CABG Surgery. In a dilemma.

IMHO I would go ahead and take care of the colonoscopy. You don't want any polyps (if any) to become the bad type. I was taking statins + baby aspirin. Went for an angiogram since my LAD shows signs of blockage through the PET scan. Yes, I have 60%-70% block in its mid section and decided NO on the stent, just very aggressive health care management from now on. Two days later after the procedure I developed a blood clot in my vein (not artery) which was not caused by the catheterization but for the way the nurse put the patch on my leg (a lot of pressure so it burst if that makes sense). Now I am on blood thinners (Eliquis) so it "melts away" the vein blood clot for 90 days. I need to have my colonoscopy done as well and will have to stop the blood thinners 5 days before the colon procedure. Cardiologist will have to give be the green light for that because of possible internal bleeding (reason why on my next appointment the cardiologist is going to have to convince me that baby aspirin is absolutely necessary).
I am asymptomatic.

Typical disclaimer: I'm not giving any medical advice. Just tossing out my thoughts.

That's a LOT you're dealing with, especially given your age. It angers me to hear you were denied bypass surgery. Insurance is just a racket. They take your money and deny deny deny, just adding to your stress.

Did your cardiologist have an explanation as to why the attacks went away?

Was the rectal bleeding a one-time occurrence or is it happening frequently? Did your primary doc tell you to have a colonoscopy done? Given you have a family history, I would expect he/she would have recommended a colonoscopy.

There's a colon cancer test known as ColoGuard (you may have seen the commercials). It's designed to analyze a small stool sample and detect cancer. There's also something called FIT (fecal immunochemical test).

FIT vs. Cologuard: https://www.cdphp.com/-/media/files/providers/toolkits/colorectal-cancer/colorectal-cancer-screening-with-fit-vs-cologuard.pdf

Both tests have their pluses and minuses (meaning one may give a false negative more often than the other, and one may give a false positive more than the other).

Can you tell us about what kind of resources or studies you're looking for specifically?

Thank you for your reply. I don't have a cardiologist yet but I have had cath procedures in emergency, was referred to a thoracic surgeon, had the surgery scheduled, then it was cancelled by the insurance. I haven't had a chance to talk to a cardiologist since the attacks stopped since I haven't had another heart emergency, so I haven't had access to them. However when I talked to an emergency doctor about my colon I explained my situation and he said my risk for a heart attack is probably only going up the longer I wait. I have read some studies that claim statin therapy can stabilize and even reduce blockages by up to 20%, that's my theory at least for why the attacks stopped but what do I know? The rectal bleeding has happened twice now in one month. I have an appointment now on Tuesday to try and get a referral. The resources I have been looking for is something to set my mind at ease. Can atherosclerosis be reduced naturally? Does a blockage always progress and is a heart attack inevitable? I've read a few studies where CABG was not done but the patient went on just fine. I've read other studies about collateral arteries picking up the slack. I haven't found anything specific about the LAD widowmaker artery though, which is where my blockage is. Are there hospitals that will take my case without insurance approval? (I have state govt insurance btw) I know the info is out there, but Google just isn't what it used to be. The search results are more generic then they were 5 years ago. I will absolutely ask my PCP Tuesday about Cologaurd and request surgery approval a 2nd time, maybe they'll change their mind. I'm just worried about going off my blood thinners for 7 days, which makes this Cologaurd seem like a great alternative. Have you had similar conditions? If so, what course of action did you take?
Thanks for your reply again, I just don't really have a support system around me to discuss this with.

Thanks for your reply! Unfortunately I'm not eligible for a stent dut to the blockage being in a bifurcated artery. How long ago were your blockages discovered? When you say mid section, do you mean the LAD? You're asymptomatic, meaning no angina or attacks? When will you do a second cath to see if it's gotten worse? Do you have hypertension? What's your cardiologist's prognosis on you having a heart attack in the future?
Thanks so much!

Robert,

Concerning the triple bypass denial, did your thoracic surgeon (or his office staff) put in a formal request for approval for this surgery?. If so, did you then receive a letter from your insurance company stating they were denying the surgery? When I needed a nuclear stress test and echo cardiogram due to a very high CAC (coronary artery calcium) score, my cardiologists office asked for approval. I received a denial letter about 2 weeks later. When I messaged my cardiologists office, I reminded them of my high CAC score and included a copy of the results I received from the radiology office that did the test. After that, about 2 weeks later I got a call from my cardiologists office saying the procedures were approved. I really believe they failed to include that info when making the request (as hard as that may be to believe). I don't know how else to explain the eventual approval.

If your thoracic surgeon's office contacted your insurance company for the triple bypass and you got a letter stating it was denied, locate the section that lists WHY it was denied and the section that states how to appeal it. Please note that there are deadlines for an appeal. Also keep in mind that even if they do eventually authorize the bypass, "prior authorization does not guarantee payment of the claim" (which sounds insane, but these are the games we live with in the good old USA). Thankfully, I had no issues with them paying for my tests.

Here are three links that may help you understand your rights and help guide you with the appeal. You obviously have a serious heart condition that requires surgery. How an insurance company can take your money and deny something like this is beyond my understanding.
https://www.healthgrades.com/right-care/patient-advocate/6-steps-to-take-if-your-health-insurance-company-denies-a-claim
https://www.patientadvocate.org/explore-our-resources/insurance-denials-appeals/where-to-start-if-insurance-has-denied-your-service-and-will-not-pay/
https://www.insurance.com/health-insurance/coverage/appeal-a-health-insurance-claim-denial.html
I wasn't aware of the distinction between a cardiologist and thoracic surgeon. From what I read, a thoracic surgeon is a big step above a cardiologist, as they can perform surgeries not only on the heart, but also the lungs and esophagus. I think the fact you are in contact with a thoracic surgeon is a big plus for you. A cardiologist is essentially limited to doing angiograms and placing stents. Anything major they would refer you to a thoracic surgeon. This is my understanding

I'll respond to your other comments in another post, but wanted to help you with the insurance part of your problem first.

Has your doctor put you on statins yet? That's something I'd definitely ask about. Statins are well know for managing high cholesterol, but they have other benefits as well:

Statins can:
• Lower overall cholesterol levels, LDL and triglycerides. By lowering LDL cholesterol levels, statins can help prevent heart attacks, strokes, and other cardiovascular events.

• Provide anti-inflammatory properties that can help reduce inflammation in the body, which is a key contributor to heart disease.

• Improve the function of the endothelium, the inner lining of blood vessels, which can help reduce the risk of developing atherosclerosis.

• Slow the progression of calcification of the coronary arteries.

• Decrease the chance of blood clots forming. They do this by reducing the buildup of plaque on the walls of your arteries, stabilize plaque so that it doesn’t break off and block blood flow to the heart or brain, and decrease swelling in the walls of your arteries.

• Improve symptoms of angina, such as chest pain or discomfort, by improving blood flow to the heart.

• Possibly improve bone health by reducing bone loss and fracture risk, particularly in postmenopausal women.

• Per a JAMA (Journal of the American Medical Association) study, researchers found that patients with CAC (coronary artery calcium) who took statins had a lower risk of cardiovascular events than patients with CAC who did not take statins.
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Everything I've read indicated you can't reduce atherosclerosis. Having said that, there is something fairly new called an atherectomy, which basically scrapes the plaque from your coronary arteries:
https://www.healthline.com/health/heart/atherectomy-heart-procedure#procedure
I recently came across the term "Coronary Collateral Growth". This is a very interesting subject. There is plenty of material out there to read up on it. Here's one article:
https://pubmed.ncbi.nlm.nih.gov/30379567/
Blockage in your LAD is pretty serious. Here's one article that talks about it. I'm sure there is tons of info and YouTube videos about the widow maker. What did your thoracic surgeon say about the blockage in your LAD?
https://health.clevelandclinic.org/why-a-widowmaker-heart-attack-is-so-dangerous/
You asked "Are there hospitals that will take my case without insurance approval? (I have state govt insurance btw)." Do you live in California? Just guessing since you mentioned Medi-Cal.

Going back to the rectal bleeding, I think given your family history, your doc would recommend you do the colonoscopy since they'll be able to see any pre-cancerous growth (vs. hoping it's detected by ColoGurad or FIT).

I don't have a high risk of CRC (Colorectal cancer), so I have done FIT and ColoGuard in the past. I'm due for one of the other this year. I've only had a colonoscopy once in my life, and that was due to some blood in my stool back around 2002. No signs of cancer.

Can you afford BCBS? My wife and I have used them and have no complaints. We decided to change from BCBS to United Health Care/GEHA this year to save some money. BIG mistake. We're switching back to BCBS next year. With this plan, I had to deal with GEHA, UHC (United Healthcare) and Evicore to get approval for my nuclear stress test and echo cardiogram. I still don't really understand the interrelationship between these three companies, but I do know that for any procedures I need, GEHA depends on Evicore to review and either approve/deny the procedure. Evicore is the company that initially denied my tests.

BCBS is MUCH easier to work with. If you can afford BCBS, I'd go with them. Just make sure they cover per-existing conditions. They do cover California (if that's where you're based):
https://www.bcbs.com/news/state-by-state/california

I stand corrected in my earlier comment about not being able to reverse plaque buildup:
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https://health.clevelandclinic.org/can-statins-actually-reverse-plaque-buildup/
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The following link talks about other benefits of statins:

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https://med.stanford.edu/news/all-news/2023/05/statins-cardiovascular-vessels.html
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You might also ask your thoracic surgeon about therapeutic angiogenesis. This is an experimental treatment that shows some promise in "stimulating the creation of new blood vessels in ischemic organs, tissues, or parts with the hope of increasing the level of oxygen-rich blood reaching these areas."

Hi, my blockages were discovered back in February this year. The artery in question is the LAD, the position of the plaque is on the artery's mid section. I am asymptomatic so I do not have any symptoms but that wouldn't mean I am not at risk. As per my cardiologist I can always go back and have a stent put on, for now we will follow up through mainly blood tests. I suggested also urine and DNA tests but the cardiologist didn't paid much interest on that. We cannot tell about the future as we live day by day but knowing what percentage blockage I have.
I think is important to take care of the colonoscopy. Everything happens because of inflammation in our bodies coming from foods that we consume and genetics. We can control the 1st. Cologuard is not 100% accurate (I hate to admit it) just like nuclear tests and stress test of the heart aren't.
Please find a cardiologist. He will give you straight answers or even try to find a friend's doctor who you can talk to. Best wishes