Dawn Weinberger, Freelance Writer

Noninvasive treatment gives heart patients hope

Pulsating cuffs push blood to heart between beats, relieving pain from angina

By Dawn Weinberger

Three months ago, Dale Backer thought doctors had done all they could for his heart disease.

"I got to a place where I didn't care whether I lived or died, to be honest about it" said the 75-year-old Garden Home resident, who had a heart attack in 1987 and continued to suffer from severe angina caused by blocked bypasses and arteries.

But a relatively unknown treatment called Enhanced External Counterpulsation has changed all that. Now, Backer is taking daily walks, tending to his 2-acre yard, and enjoying activities he thought he would have to give up permanently, like fishing and camping.

"I feel like I have a new lease on life," Backer said.

Doctors and scientists in the United States originally conceived of something like EECP more than 30 years ago. The current technology was developed in China, and now EECP is a Food & Drug Administration-approved, noninvasive, outpatient procedure for patients with angina or congestive heart failure.

During the procedure, patients lie on beds attached to heart monitors, wearing three inflatable cuffs on each leg -- one around the calf, one around the thigh, and one around the buttocks and abdomen. They also wear special blue tights, designed to protect the legs from skin irritation. Using compressed air, the cuffs inflate in sequence, pushing blood toward the heart in between heartbeats. Experts believe this reduces the workload on the heart and increases blood flow to diseased coronary arteries and bypassed grafts. Patients receive the one-hour treatment five days a week for seven consecutive weeks. During the treatment, they can read, watch television or even sleep. The body jolts each time the cuffs inflate, but Backer and other patients report little discomfort during the treatment.

Medicare and many major insurance plans pay for the treatment, which runs about $500 per session.

Dr. Ronald Schutz, a cardiologist with Legacy Health System, is one of only a handful of physicians that administer the treatment in Oregon. His clinic, Heart Centers of America in Northwest Portland, recently treated its 251st EECP patient. And while the evidence in favor of the treatment is anecdotal, Schutz stands behind its effectiveness. Many patients, he said, come to him feeling depressed and hopeless, but by the end of the treatment their outlook -- and their health status -- has dramatically improved. Not only are patients able to exercise regularly again, they report a reduced need for medications such as nitroglycerin (which heart patients take sublingually to reduce angina pain).

But EECP isn't necessarily for every heart disease patient.

"If you have multiple blockages, you are best saved by having surgery [first]," Schutz said.

In fact, most patients who turn to EECP do so as a last resort. Backer, for example, who is one of Schutz's patients, went through several surgeries prior to receiving the treatment. Candidates typically are at a point where they are taking maximum medications and surgery won't help any longer.

"Often times we can treat patients with blockages by putting in a stent [a tube permanently inserted into an artery to keep it open] and usually that works quite well," said Dr. Peter Banitt, a cardiologist with Pacific Heart Associates who has referred about a dozen patients to Schutz for EECP. "[But] sometimes we are unable to place a stent, and in those situations, or if someone has a completely plugged artery ... the EECP treatment can offer some additional benefits."

Sometimes other conditions interfere and reduce the viability of the treatment.

"This might not be good for people with heart rhythm problems, or people with bad backs who can't lie there" for an hour at a time, Schutz said.

Schutz initially decided to add EECP to his cardiology practice after a visit to a clinic in New Jersey that was successfully using the treatment. Though he spoke to several physicians who advocated EECP, it was the patients who convinced him to start offering the procedure.

"All the patients I talked to had the same story," he said. "They were skeptical at first, but they all felt better after two weeks and said things like, 'This gave me my life back.'"

Like many unconventional medical therapies, EECP has faced some hurdles reputation-wise, including debate over claims that the procedure can reduce stress or enhance athletic performance.

Earlier this month, a machine was delivered to singer Michael Jackson's Neverland Ranch by Sara Soulati, owner of Global Cardio Care Inc., an Inglewood, Calif., company that provides the treatment to cardiovascular patients but also to healthy people who are willing to pay cash for a session.

"Sara did several treatments with Michael Jackson and then took the machine out of his home," said company spokesperson Jayme Soulati, adding that Jackson was fatigued and stressed from his recent trial and believed EECP would relieve his symptoms (EECP is not FDA-approved for this purpose).

Global Cardio Care also leased EECP machines to Shaquille O'Neal and other athletes, Jayme Soulati said. These athletes have their own trained EECP technicians on staff to administer the treatment.

"We would never lease it to anyone who didn't," she said.

And while the company claims that EECP helps increase energy and improves athletic performance, doctors disagree.

In 2001, Schutz teamed up with Nike Inc. to test the effects of EECP on athletes. The study confirmed that unless cardiovascular disease is present, EECP is unnecessary.

"If you can exercise without any problems, you don't need EECP," Schutz said.

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