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From the Townsend Letter
May 2015

Managing Cardiovascular Diseases
Ramblings of a Maniacal Frenetic: Pragmatic Reflections on Helping Patients Understand Their Illnesses and Treatments
by John Parks Trowbridge, MD, FACAM
Diplomate, American Board of Clinical Metal Toxicology
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My father told me, in early 1979, that he was going to see a doctor about doing chelation therapy. I went only slightly berserk, insisting that I would have heard about it in my training or residency if it had any value for cardiovascular diseases. He "wisely" stayed away from that charlatan. Then my mother needed drastic surgery for a bleeding ulcer in the fall of 1982. As I needed to fill my days while seeing her in San Francisco, I visited the office of Robert Haskell, MD. We discussed nutritional medicine and dietary programs … and then he asked, "Well, you do chelation therapy, of course?" I explained my reservation about doing any treatments that were exaggerated in their claims of helping … especially with a wide variety of illnesses. He said simply: "Come with me." We climbed up one flight of stairs. "Here," he said, "is my nurse. And my charts. And my patients. Have a good day." And what a day it was! I could barely believe the documented results of patients who had barely been able to walk due to shortness of breath or chest pains or calf pains. And I got to hear their stunning stories, in person – and to lay my hands on their bodies. I was hooked. I spent the next five months studying everything that I could find on chelation, so that I would "ace" the written exam. At the training, I met Warren Levin, MD, of New York City, clearly the best lecturer at the meeting. I spent two glorious learning days in his office; the same for Milan Packovich, MD, of Pittsburgh; also for Charles Farr, PhD, MD, of Oklahoma City; and for another eight doctors who generously offered to share their best ideas with me, so that I could strive from the start "to be the best." H. Ray Evers, MD, of Dothan, Alabama, graciously hosted me for three days to see the best of the past. And thus began my saga, to "learn more and do better than anyone else." At the very least, each of my parents and I myself benefited greatly.

Pump, Pipes, and Performance
Cardiovascular diseases (CVD), in order to be adequately evaluated and treated, need to be classified according to the likely etiology or explanation. Simply stated, CVD are associated with the pump (the heart), the pipes (arteries of whatever size and location), and performance (impaired function despite adequate anatomy). One last classification – pediatric – will be ignored for this article, since congenital heart diseases, as genetic or developmental irregularities, have their own unique considerations. When the "pipes" involve the venous system, such as with thrombophlebitis, this is treated as a special case of inflammation.

Hey, Buddy, Can You Really Treat That?
If we have incomplete or missing diagnoses, should you proceed with treatment? In fact, that complaint has been leveled at chelation therapists for years, that we fail to do "enough" diagnostic workup. If you want the details of your problem delineated down to the molecular level, go to your local university cardiologist. But if you want to feel better now and get on with your life, why not consider a treatment that works for most heart and blood vessel problems (and those of many other systems) that plague most people? Problems that don't improve can continue to be evaluated. The only heart problems that don't reliably show desired improvement are pediatric, because of their distorted anatomic features. The only peripheral (or central) blood vessel problems that don't show expected improvement are ….. sorry, can't recall any.

What Do People Really Need to Know?
For the most part, medical explanations use technical terms that confuse or oversimplifications that mislead. Using the framework presented here, concepts can easily be offered that lead patients into a fair understanding of the treatments proposed and what to expect. (Much of "doctoring" is teaching, which improves compliance dramatically.)
When discussing "heart" disease, many practitioners fail to clarify the distinctions between problems with "pipes" and those with the "pump." The vast majority of heart conditions treated with surgery involve the pipes, namely "blockage disease" in the coronary (heart) arteries. In discussing "vascular diseases," other small arteries include those in "end organs" (where blood is finally delivered to the tissues, including inside the brain). Larger arteries are those coming off the heart, going "out" to the organs, up to the head, and down the arms and legs, and these are often more amenable to surgical intervention. In a distressingly large proportion of operations at any level, surgeons often imply that "your problem has been fixed; you're as good as new," simply because larger or medium-sized pipes have been popped open (ballooned, often with a bracing stent as well), bypassed (skipped over), or reamed out (endarterectomy) and sometimes "repaired" (patched). In actual fact, operations can be performed on just a few dozen inches of arteries but the underlying problems are widespread, affecting a distressing portion of the 60,000-plus miles of blood vessels sustaining your body organs.
When patients understand the need to restore better blood flow, distinctions can be made between surgical reduction or removal of blockage compared with nonsurgical ways to improve flow. Blockage is a "plumbing" concept, easily grasped. What is harder for many patients to grasp is that better "flow" dramatically relates to incremental reduction of blockage. Increasing the central channel diameter by merely 1/6th (just 16% widening of the vessel diameter) will just about double the flow through that vessel. (This tiny difference is difficult to "see" on angiogram X-ray pictures but is easily felt by the patient.) How could such blockage be gently removed? "Cardio" exercise sometimes helps. But what about reducing obstructions naturally … through biological changes induced by IV chelation therapy? Overly simplified, EDTA chelation appears to dissolve the "mortar" that holds together the gunk that accumulates in the pipes, interfering with flow through the arteries. As the "glue" is removed, the body can safely, easily, and naturally reduce the blockage the same way that ice melts in your water glass without shattering into pieces. In fairness, sometimes very little reduction of blockage itself occurs, but gradual improvements to the nutritional status of cells can markedly improve their function and reduce symptoms earlier attributed to blockage.
When heart disease involves the "pump" portion of your heart, we're looking at three distinct sets of pathologies. First, where blood flow has been completely interrupted to a small area of muscle, that tissue actually dies (heart attack, or "infarct") and forms a scar. The scar, incidentally, might later stretch and thin out (ballooning out as an aneurysm), with a greater risk for chamber rupture … so surgery can be advisable. Second, the cells in an area can become "sick" from reduced blood flow ("ischemia") or from nutritional deficiencies (magnesium, B-complex, even calcium), toxic accumulations (lead, mercury, arsenic, other toxic heavy metals), or other adverse changes (such as from organic toxins, pesticides, and so on). Affected muscle cells function less and less well, leading to alterations of normal contraction/relaxation patterns and pumping efficiency. Third, heart valve problems (especially for the aortic and mitral valves on the high-pressure left side) and enlargement of the aortic root or thoracic (chest) aorta are distinct anatomical problems often best treated by surgery. Recent advances are unbelievable, where certain heart valve operations (and even some large artery aneurysms) are being performed without "cracking the chest." One exception is where calcification of valve leaflets might be improved by extensive IV EDTA chelation therapy, delaying the need for urgent surgical intervention … and even improving later operative survival.
Finally, when heart disease affects the pumping efficiency of your heart, these are "performance" issues. While this category might "blur over" into the second pathological pattern described above, it is distinct in a number of ways. Foremost is where electrical conduction pathway "defects," for whatever reason, can lead to rhythm disruptions (atrial fibrillation, others) where the pump muscle – although otherwise functionally capable – beats erratically or less efficiently. "Cardiomyopathies" (heart muscle impairments) can result not only from rhythm malfunctions but also from viral (even bacterial, fungal, and parasitic) infections, nutritional deficiencies, toxic heavy metals such as mercury, decreased oxygen saturations, and even hormonal imbalances (hypothyroidism, perhaps deficiencies of testosterone or progesterone or others).

The Fire Within
Inflammation is a chemical reaction, whether in organic or inorganic systems. What causes fire damage to the "outside" – to any structures, from cell organelles all the way up to observable tissues – also wreaks havoc at submicroscopic levels inside biological systems. At the tiniest level, we're looking at the shifting around (actually, "stealing") of electrons, with resulting conformational changes of the molecules. The concept is one of "free radicals," electron-seeking molecules, first proposed by Denham Harman, MD, in 1955. Other concepts have been advanced, many of which rely upon a basic appreciation of the central role of free radicals. For example, in 1942 Johann Björksten proposed the cross-linkage theory to explain the "hardening" of tissues as we grow older or sicker (recall the stiff and brittle rubber band found at the back of your desk drawer). Again, electron changes are involved.
The greatest problem with free radicals is that they damage normal molecules in an accelerating pattern, somewhat like a ping-pong ball (the "initiating" radical) being thrown into a room full of mousetraps, each "loaded" with another ping pong ball. The resulting "fire" is akin to a nuclear reaction, wherein it tends to amplify and continue until it is exhausted or quenched. In the body, "antioxidants" are essential to interrupt ("quench") electron free radical damage, known as "oxidation" or inflammation. Virtually all degenerative diseases – including cardiovascular – are directly related to free radicals in their initiation and propagation, unrelentingly through cell injury, organ dysfunction, and finally body death. These rampant oxidative changes are the common denominator, and the damages to various intracellular organelles or metabolic pathways advance in their interruption to normal function to where they are finally identified as different disease "diagnoses." Remember: all involve effectively the same inflammation chemistry.
Since the disease promulgation process is similar in widely variant tissues, this biochemical understanding opens the door to treatment programs that can have a generalized effectiveness without being specifically targeted toward any particular diagnosis. Enter chelation therapy. Clearly chelation is a dominant answer to most cardiovascular diseases. Surgical and drug interventions might still be needed, especially for more advanced disease patterns. But chelation remains the mainstay of treatment.

Trowbridge’s Diagnostic Testing for Dummies: Cardiovascular Diseases

The following tests can be useful:
(Obviously physical exam with pulse and blood pressure and respiratory rate, CBC with differential and platelets, metabolic chemistry panel, and urinalysis, 12-lead and rhythm EKG, and CXR just to be sure that "basics" are covered) ....
ferritin, homocysteine, fructosamine, glycohemoglobin, Vitamin D3, ESR, ANA (quantitative plus pattern), RA (quantitative), fibrinogen, uric acid, LDL low-density lipoprotein, Lp(a) lipoprotein cholesterol, small dense LDL, remnant lipoprotein (RLP) cholesterol, HDL or HDL2b cholesterol, apolipoprotein B, triglycerides.

These factors look largely at genetic or epigenetic issues, to focus treatment on those factors where free radicals matter most. Anatomic function testing, as described, is directed toward specific "problem" areas.

The Missing Cardiovascular Diagnosis
Repeated (even annual for many "heart patients") treadmill EKG testing has minimal preventive value … but pays very well. My closest contact with diagnostic limitations of a resting EKG was an older gentlemen who presented with uncharacteristic discomforts at 2 in the afternoon … a regular cardiogram was normal, but I was still suspicious. Hospitalized at my insistence to a continuously monitored bed, he suffered his heart attack at midnight. "Instant" coronary care unit response meant a dramatic reduction of otherwise likely heart muscle damage. Repeated testing of cholesterol and triglycerides has minimal preventive value … but pays very well. Evolving metabolic syndrome changes, once suspected by clinical presentation and slightly elevating fasting or random blood sugars, are best evaluated merely by clinical monitoring and only periodic testing of blood sugars with concurrent insulin levels. Genetic hyperlipidemias are more ominous and pose substantial survival risks, far more significant than the trivial implication of "your cholesterol is high at 230 and you need statins!" Even repeated coronary (heart) or aortic and peripheral (belly and legs) angiographic X-ray dye pictures (merely "maps" for surgery) in symptomatically stable patients have minimal preventive value and attendant appreciable risks. These invasive tests serve primarily a mapping function, to document progression of blockage advanced to the point where surgery is now desirable. And again, the angiograms pay well … and should be reserved for deteriorating conditions where salvage surgery is imminent.
(A critical side comment on cholesterol: the "bad rap" that it has suffered over the past 65 years is simply undeserved. The normal response of your body to various situations is to raise cholesterol as a proper defense or adaptation. If you want to be sure that eating eggs and butter and meats does not increase heart disease, trust the observations of a scientist who spent 70 years of his life studying these issues: Cholesterol is Not the Culprit: A Guide to Preventing Heart Disease (2014), by Fred Kummerow, PhD – this is mandatory reading! More on cholesterol, high blood pressure, and nine other frauds in medicine: Malignant Medical Myths: Why Medical Treatment Causes 200,000 Deaths in the USA Each Year and How to Protect Yourself (2006), by chemistry professor Joel Kaufman, PhD.)

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