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      1. EECP

At age 75, I’ll have a one out of two chance of having Alzheimer’s-like dementia. I don’t know what is going to happen if I do something, but I know what is going to happen if I don’t do something. I’m either going to have Alzheimer’s disease, in which case I won’t care; or I’m going to have to take care of someone with Alzheimer’s disease, in which case I’m going to be caring for them and me.

We’ve been using a newer technique in my office for the last thirteen years that’s orthodox; we’re using it off-label. This technique, “external counter pulsation,” is also called “enhanced external counter pulsation” (EECP). This technique was based on procedures we used in cardiology back in the 70’s and 80’s when someone came into the emergency room with a massive heart attack and had lost so much heart muscle; they were in what medically would be referred to as cardiogenic shock. In other words, they had lost so much muscle mass, the pump couldn’t pump effectively, and they were dying because the heart wasn’t pumping.

One of the techniques that we used was to do counter pulsation therapy to try to keep them alive until we could get them to the operating room to do the bypass. In those days, counter pulsation was done by doing a cut down on the large artery in the leg then threading a big balloon attached to a catheter into the aorta. That balloon was much larger than the kind used now for angioplasties. We would attach this to a machine that would measure a pressure wave tracing called a “plethysmograph”, and an EKG tracing, which is an electrical technique. The machine was gated (the technical term), so when your heart would beat, the balloon would stay deflated allowing blood to go from your heart down into your legs. When the heart relaxed temporarily, the balloon would rapidly inflate, forcing the blood by pressure back up into the heart and up into the blood vessels of the upper body.

We did this process mechanically inside the person’s body. It was a pretty barbaric technique, although it saved some folks’ lives. Simultaneously, doctors in Boston and China began to wonder if a procedure could be done externally, outside the body, by using pressure suits like the G-suits that jet pilots wore. So they began developing pressure suits for the lower body, which are just blood pressure cuffs that apply pressure outside the body to the arteries, rather than obstructing the artery inside. And lo and behold, it worked! Hence, the technique called, “external counter pulsation” was born.

Because of the “low-tech, non-sexy, low-dollar” aspect present in medicine in America, it didn’t really get any traction, because everybody was doing bypass surgeries, and all these other “high dollar” therapies.  Other countries, especially the Chinese, picked up on this. Like ozone, external counter pulsation is cheap, it’s simple, and you can apply it to large populations very quickly. Most of the machines that are used today are built in China.

When we got the machine, we intended to use it for heart patients, because that is what the machine is approved for under FDA approval. It’s approved for use in very specific circumstances. One is for an acute heart attack. Most hospitals don’t have EECP machines because they compete with their bypass income. So, they don’t want them in the hospital.

A second circumstance is when EECP is used is for heart failure. This is the only FDA-approved therapy for congestive heart failure that actually can change the outcome, not just the symptoms.

A third circumstance is when EECP is used for angina – heart pain – but it has to be severe angina, Class 3 or Class 4, which is pretty much, pain at rest.

The way it was set up by Medicare is that you have to have failed on all other therapies – bypass, angioplasty and drugs – in order to be considered a “will pay for it” candidate for EECP. This is insane logic in this country. Why would we take an effective treatment that’s noninvasive, significantly cheaper than the other ones we know, works equal to, or better than, the other ones, and make it last? This is the impact of lobbying by specialists on government folks, who don’t want their “cash cow” to disappear. “Let me do all these bypass surgeries, and if they don’t work, then we will use these crazy machines.”

In Reno, as far as I know, there are three EECP machines operating. I have one, my old cardiology group has one, and another single cardiologist has the third one. If you talk to cardiologists, a lot of them refer to this as “voodoo cardiology,” because it makes no sense to them. They don’t understand how it works. They’ve forgotten all the physiology they learned in school, and now they’re just practicing medicine.  But what is being done is physiological. Some of the younger doctors coming up actually encourage EECP and use it.

Most people in heart failure were seeing cardiologists, who were putting them on the EECP machine for that purpose. In my case, I was seeing two different families simultaneously who had elders. In one case, a woman was the matriarch of her family, and in the other case, the man was the patriarch. They were both losing their memories and no one could help them.

The male, although he was in his 80’s, was very active and had traveled to South America, where he was uncovering ruins. He came back from one of the trips to South America in heart failure. He came into my office and we bailed him out of the heart failure. Then we ran non-invasive studies to try and figure out why he had heart failure. He hadn’t had a heart attack, and he didn’t pick up Chagas disease, which is a parasite bug in South America that destroys the heart. We checked him for that and we checked him for everything. The only thing we found on him was diffuse microvascular disease (sugar toxicity). That is the new thinking in physiology today…

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