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Urgent - Need Help Understanding - Stents or Bypass or ???

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  • Urgent - Need Help Understanding - Stents or Bypass or ???

    Background - I have severe aortic stenosis. The 2 options for treating are:
    1: Transcather Aortic Valve Replacement (TAVR) which is done under local anesthetic. usually requires just 1 night in hospital, and has a much shorter recovery period.
    2: Surgical Aortic Valve Replacement (SAVR) which is open heart surgery.

    Since I am considered a low risk surgical candidate, TAVR is not covered by Medicare, so I am trying to have TAVR through a clinical trial.

    I made an appointment at a high rated university hospital. They run blood tests, exercise stress test, and a CT scan. Everything seems to be a go for TAVR and the cardiologist says nothing about any arterial blockage.

    I have a cardiac catheterization, which I thought was the final test before getting the go ahead for TAVR. About an hour after the cath, my cardiologist, as well as the cardiologist who performed the cath, come to the recovery room. My cardiologist has a very serious look on his face and tells me they found major arterial blockage and I needed either stents or bypass. He didn't explain what was involved, just that my choice was stents and TAVR or bypass and SAVR. He said I needed to have an echo done and he scheduled it for about an hour later. Then he had the surgeon come in to talk to me. After a few minutes of talking to the surgeon, he said he really had no idea why my cardiologist had sent him in to talk to me.

    So you might think, so what's the problem? Two days later I get a message through the hospital system that they discussed my case at the weekly TAVR meeting and it was decided no action was needed at this time. He scheduled me for an appointment 5 months later and wouldn't provide any reason why my situation had changed from urgent to not urgent. I have lost all confidence in this doctor.

    Current Situation - I have an appointment at a different university hospital that also is participating in the same TAVR trial.

    What I Need - I can't figure out if I even need stents or bypass. From the research I have done, both are done primarily to try to stop angina (chest pain). People who don't have bypass surgery have a 10 year death rate just slightly higher than those who do have bypass. Dr Brewer has published a video on stents, but I don't think he mentioned under what conditions stents or bypass should be considered.

    Here's the info from my cardiac catheterization. If you can help explain it to me I would greatly appreciate it. (#1 and 2 just for completeness. It's just #3 I need help with

    1) Normal cardiac index at rest with normal filling pressures and normal PA pressure.
    2) Calcified aortic valve with reduced leaflet mobility ...
    3) Coronary atherosclerosis, severe stenosis of large OM2, moderate estial disease of D1, OM1, and RCA.

    Is #3 a reason to have stents or bypass surgery if I am taking a statin, low dose aspirin, have low inflammation, have very good cholesterol numbers, and eat a mostly vegetarian diet? The only current problem I know of is my OGTT indicates a problem, which I am working on.
    Last edited by rich; 04-16-2019, 01:51 PM.

  • #2
    Hi Rich,

    Very interesting and you bring up a valid point about stents/bypass being used most often for angina.
    Few quick questions for you:
    1.) What are you eating that is non vegetarian?
    2.) What Rx's are you currently taking?
    3.) Are you taking COQ10 or 1 of it's derivatives since you are on a statin?

    Comment


    • #3
      Originally posted by rginnis View Post
      Hi Rich,

      Very interesting and you bring up a valid point about stents/bypass being used most often for angina.
      Few quick questions for you:
      1.) What are you eating that is non vegetarian?
      2.) What Rx's are you currently taking?
      3.) Are you taking COQ10 or 1 of it's derivatives since you are on a statin?
      I often have a spinach omlet made with 1 whole egg and egg whites. Every week or 2 I eat some seafood and daily take fish oil capsules.

      BP med and Crestor (5 mg) plus low dose aspirin

      Ubiquinol

      Comment


      • #4

        fatmax
        #2.1

        fatmax

        Why would you assume I haven't done my own research?

        Who better to ask than other people with heart disease? I realize not everyone here does have it, but everyone here is interested in the subject and I value their knowledge and experience. Look at the articles that come back from a google search and you will see most are out of date and still pushing stents. I need cutting edge information and can't find much, Most of the medical community still wants the big bucks that come from stents and bypass, not the almost free lifestyle and diet solution.

        I don't know how many times I have to explain I have to limit saturated fat to 10 g/day or end up in ER. I would love to eat a big, juicy steak, but I can't. Eating a high fat diet is likely what caused the plaque in the 1st place. Just because a high fat diet works for you doesn't mean it is right for everyone.
        Last edited by rich; 04-17-2019, 10:45 AM.

        Comment


        • #5
          Think Dr Brewer talked about ApoE 4/4 and its susceptibility to saturated fats!

          Comment


          • #6
            Originally posted by VenSub View Post
            Think Dr Brewer talked about ApoE 4/4 and its susceptibility to saturated fats!
            I believe both 3/4 and 4/4. Bale-Doneen recommends a low fat diet. If I remember correctly, some on the APOE site are trying a ketogenic diet.

            There are so many genes involved, as well as environment, that making a decision based on just 1 snp probably isn't the best choice.
            Last edited by rich; 04-21-2019, 09:07 AM.

            Comment


            • #7
              I had my dr appointment and because they don't consider my chest pain to be angina, I am still symptom free. That means I am still in wait mode for valve replacement. This cardiologist is also talking stent, but didn't seem to be pushing bypass.

              I've got 3 1/2 months before next echo, so full speed ahead on trying to stop and reverse plaque buildup. I've got a CIMT in about week, so hopefully that will help me make my decision.

              Comment


              • #8
                HI rich,
                Sending you prayers and wishing you luck my friend!

                Comment


                • #9
                  Hi there rich,
                  Yes, let us know how you're doing with your decisions and outcomes as you go and anything more you come across.
                  By the way, what dosage of Ubiquinol are you maintaining?

                  Comment


                  • #10
                    Sherryl - 100 mg, but remember I am only taking 5 mg Crestor every other day.
                    rginnis - thanks

                    I recently watched the best video I have seen on heart disease. If you are familiar with the fat emporer, Ivor Cummins, it is one of his podcasts. Search for ivor cummins and Bill Blanchet if interested. Blanchet's advice is very similar to Dr Brewer's, but with several additional actions we can take. For example, he recommends taking aspirin based on weight instead of everyone taking 1 80 mg aspirin, and he recommends aged garlic extract. I've also increased my fish oil to 4 g/day based on his recommendation. It's worth listening to the entire podcast because in addition to treating heart patients, he owns an imaging center, so he relates actions to changes in calcium scores. In other words, when he has a patient do x, he usually sees a reduction in calcium score. An interesting example is the change in calcium score resulting from FLOSSING! The main difference between Dr Brewer and Dr Blanchet is Blanchet believes calcium score is superior to CIMT.

                    I'm also going to start cardiac rehab exercises based on youtube videos of actual cardiac rehab centers. I've never understood why rehab isn't ordered as soon as heart disease is discovered.

                    Someone who will blow your mind is Dr Jack Kruse. I'm not strong enough in biology and chemistry to understand everything he posts, but the essentials are drink good water, eat a lot of fish and seafood, get a lot of sun - especially at sunrise and sunset, ground, avoid emf as much as possible, and cold thermogenesis. I try to incorporate as much of his protocol as I can.

                    Note: remember aspirin can cause stomach bleeding.

                    Comment


                    • #11
                      Originally posted by VenSub View Post
                      Think Dr Brewer talked about ApoE 4/4 and its susceptibility to saturated fats!
                      I'm 3/3 but just found out I carry one SNP that shows I'm not good with saturated fats. But I am good with MUFA and PUFA. No wonder my lipid panel got worse on LCHF.

                      Comment


                      • rich
                        rich commented
                        Editing a comment
                        Think about what happens if you are not properly digesting and metabolizing saturated fat. First, it can leak through the gut wall taking with it endotoxins, creating massive inflammation. Second, the fat that leaked through the gut binds to LDL using the same port that LDL uses to bind to the liver, resulting in SdLDL that stays in the bloodstream. Third, ldl that continues to circulate in the blood becomes oxidized, so starting to build plaque, Fourth, if saturated fat is not metabolized by the cell (similar to insulin resistance), you are likely to suffer from fatigue plus you have high ldl.

                        I'm pretty sure those were the processes that caused me to develop aortic stenosis and blocked arteries. I've yet to find a doctor, especially a cardiologist, that was interested.

                        Have you run your 23andme data through Rhonda Patrick's app? I found I had several SNPs related to fat, especially saturated fat. That was key for me finally being able to start turning things around. And that is why a diet high in saturated fat is a killer for some people.

                    • #12
                      Yes I did run it through her website after listening to her on Peter Attia's podcast. (They are both amazing) I have listened to all of Peterattiamd podcasts and subscribe to his newsletter. But yeah, weird! I have a SNP that says I have a 67% harder time metabolizing saturated fats only. My LDL 15 months ago was 110, started LCHF by adding coconut oil occasionally and full fat Greek yogurt and cottage cheese and minimal cheese (still no meat) and 6 months later my LDL was 75! But I was taking 2000 mg of niacin which may have masked the detriment. I continued for a few more months until my liver enzymes rose too high and I stopped the niacin. My LDL jumped to 145 the highest ever shortly after. And that's when I started doing more research.

                      Comment


                      • #13
                        I have Artherosclerosis in LAD at age 48, so I am sure I have several of these mutations! So far on LCHF and IF reduced BMI. Also taking 5mg statin and Ramipril. Eating cheese here and there and little bit of butter/ghee daily. First test, LDL was ok at 75. Need to do one more test to validate.
                        Will do my 23andme also.
                        I subscribe to Peter's podcasts, but think its more for Doctors than regular person as it has very little actionable items.

                        PS: When God made living things, why couldn't he attach a specs and user manual with it?

                        Comment


                        • #14
                          Originally posted by rich View Post
                          I have to limit saturated fat to 10 g/day or end up in ER. I would love to eat a big, juicy steak, but I can't. .
                          10g of fat sends you to the ER? What exactly happens when you eat that much fat?


                          Comment


                          • #15
                            Originally posted by David View Post

                            10g of fat sends you to the ER? What exactly happens when you eat that much fat?

                            It raises ldl, sdldl, and triglycerides, but more importantly it causes my BP to spike to stroke levels - 220/130 on a night;y basis. It took a long while to figure out, but when I cut saturated fat down to minimal I was able to eliminate the spikes. My theory is I had so much fat in my blood, the liver couldn't remove it fast enough. I think that's also why I have plaque in several arteries and in my aortic valve.

                            Comment


                            • Sherryl (Australia)
                              Editing a comment
                              Have you ever taken Lipase or broad digestive enzymes?
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