This week a 59-year old woman traveled 2 hours to my office for a 2nd opinion. She was 5’3 and weighed 252 lbs., down from a peak of 320 lbs. a few years earlier. She had been diagnosed and treated for Type 2 diabetes mellitus since the year 2000 and had been treated for hypertension and hyperlipidemia for a decade. She had been treated once with laser for retinopathy and had mild peripheral neuropathy. She never smoked. Due to progressive kidney failure, she began hemodialysis in 2014 and had a kidney transplant in 2017. She had a carotid endarterectomy in 2016. She denied angina or dyspnea but underwent a chemical nuclear perfusion scan this year and had moderate to large reversible defects with an ejection fraction of 61%. She underwent right and left heart catheterization showing normal right heart pressures. Her left main was 10% narrowed, her vessels were large, her LAD after a septal branch was 70% narrowed, a first circumflex marginal was functionally occluded 100%, and her distal RCA to a dominant circulation was 80% narrowed. She was advised to have cardiac bypass surgery.
She could ride her stationary bicycle 20 minutes. She used CPAP to sleep. She had followed a whole food plant diet with no added oil on and off over the years, once reaching 180 lbs, and resumed it fully 6 weeks ago. She was down 12 pounds. She worked full time. She had a supportive family nearby. She was on a statin, aspirin, a beta-blocker, nitrates, and diabetic medications.
