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Ask Dr. Gott 10/20

Heart-disease treatment helps reader's quality of life

DEAR DR. GOTT: I am 80 and had a bypass about eight years ago. Several years later, I had congestive heart failure, atrial fibrillation and diabetes type 2. I heard about Enhanced External Counterpulsation and, as my heart disease was worsening, I thought I would give it a try instead of more life-risking surgery or even catheterization. My cardiologist said that EECP was a last resort. Since EECP was noninvasive, Food and Drug Administration-approved and fully paid for by my insurance and Medicare, I thought his advice was not logical. The cardiologist's advice might also have been self-serving.
    Despite my cardiologist's admonition, I went ahead. Before EECP treatment, I couldn't swim one pool length of 25 meters without gasping for air. After EECP, I could swim 10 lengths or more without stopping. Also, before EECP, I couldn't walk upstairs without stopping in the middle to rest in my daughter's new house. After EECP, I could run upstairs with no resting. I feel great, and my quality of life has improved dramatically. My blood pressure is down and my medications reduced. These treatment results are typical based on talks with other patients. Also, I have seen some statistics that the 30-day mortality rate of heart operations for 75-year-old-plus patients approaches 1 in 10. There is no mortality risk with EECP.
    The average cost of a bypass is reported to be about 14 times the cost of EECP, and a stent or angioplasty, six and a half times. I am curious that our HMOs have not required that EECP be done first or at least that the option be fully and honestly explained to the heart patient. HMOs require that physical therapy be done before some kinds of surgery. EECP is like some like of physical therapy, so why not require it first with heart patients before surgery is necessary, if ever?
    DEAR READER: As a practicing rural family physician, I am not very familiar with EECP. I don't use it, nor do my cardiology consultants.
    Basically, here is what happens. The patient has oversized blood-pressure cuffs strapped to his or her legs and buttocks, and they are pulsated in synchrony with the heartbeat, which increases the strength of the cardiac output. The fact that has shocked cardiac specialists is that patients with angina and chest pain experience a stunning improvement in symptoms. Readers who want more information about this novel therapy can read up on it in the March 8, 2005 issue of Time.
    To give you related information, I am sending you copies of my Health Reports "Living with Diabetes Mellitus" and "Coronary Artery Disease."

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