Friday, February 5, 2010

Visit With Specialist - A Bit Anti-Climactic

My specialist had to reschedule me because of an emergency, but I found him calm and collected yesterday when I met with him. I had prepared a ton of questions for him, but found him quickly to say in a very matter-of-fact way, "no obstructions."

I think the consultation might have ended there but for my list. The report was in the form of a text, so I couldn't see my pictures. (I had seen them in the preparation phase just after my stress test. They show "before and after" blood flow when resting and exerciing - thus showing points of blockage (if any). See this site.)
I did order them and will report on them later. The point was that while there is plaque buildup in the heart, I am, do now remain, and very hopefully will remain, asymptomatic. Probably, the thalium stress test should have preceded the calcium scan because it confirmed what I've known: that exertions like Cycle Oregon don't produce heart-issue symptons like chest pains, dizziness, fainting, clammy sweating, and so on. The Dr. recommended a follow up visit in a year.

So my specialist and my doctor essentially convinced themselves that I'm asymptomatic. But what of follow-up? When I tried to schedule an appointment a year hence, the receptionist smiled and said they didn't book that far ahead, but to put it on my calendar. But what would the doctor do in 12 months? Check blood pressure, lipid panel, etc., and perhaps do another thalium stress test. That may provide a good "before and after" but I believe that the HBCT heart scan provides a better picture of "before and after."

For example, the January scan identifies 5 areas of interest in the Left Anterior Descending Artery (LAD) and gives a total point score for these areas. Mine is 283 at present. There are 5 such areas in the Right Coronary Artery (RCA), the point score is 552. Total for both: 835.

If one follows the recommended regime (described before, but in short, keeping the LDL about 70; triglycerides below 100, and upping the HDL to 60), one should see at least a stabilization, possibly a slight reduction of these numbers next year. My RCA score might fall to 525 and my LAD might stay even at 284, for example. That would provide some reinforcement for taking the statin and enduring the flushes of Niaspan. Persistence in taking these medications might result in further reductions two years out and so on. All this depends, of course, on tolerating these non-trivial drugs which are taken in non-trivial amounts.

My specialist did link Niaspan with increasing my HDL, a key piece of the puzzle, since mine is low and need to go from 45-60. He said that nothing works as well a niacin-based prescription for increasing HDL. He prescribed 3 per day or 1,500mg a day. I am now up to 2 per day with endurable side-effects (some flushing and "pre-flushing" tingles). But I was only taking one a day at the time of the lipid panel together with one Trilipix (134mg) and one Crestor (5mg). I suspect 3 Niaspan keeping the others the same would be too much. (Happily, my liver enzymes were normal when tested at the same time.)
On other matters, I shared some data with him on training and Heart Rate Variationl (HRV), since mine was good after the Wednesday ride. He saw the value of HRV monitoring to be on the part of those who have had heart attacks, or even heart transplants. In short, the possible use of HRV in exercise training didn't appear to be on his radar. See Canutes' site for some more thoughts, in particular, this blog.

So for the present, when I resume Trilipix (I'm out of the samples and have not yet received the #90 Rx from Medco), I'll keep the Niaspan to no more than 2 and have a VAP test in March before seeing my GP. So far so good. I'll report on the VAP test, which addresses the "small-LDL trait" -- you know, the tiny, gritty, non-bouyant lipids. We'll see if this medication regime can up my bouyancy. :)

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