Part 3 – EECP: “Snake Oil” or Treatment
Photography – Peggy Richmond
My next—and most recent—visit with Dr. B was following the catherization. I was still unsure about the likely course of treatment. After he mentioned EECP (Enhanced External Counterpulsation), I did a quick search to find out about it. My first impression was…, well not real positive. The term “snake oil” came to mind.” So, in my appointment, I was hoping to hear about some treatment options—drug therapy or some other options. He pointed out that, in my case, the only drug therapy would be expensive, and probably be for the rest of my life, and not really produce any improvement—just control symptoms. The EECP, however, would actually improve the arterial blood flow to the heart, around the partially clogged artery, without drugs.
Okay, maybe I should pay more attention, and I did more research.
This image shows the increase in blood flow to heart muscles after EECP.
The counterpulsation sends blood under higher than normal pressure through smaller arteries of the heart, causing them to gradually expand and carry more blood, making up for the blood not getting through the partially clogged artery.
Dr. B. introduced me to Amy, the nurse who is in charge of the EECP treatments done right there in their offices. She explained how, when lying on the machine, cuffs around my calves, thighs, and abdomen inflate rapidly (essentially instantaneously) immediately after each heartbeat, increasing the pressure in the heart’s smaller arteries. When the cuffs inflate, they squeeze firmly and quickly, first on the calf muscle (gastrocnemius), then (milliseconds later) on the thigh muscle, and finally on the abdomen; then they immediately relax.This sequence is repeated at the pace of the patient’s pulse.
Each treatment lasts an hour, and the full course of treatment is 35 sessions over seven weeks, five days a week. If a patient must miss a treatment, they just add a day on at the end to make up the full 35 days.
The EECP Bed showing the cuffs that will be wrapped around the calves, thighs, and abdomen.
Incidentally, after more research I learned that EECP became a medically approved form of treatment in 1995, and became approved for Medicare payments in 1998. That boosted my confidence a bit.
We set up a schedule, and I arrived for my first, introductory treatment. Alexis was to be the regular nurse for my treatments. She explained that the first session would be 20 minutes and that we would add 10 minutes each day until reaching 60 minutes. She also suggested that I wear pants without heavy seams (like my jeans) and suggested something like sweat suit pants—which I bought that afternoon after the first treatment.
The basic guidelines for daily treatments are simple: no food or drink within one-and-a-half hours before each treatment. They also suggest urinating just before beginning the session. I am halfway through my treatment program and I can attest that after an hour of being squeezed in the legs and abdomen, repeatedly at the rate of 55 to 65 times per minute, you do not want a full bladder!
Nurse Amy is about to start the EECP. Note the cuffs around the ankles, thighs, and lower abdomen. Barely visible are wires attached to my chest that sense heart beats and control the rhythm of the machine.
I also learned that the sweat pants I got were not suitable. First, they were a synthetic material, and they were not tight, forming wrinkles under the pressure cuffs. These wrinkles created blisters. Amy found a pair of what looked like tights—supplied with the EECP machine—that fit snugly. I put large patch bandages over the blisters and wore the tights. Soon, the blisters healed and no new blisters have occurred. The key is to wear something that fits snugly to the leg and that will not slide around as the cuffs inflate/deflate. Do not wear shorts.
The daily routine is this: Each day, I arrive fifteen minutes before the scheduled appointment. My first stop is the bathroom, then down to the EECP room. Alexis or Amy is there to greet me. I wear my tights under my street pants, so there is no delay getting started. Shoes and pants off, socks stay on. Alexis takes my blood pressure, and I lie down on the bed. She straps the cuffs around my calves, thighs, and abdomen, snugly but not tight. She also attaches three electrical leads to my chest. These leads, similar to those used on an EKG, send the signals to the machine to control the timing of the inflation of the cuffs. She also clips a pulse sensor on one finger. Once I am strapped in, she turns on the machine, and the cuffs begin to inflate, lightly at first, gradually building up to a firm, quick squeeze. At full pressure, the inflating cuffs produce a quick, firm, but not uncomfortable, jolt.
The complete setup showing the control console.
The speed of the inflations is directly controlled by the heart, and the rate of inflations is the same as the patient’s pulse, typically a rate of 50 to 65 times per minute. Alexis has a computer control panel to monitor and adjust the pressures as necessary. The only thing more boring than lying on the bed being jolted by the machine must be sitting at the control monitor for 60 minutes!
It is difficult to move around much at all during treatment. Too much movement may cause the machine to skip a beat or two, which is a little annoying. I am told some people can read during the treatment. I prefer to take my MP3 player loaded with lots of music. Conversation, if there is something to talk about, is also possible, and I think they would allow someone to accompany me if that is what I wanted.
I just completed my 18th day of treatment. I have been out working in the yard, using a powered push mower. Before I started the treatments, I would get the pain in my chest (angina attack) after about 10-15 minutes of pushing the mower around. Now I can mow whole sections (30-40 minutes) with no discomfort. It appears that there is real improvement.
Once completed, the effects of the treatments are supposed to last three to five years. The treatment program can be repeated. For those eligible, the treatment program is covered by Medicare or most comprehensive medical insurance plans.
Angina – From Diagnosis to Treatment Part 1 – Diagnosis
Angina – From Diagnosis to to Treatment Part 2 – Treatment