Thursday, November 17, 2016

O2 Max and Maximum Heart Rate

I retested the Own Index/O2Max on my Polar i810 and came up this time with 45 - as high as it has ever been. I was pretty relaxed when I took it, but the average of 43 is good. Tops for my age group.

The i810 projects a maximum heart rate of 146 or so, down from the 168 or so from just a year or so ago. I thought this was too low. On this morning ride I got up to 165, so I was right. I'm leaving the set maximum at 160 in the Garmin Vivoactive though.

That leads to these five heart rate zones.

50% - 80-95
60% - 96-111
70% - 112-127
80% - 128-143
90% - 144-159
100% - 160

More accurately, based on 165:

50% - 83-98
60% - 99-115
70% - 116-131
80% - 132-148
90% - 149-164
100% - 165

Today, I was in zone 2 on the uphill of the GoWalk group's Thursday walk.

That Monday, I topped out at 165 at the top of K2.

My Monday rides put me in 2-3 a lot of the time, with a couple of 4's and on occasion, a 5. No 5 on the Wednesday ride.

An average HR of 110 on that Monday would equate to zone 2 on both sets above. Fatburner.

Sunday, October 16, 2016

Holding Steady - 10 Pounds Lighter

I saw my endocrinologist October 11th and was released to my GP. In effect, there was nothing more that she could add at this point. Bottom line: I need to lose another ten pounds at least. There is no medication than can improve my current state.

That's not so bad. My cholesterol is in the 160's. My HDL's are too low - 37 this past time around, only off 3 from normal. My LDL's could be lower - I'm remembering the 77 I achieved earlier. However, I did have some issues with skin allergies to the statin I'm taking - now a generic form of Crestor at 2.5mg/day. There may be some sun sensitivity there. I'm hoping that if I cover up that I won't see the eruptions on my arms and hands and I can keep the current medication. Maybe in the winter, I can alternate between the 2.5 and 5 mg/day. That would help directly with the LDL's. If I lose another ten pounds, I might be able to dispense with the finofribrate that has kept my triglycerides (almost) in the normal range.

I feel good. My heart rate recovery is good as shown by my new gadget, the Garmin Vivoactive. The heart rates dovetails with the starting and stopping on my bike rides perfectly. I got a new battery for my Polar 810 and checked my Ownindex. It is down to 41 from 43 about a year ago. Still excellent for my age. It predicted a maximum heart rate of 146, however, way down from the 168 last time. I think I will use 160 as the maximum for my Vivoactive.

I'll update my spreadsheet of test results, but it has remained remarkably consistent. My endocrinologist said that I had a shot at the A/B (the buoyant versus the dense, grity lipids). But that could only come from weight loss. There is a big convergence here, so I am working on the next 10 pounds, maybe by early next year. I achieved a recent "low" of 193 a day or so ago. That would be 12 pounds from earlier this year.

I'm now counting calories - at least for now. I can avoid the 1,000 calorie dish if I know I can feel as good with a 200-300 calorie substitute.

I've meant to add some LA Fitness workouts during the week as well, to strengthen my upper body and to continue strengthening the muscles around my left knee. I need to practice going up and down stairs. Today, though, I'm planning to do the Mills loop.

"Steady as she goes" is the tag line of the day. That and counting calories.

Friday, February 5, 2016

The Gluten-Thyroid Connection

There is some evidence of a connection. See this article. But it is hard to sort out what it all means. The "Wheat Belly" syndrome, and more. Luckily, I've tested negative for thyroid problems, though my brother has not. In my endocrinologist's notes, I see "normal, no evidence of AITD," which is the AutoImmune Thyroid Disease.

Added Note: So far the treatment is not different from what my GP has been recommending. If I qualify, and if I go with the PCSK9 regime, it would be different. (I think I would have discussed and gone with the increase in Crestor. But the testing has increased the sense of urgency...)

A Note on Diabetes Type II

I note that among my carefully organized medical "problems" as diagnosed by my endocrinologist, "Type 2 diabetes mellitus without complications" has appeared. Will check to see whether the A1c put me over the threshold.

This has long been on the back burner and is associated with "metabolic syndrome," "insulin resistance" (for which my Kaiser doctor actually treated me), and NASH, the "fatty liver" syndrome. Maybe also "gluten belly.

The key question is how they bear on my LDL and liver weakness. (No kidney weakness, yet.)

All of these can be helped by weight loss. I'll enter my lab work into my excel file and take a look. My impression though is that there are not dramatic changes.

My endocrinologist's take on the high ferritin is "long standing-therefore unlikely due to malignancy." We'll see what diet and the cleanse from milk thistle will do.

She also noted a slight improvement between my last two lipid panels and suggested it just might be because of the diet and liver cleanse.

Instruction on Understanding Calcium Scans

Yesterday I had a good conversation with my cardiologist. I have been concerned with my "High" risk scores. See earlier post. He listened to my concern and read the Orange County and Millennium Imaging results and agreed that my risk factor had not changed appreciable, or rolled back, but he showed me why he believes his stress tests get closer to the truth. He sketched the following diagram:
At the top there is a blood vessel with an effective  diameter of 3 centimeters. There is no plaque and the blood flows freely.

Just below there is the same vessel, but the swirls indicate obstructive plaque. The effective diameter is now only 1 centimeter.

But below it, there is still another vessel, with the plaque on the OUTSIDE of the vessel. The vessel is unobstructed and continues to have the full 3 centimeter diameter. A calcium scan may not be able to distinguish between the second and third case. (Now it may be that I should say "calcium" instead of plaque - the scan picks up the calcium with is found with plaque. This is the nature of the indirect measure here.)

So the point is that you could have an unobstructed - or less obstructed vessel - with the same "high" risk score. My cardiologist's point is that it is important to test the blood flow for obstruction. This is done with a stress test or a thallium stress test, both of which I have had. He offered to give me an angiogram, which would test obstruction directly, but I politely declined.

Here is one article that looks at the predictive value of so called risk factors and also for calcium heart scans and finds that neither are as accurate as has been hoped. In fact, neither is "clinically useful." Hmm.

Medicare funds stress tests once a year, so I'll have mine later, in April. That will also be in time to add my cardiologist's recommendations to those of my endocrinologist.

In the meantime, I will up my dose of Crestor slightly, alternating between 2.5 and 5 mg/day. I am now doing 2.5/day. The immediate goal is to reduce my LDL to 75 - again the recommendation of the Orange County Institute five years ago. I had achieved it, but on a greater dosage of Crestor.

He had suggested resuming Zetia, but deferred that until after a lipid profile in April. My endocrinologist wanted me to defer increasing the Crestor dose as described above until I me with my cardiologist, who she hoped would consider the inject-able PCSK9. He was not interested in doing that at this time. If the increased statin-based Crestor can bring my LDL down to the mid-seventies, that would be it. The question is whether I can tolerate that. It's worked before.

I offered to leave lab slips, etc., with my cardiologist, but he was interested only in my last LDL result, which was 99. Talk about getting down to essentials. That is the best predictor of heart incidents I do believe.

Thursday, December 17, 2015

Second Cataract Surgery: January 6, 2016

Although the focus of this blog are issues associated with lipids and heart health, I'd like to bring in other topics as well, in particular, the choices one needs to weigh in choosing the best sight strategy for the kind of lens you choose to embed.

One can go for maximum distance vision in both eyes. But then one almost surely will need reading glasses.

Or one can go for the new "multi" lens, which go for both distance and reading. As with many other compromises, you don't get the best distance or reading correction. At least that's been the story on the street.

Or one can go for "mono-vision" (as I did). This choice takes off from the natural distribution of function your eyes already have. One eye tends to do the "up close" work, the other eye, the distance work. In my case, my left eye naturally gravitates to closer reading, my right eye is my distance eye. My optometrist and I discussed this and set this up with my last several contact lens prescriptions.

Instead of correcting both eyes to 20-20, he corrected my left eye to about 20-40, so that it was easy to read. He adjusted the right eye to the full 20-20 for distance. This worked very well. I could read small text (say on my iPhone) without reading glasses or even squinting. While driving, the brain combined the two different corrections into something like 20-20 (at least during the day). This worked very well and the idea was to continue it with similar embedded lenses when I had cataract surgery.

But cataract surgeries don't typically happen together. The cataract in my left (reading) eye matured faster than the one in my right (distance) eye. So the idea was embed a "reading" lens in that eye.

But I've left out the issue of astigmatism. Both eyes have some astigmatism, which needs to be corrected in some way. My left eye was a candidate for a "toric" implant, a lens which corrects vision, including astigmatism, but costs extra.

My surgeon, who is also a lasik specialist, suggested that he could embed a regular lens and adjust for astigmatism through lasik surgery  at the time of the implant. The idea was to come up with about 20-40 in the left eye to continue my strategy of mono-vision.. This translated to a "backing off" about 1.25 diopters. (There is not necessarily a one-to-one correspondence to the 20-20, 20-30, 20-40, etc. and the diopters of correction. 1.25, 1.50, 1.75, etc. This needs to be actually tested in a standard refraction exam at your optometrist.)

Long story made short is this: while my left eye started out at 20-40, it has continued to "back off" until, almost a year later, it is 20-80. This is no problem of course in terms of reading, but I do feel some strain in combining distance vision, say while reading labels in a museum or driving at night. On a bright day, because the aperture of the iris is contracted, you get the same "depth of field" advantage as you do with a camera, so that my left eye may be even 20-30 at that time and the illusion of a full correction in both eyes is very strong.

The optometrist at the surgeon's office said something like, "The original target was 1.50 but I see that it is 1.75 or more..." I thought the original target was 1.25 (about 20-40) and was afraid the result was more like 20-100 in that dark room, but it was later tested at 20-80, which I think corresponds to 1.75.

In retrospect, I probably should have had a toric lens for my left eye. But my current status is within the acceptable window - as I attested at the office visit.

For the future, however, especially if the left eye backs off further (a real 20-100), then I would get a contact lens for it. The question is then, "At what correction"? From a discussion with my regular optometrist, it would have to have at least 0.5 diopter correction to be worth it. For me, that would mean, I think, a 20-40 "net" correction in that eye.

The question then becomes, does that compromise reading vision. If so, it doesn't appear to be worth it. My optometrist was able to simulate what it would be to have this. I really liked how it helped my distance vision (in the relatively dark room). But I was slightly put off by how I would have to slightly distance (extend out further) my iPhone for optimum reading. A close call.

In the meantime, the surgeon is going for "the best distance" in my right eye and I will get the toric lens. ($$)

Bottom line, after the surgery  and things settle. I'll revisit this.

New Component: Diet

The Scramble
I had an hour-plus meeting with my new endocrinologist's dietitian. Our shared philosophy: "Eat as much as you want, but eat the right foods." Here I remember my experience in China vividly. I ate as much as I wanted, but still lost five pounds a month. At the end of my longest stay there - three months - I lost fifteen pounds. The trick, of course, is to do it here.

She gave me four pages of recommendations, about which I'll be posting in the future. I'd like to highlight here, however, the "Scramble."

This is a variation. I started with  about a half sliced white onion, garlic, part of a sliced yellow pepper, and some sliced green onions. To those I added some already stir-fried ground turkey (just an ounce or so). When those were cooked (but not over-cooked) I poured in enough egg whites (from TJ's) to cover, then waited for that to solidify. I added some chili flakes to warm things up, and some pepper. And just a little fish sauce in place of salt. I then rolled up the scramble, cut it in two and placed it on halves of a round flat bread that I had toasted. Awesome!