Anna M. – Med Five Results

Evaluation by Dr. James Roberts - Information obtained by phone interview 10/01 and 10/10 with Ms. Anna M. and Dr. Roberts’ review of Anna’s carotid ultrasound reports. We cannot say with certainty that the changes described below did not occur by chance. Just because Anna’s carotid ultrasound improved while she was on Rejuvetate doesn’t mean that others will experience the same effect.

Anna M. (and her Left Carotid Artery) have been Rejuvetated

Anna M. is concerned about cardiovascular disease - and concerned she should be - both of her parents died from cardiovascular disease. Two of Anna’s sisters have sustained strokes. Anna is concerned, so she doesn’t smoke and she does watch her diet. Anna’s doctor has placed her on medication to provide for blood pressure and cholesterol control.

But Anna knows that there is more to cardiovascular disease than high blood pressure, cholesterol, smoking, and diabetes. She knows that diet and medication alone cannot guarantee cardiovascular health. Anna knows about cardiovascular health and disease, so when ultrasound screening was offered in her community, Anna took charge of her health and had the scan done – a good idea, as 70% Right and 50% Left Internal Carotid Artery narrowings were discovered.

Carotid narrowings of > 70% are associated with an increased risk of stroke and are usually addressed surgically (the procedure is called Carotid Endarterectomy or CEA). Surgery was recommended and Anna breezed through her CEA procedure. Less pronounced blockages, such as the 50% narrowing in Anna’s Left Internal Carotid, are associated with a much lower stroke risk. Surgery is not necessary, but as carotid narrowings typically progress, sometimes rapidly, yearly ultrasound studies are carried out. Here we are watching for progression of the narrowing to 70% or greater, for which CEA would be appropriate.

Anna underwent follow-up ultrasound studies in 6/04 and 7/05, then 9 and 21 months out from her 9/03 CEA. The percentage narrowing given on the ultrasound report is an estimate, often given as a range, and is based on the velocity of blood flow within the Internal Carotid Artery (the higher the velocity the tighter the narrowing – think of a garden hose with your thumb over the nozzle), and the ratio between the Internal and Common Carotid Artery velocities on the same side (the Common gives off the Internal, and a blockage within the Internal increases the ICA:CCA ratio).

Remember, if treatments designed to prevent disease progression are not introduced, the natural history of a carotid artery blockage is to progress. The velocity in Anna’s Right ICA fell from 208 to 111 between 9/03 and 6/04 – this represents a successful surgery – the plaque was cleared out. The flow velocity in her Left ICA, however, increased from 114 to 190, representing progression of the left sided blockage from 50% into the 60-80% range.*

This was a problem. The Left Internal Carotid narrowing that didn’t need surgery in ’03 was fast on its way to becoming a threatening blockage that does. Anna’s carotid disease was progressing, despite the BP and cholesterol lowering medication that her physician had prescribed. Anna had learned of the Med Five, a nutritional program designed to address the causes of arterial disease that standard drug therapy does not. Anna began the Med Five. Again, Anna M. took charge of her health.

Anna began Rejuvetate in 2/05, eight months after the 6/04 ultrasound that showed disease progression. Anna’s scan was repeated in 7/05, five months after Rejuvetate was added to her medical regimen. The Right Internal Carotid, the artery operated on in 9/03, showed no evidence of disease progression. The Left Internal Carotid, the non-operated artery that had shown disease progression between 9/03 and 6/28, demonstrated a fall in velocity. The velocity fell from 190 to 131, with a matching decrease in the ICA:CCA ratio from 2.4 to 1.5. The percentage narrowing decreased from 60-80 to 50-60%. We don’t operate on arteries that are opening up – instead we jump up and down and cheer.

Operating on an artery that is opening up makes little sense, and no one would recommend that. Staying with a program that seems to be improving carotid artery flow makes perfect sense, and that is what Anna will do. We don’t have to tell her, because Anna M. takes charge of her own health.

                                                       James C. Roberts MD FACC 10/16/05

* The three ultrasound scan reports contained slightly different descriptive measures, which I reconciled as best I could, and please remember, in the carotid ultrasound technique we are thinking in terms of ranges, not exact absolute values.