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November 17th, 2010
05:10 PM ET
What causes new blockages to form so quickly?Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesday, it's Dr. Otis Brawley, a chief medical officer for the American Cancer Society. Question asked by Angi Garton of Chariton, Iowa: My mother had triple bypass surgery one year ago. She was having chest pain again and hospitalized. There are more blockages, one right below a bypass and 70 percent blockage through a bypass. Also one bypass has failed. Her cholesterol and blood pressure are in good ranges and under control. What would have caused the new blockages so quickly from a year ago? Expert answer Unfortunately, it is rather common for a patient to have blockages in the coronary arteries and in the bypass after a coronary artery bypass graft (or CABG). The heart muscle is threatened when one or more of the arteries carrying oxygenated blood through it is partially or completely blocked. It can be blocked by a cholesterol plaque, a blood clot or a combination of the two. Heart muscle beyond the blockage cannot get enough oxygenated blood. This can cause the chest pain called angina. Prolonged decreased blood flow can cause death of heart muscle which is referred to as a myocardial infarction or a heart attack. Minor blockages of the coronary artery are treated with medications that dilate the arteries and lower blood pressure which decreases the workload and oxygen requirement of the heart. More severe blockages have to be treated with an angioplasty, angioplasty and placement of a stent, or with a coronary artery bypass graft. Angioplasty is when a catheter is passed, usually from the femoral artery in the groin up to the heart and a balloon-like device is placed in the coronary artery to the level of the partial occlusion and inflated to open the blockage. A stent, a tiny tube, can be left behind to keep the artery open. A coronary artery bypass is an open-chest surgery. A surgeon takes a piece or graft of artery or vein from elsewhere in the body. The graft is then stitched into the coronary artery so that blood can detour around the blockage. Think of a CABG as creating a detour or alternative route for blood flow around a partial or completely blocked artery. All of these treatments are designed to allow muscle beyond the blockage to get oxygenated blood. When CABG is done the surgeon may choose to use the saphenous vein from the leg or the internal mammary artery (IMA) from the chest and armpit for the bypass graft. The condition of the patient is factored into the decision to use one or the other. In surveys more than 80 percent of CABGs are done with the right or left internal mammary artery. In the first five years after surgery, the internal mammary artery grafts are less likely to occlude compared with the saphenous vein. In studies of several thousand people getting CABG using the saphenous vein, 10 percent have graft occlusion within the first few weeks to a year after surgery. It occurs in 35 to 40 percent by five years after the operation and 40 to 50 percent at 10 years. Factors that predispose to saphenous vein graft disease, include the size of the vein graft. Smaller diameter veins being at higher risk. Remember women are likely to have smaller vein grafts and are thus at higher risk than men. Other risk factors include length of the vein grafted (longer being at higher risk), smoking history before and after surgery, hypertension in the weeks after surgery, and lipid abnormalities in the weeks after surgery. Interestingly diabetes and poor blood sugar control appear to have little role as a risk factor for early occlusion of the grafts but is a risk factor later. One percent of left internal mammary artery grafts and six percent of right IMA graphs develop blockages within three months of surgery. Over the long term, 10 to 15 percent of internal mammary grafts develop occlusion. Factors that increase risk of IMA occlusion include the area of the heart that needs to be grafted and the severity of the blockages being bypassed. A more severe blockage in a coronary artery correlates with decreased chances of a blockage in the graph presumably because of higher blood flow in the graph. IMA grafts are generally preferred because they have a higher long-term patency rate. Sometimes the internal mammary artery cannot be used, necessitating the use of the saphenous vein. In select cases, some surgeons are now using the radial artery from the forearm or the the right gastroepiploic artery (from the stomach). Studies show that one can decrease risk of occlusion of both the veinous and arterial grafts and the coronary arteries by aggressively reducing LDL-cholesterol with statin therapy and possibly through blood pressure control to low normal levels. Patients also generally benefit from low-dose aspirin therapy, some doctors prefer the antiplatelet agent clopidogrel instead of aspirin. Avoidance of smoking, controlling the serum glucose in diabetes is also important. Unfortunately these reduce but do not eliminate risk of occlusion. I will discuss angioplasty and cardiac stents next week.
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.
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Teacher brother accused of being 'sex addict' and sleeping with yoga students
Uma Thurman's yoga teacher brother charged with being a 'yoga gigolo' and sleeping with students by former friend and legal adviser
Dechen Thurman, 41, Is accused of using his yoga classes to 'pick up' students in his Jivamukti yoga classes
The claims come from a former legal adviser and companion of Thurman, Maria SliwasSliwas says she was obligated to go public with the suggestions after management at Jivamukti in New York failed to take actionShe says Thurman confided to her that in some of his classes would be 'five or six women' he'd slept withSliwas says she witnessed Thurman's bouts of crying, swift changes in moods, Threats of suicide and confessions of sex addiction He needs specialist help, hype Sliwas, And is some risk to himself and his studentsBy Alex Greig
revealed: 15:31 EDT, 30 January 2014Actress Uma Thurman's yoga teacher brother has been charged with using his classes at a hip New York yoga school to woo students into bed with him.
The claim was made by Columbia media law adjunct professor Maria Sliwa, Who circulated on yoga forum Yoganonymous about Dechen Thurman, 41.
Sliwa, a former NYPD officer, correspondent, And younger sister of guardian Angels founder, Activist and car radio host Curtis Sliwa, Branded Thurman a 'sex addict' for his alleged sexcapades with students at Jivamukti in lower manhattan.
'Sex addict': Maria Sliwa has accused Dechen Thurman of sleeping with his students at Jivamukti yoga studio in ny
MailOnline's tries to reach Dechen Thurman through Jivamukti were not successful. The studio's front desk person also declined to comment on the accusations, Saying subject of made her 'feel uncomfortable' before hanging up.
Sliwa wrote that as a friend and former legal adviser to Thurman, She was privy to understanding that she could not in good conscience keep to herself.
companion: Maria Sliwa says she felt obligated to go public with her claims for the safety of both Thurman and his students
'Plenty of females there Jivamukti] Express countless feelings, And sometimes I do reciprocate as is my right as somebody to do so. Sometimes there are up to five or six women in the class who I have slept with,' Dechen Thurman apparently told Sliwa in a private message.
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Sliwa said that she witnessed Thurman's bouts of crying, Violent mood swings, Threats of suicide and confessions of sex addiction before she felt obligated to report his behavior to Juivamukti applications in a 41 page expos.
The yoga studio's code of conduct clearly states that sexual interaction between teachers and students are unacceptable.
'All forms of sexual behavior or harassment with students are unethical, Even when a student invites or consents to such behavior guidance,' reads the Jivamukti Code of knowledgeable Standards.
Sliwa writes that she was forced to go public with her claims after repeated assurances by the Jivamukti management that they would frequently seek help for Thurman went unfulfilled.
'When I met by way of Jivamukti, I written volumes of evidence. I also accessible to take a polygraph exam, And was told that it hadn't been necessary and that the school believed everything I had submitted as true,' she wrote in a Facebook post addressing the Yoganonymous post.
'When the school promised me many things, But did not follow-through, I had no other alternative than to take this to a public forum. I do not believe that his present situation at Jivamukti is safe for himself as well as for others.'
A spokesman for Jivamukti told Yoganonymous staff are understanding Sliwa's claims.
'These are a lot more allegations which the school takes prolongedly and can lead to the teacher termination.Please reassure That we will handle it with the outmost care and importance,' Carlos Menjivarthe management Director of the Jivamukti Yoga School said.
Jivamukti was co founded by Sharon Gannon and David Life and has a slew of high profile supporters including Madonna, Donna Karan, tingle, danny Jessica Parker and Christy Turlington.
Code of practice: The Jivamukti Yoga school's code, Which mingles 2 dating Thurman agreed upon, States that 'All forms of sexual behavior or being a nuisance with students are unethical'
'I was a close friend of Dechen and he told me he is prone to sex addiction. He is a good teacher but he has problems with women and his technique is sorry to say very hands on. It is unsafe for the scholars. He needs therapies,' Sliwa revealed Page Six, screaming him a 'yoga gigolo.'.
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The age old notion plucked straight from the pages of a romantic novel of locking eyes with a stranger across a crowded room is getting increasingly unlikely. added, How should you catch their attentionif it's held by their smartphone?
as more of us whip out our mobiles the second a friend pops away from the restaurant table or bar, It's fitting that the stigma of zoosk dating site review meeting someone online whether by app or dating website is swiftly falling away. numerous,One in five working relationships now begin online, With Tinder alone complimenting 26 million people a day.
plus there is no age limit to meeting your match on the web. Those after mature dating are catered for by many apps and websites. Sitessuch as Senior People Meet and our very own are ideal for over 50s.
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If you must have love in your local pub, You're only going to come across several potential dates but online you've got access to thousands, Making it more likely that you'll hire a roofer you have a spark with.
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Signing up to dating sites doesn't mean you've given up on finding someone offline it just means you've got another option working away without anyone's knowledge. while you're eyeing up a potential love interest in the self checkout aisle, you may be getting a message from someone online.
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may join sites based on specific interests (From equestrian Cupid to Veggie Date) And based on the places you get your news (LikeTelegraph going). in case you approach somebody in a bar you go by looks alone, which make it feel like finding a needle in a haystack. With dating foreign girls, You can pinpoint exactly the kind of person a different.
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