Posted on 09/27/2004 12:14:48 AM PDT by AZLiberty
When Bill Clinton underwent quadruple coronary-bypass surgery on Labor Day, the former president, like most Americans who have similar operations, spent time hooked up to a heart-lung machine while surgeons rerouted blood vessels to his heart.
With luck and his relative youth and health going for him, Clinton, 58, hopefully will rebound in both heart and mind from the surgery, in which doctors replace clogged arteries to the heart with veins and arteries taken from elsewhere in his body.
But many people who go through the procedure -- as 305,000 Americans did in 2001, the latest year for which figures are available -- find that, at least for a few days, often for weeks and sometimes for years afterward, their brains don't work as well as they did before.
Doctors who acknowledge the problem -- and some still pooh-pooh it -- call it post-surgical "neurocognitive deficits." Everybody else calls it "pump head," reflecting the widespread, though unproven, belief that it's the process of blood being pumped through a heart-lung machine while the heart is stopped for surgery that causes small blood clots, air bubbles or other debris to travel to the brain, disrupting memory.
Nobody really knows how common "pump head" is because, outside of research studies, most cardiac patients aren't tested on intellectual function before and after surgery. Detecting all but the most subtle cognitive changes "depends on how hard you look," said Dr. William Cohn, of the Texas Heart Institute in Houston.
Nonetheless, it has been convincingly demonstrated that 80 percent to 90 percent of bypass patients have some cognitive losses when they're discharged from the hospital, Dr. Daniel B. Mark and Dr. Mark F. Newman wrote in a 2002 editorial in the Journal of the American Medical Association.
(Excerpt) Read more at boston.com ...
Gee, maybe it's the loss of blood to the brain??
I was under the impression that a special vascular netting has been created to temporarily stop blood and other clots from making it to the brain through such procedures. Later, the netting can be removed from the arteries after the body has recovered a bit from the operation.
Surely this hasn't been commercialized yet, but it does point toward a possible solution.
As for blood stoppage to the brain, I would imaging they keep that under pretty tight control and that it is supplied enough to not be a concern to the patient.
Around the time of Clinton's surgery, an alternative medicine newsletter to which I subscribe discussed the advisability of this surgery. They said that the public description of Clinton's illness suggested that a non-surgical approach -- diet, exercise, medications -- should be tried first, especially because surgery carries the risk described in this article. Apparently, even with the best of care, surgery may leave you with a mental deficit for periods ranging from days to forever.
Sure "an ounce of prevention is worth a pound of cure." But in Clinton's case, as in all cases that required CABG (coronary artery bypass graft), the damage has already been done. These coronary arteries have been too atherosclerotic, too stenosed, too much blockage from years of neglect of exercise, from years of dietary indiscretion, splurging on fatty high cholesterol food, from years of chain smoking like a chimney. Certainly, genetic predispostion is also a major factor. In these patients cases, the severity of coronary artery disease necessitates CABG, else they face certain death from a massive myocardial infarction/heart attack. In these patients, the diagnosis is always after the fact and too late. Whenever these patients have chest pain because of cardiac ischemia/lack of blood flow to certain areas of the heart, damage to the myocardium occurs. Over time, this leads to ischemic cardiomyopathy, ventricular hypertrophy, diastolic dysfunction eventually leading to congestive heart failure and damage to the conduction pathway, cascading to life threatening cardiac arrhythmias and dysrhythmia. In these patients with severe coronary artery disease, ALTERNATIVE MEDICINE IS NOTHING BUT A CROCK OF BULL as it is too late. The surgeon moto has always been:
With the pill, you can kill
But with stainless steel, you will heal.
Oh, here's another tenet of medicine:
Eat while you can and sleep while you can,
But don't f#@! with the pancreas!!!
This was written as an open letter (I don't know anything about Dr. McDougall):
William Jefferson Clinton
The William J. Clinton Foundation
55 West 125th St.
New York, NY 10027
Dear Bill:
The chance you will ask for my opinion on your pending surgery
this week for blockages of your heart arteries is about the
same as you escaping the heart bypass business. Regardless,
for the sake of others and to clear my conscience by at least
trying, I will take this opportunity to share ten challenging
thoughts with you.
1) Don't be rushed into making a decision – think about it –
they gave you several days already – so immediate surgery is
obviously not critical – you have time to learn more.
Over 80% of men in the USA by your age (58 years) have
coronary artery disease which can be found by an angiogram,
and over half with your cholesterol level (233 mg/dl) have at
least one coronary artery already closed by 50% or more – in
other words, they are fair game for bypass surgeons.
Fortunately, coronary artery disease is not very deadly –
the over-all risk of death from this disease for people with
affected arteries is less than 2% per year, untreated. Compare
these facts with what you have been frightened into believing
this past weekend.
2) Nearly four decades of scientific research show coronary
artery bypass surgery fails to save lives in most cases. This
is because the goal of this surgery is to go around very
stable (rock hard) blockages; however, these firm, partial
obstructions to heart blood flow are not the life-threatening
problem – and your doctors know this well-established fact.
These big blockages rarely close down the arteries and almost
never cause heart attacks. However, most of the attention is
focused on these pseudo-villains found on your angiogram
because the result of their discovery feeds money into the
heart businesses.
3) The culprit lesions are tiny – invisible to the angiogram –
\sores (volatile plaques) which explode inside your arteries –
suddenly forming an occluding blood clot (thrombosis). Surgery
does nothing to stop these lethal events. Fortunately, because
the lesions are recently formed, soft, and active, this deadly
side of heart disease is also easily amenable to simple methods.
4) These little time bombs (volatile plaques) can be quieted
down quickly with a healthy diet and judicious use of
cholesterol-lowering medications. Plus, a baby aspirin will
immediately thin your blood and make the formation of a
potentially lethal blood clot much less likely if a plaque
were to burst.
5) You have a reversible disease, Bill – this is not concrete
in your arteries. Living tissues heal and your body will fight
to stay alive. Now is the time to talk to your friend Dr. Dean
Ornish. Regardless of whether or not you have the surgery,
you are going to have to change back to the low-fat,
no-cholesterol diet Dr.Ornish taught you several years ago.
Read my June 2003 newsletter article: Cleaning Out Your
Arteries.
6) The real indications for bypass surgery are:
a) incapacitating chest pain and/or b) damage to your left
ventricle (heart chamber) so that you eject 50% or less of
your blood with each heart beat. Every cardiologist and
bypass surgeon knows this. From what I have read you have
neither of these legitimate indications for surgery.
7) You are known for your wit and intellect. This surgery
causes brain damage. Measurement of chemical products
released into the spinal fluid during surgery shows that
100% of people suffer brain damage. In most cases the changes
are subtle – like personality disorders, or you may not be
able to remember names and numbers as well. A study in the
February 2001 issue of the New England Journal of Medicine
found 42 percent of patients five years after surgery had a
20% decrease in brain function. My experience has been that
doctors mislead patients into believing this is not an
important problem.
8) There is a real possibility that bypass surgery could
interfere with another of your well-known attributes.
Erectile dysfunction has been reported to be caused by
bypass surgery. (Don't you just hate it when people hit
below the belt?)
9) Your most recent attempt at weight loss, the South Beach
Diet, contributed to your present troubles. Steak, chicken,
eggs, and Canadian bacon consumed without limitation are
bad for your arteries, Bill. Even the author, Arthur Agatston,
MD, must know this – after all he, himself, takes statin
drugs to lower his cholesterol, and fish oil and aspirin to
help reduce his personal risk of a heart attack.
10) You have always been interested in better healthcare for
Americans and now you have an opportunity to make a real
difference – stand up to this big business and demand the
truth before you make your decision to have or postpone
surgery. Right now you are being lied to – mostly by omission
of vital information from doctors – you can verify everything
I have written to you within a few short hours on the Internet
(http://www.nlm.nih.gov). Your example could save more lives
and people from suffering unnecessarily than any action you
could have ever taken while you were in office. Make the
most out of this apparent set back in your health.
Sincerely,
John McDougall, MD
drmcdougall@drmcdougall.com
What I was told is that the pump damages red blood cells, leading to lack of oxygenation of the brain...I dunno.
--Boris
most cardiologists and cardiac surgeons don't find the cognitive defects because they don't look.
for a highly functioning intellect, a good case of pump brain can dull the edge significantly.
since the former does't apply to slick, he'll be ok.
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