bypass! (Higher risk folks would primarily include, but not be limited to those with left main stenosis, or low ejection fractions). This data in large part drives the current recommendations for CABG (3 vessel disease or left main disease)…with the understanding that high risk folks – low ejection fractions being a big one – benefit the most.
So it is absolutely reasonable to take an initial medical approach to someone with stable angina who has low risk features. Even if you’re medium or high risk…you could take a medical approach, as long as you understand the numbers – meaning if a 100 patients with triple vs. disease and high risk features took an initial medical approach, 15 of them would be dead in 5 years. If you took the surgical approach 10 would be dead. I don’t know your coronary anatomy, and how proximal the lesions are, but hopefully you’re among the 85% that does well. I do disagree with the non-cholesterol lowering…I think one ignores a wealth of data that suggests benefit from statins like lipitor in folks who have coronary disease.
Excellent and very helpful. I decided to go for chelation theraphy instead of Bypass recommended by the cardilogist.
I notice your last entry on this blog was in 2009. Are you still well? I have been told the same by my cardiologist. A ticking time bomb. I am a female who has grown her own bypass. Curious to see how you are now?
Also, is the prognosis for females different?
Thank you
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