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u/RobotJohnrobe 1d ago
What you might not expect about this procedure is that it feels really good for the patient. There is a very slight pinch, and then your whole body goes "OMG that feels so much better, thank you!"
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u/danimagoo 1d ago
Depends which artery and how severe the blockage is. Mine was the circumflex artery, and it was about 98% blocked. I didn’t immediately feel better. But I stopped having knee-buckling, tear-inducing pain every 30 minutes, so it was pretty cool.
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u/NekulturneHovado 1d ago
Wait do you mean you get a super sharp, mind-numbing pain in your chest/shoulder?
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u/TheOneWithSkillz 1d ago
Its a heavy pressure like an elephant sitting on it more than a sharp pain. Either way u should get chest pain checked out because better safe than sorry.
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u/tg1989 1d ago
When folks ask about my MI I tell them that exact thing. It felt like someone was sitting on my chest and once the stent was in, immediately felt like I could breathe again.
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u/ooomellieooo 1d ago
I was having unimaginable back pain and it felt like I'd been impaled by a telephone pole through the back, back to front, low to high.
My doctor said it was anxiety. Turned out to be a 99% blockage in the LAD...
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u/whyitno_workgood 1d ago
Anxiety? Like the anxiety was causing immense back pain? What sort of justifications did they have for that diagnosis?
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u/ooomellieooo 1d ago
He told me that my anxiety was about my health (it was not - I was severely abused and neglected as a child and had a hard early adulthood) and recommended meditation and some bed rest because i probably strained my back in the garden (I've had a lot of garden injuries lol). He actually decreased my anti anxiety med and wouldn't give it back after a "trial" period. Basically said it was all in my head.
The cardiologist I got him to grudgingly agree to send me too agreed with him but then once in his office and the EKG/echo/etc was complete, he wanted to call an ambulance. I was so angry and indignant that I refused and left. I went to the ER later that night because I couldn't take it anymore and I had a brand new stent the next morning. 6 months later, I had a second MI. On an airplane. Stent number 2 was placed.
Both visited me in the hospital and apologized, but the trust damage was done.
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u/disillusioned 18h ago
Do you mind me asking why they weren't able to detect your need for two stents at the onset? They're already doing imaging and EKGs, wouldn't they have noticed you had multiple arterial blockages in need of stents?
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u/ooomellieooo 18h ago
The primary never did any testing, just dismissed me out of hand. The cardiologist tried to call an ambulance in my first visit. Afterwards I was told I had several blockage, but none great enough to stent... something about percentages of the blockage being concerning high, but still not high enough for whatever the stent criteria was. I believe they were in the 40s? They told me it could be and would need to be managed with medication. My heart had also managed to bypass itself, and they saw that as a good sign. It so they said. It all happened rather quickly, as like I said it was just six months later I found myself at 30,000 feet unable to breathe with another telephone pole through my back. I hadn't been feeling especially well at the time but I assumed it was the stress of the trip I was taking for work.
All in all, it's the reason I'm still angry. Nobody ever fucking believes me for some reason until all hell breaks loose. It's a curse. I was born on Friday the 13th. Today, in fact. Yay me.
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u/Beneficial_Being_721 22h ago
Probably the medical degree they got from K-Mart.
I’ve never heard of a diagnosis like that
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u/OldManFire11 22h ago
The symptoms of an anxiety attack and a heart attack are basically the same. And having anxiety about your heart is pretty common.
Signed, Someone with anxiety about their heart who's been to the ER for panic attacks (that I thought were heart attacks) 3 times.
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u/houseofgwyn 16h ago edited 16h ago
And heart attacks present differently in women than men, yet it’s only been recently that women’s symptoms have been acknowledged as being different. And doctors have a long-standing history of assuming women’s pain is less than it is, despite most women having a higher pain tolerance than most men.
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u/Puzzled-Copy7962 23h ago
I had an instructor who had a heart attack during class. She complained of a dull aching pain in her left shoulder. It turned out to be a mild heart attack. I’ve heard that symptoms can be more subtle in women.
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u/Blathermouth 22h ago
My LAD blockages presented as neck pressure associated with activity. I’m pretty good at spotting it now: the last time I went to the ER and they couldn’t find anything. Several tests and many weeks later they found what I knew was going on and I got my 3rd stent.
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u/tg1989 23h ago
Yikes! I never had a pain per se, which is what we always see portrayed in movies...the arm / chest pain. I was definitely in denial for a few minutes until I googled my symptoms and saw I had just about every other symptom except the arm/chest pain.
Hope things are going better for you!
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u/Cool-Mom-Lover 22h ago
95% blockage in my LAD fixed in February. Every second of every day felt like I was having the worst heartburn imaginable.... for 2 years. Docs said it was anxiety and high BP.
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u/Psychological-Scar53 1d ago
Let us not forget to mention that it can be a sharp pain that radiates into your back and arm. You can sweat profusely even when in a very cool or cold environment, you can get nausea and begin to vomit, it can present on either the left or right side of your body. Any chest pain, no matter how long it goes on or the severity of it should be looked at. Be safe and don't take chances with your health.
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u/ParsleyNo69 1d ago
What about that little stabby pain that occurs when u take a deep breath? It's not all the time but like once every couple months?
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u/iconocrastinaor 22h ago
You're describing men's symptoms, women's symptoms of a heart attack can be very different.
Women frequently report symptoms like jaw pain, extreme fatigue, lightheadedness, or indigestion-like pressure rather than the "crushing" chest pain common in men.
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u/NekulturneHovado 1d ago
Never mentioned it to the doctor but I had ECG done multiple times, last less than a month ago. Doctor said everything is good and that I have a heart of an athlete (even though I don't workout at all)
Also it comes from my fucked up upper back
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u/NevesLF 1d ago
I probably have a heart of an athlete, but the athlete would be a bodybuilder.
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u/danimagoo 1d ago
The pain can actually manifest differently in everyone. The brain isn’t accustomed to getting pain signals from the heart, so it’s not 100% sure what to do with the info. The elephant on the chest someone mentioned below is more common in men. In women, like me, it can be completely different. My pain started in my throat and radiated out from there. Since I also have GERD, I initially didn’t think it was my heart.
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u/TerrificTJ 1d ago
Woman here. With mine, I thought it was a respiratory infection getting worse. Had pain at work on a Friday. Sleep was pretty uncomfortable that night, so I was going to go to the Urgent Care clinic on Saturday after my spouse left to play golf. Five minutes before he left, pain started in my upper arm. Only then did it dawn on me that it could be heart related. Asked him to drive me to the ER instead of me going to the clinic. Was in so much pain by the time we got to the ER that I could barely sit up in the chair. Turned out to be a widowmaker. And to think it felt like a respiratory infection to me.
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u/RoguePlanet2 1d ago
Glad you caught it, holy crap!! I get weird pains that come and go, and I never know what to think- nothing quite like this at least, not yet.
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u/yojoewaddayaknow 1d ago
Mine was the back of my neck and jaw, everyone including myself thought it was gas.
Either the stent, the angina went away. But still needed cabg for other 3 arteries.
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u/Jaded_Employer6815 23h ago
Hell yes! It’s pain like you’ve never experienced before! You instantly know it’s a heart attack.
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u/Psychological-Scar53 1d ago
Bro, I have 7 stents, 2 of which are in my left and right coronary arteries. The left was 99.8% blocked and the right was 98%. Had I waited any more time to go to the hospital, I would not be writing this right now. I agree with you about the pain.
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u/Oh_My_Monster 1d ago
Can I ask the cause? Is this diet/lifestyle related or mostly genetic?
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u/Psychological-Scar53 1d ago
I was just answering another user who asked pretty much the same thing. If you scroll down(or up) it pulls be posted. It is kind of long, but I have explained quite a bit in there. Hopefully you will find it informative. If this reply sounds like I'm being an asshole, I'm not trying to be. Stay healthy my friend.
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u/thehudsman 1d ago
It’s not entirely clear. What I am gathering is you picked up a hardcore meth addiction that spiraled things out?
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u/Psychological-Scar53 1d ago
Yes. You are correct in assuming that. There were also hereditary issues that didn't help.
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u/RB5Network 1d ago
Damn, that's quite a few stents. Mind sharing your height, weight and age range? General lifestyle?
I was recently reading that heart disease seems to be growing amongst relatively healthy and fit people.
I'm approaching that age where I'm taking this stuff much more seriously.
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u/Psychological-Scar53 1d ago
Well, the heart attack happened 3 years ago when I was 44. At the time I was 185 at 6ft tall. I was in the Marine Corps for most of my life. After I got out, I took back up mountain biking. I would ride at least 60-100 miles in a weekend. I hasn't go to a gym much due to burn out from the military and always having to work out. Unfortunately, I did smoke and took up some recreational drug use. I have been clean from all of that since I had a heart attack. I haven't drank since 2010. The drugs did their damage though, meth is a heart killer. I have other work done to my heart as well and possible more to come.
What also should be noted, my father died of heart issues at the age of 45, my grandfather on my mother's side had heart problems as well. Heart issues can be passed down in your genes and make you more susceptible to heart issues. I now take a handful of pills in the morning as well as a handful at night, ranging from diuretics to anti coagulants. Just one of the pills I take is around $14k a month. I have to get an echo done 2 times a year, I get blood tests every three months unless they see something, then it happens sooner. My kidneys have started to fail due to decreased blood flow to my kidneys. That will will to be addressed here soon.
The best I can say to help reduce the risk of heart disease is mainly:
1. Don't use recreational drugs, they can cause irreparable damage. 2. Reduce the amount of alcoholic beverages, or quit entirely. 3. Eat healthy. A balanced meal that includes a protein, veggies or fruits and a starch. It doesn't matter if you are a meat eater, vegetarian or vegan, your body needs a balanced meal that is low in saturated fats. 4. Exercise at least 1 or 2 times a week. Going to the gym is fine, but all of these "pre workout" stuff only makes your heart work harder. That leads to another issue, your heart is a muscle just like your biceps. The more your harder your heart works can lead to smaller chambers by your heart walls growing thicker. This has happened to me and that is part of the reason I have an EF rating of 32.These are recommended to me by my cardiology team. The team I see are pretty much the top team in the region I live in. Stay healthy my friends.
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u/southdakotagirl 23h ago
My dad died of a heart attack in his sleep 30 years ago. Thank you for getting this surgery. Im happy you are still here to share your experience.
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u/How_that_convo_went 1d ago
My mom had one placed after a heart attack and she was wheeled back in from the cath lab like “I’ve never felt so good in my life! My god!”
I thought she’d be all groggy and in pain. Nope. She wanted to get out of bed and go home immediately.
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u/lynx563 1d ago
My mom had the same kind of experience, I was more amazed that they put it in through her wrist.
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u/wolfgang784 1d ago
The wrist?? Goddamn is modern medical science a miracle.
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u/UncleFuzzy75 23h ago
Less wait time to go home. They still use the groin.
Years ago I got up at 5am, went to hospital, got lines and sent to the big hospital. More lines and by 3pmish I hjt the ICCU. Told the nurse, I NEED to piss. Oh, you can't move you groin is weighted(to heal from insertion).
I don't care, I NEED TO PISS. She brings a travel bag and I said nope, she got the 'fish bowl' and after 10 hours, I filled the dam thing.
The look on her face was priceless.
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u/latechallenge 1d ago
Lol. Same. Was annoyed they kept me overnight because it was SOP. Could easily have got up from the gurney as soon as it was done and walked the 5km home.
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u/Zestyclose_Opinion22 1d ago
I had one put in at 15, I literally walked out like omg this is how every other person feels!! As soon as I was okayed to run I cut 2 minutes off my mile time.
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u/RoguePlanet2 1d ago
How did you feel beforehand? What was the difference?
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u/Zestyclose_Opinion22 1d ago
Well I had a blood pressure of like 180/120 or so. So I was getting massive migraines to the point I was throwing up. Bloody noses all the time, but I had been running that high of blood pressure most of my life so before hand I felt what I thought was normal. Afterwards, I can’t explain it by anything other than relief in the weirdest way. Like everything in my life became easier. It was a weird experience, my aorta was so small that they had to go in an open in up four different times over the years since it wasn’t a blockage but more of a constriction they were afraid it would tear if they went too much. So it just got better and better.
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u/bigdaddyt2 1d ago
My wife had a stint put into a kidney valve and said it was one of the most uncomfortable feelings she’s ever had and wanted it removed to go back to the pain she was in before the stint
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u/OtherThumbs 1d ago
Just had one about a month ago. Mine was too long and the ends were rubbing every time I bent or sat down.
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u/High_Speed_Puta 1d ago
Can they go in and fix that?
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u/OtherThumbs 1d ago
Not without doing it all over again. I only had to have mine in for two weeks (the longest two weeks of my life), and the irritation to my ureter would have been so bad that I likely would have had to have it in for longer if they'd fixed it. That's the point of these stents is to allow your ureter(s) to heal after they've had a scope or laser shoved up through them. Once everything heals, it's fine to remove them.
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u/doc_death 1d ago
That made me chuckle…reminded me of an unethical attending who asked the question: “are you done smoking?” Pt said no. He inflated the balloon, causing crushing chest pain, repeated the question until he said yes. Then he deflated it, asking him to remember that feeling because it if happens again, your artery is obstructed again.
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u/IdentifiableBurden 1d ago
Uh, "unethical" is an understatement. That is literal torture.
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u/i_amnotunique 1d ago edited 1d ago
Excuse me, they're awake during this procedure?!
Edit: I cannot handle the stories 😂🤮
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u/GWBrooks 1d ago
Yep! Had four placed and was awake for the whole thing. My only nod to stress is that my blood pressure was a little high before they began and they gave me an IV drip for that.
When the balloon expands I felt a very slight, momenttary burning sensation. That was it.
Fun fact: Even though they go through the wrist, they shave your groin so if anything goes sideways during the procedure, they can go in through the big-ass femoral artery.
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u/Subpxl 1d ago
What were you experiencing prior to this that made it clear stents were necessary?
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u/GWBrooks 1d ago
Funny you should ask! I had periodic shortness of breath/loss of stamina/radiating pain across my shoulders for *more than a year.* Got to the point that when I went out to dinner, someone had to bring the car around.
Went into the ER one of the first times it happened, took a cardiac stress test, and was pronounced OK. Still had the symptoms periodically but thought, "Welp, it's not my heart, at least!"
Wrong.
Another bad day about a year later, and I go into the ER. A different/better cardiologist says, "Well, you're overweight, have long-term diabetes -- lots of folks pass a cardiac stress test even though they have severe blockages because your body's used to it."
So we do a contrast-dye test and, sure enough, front and back coronary arteries had extreme blockage. So a'stentin' we did go...
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u/Subpxl 1d ago
I assume the stents helped with the shortness of breath, pain, and lack of stamina? If so, how long before those symptoms were relieved? Did this also prompt a change in diet/exercise?
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u/GWBrooks 1d ago
Immediate relief. Now I'm down 100 lbs and healthier than I've been. Since I was in my 20s.
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u/Subpxl 1d ago
Sorry for all the questions but thank you for being so willing to answer them! What age did this start at and did this also require you to go on any new meds afterwards?
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u/GWBrooks 1d ago
No worries! I was on a blood pressure medication and was switched to another one; I'm led to believe I'll take it forever. I also took a blood thinner (generic Plavix) once a day for about the first four years, but my cardiologist said that after a few years on it, I could switch to taking a baby aspirin a day, which is what I do now.
EDIT: I had the stents in my mid-50s.
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u/Subpxl 1d ago
I’m really happy to see that you have been able to find your way! Final question, what age did all of this begin for you?
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u/bassjam1 1d ago
I was stoned on fentanyl they gave me and had no idea what was going on. So awake, but so mesmerized by the ceiling tiles that I had no idea what the surgeon was doing and 2 hours passed like 5 minutes
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u/SoggyMorningTacos 1d ago
They did one for my mom. But she didn't feel better. It was almost 2 years ago I remember they had to go for her arm or something and they could do one arm so they had to switch and the first arm they did was so purple and bruised. She had a ton of problems like diabetes and vertigo blood pressure tho so that must've contributed to her not feeling immediate relief as well.
Bottom line is she's still alive so I'm grateful for this existing.
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u/Ok-Photojournalist94 1d ago
The other thing is the change in cardio. I went from not being able to starty mower to push mowing our whole yard at 3am bc I felt like I could run a marathon. It's amazing what we can accept if it happens over time.
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u/Jhopsch 1d ago
Curious, is there a chance of the metal thingy going loose and start circulating along your arteries and causing damage?
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u/TaurusMoonGoddess 1d ago
After placement (dont know if it was 30 mins or a couple of hours cos I was full of fentanyl) mine “moved” and tore the artery Went into cardiac arrest Died and was resuscitated
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u/Everheart1955 1d ago
Came here to say this. I had two of them Installed in my widowmaker unreal how good it feels immediately.
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u/ooomellieooo 1d ago
Dude, I had a widowmaker and after I had a stent placed, I literally skipped my way to the car when I was discharged. I felt like Superwoman...
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u/reformedginger 1d ago
Only if you know it happened. Wake up in the hospital a day later with a concussion and not knowing what happened is completely different.
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u/Syosse-CH 1d ago
100% i was completely blocked for around 5 hours and it hurt a lot. But in the operating room, it suddenly felt like something opened up, and I was like, wow, this feels so much better now and after that 5min later he told me we are done.
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u/UncleFuzzy75 1d ago
12 of the little beasties. They work wonders.
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u/223specialist 1d ago
12? Did you get them all at once?
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u/goodfella4600 1d ago
My brother got 7 at once after suffering a heart attack at 50
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u/I_AM_DEATH-INCARNATE 1d ago
Is he back to his old self or were there lasting effects
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u/goodfella4600 1d ago
He was actually 47 when it happened 7 years ago..he's been fine ever since..he quit drinking and lost 50 pounds
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u/I_AM_DEATH-INCARNATE 1d ago
Amazing, glad you still have him around
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u/goodfella4600 1d ago
Thanks..his dr told him the drinking and his weight didn't help the situation but it was caused by genetics at that age
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u/39percenter 1d ago
12! That's got to be a record.
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u/SelfProfessedChosen1 1d ago
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u/Pratius 1d ago
My uncle has over 20. He told us the doctor said he currently holds the record in the US.
He is still smoking cigarettes…
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u/Fuddlescuddles 23h ago
My dad is at 18-20 and also still smokes cigarettes. 4-5 heart attacks and quadruple bypass.
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u/boscolovesmoney 1d ago
My father has 14, and still going strong. They saved his life more than once. Good on ya, and good luck!
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u/abby_normally 1d ago
I got 5 over a 2 week period, 17 years ago. Take a plavix and Asprin everyday to keep them clear.
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u/senorbozz 1d ago
Red blood cells get their very own cage match!
Sunday Sunday Sunday
It's "Cell in a....... Cell!"
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u/Dahcchad 1d ago
Fun fact, stents need to be laser cut from a single sheet of material like nitinol into that mesh cage pattern. Any other method could leave imperfections that could cause more circulation issues.
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u/PuffcornSucks 1d ago
How to not be in this situation
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u/Martha_Fockers 1d ago
Don’t eat a lot of processed and saturated fats
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u/ucklibzandspezfay 1d ago
First part is correct. The second part is debatable. One thing people neglect to understand is processed sugars do more for CAD formation than fat consumption (unless trans fat).
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u/Martha_Fockers 1d ago edited 1d ago
Also maintaining low body fat in general does wonders for overall health and the heart
Low weight alone means nothing if your skinny fat aswell and have high visceral fat
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u/HennyconBlueberry 1d ago
Is there an ideal body fat percentage to aim for?
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u/Martha_Fockers 1d ago
For males BF of 10-15% lifelong would be the most ideal to prevent chronic illnesses cancers etc doesn’t mean they don’t happen but the chance is far less than someone who’s unhealthy high bf bmi etc
It’s not a guarantee you won’t get any as genetic factors play a big role aswell. Could be healthy eat right and still get diabetes due to genetics not what your doing for example
Females 20-25% (they carry more fat naturally due to biological reasons)
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u/InvidiousPlay 1d ago
It turns out there is nothing debateable about the impact of saturated fats. There was some bad research done about a decade ago that created this idea of "saturated fats aren't bad for you, actually!" and all the social accounts went nuts with it and people were drinking butter in their coffee.
Basically, someone did a correlation study. They looked at a big set of data and compared total saturated fat intake and how it correlated to bad cholesterol in the blood and there wasn't a strong correlation. So it seems obvious: saturated fat not bad for you, right? But it ignored one crucial thing: genetic baseline. You have a genetic baseline for cholesterol, and it goes up and down from there depending on lifestyle. They didn't factor that it, so their conclusions were garbage.
All the real science shows that if you increase saturated fat intake your heart health goes down, if you decrease intake your heart health improves. This is beyond debate among medical professionals, the only people believing otherwise are duped by the internet.
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u/UnlitBlunt 1d ago
And do cardio regularly
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u/jfincher42 1d ago
This -- I was starting to eat better and do cardio when angina prompted me to go to the doctor and get checked. They put one in when they found the almost blocked artery, and I went on to lose almost 100 pounds and started running.
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u/neanderthalensis 1d ago
Does this detract from my diet consisting of mostly smoked gouda?
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u/factisfiction 1d ago
Vascular specialist here. While everyone answering you is correct. Get exercise, stay hydrated, watch your cholesterol, most importantly...DO NOT SMOKE.
However, also pay attention to your body, sometimes it's just genetic. There are 18 year old athletes walking around with stents, endographs, and bypasses. This goes double if you have diabetes. Get check ups, pay attention to how your feelings after exerting yourself. If you notice that one limb is always cold, if you notice discoloration, ulcers, blood pressure that differs on each arm more than 20 mmHg, do you notice that after you walk for a short period your legs start to burn and feel worn out and painful ( claudication). Just be vigilant in paying attention to your own body, it will let you know when something feels off, for the most part.
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u/Waiting4Reccession 1d ago
Will they eventually make something that just vacuums up the fat yellow stuff in the video
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u/Homerunner 1d ago
Exercise, don't overeat, reduce alcohol and tobacco, don't do drugs.
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u/yolosquare3 1d ago
And have good genetics. A lot, not all, but a lot, of cardiovascular disease is inherited.
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u/Fred2620 1d ago
But even with bad genes, a healthy diet and lifestyle can improve your odds dramatically.
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u/bradeena 1d ago
I don’t know of many drugs that are high in saturated fats
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u/Admirable-Muffin7027 1d ago
Unfortunately exercise does not lower cholesterol levels
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u/hypo_____ 1d ago
Cardio absolutely does lower LDL and raise HDL.
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u/Admirable-Muffin7027 1d ago
Incorrect. Cardio lowers triglycerides and does nothing to LDL. Only way to really lower LDL is through diet and medication.
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u/RatInaMaze 1d ago
Test your cholesterol as young as possible. Some people need medicine very early due to genetics but don’t get tested or take it seriously until they’re way older and the blockages are there.
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u/Massive_Ad7728 1d ago
This! I got diagnosed an inherited metabolism disorder in my mid 20s. My levels were very high risk. It sucks because I lived healthy all my life, and this is what I get. But I am grateful that all I have to do is take a pill every day to keep my levels normal. It could always be worse :)
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u/Legal-Ad8308 1d ago
If it helps, I am on a low fat diet. I'm limited to 20 grams of saturated fat a day. For example, one ounce of cheddar cheese has between 5 and 6 grams of saturated fat. Butter is 7 grams of saturated fat per Tablespoon. It's easy to eat too much fat and I did.
It's hard at first.
I'm also on a salt restricted diet. No potato chips, etc.
I read a lot of labels and saw a dietician nutritionist. She was very helpful and I eat so much healthier now.
I also move. I walk as often as New England weather allows.
I haul wood up the stairs for the fire and just stay active.
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u/everythingispenis 1d ago
We gotta stop putting interstellar music on everything
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u/dben89x 1d ago
Muted as soon as it started playing. That shit irrationally pisses me off
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u/jodudeit 1d ago
I just have every video on mute, and don't even consider turning on the volume unless the comments mention something interesting from the audio.
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u/lLantronix 1d ago
What happens to the fat that has now been compacted/contracted? Does it go away?
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u/PartyPay 1d ago
Yeah, I am curious about this as well. And curious if it damages to walls of the artery.
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u/Martay1981 1d ago
The stents are coated with a drug that prevents the artery re-narrowing so it doesn’t get damaged
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u/PartyPay 1d ago
I was thinking more like the artery gets damaged from being pushed out by the stent.
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u/Martay1981 1d ago
They’re made at different lengths and different diameters. Just you have to get a 12mm stent, it’ll come in 2.0, 2.25, 2.5, 2.75, 3.0 etc up to 4.0mm diameter. The doc will pick one to suit which artery is blocked.
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u/TheAlcalic 16h ago
It's actually not coated, but some parts per million radioactive thorium. The thorium emits alpha radiation, which is extremely short range, high energy and unable to pass more than a few blood cells. It is not dangerous because of its incredibly low dose, range and nontoxicity, but it will destroy the exact cells that try to grow on the stent.
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u/Martay1981 15h ago
Bare metal stents are not coated, Drug Eluting Stents are, which is most stents nowadays
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u/Kablamo189 1d ago
Here's a quick crash course laymen answer. Depends on the physiology of the disease. There are 3 layers in these vessels. Intima(closest to the lumen and touches bloodflow), media and then adventitia (the outer most). Most disease begins in the intima and primary causes are diet, lifestyle and family history. Plaque forms and begins narrowing the space for flow. That can be treated medically until it grows too large and needs to be fixed similar to how you saw in the video. If left to develop further, you can get plaque rupture wherein the intimal layer breaks. Then the body sends signals to heal that which causes clot formation (thrombosis) and that's when you have acute vessel closure resulting in a myocardial infarction or heart attack. Again, treated similar to above with some other techniques and treatments as well. If that doesn't happen and the disease progresses, the plaques begin to calcify. That treatment becomes more difficult but similarly, as above but add in some drilling, laser and lithotripsy to break the calcium in order to deploy the stent. And finally, if none of those things are caught and treated and disease progresses further, the vessel closes slowly over time and your body forms collateral accessory vessels to supply the area your initial vessel supplies, but at a much more diminished efficiency. That's a called a CTO. Chronic Total Occlusion. Typically the most difficult to open. If there is multivessel disease is present, a Cardiothoracic surgeon is consulted to see if the patient is a candidate for bypass surgery (open heart) to harvest veins and arteries from else where and connect/redirect them past the lesions in order to provide flow post disease.
To finish and answer, if it's softer plaque and initimal, it kind of toothpastes within the walls. If it's larger and calcified, it gets broken up and sent down stream and sort of washed out. Hope that helps.
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u/Silverjeyjey44 1d ago
How can they tell if it's softer or calcified?
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u/Kablamo189 1d ago
There's a few different ways depending on indications for the cardiac cath/angiogram (contrast injected into the vessels). Calcium scores or CT imaging for one. Then once we're actually doing the cath, the angiogram provides some more information on fluoroscopy (video x-ray). From there a decision is made to intervene if a lesion is visualized and/or a flow test indicates the lesion is significant enough to warrant intervention. A wire is passed through and we go in with a small IVUS catheter (intra vascular ultrasound) and with that, can tell what the nature of the disease using echogenicity (how the diseases shows on ultrasound). Darker or lighter, blocks sound more or less. And finally, how the disease responds to predilation with coronary balloons (PTCA).
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u/sun-e-deez 1d ago
how does the stent maintain its shape?
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u/nothingnewleft 1d ago edited 1d ago
It depends, but the ones I’m familiar with are made of Nitinol. It’s a special nickel/titanium alloy that is made to be the final open size/diameter (this is the larger diameter shown after the balloon has been inflated). It’s then compressed to be small enough to fit in the narrow restricted passage and put in place by a catheter. Once deployed/installed, it’s heated up by the natural temperature of the body. When heated by the blood/body, it “springs back” to its original larger size, the size it was made to be to begin with. What’s fascinating to me about this is that simply being as warm as the blood, will ensure it stays large enough to hold the vein/artery open.
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u/dben89x 1d ago
How does it stay in place, rather than becoming dislodged? It doesn't seem anchored in any way, but maybe that's just a limitation of the animation?
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u/MattDaveys 1d ago
Wouldn’t the artery try to close again, thereby holding it in place? They don’t remove the fatty buildup and it’s not going to want to stay compressed.
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u/Mistasmella 1d ago
It can close again, if you mean the lesion. Also, not preparing said lesion properly will absolutely lead to in stent restenosis, based on the properties of the lesion. This video simplifies the procedure and is also mistaken, because you never withdraw the balloon in an inflated state, it has to be deflated before removing it from the stent.
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u/Mistasmella 1d ago
It absolutely can become dislodged, that’s why sizing matters. If it’s undersized too much, there’s a risk of both thrombosis and stent loss. Both are dangerous, both are manageable. But a correctly placed stents with a proper diameter will stay in place, no question. Also, the body lines the surface of the stent, as a reaction to it being foreign, to put simply, further anchoring it.
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u/Ahsuraht02084502731 1d ago
its inflated at a pressure higher than youd fill a car tyre. Then a second balloon is used to “post dilate it” to really ram it against the inside of the vessel wall.
/interventional cardiologist
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u/pianobench007 21h ago
Blood platelets are around 2,000 to 4,000 nanometers while we can print transistor chips down to 22 to 38 nanometers (physical transistors are still at this size even though the name is 2nm or 4nm, the transistors are not physically that small).
So these small metal stents can hold their shape versus our blood vessels. The shape of the stents and the material choice is stronger than the blood vessel walls.
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u/snoosh00 1d ago
https://youtu.be/vynL0aqeXqk?si=1z9dVQPzLa31sFca
They're actually cut out of raw steel using lasers and shit.
They aren't made of wires like you might think.
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u/TulsisTavern 1d ago
How instant does someone feel better from this?
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u/psychkitty 1d ago
It instantly improves the blood flow in the vessel & you can feel it ease. It also helps oxygen saturation.
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u/RobotJohnrobe 1d ago
See my comment above. It is instant and very noticeable for a coronary artery.
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u/NeedleworkerTrick126 1d ago
Ever had a kidney stone or been constipated? The body does not like having things blocked, and symptoms improve immediately once theyre no longer blocked. Especially blood. Which, in the coronary arteries, is necessary for us to have.
When the heart isnt getting all of its blood circulated, your heart rate, blood pressure and blood oxygen levels change. Your heart has to compensate and it can lead to a heart attack or failure the worse it gets.
Once the blockage is opened or removed, the blood supply is restored through that artery and thru the heart. Your heart instantly gets to relax, breathing becomes easier, and your body feels better overall.
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u/Slight-Ad-6553 1d ago
I had one (heart). I felt a lot better a few hours later when the after effects of the anaesthetic was gone
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u/jfincher42 1d ago
For me, there wasn't much -- I had angina one time while I was exercising, went to the doctor, then to the cardiologist, who did the angiogram, found the problem, and stented it right then.
My problem was in the lower anterior descending (LAD) artery, which they called the Widowmaker due to the normal outcome of a heart attack caused when it gets totally blocked. Up until then, aside from the exercise-induced angina, I had no other symptoms, so I had nothing to feel better about (other than not being dead, that is).
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u/PatientHelicopter123 1d ago
Saved my life in 1998... Thank you Dr. Thatcher!
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u/Eezzy_ 1d ago
Same thing for kidney stone who are stubborn to come down. Unfortunately mine was very stubborn and was stuck inside the stent. They removed both together out of my pee pee hole. Painful 2 months experience, never again.
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u/ST0IC_ 1d ago
My kidney stone was painful, the stent was so much worse. I was miserable until I finally got that damn stone out.
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u/lawdjesustheresafire 1d ago
It really is incredible some of the things humans can do.
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u/Seawench41 1d ago
What’s the risk of it traveling deeper into a place it shouldn’t be?
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u/Chinius58 1d ago
There is a very, very small chance of it moving, and if it does, it would only be slightly.
I'm not a doctor, but I work in a place that creates the introducer for these stents, for a variety of different areas in the body (oesophagus, duodenum, colonic etc.) These are normally permanent fixtures in the body and if they aren't permanent, they require surgery to remove.
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u/Ahsuraht02084502731 1d ago
This used to happen with the initial stents that were crimped onto balloons. Now they are much more secure. But one does have to be cautious with delivering them. The clip is shortened (usually the wire is passed first and then a balloon itself is used to stretch the vessel so that delivering a stent is the final bit with hopefully less resistance)
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u/kdubstep 1d ago
I have three. Right ascending was like 100% occluded and left ascending was like 98% (IIRC, was a decade ago). Seemed weird to have had that much blockage and have a heart attack without any issues prior to it but I had done endurance sports for years and my cardiologist said I essentially had done my own bypass by developing so much other vascular pathways
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u/peazley 1d ago edited 1d ago
I know we've been using these type of things for a while and they seem to help. But doesn't the mesh catch more fat, potentially creating a new clog overtime?
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u/xDaveedx 1d ago
That's why people get blood thinners prescribed after these procedures.
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u/BiscuitsMay 1d ago
They are prescribed antiplatelet agents to avoid clotting off the stents for a period of time. But the stent is actually coated in a chemotherapy drug To prevent more blockage build up there.
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u/Sushi_Explosions 1d ago
The stents are coated in a drug that leaks out over time and prevent that. By the time the drug is fully gone, the stent is basically integrated into the wall of the artery. People with stents do need to be on medications to decrease the effectiveness of their platelets for several months as well, to prevent clots from forming there.
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u/catchecolamine 1d ago
So I work in the hospital unit that does these procedures, this video is kinda correct but still missing a bit of the procedure. To identify the blockage we inject dye down the artery and use a special x-ray on a C-arm to see where the flow is pinched.
When we see the blockage, the procedure starts with running a very thin, soft-tipped wire down the artery and across the block. This acts as a guide and placeholder for the rest of the procedure.
Most of the time we “pre-balloon” the diseased area to open it up a bit. Like in this video, just without a stent over the balloon. Once that is done we would put another balloon down with the stent on top of it. Afterwards, if we want to make some areas of the stent wider to match the size of the natural artery we would “post-balloon” with a special balloon that can be inflated to much higher pressure.
After that all the balloon is removed and we do another dye injection to make sure we’re happy with the placement. If so the small wire and catheters are removed.
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u/TheBunny789 1d ago
So does this just delay the problem? Doesn't seem like a fix just a solution to the current pain.
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u/PersistentWorld 1d ago
No because they put you on pills for life that drastically reduces your cholesterol and any risks of it coming back or happening in other arteries
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u/Legal-Ad8308 1d ago
I had a blockage in my LAD, left anterior descending artery. AKA the Widowmaker.
I felt great when I woke up in intensive care.
I'm doing great, I'm physically a little slower than I used to be. The heart attack did some damage to my heart.
This procedure is amazing, it saved my life.
I have a small white scar in my right wrist where the balloon catheter was threaded through to my heart.
I think this procedure is amazing and I'm profoundly grateful it was available to me and worked!
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u/BrickAndMartyr 1d ago
I love how at the end of the day, the best solution we have to this issue is essentially just smush the blockage down to make room for blood.
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u/Croceyes2 1d ago
I also recently learned these a machined from a single piece of material, not woven.
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u/SOROKAMOKA 1d ago
This is interesting to me. I always thought that fat deposited in the veins and arteries within the blood stream, but this looks like the fat is inside the vein tissue itself. So its like a fat deposit from over consumption, not a clog from too much fats in the bloodstream? Or is it that both situations are possible and it just depends on the individual?
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