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The Portland Community Free Clinic

For some time now I have been a volunteer physician at the Portland Community Free Clinic (part of the India Street Public Health Center of Portland, Maine), where low-income residents in the area receive free medical care. When you visit CardiacHealth to get a question answered, please consider making a tax deductible contribution to the Friends of the PCFC.
The FPCFC is a non-profit organisation, created to support the Clinic.

Treating Esophageal Cancer

Question: 
I was very interested to read about your patient Bill who survived 27 years after you operated on his oesophagus. You mentioned that you used unconventional theraphy combined with Chemo and radiotheraphy.  I have been diagnosed with Oesophagus cancer and am seeing the oncologist tomorrow to get my PET scan results and I would like to know how your treatment varies than the norm that a oncologist would use.

Hi JG,

It has been a long time since I have talked about my patients! If you followed the links you have read the scientific analysis of my approach to treatment for adenocarcinoma:

If the tumor size is <5 cm, this was the treatment:

Recovery after bypass surgery

Question: 
My father (85yrs old) had a bypass three weeks ago. He has recovered very well, but comments that he is passing much more urine than before the op. (he had his bladder removed 5 years ago as he had Ca Bladder and now wears a urostomy bag).  Is this normal, or could he have a urinary tract infection? 

It certainly can be a urinary tract infection, but the way a CABG is performed often leads to a lot of fluid administered during the operation, which your father’s body is now getting rid of. If so, that is a good sign and shows his heart and kidneys are working just fine! In any case, I’d recommend a urinanalysis and culture to make sure.

Hope this helps,

Clarification following CABG

Question: 
Dear Dr T,
I underwent CABG x3 in Sept 2012 and have recently had access to my medical reports and I was wondering if I could trouble you to explain some of the medical terms to me.
1. Result of catheterisation pre-op showed ‘right coronary artery had no obstructive disease. The left main stem had a critical distal lesion – 90% and this was a true bifurcation lesion involving the ostia of both the left circumflex and LAD. The LAD had some mild disease after a large diagonal branch. The left circumflex had no other significant disease apart from the ostium. Left ventricular function was good.
2. Intra operatively patient had a pedicle LIMA anastomosed to the LAD, vein graft to the diagonal, vein graft to OM1.
I heard the term widow maker mentioned to me on the ward, is this what I had with some or one of my blockages Dr T? I was also wondering, based on the pre-op findings, just how serious was my situation back then?
Many thanks for listening
James
Hi James,
  • The term LIMA refers to a Left Internal Mammary Artery graft.
  • This artery is usually connected to the left anterior descending artery and/or one of its major branches, as was done in your case. The major advantage of using internal mammary arteries is that they tend to remain open longer than venous grafts and much longer than PCI. Ten years after coronary artery bypass graft surgery (CABG), 90% of internal mammary arteries and 66% of vein grafts are usually still working.

Don’t let your right hand know what your left hand is doing…

Description: Macintosh HD:Users:joan_tryzelaar:Desktop:Cialis.png

I am sure you have seen the Cialis ad; it has been around for quite a while and like many others, it plays on TV in context with the expected male audience. While morning shows receive their share of women-focused advertising, men are targeted when sport shows are present.

Men are expected (when not lusting after manly trucks, boats or guns) to struggle with hair loss and/or ED, while on the internet (where things are less strictly supervised), they get encouraged to grow their penis size to unheard-of proportions.

Dizziness and my ECG report results

Question: 
I am 65 year old. I felt slightly unstable a couple of time during the day. Immediately got the  done. My readings are Rate 86; PR 140; QRSD 82;QT 396; QTC 474 AXIS P 69; QRS 6 T 4 Speed: 25 mm/sec  Limb: 10mm/mv and Chest: 10 mm/mv. The emergency doctor said it is Normal and my unsteady gait relates vertigo. Pl confirm his findings for my assurance. Thanks

The ECG reading explains nothing about your symptoms. While vertigo may be associated with a cardiac problem, this EKG doesn’t prove anything. You need a doctor’s consultation to evaluate your heart, your ears and possibly your brain as well as other causes.

An assessment for any serious underlying disorder requiring urgent treatment such as coronary artery disease, cerebrovascular disease.

Identifying the nature of the presenting symptom in terms of true vertigo, syncope (fainting), presyncope or any other form of dizziness. Dizziness can usually be categorised into one of four main groups:

Burning Feet after Bypass Surgery

Question: 
 Hi. In July of ’11 I died twice the same night from cardiac arrest. After quad bypass surgery, and beginning to come more and more from some of the strong meds for I guess keeping me sedated, I noticed a tremendous burning on the tops of both feet…neuropathy. The bottoms of my feet are both numb which makes it even stranger. I realize this isn’t your specialty, but my ex brother in law had a heart attack and now he also has neuropathy, but his has now effected not only his feet, but he says it’s advanced up to his knees. Do you know how or why we’re both experiencing a nerve disorder, and a nerve disorder right after a cardiac event? And is there a cure for it that you’re aware of? My personal Dr. can’t give me any answers, and even the manufacturer of the medication I’m on for it, Gabapentin, can’t tell me, or even tell me how the medication works. Anyway, any info you can give me would be greatly appreciated, and I’d LOVE to find some cure because I’m tired of not only the pain and numbness, but looking like I’ve been drinking heavily when I try to walk. Thank you.

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