>>>What would happen if you quit the isosorbide? Just hand pain, or more?
I am loathe to stop the isosorbide, and thus, have not...not something I want to experiment with right now (see below for hypothesis)
>>>Have you ever had the pain WITH exertion, or just at rest?
First exercise yesterday produced very low hand discomfort.
Last night, awakened from sleep with hand pain and definite chest discomfort, relieved by sublingual. I had noticed that my nightly headaches from the slow release nitro were quite diminished just last night. The local pharmacist said that I am developing tolerance to the nitro but only in the peripheral arteries (the ones causing the headaches); she said, pretty definitely, that this did NOT mean any lessening of the dilation of the coronary arteries. I am suspicious of that and will call some other pharmacists to see if there is a consensus.
>>>Is the discomfort the same NOW as before the stent?
This is most curious. Angina before the stent presented at the inner left elbow. Post first stent, pain presented in inner edge and fingers of left hand and no left inner elbow. The fingers feel numb like when you hit your "funny bone" nerve and your hand/fingers tingle and are numb for awhile.
>>>Does a certain POSITION make the left hand pain worse?
No, not that I can tell.
My hypothesis (dream really): the edges of the stent, whether or not they are fully "seated" into and along the artery wall, are providing a local irritation, causing localized release of vasocontrictive chemicals as well as perhaps intra-artery muscle irritation leading to repeated spasm. The spasms, small to begin with, produce the angina symptoms and probably contribute to some localized stent-edge platlet buildup. My hope would be that if this build up can be minimized long enough that the localized irritation will abate, scar tissue will form over the edge of the stent edges, and smooth flow will continue without the irritation-induced spasm. I can find no writing of any kind even suggesting this is a mechanism, and have found very few papers even talking about stent-edge restenosis. I do not think anyone knows.
I also doubt that placing a stent in front of the original stent is a solution as the new, upstream edge of the newly placed stent becomes the source for additional spasm and buildup. I have a long way to go yet (I think) but CABG may be looming larger and larger as a possible solution.
Appeciate any comments/speculations/thoughts/etc.
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