ABLEnews Extra

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              Old Remedy, New Hope
     
By the time John Hamilton admitted he had heart trouble, he was
willing to try anything to take the pain away.
   
The Oswego County truck driver had shrugged off chest pain before.
When a crushing pressure drew him out of sleep Jan. 23, Hamilton knew
something was wrong. His arms were numb from the elbows up, and he was
ashen and sweaty the picture of a heart attack.
   
This time, he didn't argue with his wife. "He didn't have a choice,"
Bobbie Hamilton said. She drove him to Crouse Irving Memorial
Hospital.
   
There, Hamilton, 64, of Phoenix agreed to try an experimental drug.
   
In centuries past, doctors used leeches for blood-letting. Something
in their saliva, called hirudin, thins the blood as the leeches feast.
Science has known of the leech's ability to dissolve blood clots but
only now is a drug company putting that substance to use in a
medicine.
   
Ciba-Geigy [has manufactured] a genetically engineered version of
hirudin. In 500 hospitals in 14 countries, hirudin is being tested
against the popular blood-thinner, heparin.
   
Hamilton is one of seven patients from the Syracuse area who are
involved in the study.
   
In the emergency room, Dr. Alan Simons told the Hamiltons about the
study. The Food and Drug Administration had approved the use of
hirudin in human patients. It wouldn't cost anything.
   
John Hamilton was game.
   
"Something had to work," he said, cringing as he recalled the pain.
"If it didn't, they'd try something else, right?"
   
He got a dosage of heparin or hirudin doctors and patients aren't told
which along with aspirin and nitroglycerin, a drug that helps widen
narrow vessels.
   
The electrical activity in Hamilton's heart was abnormal when he got
to the emergency room. After Simons gave him the medications, the
cardiologist looked at the heart monitor again.
   
"Everything calmed down," Simons said. "He did not have a heart
attack. It was probably prevented."
   
Hamilton had unstable angina chest pain that occurs without exertion
and can easily lead to a heart attack.
   
The next day, Simons used a cardiac catheter to examine the arteries
feeding Hamilton's heart muscle. Two of the three contained blockages,
plaque built up along the arterial walls. The chest pain occurred
because blood flow was blocked, starving the heart of oxygen. The
blood-thinner he got helped for the moment.
   
Leeches date back 2,500 years, when they held a prominent place in
every doctor's bag. That practice has been abandoned, but in recent
years, the bloodsucking water worms have made a medical comeback.
   
Plastic surgeons sometimes turn to leeches to help stimulate blood
flow after they reattach damaged tissue. Veins often fail. Blood will
flow to the reattached part through arteries but is unable to flow
back through the damaged veins. The part begins to swell as blood
builds up. Without relief, it will die. By sucking out the excess
blood, leeches provide time for the veins to heal.
   
Heparin and hirudin create a similar effect, but their actions are
different.
   
Heparin works indirectly. It inhibits the formation of clots by
binding with a protein that's needed to form a clot.
   
Hirudin works directly on the clots, by breaking them down.
   
"I think it's going to replace heparin," Simons said.
   
Cardiologists are always looking for ways to reduce the number of
deaths from heart disease, which remains the No. 1 killer in America.
   
It used to kill up to 13 percent of the population. That dropped to 10
percent when doctors started using aspirin as a blood thinner. The
rate dropped to 7 percent with the arrival of streptokinase and TPA,
drugs designed to dissolve clots in the early stages of a heart
attack.
   
Now the focus is on prevention and looking for ways to treat
conditions that often foreshadow a heart attack.
   
The heparin-hirudin study will include 12,000 patients and may wrap up
as soon as July. It began in November, after a year's delay, during
which time dosages were adjusted.
   
Heparin and hirudin can cause lethal bleeding in high dosages,
especially when given with other blood-thinners or clot dissolvers.
   
More patients in Syracuse may be added to the study.
   
"We'd like to get as many as we can," Simons said.
   
Patients have to have unstable angina, with an episode of chest pain
that hasn't exceeded 12 hours. Those who have a sensitivity to
heparin, a bleeding disorder, kidney problems or a previous stroke are
excluded. Women of childbearing age, and people taking blood-thinners,
also are not eligible.
   
Hamilton wasn't out of danger after taking blood-thinning medication.
He had to be scheduled for heart bypass surgery.
   
Experts say Hamilton was a perfect candidate for the study because he
was healthy otherwise. He had bypass surgery four weeks ago and was
walking the day after.
   
Now he's in cardiac rehabilitation. Three times a week, he goes to
Simons' office at 1000 E. Genesee St. for a workout that's monitored
by nurses and exercise physiologists.
   
He uses a rowing machine, stair-stepper, treadmill and stationary
bicycle alongside a dozen other people with medical stories similar to
his. Big band hits from Benny Goodman drown the whir of the machines.
Nurses come by to check blood pressure periodically.
   
Cardiologists use rehabilitation therapy as a way to launch their
patients into healthier lifestyles. It can ease them into an exercise
routine, which is coupled with diet plans and other changes that
Hamilton didn't have to make. He doesn't smoke, and he doesn't drink
coffee two habits that contribute to heart disease.
   
Hamilton will exercise under his doctor's care for six to eight weeks.
All the while, a portable heart monitor will be attached to his chest.
   
A vertical red scar peeks from the top of his flannel shirt. He breaks
into a boyish grin often as nurse Kathy Donegan works with him.
   
"To start with, we'll go with 3 pounds. This may feel pretty light,"
she said, handing him a pair of weights. She demonstrated the slow
up-down of bicep curls. Hamilton had to bend his knees a little and
point his tailbone inward without arching his back. He got the hang of
it quickly.
   
In the waiting room, Hamilton's wife, Bobbie, worked crossword
puzzles. She thinks he looks better now than he has in five years.
   
"I'm just in awe of the way he's come through this."
   
[Leaches Teach Science a New Heart Remedy, Amber Smith, Syracuse
Herald-Journal, 2/20/95]

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