Dear Dr. Roach: My friend had a triple bypass last August. He still has problems. At a recent visit to the cardiologist, he was told that one of the grafts has fallen away. What does this mean? Where is that blood going? The doctor says he still has coronary heart disease, and they are trying new meds. What does this mean for him 鈥� could he have another heart attack?
P.B.
A coronary bypass surgery is the placement of a new blood vessel to allow blood to go around an obstruction in one of the vessels that supply the heart muscle with blood. The new blood vessel can be taken from the patient鈥檚 own vein, usually the saphenous vein in the leg. Or, it can come from an artery, usually the lift inferior mammary artery. The new blood vessels are referred to as 鈥済rafts.鈥�
In a triple bypass, three grafts are created. These grafts improve blood flow to the heart and improve long-term survival for a subset of people with coronary artery disease. However, the grafts are subject to blockages themselves, either through blood clotting or from developing the same cholesterol and calcium plaques as the native coronary arteries. When a graft no longer carries blood, we usually say it has failed, but it sounds like your friend鈥檚 cardiologist used the term fallen away. This doesn鈥檛 mean the graft became unattached, a situation that would lead to death in seconds. That is something cardiac surgeons take great care to prevent.
Medications 鈥� such as aspirin, beta blockers and statins 鈥� also reduce the risk of heart attack and death in people with coronary heart disease, especially when combined with a heart-healthy diet and a good exercise program. However, they only reduce the risk of, not completely prevent, a heart attack. A rough estimate is that 75 per cent of people who undergo bypass surgery will be free of coronary events five years after surgery.
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Dear Dr. Roach: I have a seborrheic keratosis on my face (cheek), and I was wondering what you thought was the best method for removal that would give optimal cosmetic results. Also, are there certain foods, vitamins/supplements or creams that could help?
T.A.
A seborrheic keratosis is a common, benign skin condition. It appears as a raised, slightly bumpy lesion, usually brownish, and can occur anywhere on the body. They often look as though they could be peeled off, but don鈥檛 attempt to do that. They don鈥檛 need to be treated, but many people find them unsightly and want them removed.
Seb Ks, as they often are called, are treated with either liquid nitrogen or are surgically removed. Both methods usually provide very good to excellent cosmetic results, but a recent study showed that liquid nitrogen freezing generally provides better cosmetic results, and it鈥檚 easier for the patient. A dermatologist with lots of experience can make a personalized recommendation for you based on the lesion, its location and your skin. I could not find reliable evidence that any foods or supplements can prevent or treat these. Creams can cover them up but not get rid of them. Electricity and laser are less common treatments.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
