Do Primary Care Doctors, Especially Cardiologists, Not Know About the Raging Success of EECP for Patients or Do They Not Care?

I'm naturally small boned, have never been overweight, except perhaps in my fifties when I was struck senseless by peri-menopause for a few years.  I'm reasonably athletic, and have tried to eat "healthy" (admittedly a wildly moving target) for probably 40 years.  But I still got Coronary Artery Disease.  So do a lot of other people, millions in fact.  I have angina, chest pain when I exert or exercise, which started when I was 62 and increased slowly but steadily until about March of 2018, when I discovered and experienced a noninvasive treatment that changed everything for me. I didn't learn how to help myself from the patient pages of the American Heart Association or the brochures in my cardiologists office, nor from the patient info pages of the Cleveland Clinic.  There you will find long-standing dogma, instead of the very latest science. For one thing, these medical institutions and many doctors are terrified of deviating from their herd mentality, as they reasonably believe it will protect them professionally to follow the local "standard of care." You might view this as  the "don't be different rule" and you might blame it on the legal profession, which of course doctors usually do. The problem is this isn't necessarily the best thing for patients. Life changing technologies, treatments, and knowledge are not often born of the status quo.  They are new and different, and in medical practice, they take many more years than they should to become available and accepted.  This is a terrible story.  Thousands of people die and suffer waiting for "more evidence" when we already have it.  So, you won't hear the whole truth from mainstream medicine but from some unlikely challengers to the medical dogma we usually encounter  - and you would do well to "follow the money" in your inquiries.  

With apologies to those heart specialists who are more rigorous and ethical in their work - not every cardiologist is trying to do a bad job of informing patients of their options - they just don't seem to have the best opinion of their patients' intelligence.  Oh, yes, I'm going to give you examples from my months of research.  The story of EECP is one of the more shameful ones in modern medicine, even beginning with it's earliest approval for the treatment of angina.  

Ok, so I'm not even close to overweight, I exercise regularly, and I still got heart disease.  But first, I just got chest pain while playing tennis.  Couldn't swing the racket.  Sat down, drank water, tried again, more pain.  I went home.  Climbed a single flight of stairs to my apartment, more pain.  At that time I weighed under 110 pounds, lifted weights 2 or 3 times a week, played tennis and hiked 2 or 3 times a week, so I was in pretty good 62 year old shape.   I really didn't want to, but I had to consider it was my heart.  It sure felt like it, and was certainly induced by exertion, and stopped when I stopped exerting.  It was an early Friday evening.  I'm from a family overrun with MD's so I knew I didn't want to go to the ER on a Friday night.  I got on the phone trying to get some reassurance that I could just go to the doctor on Monday.  However, prudently but reluctantly, I went to the emergency room on that night, at the insistence of my own internist, an internet doctor on call, and about 4 other doctors in my family and client base.  I incurred about an $18,000 bill, including the $800 check they insisted on at my bedside before any determined I was ok, no admission to hospital - just observation for a night, hahahaha...not admitted, but you stay in the hospital section marked "observation" in a hospital bed with nurses and attendants and doctors.  What kind of insurance joke is this?  In the morning, before I left, I had a stress test with a nuclear medicine scan immediately after they got my heart rate to 200 bpm on a treadmill, with no repeat of the pain.  The very nice cardiology fellow at Banner in Phoenix told me I was in the fireman class for fitness!  So flattering, right?  They sent me home with some instructions to lower my cholesterol and see a cardiologist. 

Now I had known my cholesterol was a high number, and I also knew I had a not good, but not terribly bad, genetic version of the ratios of large fluffy safe particles to small dense dangerous particles.  Following this not a heart attack experience, my internist sent me to a local cardiologist, who clearly thought he was a hotshot, or at least chose to present himself that way.  You will notice a pattern in my opinion of medical specialty personalities, I'm totally unfairly profiling them, I know.  Cardiologists are, profile wise, fastidious and arrogant, they are "heart" specialists, after all, and what is more important than that?  I repeated a coronary CTA in his office and passed, a good thing given I have strangely configured arteries no one thought was a big problem. And a stress echo.  Cardiologist No. 1 then prescribed a drug I've since learned is the darling of angina prescriptions, Ranexa, or ranolazene.  Did it work?  Maybe, I thought so for a few weeks, but back at tennis and the gym, I was still hurting and seemed to be slowly getting worse over the next few months. Frankly, I think it was a placebo effect, and I love that, and consider it just as good as any other treatment, but it didn't last, whatever it was.  So, no, it didn't.  Work.  Cardiologist No. 1's diagnosis:  "Left ventricular stiffness due to age."  That sounds like a dead end, doesn't it?  He was satisfied, and of course I wasn't.  If you had seen his waiting room you might understand why he wasn't all that worried about me, as it was full of gravely ill, many obese, wheelchair candidates and occupants with what I suspect are difficult co-morbidities, which is med speak for multiple diseases at the same time, with an underlying slightly judgmental tone of "you did this to yourself" by not behaving in healthy ways.  Often partly true, of course.  I was not one of the worried well, I was losing exercise capacity from the pain, which stopped me from sprinting and eventually from even exerting to a reasonable heart rate.

Not better, and not satisfied that was it, I went back to my internist and told her I thought that was kind of an evasive answer, I mean, ventricular stiffness is kind of a non-diagnosis, right?  Her take coincided with mine:  he was guessing. We agreed. Ok, it was a highly educated guess, but obviously not what I came for, and not getting value for my money, not getting better, getting worse. 

Then she referred me to Cardiologist No. 2, this guy was experienced, distinguished, Harvard trained, geez, if anybody has seen this before he will have, she says.  Cardiologist No. 2 assured me he could figure this out, and he scoffed that he knew what Cardiologist No. 1 was thinking and it was wrong.  Hotshot song plays again.  After ruling out my gall bladder with an ultrasound and after detailed conversations about the side effects and possible neurologic and muscular issues my mother experienced on statins, (which he refused to acknowledge) I agreed to a very small dose of Crestor, very small, and added amlodipine because he insisted both could have some healthy effects on the endothelium inside my arteries. He also prescribed nitroglycerine pre-exercise and for chest pain that persisted.  I tried the nitroglycerine before going to the gym, (the tiniest human dose, according to Harvard cardiologist No 2) but two times out of three ended up with crippling migraine (vascular) headaches which lasted all night. (Yep, I've got great info on that problem too!  Stay tuned!) I was soon back in his office, my condition not improved and perceptibly worse.  BTW, good patient that I am, I was also taking resveratrol, a baby aspirin, and fish oils at his and others' recommendations.

He said he had to be able to see more than the coronary CTA, and suggested a coronary catheterization, or angiogram.  Since I wasn't sure I'd end up with a stent or not, and I have an odd arterial formation from birth, we decided I would go to the Cleveland Clinic for the procedure, which I did.  After more research, I chose one of their most experienced interventional cardiologists for Cardiologist No 3.  He had done thousands of these procedures so I figured he was as safe as I could get and I also asked for an early appointment, so he'd be "fresh."  I got the usual complicated history workup, spent an uncomfortable following night in my AIRBNB, the groin discomfort from the puncture and hematoma made it hard to sleep.  I came home again, with an unsatisfying diagnosis, after more thousands of dollars spent, including my out of pocket travel costs and the private duty nurse I hired to watch me overnight in my AIRBNB so I didn't bleed out or something.  I had, it seems, either a congenitally narrow or diseased LAD (left anterior descending) artery in my heart.  Why didn't they know which?  Well, doctors' first rule of ethics is "first do no harm."  (At least that is what they are supposed to adhere to.)  So you (the cardiologist) see a really narrow artery in a small apparently healthy woman (and a lawyer, wonder if that has a chilling effect?), and you decide not to go into said small narrow artery to see more with your little tiny catheter, because the worst thing you could do would be to dislodge a plaque that might be there, probably is, and maybe kill me.  Cleveland Clinic cardiologists don't try to kill healthy  63 year old tennis playing lawyers from Arizona if they can avoid it. In fact, they love keeping patients alive, I'm pretty sure.  I get that and I appreciate it. This particular piece of artery, when compromised, I believe is known as the Widowmaker, rather a sexist term, don't you think, not to mention kind of frightening?

But, the cardiologists at The Cleveland Clinic also didn't do their job in offering me state of the art care I needed. Yes, I'm coming down hard on a revered institution.  They so let me down.  I asked specifically: "What else can I do?" "Is there anything that will slow down or reverse this condition?"  "What are my options in the future?"  They had a treatment on that very campus that would have improved my condition back then and they didn't even mention it.  I asked and asked, and no one mentioned it.  Not the interventional cardiologist who did my catheterization, not the eager fellows who took my detailed history, none of them.  Go home and take this medication.  That's what I got.  It's really appalling.  

These THREE Board-certified cardiologists, members of The American College of Cardiology, fellowship trained, experts in their field, (which is only about caring for diseased hearts, right?)  all know I have chest pain and believe it to be cardiac pain.  This means my heart muscle is not getting the blood it needs because I have a narrow artery feeding the left ventricle.  I'm not a candidate for surgery or a stent. 

So what are my options?  More importantly, what do they suggest for options?  Why medicine, pharmaceuticals, of course!  The euphemistic term is "medical management."  While doctors may suggest exercise and lifestyle changes, it is clear they don't do it with enthusiasm, like internet dates don't expect you to look like your pictures.   Doctors want you to lose the cigarettes, quit drinking anything other than your one or two glasses of resveratrol-laden red wine a day, lose the extra weight (hahaha...here, have some dry skinless chicken and broccoli) by eating less than you want for the rest of your life. Their real message is take these drugs and don't stop.  Ever.  There are five drug types prescribed everywhere: cholesterol-lowering drugs, beta blockers, calcium channel blockers and blood pressure lowering drugs. Ok, six, with the vasodilators. The variations on the theme are plenty, as to brand, dose, delivery method, etc., but that is basically the arsenal.  Here's my question, and I asked them this:  are any of these going to help me reverse this disease?  Kinda, no, probably not, was the answer, well, maybe we can soothe and slightly heal the inflammatory disease that is compromising the lining of a diseased artery, that long one, the LAD.  More on the drug issues later.  Here comes the miracle.

Back to the internet, my giant library in the sky, I'm seeking ANYTHING that teaches me about ANYONE who thinks they can actually halt or reverse this disease process. Mostly I find smart young guys like Dave Feldman and Ivor Cummins who want to PREVENT heart disease, and readily admit their research started from personal interest, or personal fear.  I discover the longevity researchers all focused on what you eat and how, Valter Longo and Jason Fung and Rhonda Patrick, the biohackers who have found the researchers and interviewed them--thank you all, the self-experimenters, and I jump back into nutrition research.  Of course I want to PREVENT the progression of the disease, so I get on board with them.  When I'm trying to figure out how to REVERSE the disease, I'm finding lots of BS, and some science (autophagy?) mostly too-hyped cures that aren't.  

I found and explored some other treatments, but didn't feel sure about them.  More on that later.  Finally I found a strange-looking treatment called Enhanced External Counter Pulsation or EECP.  It is an awkward, loud machine that squeezes your legs and torso in time with your heartbeat to significantly increase your blood velocity while you lie on a table.  You lie there being squeezed pretty hard on your calves, thighs and lower abdomen and buttocks for an hour a day, 5 days a week for 7 weeks, by big loud under-table pumps connected to what look like giant blue blood pressure cuffs.  The machine knows when to squeeze to assist your heart because it is connected to you with EKG sensors.  You do get to watch TV.  With headphones, because it is crazy loud and you can't hold a phone or laptop.  

And your chest pain diminishes or, in my case, pretty much goes away after about 3 or 4 weeks. How the heck does it work?  I'm going to interview everyone I can find to explain that to you, but here is what I think I understand so far (my nonscientific take on the science).

1. It has a shearing effect on the interior of your blood vessels. This is healing to the endothelium, the lining of your vessels, a critical diseased part of your heart vessels when you have heart disease.  More on this later.  There are drugs that are believed to do this as well.  I'd LOVE to see a study comparing the effects of those with EECP but I don't think that is likely to happen.

2. EECP stimulates your stem cells, hormones, and the hormone known as human growth factor (HGH or GH) to develop a network of brand new micro-vessels to feed oxygen to your heart (and presumably other) muscles.  This is known as angiogenesis, and it's a medical miracle your body is capable of with the assistance of this treatment.

(More on neogenesis, angiogenesis, and circulation later, don't let me forget to tell you what I've learned about other promising stem cell treatments.) That is why they call it a "natural bypass."  Blood can get to the heart muscle because your body is rerouting flow to where it is needed and actually re-vascularizing the heart muscle.  Maybe that could be why mine stopped hurting when I exercise? 

3.  This procedure seems to have an amplified effect similar to athletic training, except elite athletes cannot achieve the blood velocity even sedentary people can with the assistance of this device.  Boom.