Q: My father is a 77 years old diabetic suffering form hypertension. He had an attack 3 years back and is now suffering from pain. On angiogram, doctors found 5 blocks and advised that the only treatment is to go for a by-pass surgery as angioplasty is not possible. Because of his age and attendant problems, we are not in favour of a by-pass surgery. The doctor advised us to put him on medication & diet control and leave the rest to god. When he suffers pain, he keeps a tablet under his tongue and the pain disappears. The pain ususally comes when he is lying or sleeping. the doctor says this is not a good sign. What should we do now?

A:I am afraid, you have absolutely no choice what so ever, but to undergo bypass surgery. Triple vessel coronary artery disease in presence of unstable angina carries rather dismal prognosis with medical management and the risks with surgery, specially with modern day Beating Heart Surgery, is much lower than the risks involved with medical management and therefore I strongly feel you must undergo bypass surgery. However, to be able to give a full opinion, we do need to see your angiography film and evaluate the patient in person before a final decision can be taken.