Letter

I received an email from my friend Maria in Mexico City yesterday. Sadly, it is as difficult there to find a noninvasive cardiologist as it is in the USA. Here is her news:

Hello Jeff,

I was reading your blog today. I´m sorry to know that Dr. De Vries is leaving his practice.
And I´m sorry that every doctor wants to do an invasive test in order to prescribe EECP to you.

We are also still seeking a real noninvasive Cardiologist, we haven´t find one yet. Every potential doctor does not want to hear about anything but CABG for my husband.

All this is almost unbelievable :-( , but sadly very true not only in the USA, but at least in Mexico too.

Have you talked to Gypsy? We talked to her last February. she said she was actively trying to find someone interested to buy Dr Wayne's practice. We haven´t heard from her since then.


I´m constantly searching information in the Internet, I ´ve found a few doctors that call themselves noninvasive.
I have not talked to any of them, so I don´t know how true is that. I want to share their names with you, probably you already know them. Maybe one of them can help you.

I was thinking that probably this Dr. Chung could prescribe you the EECP treatment. I don´t know anything else about him than what he has posted in that Cardiology forum, but at least he says he would respect the patient decisions.

There is also this noninvasive center that prescribes EECP: http://whitakerwellness.com/our_therapies/eecp/

Another noninvasive Cardiologists: Dr. Thiak: http://www.drthaik.com/ , Dr. Gould : http://www.uth.tmc.edu/pet/ , Dr. William R. Davis http://heartscanblog.blogspot.com/ and www.trackyourplaque.com



My best wishes in your search.

Best regards from Mexico City.

Maria

EDTA vs EECP

On another forum that I spend a lot of time on, Cannuck had a comment about EDTA:

Originally Posted by Cannuck Chelation has been used for many decades for a variety of reasons. My wife's Aunt was treated with EDTA for the aftereffects of the concentration camps, as were German citizens from the Ruhr Valley for heavy metal poisoning. I personally know seniors who have done so here for various cardiovascular conditions (most with significant success), and can tell you that the results are VERY short in coming.

I wanted to clarify a comment I previously made regarding EDTA and explain my reason for using EECP as my next step in treating my angina. Here was my reply:

When I said EDTA (Chelation therapy) either oral or IV is controversial, that doesn't mean I disapprove of it. Quite the contrary, I feel it is a choice of treatments that has been effective in treating CAD and some other coronary diseases and despite the fact it hasn't been approved by the FDA for use in such diseases, should be available to patients making informed choices. The reason I am opting for EECP is because I have studied its effects, side effects and contraindications and have talked with patients who have received it. Unlike bypass surgery "victims" and angioplasty (balloon & stent) recipients, none of them had negative reports of their experiences.

Further, angiogenesis and the development of a collateral vessel system to naturally bypass the clogged coronary arteries is a process the body already has started on its own, without the introduction of any drug. Like it or not EDTA is a drug and therefore could have side effects or be harmful. There are reports of unexpected deaths during or following chelation therapy. I have found none associated with EECP. That is not to say EECP recipients haven't died as a result of therapy, there simply are no reports where the therapy caused the deaths, that I have found.

I realize EDTA is a natural enzyme and as such can be sold as a nutritional supplement and I am not opposed to nutritional supplements as long as they are used wisely and in some form of a therapeutic regimen. I personally take the following supplements daily in the strengths and doses indicated:

Organic Flaxseed Oil 1200 mg, three times a day
Borago Seed Oil 1200 mg, three times a day
Omega 3 Fish Oil 1200 mg, three times a day
d-Alpha Tocopheryl (Vitamin E) 400 IU, one time a day
Glucosamine 750 mg Chondroitin 600 mg, twice a day
Folic Acid 800 mcg, one time a day
B-100 Ultra B-Complex, one time a day (Puritan's Pride Brand)
l-Arginine 500mg, one time a day
Super C Complex 1000 mg, three times a day (Puritan's Pride Brand)
Acetyl L-Carnitine 400 mg with Alpha Lipoic Acid 200 mg, one time a day
Natural Selenium 50 mcg, four times a day
Co-Enzyme Q10 100 mg, one time a day
Magnesium Oxide 400 mg, one time daily
Multiple Vitamin, one time daily

I always try to take my supplements with food and I am on a schedule that has me taking something, prescribed medications and supplements every six hours.

Just for the information to folks with CAD and angina, my medical treatment regimen is aimed at not only controlling my blood pressure, but keeping it as low as possible without adverse side effects. I try to keep mine around 90/50 when I am at rest. It usually ranges between 80/40 to 100/50. When my BP is a normal 120/70 or more, during stress or increased physical activity, I often experience symptoms of angina. Here are the prescribed drugs I am on daily

Aspirin 325 mg in the morning
Fosinopril
Metopropolol Tartrate
Isosorbide Mn
Nitroglycerine (as needed)

No dosages are provided because you need to consult a physician before starting this protocol. Suffice it to say, some of the dosages are higher than usually recommended. The Isosorbide and Nitroglycerine were recently added to my regimen and Modiuretic was discontinued due to an abnormal increase in blood tests that indicated my liver was being adversely affected. I also take prescription medication for Parkinson's disease.

I cannot emphasize enough the need to be under the care of a medical doctor who you trust and have a good working relationship with. I encourage anyone who has CAD or angina or has a loved one who does to read my blog from beginning to end and to get a second opinion from a non-invasive cardiologist before being coerced into bypass surgery they do not need.

One More Opinion About EECP

A noninvasive procedure for treating angina has proven nearly as effective as angioplasty, said a cardiologist who has been using Enhanced External Counterpulsation for his patients for the past several years.

Dr. James P. O’Neil, a cardiologist with the Cardiology Group, which administers the procedure at its Mount Laurel office, said coronary angioplasty, a medical procedure which involves inserting a balloon catheter to open a blockage in an artery, and the EECP offer patients “about the same success rate.”

During EECP, cuffs similar to blood pressure cuffs that have been wrapped around patients’ legs are inflated and deflated, forcing blood to flow through arteries. “The body reacts by improving collateral blood flow” with small capillaries expanding to compensate for the blocked artery, said O’Neil.

He said the aim of both procedures is to “improve exercise tolerance and fatigue,” common problems for heart patients.

Angina is a symptom related to coronary heart disease. Blockages in coronary arteries created by the buildup of plaque on the inner walls of the vessels limit the supply of oxygen-rich blood to the heart and cause the chest pain or discomfort known as angina and shortness of breath.

O’Neil said medications are usually the first step in an attempt to ease the discomfort, but if they do not work, then cardiac bypass surgery, angioplasty or EECP treatments should be considered.

He said EECP relieves symptoms in 75 percent of cases, “a little bit less than angioplasty,” which eases symptoms in 80 percent of cases. Cardiac bypass surgery improves symptoms 90 percent of the time, said O’Neil.

O’Neil said The Cardiology Group, which has five offices in Burlington County, has done nearly 300 of the lower risk EECP procedures since it began offering EECP six years ago. The procedure is administered the same now as when it was introduced, in one-hour sessions five days a week for seven weeks.

The time commitment is the only disadvantage of using EECP, said O’Neil, who cited several advantages of using it instead of angioplasty to relieve angina.

“Angioplasty is three times the cost as the EECP, the risk is higher, there is no survival advantage of angioplasty over EECP,” said O’Neil.

O’Neil said a report issued during a recent American College of Cardiology conference supported the view that the two procedures offer similar success.

“We used to think that people lived longer (by having angioplasty),” he said. “Angioplasty is really stretching the vessel and really tearing the vessel. During angioplasty, that vessel is damaged and as it heals, it can cause a scar.”
The resulting scar can create a new blockage, although a drug-eluding stent sometimes is used to hinder the scar buildup, he said.

“One out of 10 patients tend to block up again with that artery,” he said. “With EECP, we’re not damaging an artery and causing scar tissue to build up.

“The big thing that has been found with EECP, a patient is not going to die any more often than those who have angioplasty. There’s a big misconception that if we do angioplasty it’s going to make them live longer.”

An exception, he said, is that when performed during a heart attack, angioplasty can serve as a lifesaving procedure.

O’Neil compared the effectiveness of the three procedures used in relieving angina. He said cardiac bypass surgery improves symptoms in 90 percent of cases, angioplasty in 80 percent and EECP in 75 percent.

The cardiologist said some insurance carriers, including Medicare, only recommend EECP as a remedy for patients who are not considered candidates for cardiac bypass surgery or angioplasty.

“I and many physicians don’t agree. We think EECP should be offered along with bypass and angioplasty,” O’Neil said. “One of the reasons patients don’t want bypass is they are afraid.”

He said insurance regulations sometimes deter patients from taking advantage of EECP.

“One of the biggest obstacles is how the insurance companies can make it difficult. They can and do make it difficult for patients to go through this,” said O’Neil, noting that out-of-pocket charges such as per-visit co-pays can deter patients from having the treatments.

“They might not have as big an out-of-pocket expense if they take the riskier, higher priced procedure,” he said.

O’Neil said EECP costs $6,000 to $7,000 whereas the angioplasty costs $20,000 to $30,000.

Patients who have had EECP say they are happy with the results.

That includes the Cardiology Group’s first EECP patient.

At 83, Nick Russo still mans a tractor to cultivate the pumpkin patch at the family farm in Chesterfield. In March 2001, he was the first patient to undergo EECP at the Cardiology Group.

Although Russo stashes a bottle of nitroglycerin pills in his pocket — just in case — the Westampton man said he hasn’t needed any of the medication since 2003, when a second round of EECP treatments seemed to ease the lingering angina.

Russo, who was diagnosed with a heart problem 10 years ago, underwent an open heart procedure at Deborah Heart and Lung Center in Browns Mills, Pemberton Township, in 1999. He took nitroglycerin to ease angina, eventually deciding to have the EECP.

Russo said his initial EECP treatments were “a little frightening at first. You get a shock.”

After having the EECP in 2001, Russo said, “I would still get out of breath. Once in awhile I would have to take a nitro pill.”

He said he noticed the angina “when I would do anything that was exertion” — lifting bags of fertilizer, loading crates of corn — and his cardiologist suggested a second set of treatments.

Marlene Donnelly of the Cardiology Group said EECP can be repeated “as long as it’s medically indicated.” She said one patient has had three sessions of EECP.

Angioplasty also may be repeated, Donnelly said.

After having a second angioplasty last July (the first was in May 2006), Edward Stickel of Delanco “felt better for a while, and then I started to experience unstable angina. For about 11 consecutive days in September and October I had angina in my left shoulder,” he said.

Stickel, 68, said cardiologist Samuel Ventrella thought EECP would help. He started the treatments on Nov. 6, and after about 12 sessions “started to feel much better.” By Dec. 6, “I stopped having the angina,” said Stickel, who retired from teaching at Palmyra High School, where he also coached freshman football for 18 years. He enrolled in the Cardiology Group’s rehab program, and exercises at the Mount Laurel center twice a week.

The former educator also said he is still able to go waterfowl hunting and fly fishing.

Stickel said he is covered by Medicare and by a Blue Cross/Blue Shield plan and was not troubled by the cost of the EECP treatments.

“I was charged a $5 co-pay, which I found to be not a real problem,” he said.

Jane Tabone-Yerkes of Pemberton Township, who is covered by a Civil Service insurance plan, said she had no co-pay for her EECP treatments, which she completed on Feb. 5.

Diagnosed with a heart problem 17 years ago, Tabone-Yerkes, 76, said, “I feel wonderful. I can go up the steps, I go up and down and I have no problem.”

Tabone-Yerkes, who had a stent inserted following a heart attack in 2005, said she asked her cardiologist for the EECP after reading about the procedure in a magazine. She said a second bypass surgery was not recommended.

During the procedure, “You are plummeted,” said Tabone-Yerkes, describing the sensation.

“It’s like a boxer socking you in every blood vessel of your body, but it was not hard to take,” she said.

Tabone-Yerkes said her angina, which she felt “down one arm,” “disappeared completely after 15 sessions.

“I felt like I did when I had the bypass 17 years ago,” she said.

A nitroglycerin tablet is part of her daily pill regimen, which also includes medications to control diabetes, high cholesterol and high blood pressure. Tabone-Yerkes, who retired from her job as an accounting technician at McGuire Air Force Base, said a low-fat diet and swimming five laps each morning in her pool helps her stay fit, and she recently joined a fitness center that caters to cardiac patients.

She said EECP was a good choice.

“They used to say it’s the last resort, but I don’t think that’s true,” said Tabone-Yerkes.

(from the Burlington County Times)

Don't Believe Your Cardiologist

Recently, "Big Dave" made a statement regarding CAD on a forum I spend a lot of time. Here is his statement and my reply, for the record:

Big Dave

No matter how you do it, removing the plaque buildup is the cure to most coronary disease. A pharmacological cure would put a lot of heart surgeons out of business.

Actually that's not so, especially for males over 50. We have an uncanny ability to grow collateral vessels through a process called angiogenesis. Now if you have cancer, angiogenesis is a bad thing. It is responsible for the cancer traveling, becoming malignant. In those of us with coronary artery disease, the process actually helps the growth of collateral vessels. That is why, for the great majority of patients with coronary artery disease, a bypass does more harm than good because it destroys our natural bypass.

Regarding the pharmacological cure: if a cardiologist tries to coerce you into a bypass immediately after you have been diagnosed with CAD, believe me, he doesn't have your best interests in mind. Your interests are far behind the interests of the cardiologist, cardio-thoracic surgeon and his team, the hospital, the therapists, etc. A CABG is the most commonly performed and lucrative cardiac surgical procedure. The American Heart Association and the American College of Cardiologists have both officially stated a CABG should be a last resort, after medication and lifestyle change. Yet, most of these medical terrorists whho try to scare, and usually succeed, into scaring you and your wife into having your chest split open, will use every trick in the book to make you think a heart attack, stroke or death are imminent if you don't have an immediate CABG. That is a bald face lie.

I have challenged these blood sucking scum to debate me on my website or any forum of their choice. They do not even acknowledge the challenge because they know such an event would expose them for the charlatans they are.


That challenge still stands. I am not a physician. I am not even a current medical professional, though I was a nurse in the Army for 20 years and have worked for more than 15 years as a safety officer and senior medic on oil rigs. How about it, you medical terrorists who scare your patients into making your Mercedes and pool payments, care for a debate?

Your EECP Questions Answered

What is Enhanced External Counter-Pulsation (EECP)?

The Cleveland Clinic defines EECP as a treatment for those with symptomatic coronary artery disease, not eligible for standard treatments of revascularization. During EECP, cuffs wrapped around the calves, thighs and buttocks are inflated and deflated, gently but firmly compressing the blood vessels in the lower limbs, increasing blood flow to the heart. EECP may stimulate the openings or formation of collateral vessels to create a “natural bypass” around narrowed or blocked arteries.

The Sanger Clinic further defines EECP as a non-invasive procedure for patients with severe refractory angina… (It) can relieve or eliminate angina in patients who are not candidates for angioplasty or bypass surgery.

How does EECP work?

That’s a good question. EECP is designed to relieve angina by improving perfusion in areas of the heart deprived of an adequate blood supply. The cuffs inflate during diastole, the period when the heart muscle relaxes and the chambers fill with blood. The cuffs inflate sequentially from the calves upwards, resulting in increased pressure in the aorta and coronary arteries. Compression of the vascular bed in the legs also increases the return of venous blood to the heart and increases cardiac output. Patients are customarily treated with EECP for an hour a day for a total of 35 hours.

What is the history of the use of EECP in the USA?

The concept of counterpulsation is not new (it was first introduced in the late 1950s at Harvard), but the computerized technology currently available with EECP makes it a relatively new procedure, introduced less than 10 years ago. As of 2003 it is available in only about 200 centers across the United States.

EECP is used to treat patients with chronic stable angina, coronary artery disease, or high blood pressure. Most recently, the Food and Drug Administration (FDA) has approved EECP for the treatment of congestive heart failure. The treatment may be appropriate for patients who are not eligible for such non-surgical interventional procedures as balloon angioplasty, stent placement, rotoblation, atherectomy, or brachytherapy. It may also be used for patients who do not qualify for such surgical treatment as coronary artery bypass graft surgery.

EECP is not the first-line treatment for angina. Rather, it is reserved for patients who have not achieved good results from medication or interventional management of their symptoms.

EECP may benefit patients with such other medical conditions as erectile dysfunction, kidney disease, eye disease, diabetic neuropathy, and other circulatory disorders. More research is needed to evaluate the outcomes of EECP for these patients.

Are there any contraindications for EECP?

EECP is not recommended for patients who have certain types of valve disease; uncontrolled arrhythmias (irregular heart rhythms); severe hypertension; uncontrolled congestive heart failure; significant blockages or blood clots in the leg arteries; or those who have had a recent cardiac catheterization, angioplasty, or bypass surgery.

Are there any risks or side effects?

EECP is a relatively safe and effective treatment, and few adverse side effects have been reported. The main adverse side effect is chafing (skin irritation from the compression of the cuffs). To reduce or prevent this side effect, patients are instructed to wear tight-fitting cycling pants or athletic tights. Leg pain is another adverse side effect.

What are the normal results?

The benefits of EECP are comparable to the results of angioplasty and coronary artery bypass graft surgery: 80% of patients experience significant improvement after EECP treatment. The largest research study on EECP indicates that after receiving treatment, patients used less medication, had fewer angina attacks with less severe symptoms, and increased their capacity to exercise without experiencing symptoms. EECP improves the patient's sense of well-being and overall quality of life; and in some cases, prolongs the patient's life. Benefits five years after EECP treatment are comparable to surgical outcomes.

The effects of EECP treatment last from three to five years and sometimes longer.

EECP does not prevent coronary artery disease from recurring; therefore, lifestyle changes are strongly recommended and medications are prescribed to reduce the risk of recurrent disease.

What sort of lifestyle changes are we talking about?

These are changes you already have, or should have taken:

• Quitting smoking. Smoking causes damage to blood vessels, increases the patient's blood pressure and heart rate, and decreases the amount of oxygen available in the blood.
• Managing weight. Maintaining a healthy weight, by watching portion sizes and exercising, is important. Being overweight increases the work of the heart.
• Participating in an exercise program. The cardiac rehabilitation exercise program is usually tailored for the patient, who will be supervised by professionals.
• Making dietary changes. Patients should eat a lot of fruits, vegetables, grains, and non-fat or low-fat dairy products, and reduce fats to less than 30% of all calories. Alcoholic beverages should be limited or avoided.
• Taking medications as prescribed. Aspirin and other heart medications may be prescribed, and the patient may need to take these medications for life.
• Following up with health care providers. The patient needs to visit the physician regularly to control risk factors.

A Letter to the Editor about EECP

Dear (Napa Valley Register ) editor,

This is a belated thanks to Dr. Dizman, Napa cardiologist, and nurse Susan Hart for giving me medical service that changed my life and avoided the problems that come with bypass surgery.

For some time before October 2001, I was suffering periodic chest pains. I finally went to a cardiologist (not Dr. Dizman) who after an examination scheduled me for a bypass operation. Before I had the operation, I went to see Dr. Dizman about his non-invasive heart treatment program, Enhanced External Counter Pulsation.

I canceled by scheduled bypass operation and started the EECP therapy given by nurse Susan Hart. After completing the 35 daily sessions, my chest pains were gone, and I haven’t had any problems since then. I strongly recommend that anyone thinking about getting a bypass operation check out the EECP therapy available at Dr. Dizman’s medical center. If it doesn’t help, you can always get a bypass operation. Medicare paid for the EECP therapy, so it must be an approved medical program.

John J. Eberle / Napa

Seeking a Noninvasive Cardiologist

I am actively seeking a noninvasive cardiologist to treat my stable angina and coronary artery disease using noninvasive diagnostic procedures and treatments. I do not want any tests that require the insertion of any tubes or catheters inside my body. I will not consider any invasive treatments such as coronary angioplasty, the insertion of stents, or coronary artery bypass graft (CABG) surgery, until and unless noninvasive medical treatments and procedures have been used and proven unsuccessful.

If you have not read my blog from the beginning, you may not understand why I am so adamant about this. Let me briefly bring you up to date and encourage you to read my entire blog.

In April 2004, I was diagnosed with coronary artery disease (CAD) which I was told was the cause of the angina I had been experiencing for about six months. The interventionalist cardiologist my family doctor sent me to, tried to coerce me into an immediate quintuple CABG, despite the fact, that as he put it, my heart was "in great shape." He wouldn't tell me how my heart could bee in great shape when the arteries that were providing it oxygen were 85 to 100 percent blocked.

He did try to schedule me for the quintuple CABG on Thursday, two days later. When I told him I wanted a second opinion, he told me I was a "walking time bomb," and that I could "have a heart attack, stroke, or even die within three months." I replied that I had been experiencing angina for six months and would take the risk.

I'm glad I did. I sought out the opinion of Dr. Howard Wayne of the Noninvasive Heart Clinic in San Diego. To make long story short, he evaluated me and started me on medical treatment I remain on until this day, three years and four months later.

Unfortunately, in November 2006, the angina returned while I was running to make a connection at Charles De Gaulle Airport in Paris. I contacted Dr. Wayne's clinic and sadly learned he had passed away three weeks earlier. (Lest anyone assume he was the victim of heart disease, Dr. Wayne died while climbing mountains near Lake Tahoe. He was 83.)

I saw a doctor in Chicago who agreed to follow the protocol set up by Dr. Wayne, although he did feel I should have the CABG. He also thought I might benefit from Enhanced External Counterpulsation. EECP is a noninvasive therapy.

My doctor in Chicago is leaving his practice and I can not find a cardiologist in Indianapolis that will prescribe EECP unless I undergo an angiogram. Readers of this blog will understand why that is out of the question.

There may come a time when I will be convinced the medical and noninvasive treatments for my angina and CAD are no longer working and I will undergo a CABG. However, I will not be coerced into what I consider to be unnecessary surgery by people I consider to be medical terrorists who are more interested in making money than properly treating my medical conditions.

Therefore, I am seeking a noninvasive cardiologist to prescribe EECP and follow me during and after the seven weeks of therapy. If you know one, please have him or her contact me at jeff.brailey@gmail.com.

Your Angiogram Increases Your Cancer Risk

CT Coronary Angiography Carries "Nonnegligible" Cancer Risk

Computed tomography coronary angiography carries a "nonnegligible" risk for cancer, which varies greatly by age and gender, according to a study in JAMA.

The study was based on risk estimates -- developed for the National Academies' Biological Effects of Ionizing Radiation report -- that were applied to simulation models.

The lifetime attributable risk for cancer from a single CTCA for women was 1 in 143 at age 20, 1 in 284 at age 40, and 1 in 466 at age 60. Lung and breast cancer accounted for about 80% of the cancer risk in women.

Men's risks were considerably lower: 1 in 686 at age 20, 1 in 1007 at age 40, and 1 in 1241 at age 60. Women's higher risk was attributed to the greater radiosensitivity of their lungs and to the fact that the breast lies in the field irradiated during CTCA.

The authors note that CTCA "should be used particularly cautiously in the evaluation of young individuals, especially women."

Choose Your Doctor Carefully

A legal dispute involving a 69-year-old Miami heart surgeon has revealed that he has has been suspended from the staff at Cedars Medical Center while the hospital investigates 24 of his cases, which include ''numerous patient deaths,'' court filings show.

Other documents say the surgeon, Alex Zakharia, suffers from memory lapses that have been worsening, and he's been charged in a criminal case with fraud and perjury for allegedly exaggerating his surgical experience.

Zakharia's lawyers insist he has done nothing wrong, and the doctor has challenged his suspension. He continues to work in at least four South Florida hospitals. One week last month, he performed 21 procedures, according to court documents.

Doctors' problems are usually closely held secrets in the healthcare industry and can persist for years before becoming public with any disciplinary action.

But in this case, Zakharia's difficulties have been disclosed by the doctor's own lawyers in documents filed in Detroit and Miami-Dade County courts.

Zakharia refused to discuss any specifics and threatened to sue anyone who wrote about his situation.

In court papers, the surgeon and his lawyers have said there are no problems. The memory lapses don't affect his work, Zakharia told his doctors. He has pleaded not guilty to the fraud charges, and he has sued Cedars to be put back on staff. The lawsuit says hospital executives suspended him ``abruptly without . . . sufficient inquiry to confirm the credibility of the allegations.''

The four hospitals where he works are Mount Sinai Medical Center in Miami Beach, Select Specialty Hospital in Miami, North Shore Medical Center in North Miami-Dade and Larkin Community Hospital. Officials for Sinai, North Shore and Larkin said they didn't have any information about performance issues involving Zakharia. Select did not respond to phone calls.

According to his résumé, Zakharia received his medical degree from the American University in Beirut in 1962, followed by surgical residencies at Baylor, Case Western, the Mayo Clinic and the University of Miami. He has practiced in Miami since 1982.

START OF TROUBLES

Zakharia's present troubles stem from a 2003 case in which he testified for a man who sued the Veteran's Administration for malpractice. In November 2006, the U.S. Attorney's Office in Detroit indicted him on charges of fraud and false declaration concerning his surgical experience.

According to the indictment, he stated in a deposition that he had wide experience in coronary artery bypass graft surgeries, but records at Cedars and Miami Heart Institute didn't back up the testimony. Zakharia told The Miami Herald at the time that the lawyers had misunderstood him and that his background wasn't relevant to the malpractice case.

That same month, Cedars suspended his surgical privileges, saying in a letter to the surgeon that it had ''credible evidence'' that his surgical care in one case was ``below the standard of care.''

Several weeks later, another Cedars letter to the doctor said the medical executive committee recommended revoking his hospital privileges because of his ''clinical performance or competence'' in two other cases. Zakharia was offered a hearing to give his side.

Lourdes Garrido, spokeswoman for the HCA hospital chain, Cedars' owner, said the hospital couldn't comment because the matter is under litigation.

Zakharia sued Cedars in Miami-Dade Circuit Court to stop the hearing, alleging it was ''tainted'' because of the hospital's prejudice against him. The hearing, which has been frequently postponed, is now set for next month.

Cedars responded that it needed to ''protect the life and well-being of patients'' and that the hospital had summarily suspended him in November ``after several of his patients died.''

The court filing said that in December the Medical Executive Committee had received ``credible information regarding his clinical performance or competence concerning the deaths of two patients.''

Later, the Cedars staff said it would present 24 cases at his hearing. ''The additional 22 cases, which cover a period of 18 months, include numerous patient deaths,'' the court filing said.

Cedars said the surgeon's actions were motivated by ''ill will and animus,'' because Cedars had provided information to a federal grand jury that ended up indicting Zakharia for perjury.

NO COMMENT

Cedars lawyer Stephen Bronis said he couldn't comment because the case involves a ``confidential and privileged peer review.''

Zakharia said if an article were published about his situation, ''I am having the biggest lawsuit The Herald has ever seen. You have demeaned me'' by calling and asking questions of hospitals and others, he said. ``I am suing for $5 million. You tell your boss that.''

Zakharia's Detroit and Miami attorneys did not respond to five calls over a two-day period.

As the Cedars case grinds on, Zakharia's Detroit lawyer has filed motions seeking to get the federal perjury case moved to Miami because he was too ill to make the trip. In support, his lawyer submitted letters from doctors who have been treating him.

In one, Guillermo Blanco, a North Miami Beach neurologist, stated Zakharia suffered ''an episode of dizziness'' during one flight to Detroit for a hearing, and a magnetic resonance imaging test revealed ''two possible TIAs.'' A TIA is a transient ischemic attack, which the National Institute of Neurological Disorders and Stroke describes as a ``stroke that lasts only a few minutes.''

From Blanco's letter: 'Dr. Zakharia today complains of progressive difficulties with his memory. He has difficulty focusing on things and although he performs surgery without any difficulties, he has noted that he forgets names of patients and he has to ask his secretary frequently about it. Again he admitted not being as `sharp' as he use[d] to be. This has been going on for several months and probably longer than a year but has been worse lately.''

Blanco recommended Zakharia not fly ''because of a high risk of a stroke,'' and he recommended the surgeon take Aricept. The drug's website says it is the only drug approved ``for all stages of Alzheimer's disease.''

Carl Eisdorfer, director of UM's Center on Aging, said Aricept ''has really one specific use -- it's used in patients with Alzheimer's disease,'' but he couldn't say why Blanco prescribed it.

Blanco said he couldn't talk about a patient's medical problems.

ADVERSE EFFECTS

Another doctor treating Zakharia, Rafael A. Soto, said the surgeon had suffered during two Detroit flights, one of which ''caused heaviness in his speech. . . . While his condition does not prevent him from doing his normal professional duties, he is strongly advised not to fly.'' Soto did not respond to a phone call seeking comment.

Florida Board of Medicine records show no disciplinary actions against the surgeon. A spokeswoman said any existing investigations concerning Zakharia would not be public until the board ruled.

Zakharia remains busy. In one week last month, he did nine procedures at Mount Sinai, 10 at Select and one each at North Shore and at Larkin.

Cardiologist William O'Neill, executive dean for clinical affairs at the University of Miami's medical school, reviewed the list of procedures for The Miami Herald and said many were relatively simple -- inserting tubes into veins -- but three (one at Sinai and two at Select) were more complicated tracheotomies -- cutting open the throat to insert a ventilator tube.

While he doesn't have firsthand knowledge of the Zakharia case, each of the elements raises issues, O'Neill said.

``I would be very concerned to find out the reason he was suspended by another hospital. I would be incredibly concerned about the accusation of perjury, and I would be even more concerned about the memory issues.

``Before I let him continue at a hospital I was associated with, I'd want to know from the physical standpoint that he's mentally competent.''

Sidney M. Wolfe, a physician with the consumer group Public Citizen in Washington, said the Zakharia case is rare. Typically, physicians' problems are handled very quietly -- if they are handled at all.

Without the court cases, ''he presumably would be treated'' for his memory problems, Wolfe said, ``and no one would know the difference.''

Number of CABG's to Increase

Three years and three months ago, I was told by a cardiologist in Indianapolis, that if I didn't undergo a quintuple coronary artery bypass within a few days, I stood a good chance of having a stroke, heart attack or being dead within three months. My heart is still ticking, it is still receiving vital oxygen and I didn't have to have my chest cracked open. I was put on a course of medication which I continue on today. If you want to know the whole story and truth, start reading this blog from the first post until the last. AND BEWARE OF NEW RELEASES LIKE THIS ONE.

New Trend Reverses Almost 5 Years of Decline

WALTHAM, Mass., June 28 /PRNewswire/ -- Millennium Research Group (MRG)has conducted a detailed analysis of the cardiac surgery market in its US
Markets for Cardiac Surgery 2007 report. The analysis reveals that there will be an increase in the number of coronary artery bypass graft (CABG)
procedures in 2007.

This marks the first time in almost 5 years that CABG procedures have increased over the previous year. The historic decline was due to the adoption and
increased popularity of less invasive methods of coronary revascularization.

These less invasive procedures have had their safety called into question over the past year.

Safety concerns of alternative procedures, combined with the increasing incidence of heart disease and demographic pressures will result in uncharacteristic CABG
procedure growth of 0.9% during 2007 and will help to support nominal growth in overall CABG procedures through 2011.

Clinical data published in late-2006 questioned the efficacy of percutaneous coronary interventions (PCI) and particularly drug-elutingstent (DES) procedures
for the treatment of certain forms of complex coronary artery disease (CAD).

Published data reported increased risk of late-stent thrombosis associated with DES implants up to a year post-operatively in patients with complex CAD including
multi-vessel or left main artery disease.

"The increase in CABG procedures in 2007 reverses a long-standingdecline," says Nadia Lachowsky, Senior Analyst at MRG. "CABG is a proven choice for many physicians
and patients. It will likely remain an importantoption for complex CAD despite technological advances in minimally invasive
treatments.

Besides CABG devices, the US Markets for Cardiac Surgery 2007 report covers markets for heart valve devices, endoscopic vessel harvesting
devices, anastomosis assist devices, cardiac assist devices (ventricular assist devices, intra-aortic balloon pump catheters, total artificial heart
devices), surgical ablation probes, and transmyocardial revascularization devices.

What this report fails to tell you is upwards to 95% of all CABG's performed in the USA are UNNECESSARY.

It fails to tell you that the CABG is one of the biggest money makers for hospitals, cardiologists and cardio-thoracic surgeons.

It fails to tell you the most prudent initial treatment of conditions like angina and CAD is medication.

BEWARE OF MEDICAL TERRORISTS WHO LIE AND TELL HALF TRUTHS TO SEPARATE YOU FROM YOUR HARD-EARNED MONEY AND PERFORM UNNECESSARY SURGERY ON YOU.

ALWAYS GET A SECOND OPINION FROM A NONINVASIVE CARDIOLOGIST.