The Eucatastrophe of External Counterpulsation (EECP)
Enhanced External Counterpulsation or EECP feels like such a catastrophe – such an extreme misfortunate. It makes me feel so imperiled and helpless. It causes total loss of control… and then there is the “uncomfortable” squeezing and repetitive pumping sensation in the hour-long process. The sessions are daily and consist of a series of 35 to 50 meetings. As much as I realize that this is my hope, it feels, at least initially, like a catastrophe. EECP is a proven alternative to coronary stents and bypass surgery promoting the development of collateral coronary arteries, used in patients who are not good candidates for surgery. It is used in prominent clinics such as Mayo Clinic, Johns Hopkins and the Cleveland Clinic.
The knowledge of less angina and increased energy changes my “catastrophe” into a eucatastrophe. Less angina and increased exercise tolerance is the “eu” – the Greek prefix meaning “good.” It makes me realize that this catastrophe is truly a eucatastrophe. J.R.R. Tolkien coined the term and it is how I choose to move forward. It changes the thrust of the word. It takes a sudden turn for the good. I possess a strong commitment to healthy lifestyle changes which includes exercise. Chronic pain and fatigue from angina make exercise difficult to accomplish. EECP will allow me to gain some of that stamina and endurance back.
The American Heart Association (AHA) defines angina as “chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back.” I notice angina symptoms most in relation to emotional stress, increased physical activity and cold weather. I also notice increased angina when I am unable to get an adequate nights rest. It can interfere with daily living and quality of life. Angina, in itself, is not a disease. It is a symptom of an underlying heart problem — in my case, coronary artery and microvascular disease. The chest pain occurs as a result of the heart muscle not getting blood because one or more coronary arteries are blocked or narrowed from atherosclerosis or the build-up of cholesterol plaque. Approved by the Food and Drug Administration, EECP or Enhanced External Counterpulsation is a nonsurgical therapy for angina.
I know the process well. After I stretch into a pair of navy blue leggings (and feeling ever so vulnerable) daily, I will rest upon a padded exam table. The nurse then places electrodes on my chest and wraps pneumatic compression cuffs around my calves, thighs and buttocks. These cuffs are attached to air hoses that connect to valves that inflate and deflate the cuffs based upon my heart rate. I hear the humming and thumping and feel tightness and pressure that increases and decreases depending on the irregularity of my heart beat on any particular day. EECP has improved my quality of life – and gives me hope. It takes commitment and willingness to complete the process – of that, I have no doubt. Studies have shown the process stimulates the formation of collateral blood vessels in the heart by stimulating the release of nitric oxide. Collateral arteries are small blood vessels that open and create a detour for blood to flow around blockages in major arteries. Following the hour-long procedure, I head into Cardiac Rehab for a monitored exercise session.
EECP is not new to me. This will be my fourth series of 50 treatments. My cardiologist believes this will be advantageous before the warm days of summer surrender to the bitter Wisconsin cold of winter. It only makes sense to be able to offer EECP before symptoms become worse. Angina takes control of my life when the cold constricts my coronary vessels and cause pressure and pain of angina. I know. I should be used to this process! I will readily admit that Enhanced External Counterpulsation is a peculiar-looking and an unconventional procedure accompanied with a loud whooshing and clunking sound in sync with the beat of my heart. I know I will experience that strange jerky like movement on the table as the cuffs inflate and deflate. I know where the “red button” is located — the one I can push at any time — that will stop the machine — in case I need it for any reason.
This is the route to go for me right now.
It requires no surgery.
It is less risk.
It is less time-consuming.
It is less pain.
It is performed on an outpatient basis.
It is lower cost.
AND… I know it will work. I will have less angina and take fewer nitro in the end. The success rates of clinics that I researched range from 80 to 90 percent.
The Heart.org website has an article entitled: “With external counterpulsation, there’s suddenly a whole lot of shaking going on.” The title explicitly summarizes the entire process in a realistic manner. You do adjust to the strange feeling the cuffs and bouncing create but I can only imagine how bizarre it all looks. With that statement made, I will add my own realistic, bounding comments and recommendations to give you further insight into EECP:
1.) Do not drink a large amount of fluids before the procedure. Empty your bladder prior to beginning EECP. The cuffs press up against your bladder and undoing all the cuffs is a time-consuming process. Conversely, having the thrust of the compression cuffs against your bladder is disturbing (to put it mildly)!
2.) Equally important, do not eat a large meal before the procedure. Preferably eat your meal after completion of EECP.
3.) Bring a friend or family member to distract you. I found it difficult to read or accomplish any activity due to the jerky movements. The EECP medical apparatus is loud to the point you cannot even hear the television clearly. An iPod with ear buds is helpful.
4.) Develop a good rapport with the nurse as she can distract your attention and discomfort. An hour can feel like an eternity.
5.) Ask for foam cushioning or lamb’s wool padding on hips or calves under compression pads, as some of the compressions against the body cause a large jolt and bruising, especially if you have any irregularity to your heart beat.
6.) Wear fun and colorful socks because that is what you see when you are lying on the exam table! It adds some novelty to your treatment – for both you and the nurse.
7.) You will be physically exhausted the first couple of weeks and require more sleep than usual. After three to four weeks, a new-found energy emerges.
8.) Plan on losing approximately 10 pounds. I do not know why but I have lost weight each series of EECP.
9.) Think good thoughts!
The website Angioplasty.org has a patient discussion forum that lends additional information and perspectives of EECP heart patients who report such outcomes as:
~ Reduction or elimination of chest discomfort as a result of heart disease.
~ Natural bypass by growth of new coronary arteries.
~ Lower blood pressure without need to further medicate.
~ Improvement in debilitating symptoms of stroke such as reduced motor skills, speech
~ Enhanced stamina and endurance for exercise.
~ Improved quality of life.
~ More restful sleep and less fatigue.
~ Overall happier outlook
For me, Enhanced External Counterpulsation improves my quality of life in all ways. I can exercise more and for longer periods and take less nitroglycerin. I notice a marked improvement in peripheral edema. I become less short of breath with activity. I become energized and more alive. I can go on vacation without that troublesome fear of having an angina attack. In the end a change has occurred – the change from a catastrophe into a EUCATASTROPHE!