QM Case History: Severe Heart Disease Reversed

A 57 year old male, lets call him ‘Joe,’ new to me, came in to be seen for a sinus infection. The history and findings were consistent with this diagnosis but he seemed to want to talk about something else.Male Doctor Hand Abstract with Lab Coat and Stethoscope.

Joe’s brother had just had a heart attack, subsequent bypass grafting for the blockages in his heart arteries, and his father had had early heart disease as well. My new patient wanted to talk about his heart more than his sinuses. Who could blame him?

He jogged for health and ate what he had been told was a heart healthy diet; low fat, little dietary cholesterol, you know the drill. He also knew I had an after hours clinic I called “The Performance and Prevention Clinic.” That mouthful was what I named the part of my practice devoted to working with high performance athletes and those who wanted to prevent, rather than merely treat, disease.

He was asking me to work with him to help ensure that he did not experience his brother’s fate. Well, maybe… But first I wanted some baseline testing to see if I had anything to offer. Joe’s first Berkeley Heart Lab panel, now 17 years ago, showed his triglycerides were 601 mg/dl, a predictable B pattern LDL, total cholesterol over 300 and a very low HDL besides. To make matters more interesting he had a high fasting insulin and Lp(a). Oh, and he was also heterozygous for Apo E4.  His genetic gun was loaded and he had been pulling the trigger; it looked like he was lucky to not already have suffered his brother’s fate.

CAI told him I could not work with him without a coronary angiogram. The cardiologist to whom I referred him agreed and performed a coronary catheterization angiogram. In the middle of that procedure is when I got the phone call. The cardiologist was on the phone and telling me that my patient had a nearly completely occluded left anterior descending arterial (LAD: ‘the widow maker’) blockage, as well as other blockages, and that the patient needed to go straight to the operating room for multi-vessel bypass graft. “Fine”, I said, I trusted the cardiologist. “Mike”, the cards guy said, “this guy wants to come see you and I don’t think he should leave the hospital, would you talk to him?” I told my patient to stay there and get the procedure. He said, “no,” that he wanted to try my program. A fairly long discussion ensued during which he assured me that neither he nor his family would sue me if he died or had other complications. While I cared very much about those details, I was more concerned about his life and health.

His story worked out very well, I will outline that part, but absolutely similar stories have been told and the patient did die on their way out the hospital door so do not misunderstand my point. I am not encouraging anyone to take such foolish risks but I am recounting the reality of how powerful life behavioral changes can be in restoring health.

This will look like a tangent but bear with me and you will see its relevance to Joe’s rehabilitation. There is a nice hill not too far from my office. I had a civil engineering firm greek god‘shoot’ the hill to get precise measurements on its slope and length. With that data I can calculate the exact power output anyone achieves going up that hill.(We don’t call this Quantitative Medicine for nothing.) The relevant part of the hill is a 27% grade almost exactly 100 yards long.

A week ago, as we have done off and on for 15 years, Joe and I ran up that hill. His heart rate typically gets into the 170 range. He is now in his mid 70’s. These are Joe’s words: “when I started with you I was a short, fat Italian, and now I look like a Greek god.” Now that comment was several years ago and I won’t elaborate on his political sensitivity but it sure was a funny remark that summarized his transformation. Joe never did get that surgery. Tragically, his brother developed dementia and died several years ago. Of a heart attack.

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