Search This Blog

Monday, February 25, 2013

Questions and Answers on How to Prevent and Reverse Heart Disease from Dr. Esselstyn

I am committed to the Prevent and Reverse Heart Disease Diet developed and clinically proven out by Caldwell Esselstyn, Jr. M.D.    With DH and I now walking this earth with optimal blood pressure, blood sugar, and cholesterol in our middle ages, after having suffered from blood pressure, blood sugar, and cholesterol issues, not to mention weight problems in the past, we can't deny that eating a low fat plant based diet reverses many conditions that plague middle aged Americans.  I only wish we had been as committed sooner because I might have kept my gallbladder, escaped other digestive damage from the bile issues caused by my gallbladder troubles, and Dh would be stent free.  But, we can look forward to a more product future life thanks to Dr. Esselstyn's research.

I am posting his Q & A here for my friends and family for their convenient reading of the basics of his diet and encourage anyone that has health concerns, not just heart health concerns to buy and read his book Prevent and Reverse Heart Disease.

Please note, I am not earning and will never earn a penny from this blog.  So while I am providing book titles, they are not linked to any money making systems.  I am not in cahoots with Dr. Esselstyn to promote his book either.  I am providing a copy and paste of his Q & A from  because I believe in his work and want to make the information easily accessible to all people who can benefit from it.

Just to note, as and LDS person this diet is a great companion to the dietary counsel given in the Word of Wisdom in Doctrine and Covenants 89.

I encourage anyone who is serious about healing the physical heart from the food born illness caused by the American Diet to buy his book or check it out at the library and comb through it several times.  You can even go see Dr. Esselstyn at a seminar at the Cleveland Clinic, the nation's number 1 rated heart care facility.    Just e-mail his secretary, Jackie.  Her e-mail is on his web site.  She will answer within a day or two and send you all of the information.

We haven't gone to see him yet, but we have talked to him on the phone and plan to see him in the future if we need more guidance, but so far the book has been adequate for us.

By the way, look at his picture.  He is 79 years old.  He is vibrant, healthy, and very kind.

Here is the Q & A from his web site.....

Q&A with Caldwell B. Esselstyn, Jr., MD

Caldwell B. Esselstyn, Jr., MD, F.A.C.S.
Please note: If your question is about finding a doctor in your area who supports a plant-based diet, please see this link: How to Find a Plant-Based Doctor.
1. How is your approach to treating heart disease unique?
My program is a nutrition-based therapy that has been scientifically-proven to reverse heart disease. There is no other treatment plan backed by a study as long as the one I conducted, or a study that has produced such dramatic, visible results. Coronary angiograms (X-Rays) of the patients in my study show an actual reversal of the disease. To experience these benefits, my patients must stick to my plant-based diet program strictly, but the effects are more than worth the effort. For those that are very sick, it is the most effective treatment option--far less dangerous and more effective than invasive surgical procedures such as stents and bypass (except in acute emergencies), and much more effective than drugs alone. Traditional cardiology has relied on technology to ease the symptoms of heart disease, but has not addressed its causes. My approach is not another stop-gap solution, it prevents heart disease from occurring in those who don't yet have the disease, and it heals the body and reverses the disease when symptoms are present.
Best of all, over time the benefits endure and continue to improve. I am always excited when I see arrest and reversal in patient after patient and their joy and relief when they are free of the disease that was destroying them.
2. What would you say to someone considering a stent or other surgical procedure or drug therapy, to treat their heart disease?
All heart patients who are not absolute emergencies should first have an aggressive opportunity at non surgical medical therapy. This is not just my opinion but that of expert cardiolgists from Boston, Hartford, Houston, Stanford, San Diego, Seattle and Cleveland. The difference in my case is that I advocate an aggressive plant based nutrition program to arrest and reverse the disease and to avoid all surgery. Drugs alone do not prevent heart attacks and stop symptoms of heart disease.
3. How do you encourage your patients to stay on the diet?
There is no question it is hard at first. And it is hardest eating out at friends' houses. However, I am always impressed how well my patients do once they experience the relief of chest pain, weight loss, and the improved feeling of well being they have eating a plant-based diet. Then the motivation comes from within. It also helps that within 8-12 weeks of starting the program the fat receptor in the brain down regulates and they lose the craving for fat. And as they start feeling better and better, they know that they are the ones-- not their physician or their surgeon--that have control over the disease. It is a powerful feeling!
4. Why does the diet eliminate oil entirely?
NO OIL! Not even olive oil, which goes against a lot of other advice out there about so-called good fats. The reality is that oils are extremely low in terms of nutritive value. They contain no fiber, no minerals and are 100% fat calories. And above all they contain saturated fat which immediately injures the endothelial lining of the arteries when eaten. It doesn't matter whether it's olive oil, corn oil, or any other kind of oil. You should not consume any oil if you have heart disease. This is so important I have detailed oil in Chapter 10.
5. Can you actually enjoy food on the program?
We LOVE our food. Our children and grandchildren love our food and the patients love the food. Everyone loves the food once they give it a try. It is all a matter of attitude--and you do need a positive attitude to get started and to understand that this new way of eating is the best thing you can do for your body. Then, the body will help you adjust. You actually begin to lose your physiologically-based craving for fat. Once that occurs, you can fully appreciate the natural taste of plant foods--the colorful tastes and textures are difficult to surpass.
6. Why should I change? My health is excellent.
No one escapes in the end--eventually the traditional western diet guarantees some form of disease in all of us. While it may not be heart disease at the moment, eventually it will be or hypertension, diabetes, stroke,obesity, gall stones, diverticulitis, rheumatoid arthritis, lupus, multiple sclerosis, or a greater likelihood of breast, prostate, colon, ovarian and uterine cancers. Even erectile dysfunction and dementia. The world famous Framingham Heart Study now approaching its 60th year looked at 1,000 people at age 50 who had normal blood pressure. They looked at the same group at age 70, and 90% now had high blood pressure. But there is something that you can do now to stop the cascading events that occur in the body and lead to disease. You can change your diet and begin safeguarding your health for the future.
More Commonly Asked Questions
Protein - Where do I get my protein / What protein drink is best? 
Extra protein powder and shakes are truly unnecessary and have the potential for harm if they contain animal protein. The protein available through plant-based nutrition is adequate to nourish professional champion athletes such as the iron man, professional football, mixed martial arts, track and field, etc.
Calcium – Where do I get calcium?
Calcium supplementation is unnecessary. There is more than adequate calcium in a plant- based diet of whole grains, legumes and grains and especially the green leafy vegetables.
Vitamins – What Vitamins should I take?
A multivitamin is a reasonable way to be sure of obtaining the full spectrum of vitamins, but my preference, especially if one is eating copious amounts of green leafy vegetables, is to limit supplements to Vitamin D as necessary to maintain blood level in the normal range and B -12.
Fish Oil - Should I take fish oil?
Fish oil is not essential. Fish get their omega 3 from plants. It is difficult to be deficient in Omega 3 if eating 1-2 tablespoons of flax seed meal and green leafy vegetables at several meals. There is also research that suggests that those on plant based nutrition become highly efficient in their own manufacture of omega 3. Patients on fish oil are also at increased risk for bleeding.
Flax Seed Oil/ Flax Seed Meal – What about flax seed oil?
Flax seed meal is well tolerated and supplies a bonus of omega 3 using 1 or 2 tablespoons on cereal daily. Avoid flax seed oil.
Olive oil, canola oil, coconut oil, Sunflower oil, soybean oil, peanut oil, any oil –
Which oil is best?

Avoid oils. They injure the endothelium, the innermost lining of the artery, and that injury is the gateway to vascular disease.
Lotions with oil – Is it all right to use lotions with oil on my skin?
It is fine to use lotions with oil on your skin.

Omega 3 – How do I get my Omega 3’s?
Omega 3 ‘s are essential fatty acids supplied in adequate amounts in people consuming plant based nutrition with plenty of green leafy vegetables.
Family history –I have a bad family history? Does it matter?
Family history can shed light on whether one has an increased risk, but multiple autopsy studies of the young confirm that all who are consuming the standard western diet have established, albeit early, vascular disease. Family history loads the gun but lifestyle pulls the trigger.
Nuts – What about nuts? I hear so many different opinions.
For those with established heart disease to add more saturated fat is inappropriate.
For people with no heart disease who want to eat nuts and avocado and are able to achieve a cholesterol of 150 and LDL of 80 or under without cholesterol lowering drugs, some nuts and avocado are acceptable. No nuts for heart disease patients, includes peanuts and peanut butter, even though peanuts are officially a legume. Chestnuts are the one nut, very low in fat, it is ok to eat. (For a clarification of misinformation about nuts and this diet, see here.)
Seeds (sunflower, pumpkin, sesame) Are seeds ok to eat?
Some seeds sprinkled on bread or crackers, etc., are acceptable. Just don’t eat handfuls.
Coconut water – Is it all right to drink coconut water?
Coconut water is 8% saturated fat  (If the fat is less than .5 per serving it does not have to be listed on the label) and about 50% sugar.  So save your money and don't use it.
Prostate cancer- Does plant based eating help prostate cancer?
Prostate cancer is greatly lessoned by plant- based nutrition as best exemplified by the 1958 report confirming by autopsy 18 deaths in the entire nation of Japan.
Egg whites, fat free milk, yogurt – So What is wrong with egg whites, fat free yogurt, skim milk?
Egg whites, fat free milk and yogurt are ALL animal protein, and animal protein injures the lining of the arteries. Do not eat.
Cholesterol Number fluctuation – Why do my cholesterol numbers fluctuate? 
Fluctuation of cholesterol is normal. It is nice to have it fluctuating in a range that would indicate you are unlikely to have cardio vascular problems.
Losing weight –What can I do to stop losing too much weight?
If you are losing too much weight, EAT MORE calories. Increase portion size. Eat snacks. Eat more whole grains and beans.
Tired, no energy - Why am I tired and have no energy since eating plant-based?
If you feel tired and lacking in energy, be sure you are eating enough calories. Also exercise because you need to use energy to make energy. Depression also contributes to lack of energy. But first of all eat more.
Not losing weight – Why haven’t I lost weight/ Why have I stopped losing weight?
If not losing enough weight, eliminate flour products like bread, pasta and bagels. Instead, eat whole grains like rice, quinoa, barley and farro, etc. Reduce portion size. Increase leafy green vegetables and exercise.
Triglycerides– Why did my triglycerides go up?
If your triglycerides are high, cut back on simple carbohydrates which would include alcohol, wine, beer, white flour products, sugars including dried fruit, honey maple syrup, molasses, rich desserts, fruit juice or an excess of fruit,
HDL- My doctor is so concerned because my HDL has gone down
It is not uncommon for HDL to fall when cholesterol falls. Do not be alarmed. The capacity of HDL to do its job has been shown recently by scientific research that there is no relationship between the capacity of the HDL molecule to function optimally and its blood level. Recent research has confirmed that the HDL molecule can be injured and weakened when one is ingesting a pro inflammatory western diet and conversely it appears despite a lower than normal level to be optimized by anti inflammatory plant based-nutrition.
LDL - Where should my LDL be?
LDL is the bad cholesterol. The closer it can be to 80-85, the better. However, if one is unable to take statin drugs and eating plant-based nutrition, and the LDL won’t go lower than 95-105, it would appear that they will still be fine. The lesson we learned from the Tarahumara Indians, who never have cardiovascular disease, is that the most key protective element is not so much the pure LDL number as is knowing that nothing ever is eaten which is a building block of vascular disease or can injure endothelium.
Statins - Should I take statins or not?
Statins are not the reason that cultures such as the Tarhumara and the Papua Highlanders do not have cardiovascular disease. Statins appear to have no benefit in primary prevention but are of some help in slowing disease progression for those who already have an established diagnosis of cardiovascular disease. Clearly some of our most profound successes in arresting and reversing disease were with patients who either refused or were incapable of taking statins. Nothing is as powerful for the prevention of cardiovascular disease as plant based nutrition.
Coumadin – Can I eat leafy greens when I am on Coumadin?
Coumadin (Warfarin) is an anti clotting drug shown to have significant benefit in protecting people with atrial fibrillation from having a stroke. Can patients on Coumadin eat all the green leafy vegetables with vitamin k, which may shorten their clotting time? The answer most emphatically is YES! Merely inform the physician who is monitoring the Coumadin and clotting time that you are regularly going to be eating copious amounts of healthy green leafy vegetables. He/she will appropriately adjust the Coumadin dose.
Juicing- Is it all right to juice?
Do not juice. You lose all the fiber and its benefits.
Fruit juice – What about fruit juice?
Drinking fruit juice is like pouring the sugar bowl down your throat. It is fine to eat the whole fruit. Do not drink the juice.
Smoothies – How about smoothies? I love them! 
Avoid smoothies. The fiber is so finely pureed that its helpful properties are destroyed. The sugar is stripped from the fruit, bypasses salivary digestion and results in a surge of glucose and the accompanying fructose contributes to inflammation and hypertension.
A Fib- Will plant nutrition work for A Fib?
While A Fib is largely independent of nutrition, and is a heart rhythm abnormality, there are some subset of cases which are presumably related to less than optimal heart circulation. While it would be totally inappropriate for me to suggest plant - based nutrition would cure atrial fibrillation, the many ancillary benefits would indicate plant based nutrition would be of value.
Calcium score- Is a calcium score helpful?
With cardiac CT you get a big hit of radiation. If you have been eating the typical American diet, you have heart disease as autopsy studies have shown.
Erectile dysfunction- Will erectile dysfunction reverse with plant based nutrition?
We have seen erectile dysfunction reverse on multiple occasions. Those who follow the program most closely have the best results. How long it takes varies.
Do Cholesterol Numbers Matter?
What you eat matters most. LDL 85 or under is the ideal but it can vary if you eat plant based.
Sugar- How much sugar is safe?
Newer information suggests that excess sugar is harmful, especially fructose, one of the most commonly ingested sugars, which can contribute to inflammation and hyper tension as well as weight gain and exacerbating diabetes
Coffee – Can I drink coffee?
Avoid coffee with caffeine. Several studies indicate it may contribute injury to the lining of the artery.
Soy products – What about soy products?
Soy products are 40% fat and most of them are highly processed. An excess of soy protein may stimulate insulin growth factor, which is a tumor promoter. Eat soy products cautiously.
Does eating plant based help with congestive heart Failure?
There are multiple components in  the treatment of congestive heart failure.   It is our experience that when all the usual therapies have been instituted, there can be additional improvement with the introduction of whole food, plant based nutrition.
There are so many different diets out there…Paleo, blood type, how do I know which one to choose?
That is not as challenging as it may appear. You can separate hype from scientific reality by seeing if the author has done peer reviewed scientific research prior to bringing the ideas to the public.
What is the difference between plant protein and animal protein?
While the precise mechanisms need to be elucidated, animal and epidemiological studies as well as the brachial artery tourniquet test, confirm that animal protein accelerates both atherosclerosis and cancer,  whereas plant protein does not.  

Saturday, February 23, 2013

Update on DH's Chest Pains and Xience V research

Dh is feeling much better today, and I have to blame his chest pains on a non-cardiac cause.  He has been very active today with no chest pain at all, none for the whole day, and this is his first pain free day in over a week.

The family has been passing around a cold, so I'm assuming that his pain was bronchial related instead.  He has had pneumonia the past two winters, so he's vulnerable in his bronchial area.

I did follow up and do research on the Xience V stent.  I'm so glad that Dr. Tannenbaum is the consciencious interventionalist that he is.  He has chosen what seems to be at this point, the drug eluting stent as far as I can tell.   The Xience V is noted to have a very low rate of restenosis and late thrombosis, which puts my mind at ease, especially since Dh is feeling better today.  Ahhhh!  Such is the life of a heartmate.  So much worry, so much relief, back and forth, back and forth.

I'm posting the article here about  the Xience V clinical trials found on the following web site.........

COMPARE and SPIRIT IV: "Durable, progressive relative benefit" of Xience V over Taxus

SEPTEMBER 23, 2010 
Washington, DC - Two-year results from the COMPARE and SPIRIT IV trials confirm the superiority of the everolimus-eluting Xience V stent (Abbott) over two iterations of the paclitaxel-eluting Taxus stent (Boston Scientific). In COMPARE, an investigator-initiated, all-comers trial, researchers showed that the everolimus-eluting stent remained superior to the Taxus Liberté stent, with significant differences in the composite end point of death, nonfatal MI, and target vessel revascularization (TVR) observed at two years.
Similarly, the SPIRIT IV investigators, led by Dr Gregg Stone (Columbia University, New York), also showed sustained benefit of the Xience V stent over the older Taxus Express stent. At two years, treatment with the everolimus-eluting stent resulted in a relative 30% reduction in target lesion failure, a composite end point reflecting cardiac death, target vessel MI (TVMI), or ischemia-driven target lesion revascularization (TLR).
Dr Dean Kereiakes
Dr Dean Kereiakes
Presenting the results of the SPIRIT IV study during a morning press conference at TCT 2010, investigator Dr Dean Kereiakes (The Christ Hospital, Cincinnati, OH), said both trials show a "durable, progressive relative benefit" of the Xience V stent over time.
"The other revelation is that the very late stent-thrombosis rates with the Xience V are low, either with or without extended dual antiplatelet therapy," Kereiakes told heartwire. "Our trial had 72% of patients taking dual antiplatelet therapy at two years, while their trial [COMPARE] had just about 10% of the Xience V cohort on dual therapy at two years. Either way, the very late stent-thrombosis rates were very low with the Xience V stent. Not so in the Taxus arm."
Dr Stephan Windecker (Bern University Hospital, Switzerland), who was not affiliated with the two trials, agreed, telling the media the message from the COMPARE everolimus-vs-paclitaxel comparison was the difference in stent-thrombosis rates between the two stents at one and two years.
"In terms of efficacy, I don't think we're surprised to see the superiority of this newer-generation stent," said Windecker. "The new message relates to the one-to-two year interval, a very late period, and the significant reduction in very late thrombosis. This is an important advance, because it was the principal limitation of both Cypher and Taxus."

COMPARE and SPIRIT IV at two years
Presented last year at TCT 2009 in San Francisco, CA and reported by heartwire at that time, SPIRIT IV investigators randomized 3690 patients in a 2:1 fashion to the Xience V or the Taxus Express 2 stent. Regarding the primary end point at 12 months, there was a 2.6% absolute difference in the rate of target lesion failure between the two stents, statistically favoring the Xience V. A statistically significant difference in stent thrombosis between the two arms was also observed at one year: 1.06% for Taxus vs 0.29% for Xience V (p=0.003).
With the two-year data presented today, there was an absolute 3.0% difference in target lesion failure, again statistically favoring the Xience V stent. There were also significant reductions in ischemia-driven TLR and TVMI with the everolimus-eluting stent, but no significant differences in mortality. The differences in definite or probable stent thrombosis were also in favor of the Xience V stent, with a two-year stent thrombosis rate of 1.23% among the Taxus-treated patients and 0.42% for the Xience-treated patients.
SPIRIT IV: Primary and secondary end points at two years

End point Xience V (n=2458), % Taxus (n=1229), % p 
Target lesion failure
Ischemia-driven TLR
Cardiac death
Target vessel MI
Definite or probable stent thrombosis 0.421.230.008
Dual antiplatelet therapy was maintained in a majority of patients, 72% among patients treated with Xience and Taxus, until two years, note the researchers. They also note that diabetics did not fare as well as those without diabetes. At two years, as with the one-year data, there was no significant difference in the primary end point of target lesion failure among diabetic patients treated with the two stents.
Dr Ian Meredith
Dr Ian Meredith
Speaking during the late-breaking clinical-trials session, Dr Ian Meredith (Monash Medical Center, Melbourne, Australia) said the sustained benefit of Xience over its Taxus counterpart is an important finding. He stressed, however, that SPIRIT IV was not an all-comers trial and that while investigators treated a wide range of vessels and lesion lengths, many patients were excluded.
"It's important to recognize that there were certain patients that weren't treated in this study, bearing in mind that we can't necessarily generalize the stent-thrombosis rates to these other patients, namely those patients with ostial lesions, chronic total occlusions, calcified vessels, acute MIs, saphenous vein grafts, and patients with thrombus, all of whom have a significant rate of early and late stent thrombosis," said Meredith.
Regarding the diabetes data, Meredith said that the Xience V stent appears to lose some efficacy among diabetic patients, and the reason is not entirely clear. By his interpretation, he said the results suggest that both stents fared equally well in the diabetic cohort.

Taking on all-comers in COMPARE
Dr Peter Smits
Dr Peter Smits
In contrast with SPIRIT IV, the COMPARE investigators did take on all patients and included 1800 complex patients, such as those with acute MI and STEMI, as well as those with relatively high proportions of calcified lesions, bifurcations, multivessel disease, and diabetes. As reported previously by heartwire, the Xience V stent performed better than the Taxus stent, with significant reductions in the primary composite end point of death, nonfatal MI, and TVR. Similarly, there were reductions in secondary end points, as well as reductions in the risk of definite or probable stent thrombosis.
Presenting two-year data today, lead investigator Dr Peter Smits (Maasstad Ziekenhuis, Rotterdam, the Netherlands) reported that the difference in the primary end point was maintained at two years, with larger absolute differences between the Xience V and Taxus stents than at 12 months.
COMPARE: Primary and secondary end points at two years

End point Xience V (%) Taxus (%) p 
Cardiac death, nonfatal MI, and TLR 7.411.40.0038
Nonfatal MI
Definite/probable stent thrombosis 0.93.9<0.0001
Early stent thrombosis (<30 d)
Late stent thrombosis, (30 d-1 y)
Very late thrombosis (1-2 y)
MACE=major adverse cardiac events (all death, nonfatal MI, and TVR)
To download tables as slides, click on slide logo above
Unlike SPIRIT IV, where a majority of patients continued to take dual antiplatelet therapy at two years, just 13% of COMPARE patients were taking clopidogrel and aspirin after two years. Despite this, there were significantly lower rates of definite/probable stent thrombosis among those treated with the Xience stent.
Dr Jeffrey Popma
Dr Jeffrey Popma
Speaking during the late-breaking clinical-trials session, Dr Jeffrey Popma (Beth Israel Deaconess Medical Center, Boston, MA) said the stent-thrombosis data suggest that "there is something clearly there" with the Taxus Liberté stent. To heartwire, Kereiakes said the relative lack of dual antiplatelet therapy in the COMPARE trial highlights the differences between the two stents and exposes the "relative hazard" of Taxus, especially when patients stop taking clopidogrel.
Like the SPIRIT IV study, there was no benefit of Xience in diabetic patients.
A spokesperson for Boston Scientific noted that the Taxus Express stent, tested in SPIRIT IV, is no longer commercially available in the US. He also said the event rates observed in COMPARE, "specifically for early stent thrombosis, TLR, and MI," are not in line with results observed in other trials.
Stone disclosed receiving research grants from Atrium, Volcano, and TherOx; consulting fees from Osprey Medical, InfraRedx, Reva Medical, Boston Scientific, Abbott Vascular, the Medicines Company, AstraZeneca, Eli Lilly, Bristol-Myers Squibb, Edwards, Evalve, Ortho McNeil, and Otsuka; holding equity in Devax; BioStar I and II funds; MedFocus I, II, and Accelerator funds; FlowCardia; MediGuide;Guided Delivery Systems; Arstasis; Micardia; and Access Closure. Kereiakes reports research support from Abbott Vascular, Amylin Pharmaceuticals, Cordis, Boston Scientific, Medtronic, and Daiichi Sankyo and consulting fees from Abbott, Boston Scientific, Eli Lilly, Medpace, and Reva Medical. Windecker reports speakers' bureau fees from Abbott, Cordis, Medtronic, Boston Scientific, and Biosensors. Meredith reports consulting for Medtronic, Boston Scientific, and Abbott Vascular. Popma disclosed research support from Cordis, Medtronic, Boston Scientific, and Abbott and consulting fees from Cordis and Boston Scientific. Smits disclosed receiving unrestricted research grant support from Abbott, Boston Scientific, and Terumo Medical. 

New Chest Pains - Learning about Stent Restenosis

Dh is dealing with chest pain again.  I'm a little bit worried, but he doesn't seem to have exertional pain.  In fact, exertion tends to rid him of the pain, so far.

He went surfing last Friday, and while in the water he had no chest pain, and while walking the long walk from the beach to the car he had no chest pain, but when he twisted his body to look back in order to pull the Yukon out of a tight parking spot, he felt the pain.

He feels it when he turns his head to the right, when he bends over, and when he's tired at the end of the day.  

I sincerely hope it's a problem with his muscles or spine instead of his heart.  I do feel encouraged today because he did have some physical activity last night that actually relieved the pain, so I'm hopeful, and no pain this morning.

He is not out of breath, not dizzy, and not fatigued, so I'm crossing my fingers, but since he has revealed that he is having chest pain, I have been on edge and a bit depressed.

In the meantime, I felt I should do some study on stent restenosis, the risks of this happening to Dh, and what symptoms to look for.

Restenosis happens when the artery tissue cells attempt to heal around the stent and make scar tissue that is too thick to allow free flowing blood through the artery.  It used to be that 30 - 40% angioplasty patients with bare metal stents would develop restenosis and end up with a serious heart blockage.  In the past ten years or so, the cardiac care world has wrestled with the development, and much trial and error, which includes the experimentation on many heart patients, Dh included, of drug eluting stents.  Generally, the outcome has been a good one.

Drug eluting stents are coated with chemotherapy drugs that cause the artery tissue around the newly placed stent to resist tissue development, making the development of the tissue much more gradual and less vigorous.

This has taken the early restenosis risk down to single digits.  Dh is currently participating in a later generation clinical trial of the Xience V Everolimus Eluting Coronary drug eluting stent, which he will be in for five years.  Why the five years?

I think it's because the cardiac care world has discovered the drug eluting stents tend to create other complications that the bare metal stents don't - up to five years after the procedure.  These drug eluting stents have been known in some cases, particularly in diabetics, and patients with metabolic syndrome, like DH, to create later complications when the blood thinner medications are discontinued.

You see, when a heart patient receives a stent, he/she is typically placed on a blood thinners like Plavix to prevent blood clots from forming around the stent.  Blood clotting is call thrombosis, and is not restenosis, but another risk of having a stent.  After stent placement, the risk is high for thrombosis development which can lead to artery block and heart attack.  This risk makes the blood thinners imperative.

These are risks you are not usually told about when your spouse is being wheeled into the cath lab prior to surgery, and this probably is because the risks outweigh the benefits in a big way.

With drug eluting stents, there have been cases reported of patients developing thrombosis after the blood thinners are stopped.  When the first trials came out during the early use of drug eluting stents, interventional cardiologists were excited by the results of restenosis prevention.  But, in time, a dilemma developed when it was found that late thrombosis was a risk they did not anticipate, and this has been a noted risk up to five years after stent placement!

Dh's stent is a late generation stent, which is hoped to prevent this risk of late thrombosis.  He will have to be on blood thinners for at least a year, and I'm hoping that clinical trials done up to that point will show that these newer generation stents are less prone to late thrombosis.  I am hopeful that they are, but extremely cautious.

When his stents were placed, I thought that would be the end of my worries, but I'm now resigning myself to the fact that I will always have to be on guard, watching him to see he if is developing any blockage symptoms.  We all have our own trials and situations that seem to be chronic, and this is one of ours that will certainly keep me on my knees for years to come.  As I have said before, as Dh's heartmate, part of my mission in life is to help him keep his heart healthy.  Metal stents create inflammation by the very nature of them not being a perfectly matched human tissue for DH's arteries, and this makes keeping Dh on a diet that naturally keeps the blood less "clottable" very important, although I'm not sure that thrombosis can be completely avoided with just diet.  But what I do know is that diabetics and Syndrome X patients have higher arterial inflammation, so my call to diet vigilance has been sounded and heeded.

My next post will probably be a research paper on the stent that has been placed into Dh's arteries.

Monday, February 18, 2013

Got Through Vacation Without One SVT

I am happy to report that I got through my entire vacation without going into SVT once!!!!!

I am so excited about this because vacation can put a person in so many situations that could cause an SVT episode.

On this vacation, I was subjected to lack of sleep, large meals, adrenaline rushes from airplane take offs and landings, adrenaline rushes from Disney roller coasters, anxiety from family illness, and family dynamics, PMS, and gluten exposure.

I wanted to allow myself to experience many situations while on vacation to prove to myself that I can keep living and full and happy life, even with the threat of an SVT episode looming around the corner.

I wanted to test out a theory that if I kept myself hydrated, took my magnesium, kept my potassium levels up by eating plenty of bananas, and tried to keep my emotions under control, I would not go into SVT.

It seems to have worked, but only time will continue to prove that out.

Here is how I handled myself during my ten day trip.  Each morning I drank 16 oz of water and took 100 mg  of magnesium glycinate.  I also took 1/2 of a 100 Stress B complex vitamin supplement which also contains copper, zinc, and vitamin C.  I made sure I ate one banana in the morning, one in the afternoon, and one in the evening.  I made sure to drink several glasses of water throughout the day, and I took 100 mg. of magnesium two more times, in the afternoon, and evening.

I made sure to eat a wide variety of low-fat plant based foods, and whenever I felt I was getting overly stressed I would do something to destress, like breathe deeply, close my eyes, and pray.  Each morning I asked the Lord to keep me out of SVT, and I think He helped me by giving me ideas to stay out of it.

In the California traffic, I tried to stay calm, and on the Disneyland roller coasters, I kept telling myself that I have never had and SVT on a roller coaster so I don't know until I try if they are going to trigger one.  The funny thing is, the only anxiety I had on the roller coasters was buckling up.  Once the ride started, I was having so much fun I could feel myself relax and destress.  I road the Matterhorn, Space Mountain, and Radiator Springs Racers, with no trouble at all!

I am so happy because all of these things put me in stressful situations that were far more stressful than what I experience at home and if stress were the trigger, I should have had several episodes.  This leads me to believe that my SVT episodes are being caused by electrolyte issues.

One day, while on vacation, I had the classic feeling of leg crampiness I have had on every SVT day that I have had.  So, I decided that day, I would not go on a roller coaster unless the crampiness went away.  I also drank a lot more water and made sure I had my three bananas that day.  By mid-morning the crampiness went away, and by afternoon, I felt fine and was able to ride two roller coasters that day.

I am so grateful because this has really boosted my self-confidence.  I will continue to take my supplements, drink my water, and eat my bananas and see if that puts the episodes farther apart from each other.  How I would love to eliminate them altogether, or at least, keep them at the low frequency so as not to alarm my cardiologist and rattle my confidence.

Doesn't DH look great?  Here we are with our three youngest of seven children at the Tiki Room at Disneyland.

I rode this with out any ticker trouble!