Clinic helps people avoid heart attacks

In the moments after Camille King’s heart attack last summer, she felt she’d slipped into a dream state. She was only 41, after all, and had been told her chances of having one were 1 in 100.

But what shocked her more was the message from her cardiologist.

“As soon as you’re in recovery for a heart attack, they start preparing you for your next one. These are your symptoms. Dial 911 if you feel them,” she said. “I didn’t find that acceptable. I didn’t want a second heart attack.”

So King, who lives in Post Falls with her husband and 8-year-old son, found the Heart Attack Prevention Clinic, a Spokane practice founded by family physician Bradley Bale. The clinic helps patients make lifestyle and medical changes to avoid heart attacks and strokes. Bale and nurse practitioner Amy Doneen’s unique – and apparently effective – methods are gaining recognition in the national medical community. They’re also gaining accolades among patients, even though most of the clinic’s services must be paid for out of pocket and some patients said their cardiologists won’t acknowledge Bales’ approach.

“We believe that heart attacks are all preventable,” Bale said. “Lifestyle is No. 1 at stopping heart attacks, but a lot of people need more.”

Eight years ago, Bale grew frustrated that one of his patients was having a heart attack every two or three months. He revamped the family practice he had run since 1975 to pinpoint patients’ problems. “I started finding other ways to identify risk,” he said.

Since changing his approach, only two of the practice’s 3,800 patients have had heart attacks, and both had strayed from their treatment programs.

Bale debunks some standard practices in cardiac care.

One widely accepted way doctors measure the heart health is to put a patient on a treadmill and watch how their bodies react. The so-called stress test can show if blood supply is reduced in the arteries that lead to the heart, signaling blockage that could lead to an attack.

But in order to fail a stress test, a patient’s arteries must be blocked 70 percent or more, Bale said. Because 86 percent of heart attacks occur when plaque in the wall of an artery is less than 70 percent obstructed, a person’s risk is often missed, he said.

“You don’t want to flunk that test, but passing it doesn’t mean you don’t have dangerous disease sitting in there,” Bale said.

Americans are inundated with advice on combating heart disease, but those messages are aimed at the average person, Bale said. He uses a variety of specific tests to zero in on patients’ needs. By testing someone’s genes, looking at the thickness of their arteries and examining other markers, the clinic builds a plan for each patient.

“When you go through this clinic, you will not be treated at the standard of care,” Bale asserted. “The standard of care will get you killed.”

One procedure new patients undergo is the Intima Media Thickness (IMT) test. A technician uses an ultrasound wand to do a painless scan of the carotid arteries in the neck. A computer displays a picture of the arteries, which offer a good indication of how the coronary arteries look. The results are sent to a lab, which gives the patients’ arteries an “age” based on their condition and identifies the presence of soft plaque.

“I had the arteries of a 70-year-old. When you’re 57, that’s not what you want to hear,” said patient Lynne Proudfoot, a Spokane muralist.

Proudfoot goes back to the clinic in October to learn the new age of her arteries, but she’s confident she’s shaved off some years because her cholesterol has dropped from 414 to 138 and her blood pressure has gone from 197/107 to 120/75 since she went under the clinic’s care last fall.

On average, Bale’s patients reduce their artery age by seven years after a year on the program. Their soft plaque, another indicator of heart attack or stroke, is reduced an average of 94 percent.

The clinic also draws blood to identify patients’ apolipoprotein E, or apo E, gene. Apo E genes are classified as either a 2, 3 or 4, and each group has different dietary and exercise needs.

“To give somebody dietary advice without this gene type, you might be giving them the wrong advice,” Bale said.

For apo E 2s, it’s extremely important to exercise and not eat refined carbohydrates such as white bread and sugar, he said. Drinking a glass or two of wine a day is good for apo E 2s.

Bran is important to apo E 3s and exercise has a moderate impact on this group.

For apo E 4s, it’s important to eat a low-fat diet and avoid alcohol. Following the widely reported advice to drink a glass of red wine a day could be detrimental to apo E 4s, Bale said.

Dr. Gerald Bernstein, a Seattle dermatologist and cosmetic surgeon, said learning he was apo E 4 was “one of the greatest disappointments in my life.” Bernstein replaced his evening cocktail with sparkling water when he became a clinic patient a year ago.

The slender Bernstein didn’t need to lose weight but dropped 10 pounds after cutting fat from his diet. At his one-year checkup two weeks ago, Bernstein learned that the thickness of his carotid artery wall went from 1.073 millimeters to .947 millimeters. He’d shaved 12 years off his artery age.

“Does this mean I can go have a drink?” he asked Doneen.

Bernstein and Proudfoot aren’t the only patients making big strides. King, of Post Falls, has lost 45 pounds since she began seeing Bale in September. Her cholesterol has gone from 253 to 148 and she exercises six days a week now.

But in an era when Americans can’t stand in line at a grocery store without being bombarded by healthy messages, why are patients listening to Doneen and Bale while others are ignoring what they know is good for them?

For one, the data they’re getting at the clinic is specific to them, Doneen said. Plus, the clinic spends time teaching them why they need to change their lifestyles and possibly their medications.

“For people to physically be able to look at the health of their arteries and see after one year you can make an impact – they go through the roof,” Doneen said.

Bale doesn’t accept insurance because most companies don’t cover aggressive preventive care or the extra time the clinic spends with patients. Often the lab work is covered, but the initial visits to the clinic will put a patient back $650.

King, who works in the accounting department of a plumbing wholesaler, said she has paid almost $2,000 to the clinic since September. She and her husband, an assistant manager at Wal-Mart, together earn about $65,000 a year.

“We’re not rich,” King said. “But it’s your life, and there’s a cost to another heart attack.”

More than a decade ago, Dr. Fred Viren, an internist-endocrinologist, began doing research with two other Spokane doctors on some of the ideas Bale puts into practice. They suspected that coronary artery disease was a disease of inflammation, a basic premise in Bale’s practice.

“Dr. Bale has advanced this one step further by looking at the carotid arteries,” Viren said.

Viren agrees with the clinic’s patients who lament that the American health care system resists paying for preventive care, but he refers to what Bale is doing as “early detection of disease.” Until it’s more widely accepted for insurance companies to tackle disease in its early stages, Viren doesn’t see a problem giving access to top-quality care to those who can afford it.

“When everyone drives a Yugo then maybe we’ll all settle for basic health care,” Viren said. “But there are a lot of people driving a Lexus, and these people want quality health care and the most information they can get.”

Bale’s method is gaining attention around the country. He spends most of his time on the road now, teaching physicians his approach.

So why aren’t more doctors implementing similar programs now? Bale said part of it deals with the amount of time his clinic must spend with patients. A visit typically lasts two hours.

Many physicians also are cautious about trying medical approaches that aren’t backed by 20-year studies, he said. Bale said he doesn’t want to wait decades to try approaches that researchers are proving to be effective now.

Patients said they heard about the clinic through the grapevine, not from local cardiologists. King’s general practitioner and cardiologist are excited about the changes she has made, but they don’t acknowledge the clinic’s role in her success, she said.

A call last week to Spokane Cardiology, a leading cardiology practice in Spokane, wasn’t returned, although an office manager there spoke positively about Bale in a brief conversation.

Bale knows some doctors are leery of his methods. His goal is to work with cardiologists, though, not to compete. And plenty of cardiologists from out of town are endorsing his methods in a big way – they’re becoming his patients.

In the meantime, the clinic will continue racking up success stories. Bale recalled one patient who visited him in September 2003. The man was in Spokane saying goodbye to friends after having a heart attack that year. Doctors did bypass surgery and inserted stents, but told him nothing more could be done to clear his arteries and that he had three to six months to live.

While in town, he heard of the clinic and convinced Bale to stay late one night so he could see him. Clutching a Kleenex and crying, the 68-year-old man learned from Bale that more could be done to treat his condition.

The patient visited Spokane again this spring, this time to volunteer for Bloomsday. Next year, he plans to run it.