Saturday, June 03, 2006

Clogged Arteries: Why is Bill Clinton Bugging Me About My High Cholesterol?

For a couple of years now, Bill Clinton has been stalking me. Every time I forget that I have a mortal body and feel good about life, the former president pops into my head wagging a finger and saying, "So you think it can't happen to you? Better think again, my complacent friend."

Bill Clinton has reason to be nagging people like me. Nearly two years ago, he was happily going about his business of being a popular and much sought after former president, as well as indulging in his taste for fast food. He was young, only 58, and was at the top of his game jetting around the globe advising world leaders on the great issues of our time.
Impeachment and Monica Lewinsky were dim memories. Life was a dream; that is, until it suddenly became a nightmare; until one day, without warning, death knocked on his door. On September 2, 2004, while resting at his Chappaqua, N.Y. home, he experienced chest pains and shortness of breath.

He checked himself in at the Westchester County Medical Center where an angiogram showed that he had nearly complete blockage in four coronary arteries. He was quickly transferred to New York Presbyterian Hospital/Columbia where he had successful quadruple heart bypass surgery to reroute the blood flow to his heart.

During the highly invasive four-hour operation, the former President's chestbone was sawed open and his heart was stopped for 73 minutes. During this time, Mr. Clinton was put on a heart-lung machine which kept his blood flowing and his heart oxygenated. Surgeons led by Dr. Craig R. Smith took blood vessels from his chest and left leg and sewed them into arteries feeding his heart, bypassing the blockages.

Though he was relatively young, physically active, and had had the benefits of eight years of top-flight presidential medical care, he was, in coronary terms, on the edge of a cliff -- and about to plunge to his death.

His arrival there was not as sudden as it seemed. For the past several months, he had been experiencing chest pain and shortness of breath. He blamed them on acid reflux and irregular exercise grabbed between long flights, airports, and speaking engagements.

For years, he had cheerfully gone along indulging his love of fast food, jogging regularly, acing stress tests, and carrying extra weight. Leaving the White House in January, 2001, Mr. Clinton had a total cholesterol count of 233 and a “bad” cholesterol count of 177. He began his new life as a private citizen by taking a statin drug, Zocor from Merck, to lower his cholesterol. His cholesterol dropped to normal levels.

After awhile, feeling good and his mind on other things, such as writing a bestselling book, he stopped taking the drug. About six months before entering the hospital, he went on a modified low-carb, low-fat South Beach diet and had slimmed down. However, the better diet and weight loss “was not enough to reverse years and years of unhealthy living,”said Dr. Christopher Cannon of Brigham and Women's Hospital in Boston.

By the time the former President presented himself at the Westchester County Medical Center, four of five arteries to the heart were dangerously choked with plaque. Unknown to himself or his doctors, he was a medical time bomb. Dr. Allan Schwartz, chief of cardiology at Columbia-Presbyterian, said: “There was a substantial likelihood that he would have had a substantial heart attack in the near future.”

Mr. Clinton was lucky. He sought medical care literally in the nick of time. Many people are not so lucky. Heart disease is the number one killer in the U.S. Every year 1.6 million Americans have a heart attack and half die.

Heart disease is a silent and invisible scourge that does its deadly work over many years. Often there are no symptoms at all. The first symptom is frequently the last. Or if there are symptoms, they are attributed to things like heartburn or acid reflux, as was the case with Bill Clinton.

High cholesterol? It is easy to put it out of your mind when you feel great and you're eating the way you always have and you're doing everything you have always been doing. That's how it has been for me for years.

Sure my cholesterol was higher than my doctors said it should be. But so what? I felt great. Don't bother me with that cholesterol crap! It's important to note that I had that attitude while not being exactly sure what cholesterol is.

This is how the National Institutes of Health describes cholesterol:

Cholesterol is a waxy, fat-like substance that occurs naturally in all parts of the body and that your body needs to function normally. It is present in cell walls or membranes everywhere in the body, including the brain, nerves, muscle, skin, liver, intestines, and heart. Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If you have too much cholesterol in your bloodstream, the excess is deposited in arteries, including the coronary arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease.

To learn more about cholesterol, a good place to start is the NIH Home Page.

Now that I know a little about cholesterol and this latest blood test has got my attention, Bill Clinton is really getting in my face. My total cholesterol was 233, exactly what his was when he left the White House and, on the advice of a top-flight medical team, went on Zocor. My doctors are saying that it's time I did the same. It would seem to be a no-brainer.

Many older folks, such as me, were middle-aged before they ever heard the word “cholesterol.” Some of us old fogies find it hard to take seriously something that we can't see or touch. There are so many other things to worry about, such as paying the bills and holding your own on the tennis court.

Because of this mindset, many people either don't worry enough about their high cholesterol to do anything about it, or, if they begin taking a cholesterol-lowering drug, they stop. Mr. Clinton stopped taking his Zocor and some heart specialists say that this was almost a fatal mistake. They say that if he had continued taking the drug, he might have been able to stop the disease from spreading.

Dr. Cannon said, “Had he been on a statin medication, with much lower cholesterol levels, that might have prevented his developing these severe blockages.”

Mr. Clinton has resumed taking a statin drug, though which one has not been disclosed. An endorsement contract in the works?

Meanwhile, Mr. Clinton recovered nicely and seven weeks after his bypass surgery he was back out on the campaign trail. A week before the 2004 election, he appeared with John Kerry in Love Park in downtown Philadelphia, looking thinner and sounding slightly hoarse.

But his spirits were buoyed by an enthusiastic welcome. “If this isn't good for my heart, I don't know what is,” he told the cheering crowd. Mr. Clinton went on to log thousands of miles campaigning for Mr. Kerry.

However, about a year ago, on March 10, 2005, Mr. Clinton was in the hospital again. This time, he had follow-up surgery to remove scar tissue and fluid from his left chest cavity, residual effects of his open-heart surgery.

In retrospect, Mr. Clinton was at high risk for a heart attack. He had high blood pressure, high cholesterol, a history of heart disease on his mother's side, and years of a fatty diet. His exercise and belated weight loss had served only to push these these risk factors into the background and to camouflage a massive build-up of plaque over many years, causing a 90% blockage in four coronary arteries and a virtual sentence of imminent death.

In view of Mr. Clinton's experience, should I -- eight years older, with the exact same total cholesterol, similarly asymptomatic -- learn from his experience and take the damn Zocor? Should I stop bashing the authors of the new cholesterol guidelines urging more aggressive use of statins and just take a proven medicine that could save my life?

So what if the authors of the guidelines are on the take from the drug companies? Why worry about something as pointy-headed as conflict of interest, when the statins are known to work? Why worry about possible longterm side effects when there is perhaps a better chance that taking a statin may avoid a heart attack now or in the very near future?
I called my sister, Marion, a retired nurse who was once Director of Nursing Care at a large Boston-area hospital and is today a hospice volunteer. I gave her my cholesterol numbers and my whole spiel about not wanting to go on a statin unless I absolutely have to.
First of all, she said that the "bad" cholesterol of 169 was "not good, not good at all" and that I had to get it down. "But I have already tried diet and exercise,"I said. "I can't eat any better, I don't need to lose any more weight, and I already exercise like a maniac; I can't exercise any more. No matter what I do, my cholesterol stays where it is -- high."
"About fifteen percent of the population have bodies that produce too much cholesterol, regardless of diet or lifestyle. No matter how much they exercise or how few fat colories they consume, the body still produces more cholesterol that it needs. You may be in that population. Which means that you don't have much choice but to go on a statin."
I gave her my spiel about side effects, conflict of interest among those pushing the statin drugs, the lack of longterm studies. "You know, George," she said. "You're an informed health-services consumer. That's good. But you don't want to be a foolish health-services consumer. Whether you have build-up now or not, you need to prevent future build-up. You need to think prevention and that's what a statin will help you do."

Marion's giving me a good talking-to, on top of the close call that Mr. Clinton had has me rethinking. Am I being pig-headed about avoiding a statin drug? What if my coronary arteries are already hopelessly clogged as Bill Clinton's were? What if the glogging is getting worse? There is no way to tell, short of an angiogram.

This was the test that Bill Clinton was given, in which a dye was inserted into the bloodstream from the groin to the heart, revealing blockages. The only trouble is that the angiogram is not given to people without symptoms. In fact, there is no good test for people without symptoms, though work is being done on using multidetecting CT scans for heart disease that yield much more detail and information than angiograms and are much cheaper, $700 instead of $4000. Unfortunately, these scans are unreliable and expose the patient to large doses of radiation.

If I asked for an angiogram, would Dr. Donna Santora or Dr. Marelli say “sure” and order one? The answer is no because neither the VA nor the private health care system work that way. You get the angiogram when you are in the hospital at death's door, as Bill Clinton was (and as I may be for all I know). Or you get it if you survive the heart attack.

So what I have decided to do is figure out a way to get myself tested for blockage, even though I do not have symptoms. All I know is that I have a total cholesterol count of 233 and, ask Bill Clinton and my sister Marion, this is not good. But I do not know if I have serious blockage as he did.

I also know that cholesterol-build-up is chronic, slowly progressing, and cumulative. It is associated with a narrowing of the arteries (stenosis) and blood clotting (thrombus) that rapidly slows or halts blood flow that carries life-sustaining oxygen.

With four of his five arteries to his heart blocked, Bill Clinton's heart was strangling from lack of oxygen. The same thing may be happening with me and I am now going to find out if it is. No more complacency for me.

I'll let you know what I find out.

Thank you, Bill Clinton. And now that I am getting off my duff and doing something about my cholesterol, would you please stop bothering me? And, yes, I'll consider Zocor.

So long and keep moving.

 E-Books by George Pollock

"State Kid: Hero of Literacy" is fiction based on his  real-life experiences  growing up in foster homes; "Last Laughs," is the true story of how five foster kids (he and four younger siblings) found their way in life and each other. "Killers: Surprises in a Maximum Security Prison," is the story of the author being locked up for 23 hours with killers in a maximum security prison;  "I, Cadaver" is about the author's postmortem adventures and mischief in the anatomy lab at UMass Medical School. “A Beautiful Story” demonstrates the art and process of creative writing as a 16-year-old boy goes all out to write a story good enough to get him into an exclusive college -- on full scholarship; and "A Long, Happy, Healthy Life," which is about how to live the title every single day.

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At July 11, 2008 6:35 PM, Blogger chef4cook said...

The same thing happened to me at age 50, a year ago. Only difference was that for the past 20 years I did have chest pain and warning signs that were presented to doctors over and over but not once, until I was on deaths door did they do the angiogram that found a 99% occlusion in all four of my arteries. Unfortunately, I had to have two back to back open heart surgeries because one of my "new" arteries sprung a leak. That doubled my recovery time.


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