Heart at­tack still pos­si­ble af­ter triple by­pass

Cape Breton Post - - IN MEMORIAM/TV HIGHLIGHTS/ADVICE - Keith Roach To Your Good Health

DEAR DR. ROACH: My friend had a triple by­pass last Au­gust. He still has prob­lems. At a re­cent visit to the car­di­ol­o­gist, he was told that one of the grafts has fallen away. What does this mean? Where is that blood go­ing? The doc­tor says he still has coro­nary heart dis­ease, and they are try­ing new meds. What does this mean for him — could he have another heart at­tack? — P.B.

AN­SWER: A coro­nary by­pass surgery is the place­ment of a new blood ves­sel to al­low blood to go around an ob­struc­tion in one of the ves­sels that sup­ply the heart mus­cle with blood. The new blood ves­sel can be taken from the pa­tient's own vein, usu­ally the saphe­nous vein in the leg. Or, it can come from an artery, usu­ally the lift in­fe­rior mam­mary artery (LIMA). The new blood ves­sels are re­ferred to as “grafts.”

In a “triple by­pass,” three grafts are cre­ated. These grafts im­prove blood flow to the heart and im­prove long-term sur­vival for a sub­set of peo­ple with coro­nary artery dis­ease. How­ever, the grafts are sub­ject to block­ages them­selves, ei­ther through blood clot­ting or from de­vel­op­ing the same choles­terol and cal­cium plaques as the na­tive coro­nary ar­ter­ies. When a graft no longer car­ries blood, we usu­ally say it has “failed,” but it sounds like your friend's car­di­ol­o­gist used the term “fallen away.” This doesn't mean the graft be­came un­at­tached, a sit­u­a­tion that would lead to death in sec­onds. That is some­thing car­diac sur­geons take great care to pre­vent.

Med­i­ca­tions — such as aspirin, beta block­ers and statins — also re­duce the risk of heart at­tack and death in peo­ple with coro­nary heart dis­ease, es­pe­cially when com­bined with a hearthealthy diet and a good ex­er­cise pro­gram. How­ever, they only the re­duce risk of, not com­pletely pre­vent, a heart at­tack. A rough es­ti­mate is that 75 per­cent of peo­ple who un­dergo by­pass surgery will be free of coro­nary events five years af­ter surgery.

Heart dis­ease re­mains the No. 1 killer. The book­let on clogged heart ar­ter­ies ex­plains why they hap­pen and what can be done to pre­vent clog­ging. Read­ers can ob­tain a copy by writ­ing: Dr. Roach — No. 101, 628 Vir­ginia Dr., Or­lando, FL 32803. En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent's printed name and ad­dress. Please al­low four weeks for de­liv­ery.

DEAR DR. ROACH: I have a se­b­or­rheic keratosis on my face (cheek), and I was won­der­ing what you thought was the best method for re­moval that would give op­ti­mal cos­metic re­sults? Also, are there cer­tain foods, vi­ta­mins/sup­ple­ments or creams that could help? — T.A.

AN­SWER: A se­b­or­rheic keratosis is a com­mon, be­nign skin con­di­tion. It ap­pears as a raised, slightly bumpy le­sion, usu­ally brown­ish, and can oc­cur any­where on the body. They of­ten look as though they could be peeled off, but don't at­tempt to do that. They don't need to be treated, but many peo­ple find them un­sightly and want them re­moved.

Seb Ks, as they of­ten are called, are treated with ei­ther liq­uid ni­tro­gen or are sur­gi­cally re­moved. Both meth­ods usu­ally pro­vide very good to ex­cel­lent cos­metic re­sults, but a re­cent study showed that liq­uid ni­tro­gen freez­ing gen­er­ally pro­vides bet­ter cos­metic re­sults, and it's eas­ier for the pa­tient. A der­ma­tol­o­gist with lots of ex­pe­ri­ence can make a per­son­al­ized rec­om­men­da­tion for you based on the le­sion, its lo­ca­tion and your skin.

I could not find re­li­able ev­i­dence that any foods or sup­ple­ments can pre­vent or treat these. Creams can cover them up but not get rid of them. Elec­tric­ity and laser are less com­mon treat­ments.

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