Saturday, October 1, 2011

September Dr. Visit

Good follow-up meeting on September 26 with my doctor. No surprises. Again, one of the best lipid profiles -- and with only one Niaspan/day, so I have some margin. I'll meet again in January for my physical. Thumati after that for a yearly, probably only a stress test, maybe not even that.

Of note: my Ownindex readings are down slightly from the summer. 725 gives me 39; 810, 37; Readings were above 40 in the summer, with a high of 43.

The 725 monitor reads a little higher than the 810, the latter I think is more accurate. These are near margin-of-error, but they are consistent between the two monitors, so my overall O2Max is down slightly. Maybe step up training a little?

Wednesday, September 7, 2011

August Tests Back

Did pretty well this time. Predictions: "... this time I expect an HDL of maybe 41; Overall Cholesterol 140; LDL 75 (I hope); Triglycerides of 125 or below." (last post)

HDL was better at 48. I estimated 41. This reflects the 4 grams of Omega 3/day plus the 2.5 Crestor plus the Trilipix plus the Zetia plus at least one Niaspan. In China I did do the Niaspan but not the statin. The statin does great for LDL and with the Trilipix - triglycerides.

Overall Cholesterol was 143 which was pretty close to my estimate of 140.

LDL was 79. I estimated 75 but was worried that it might be higher. It was, but not much. There is an habituation issue, I suspect. But I think this would have been lower if I had consistently taken 2 Niaspan/day plus all the rest. That will be worth doing. If I remember to take the Niaspan early and there is not a stomach problem, I'll take two. Otherwise one.

I predicted that triglycerides would be 125 (normal) or below and that is true. In fact, this is one of the lowest readings I have had at 76. Not sure what to make of this. I think Trilipix is key, but the Crestor, even at 2.5mg/day, and the one Niaspan all contributed.

My Dr. (didn't see him today) will say that's pretty good. I'm curious about whether there is any rollback that might be shown in a scan. I did get a note, as I mentioned, from the Orange County Group that ran the scan recommending an 18 month followup. My Dr. will say "wait, there's too much radiation to warrant doing it now." And he will say that no result from the scan would be likely to indicate any different response.

I'm averaging 121/67 in blood pressure over many hundreds of readings over the past year. There is a slight downward trend. I still need to do more stretching and some upper body work and lose ten pounds. I'm at about 200 now, up 4-5 pounds from my last trip. 185 would be ideal. I did get to 189 briefly in Hangzhou last Fall. Maybe I could shoot for 190 by Christmas.

I'd like to get off the statin entirely but it is effective, especially with respect to LDL. Still, there are rumors on the net about a connection between statin use and Alzheimers. But maybe muscle cramping could be an indicator that all is not right with Crestor. I haven't had that as yet (at least).

Next tests would be 4 months from now or early January. That would cohere with my PSA as well.

Friday, August 26, 2011

August, 2011 Predictions

Just had my blood work done at the Claremont Branch of Pomona Valley Hospital. They draw blood in the Occupational Medicine division there.

I've done pretty well keeping up with my Rx's. Averaged only 1 Niaspan however, but have done well on the rest. So this time I expect an HDL of maybe 41; Overall Cholesterol 140; LDL 75 (I hope); Triglycerides of 125 or below. All okay except for the HDL. To get it higher, I need to ramp up the Niaspan.

Last time with three Niaspan and 2.5mg Crestor, the LDL dropped to 69; Chl to 137 and HDL went up to 43. Triglycerides normal. These are diminishing returns, but important.

Today was a basic lipid profile. The best predictor though is relative size (buoyancy) of the lipids. You get this in the VAP tests. My Dr. will say that the response would be the same. Still, it might give me more incentive with the Niaspan.

Orange County Imaging sent me a note reminding me that this is the 18th month anniversary of my scan there and to follow up. That's another $300 but my Dr. doesn't want me to do it because of the radiation. Still, that could provide incentive, too.

Friday, May 13, 2011

May Doctor's Visit

Good visit. Dr. confirmed I was doing as much as I could do. More statins might actually reverse plaque, but I would almost certainly not be tolerant of the dosages needed. I'm clearly in maintenance mode, however. This could be confirmed by going back to the same facility/machine (different machines "slice" in different ways). But there is still the issue of radiation. He suggested 5 years. Since last test was 2009 if I remember, that would make it 2014 or about three years from now. That's fine with me.

With the low 69 LDL it is not as important to get the HDL up to 60 -- virtually impossible for me. Anything over 45 should be adequate for maintenance however. I can tolerate 3 Niaspans and will plan to do so, though may backslide to two if my stomach is acid.

Before I returned from China I was not using any statins and still had a respectable profile: 165 Chl; 103 LDL; 39 HDL. (Triglycerides were in the normal range both times.)

That was with one Niaspan. With three Niaspan and 2.5mg Crestor, the LDL dropped to 69; Chl to 137 and HDL went up to 43. These are diminishing returns, but important.

Next tests in August.

Tuesday, May 10, 2011

Cumulative Lab Results

On a trial basis I'm posting my Excel spreadsheet collection of lipid watch results over the years. It can be viewed via Google Docs, even on an iPhone. Might be helpful.

Sunday, April 24, 2011

Cross Training: Heart Rate Creep

I brought along my Polar 725 HRM and transmitter this last Saturday for a familiar run on Euclid Avenue in Upland, CA. My friends and I have been doing this since I started running in the late 1980's. On Saturday I ran up to the fire station on 24th from our start on 17th. That's 1.75 miles up. Then I ran back. I felt good so I ran down to 16th and back to 17th twice to add another mile. (The blocks are conveniently 1/4 mile each.) My total: 4.5 miles.

I made it a point to back off if my rate went over 140 going up. I'd walk until it came down to about 120 and would start again. I was pleased that the "creep" in heart rate was modest. See the sawteeth just before the peak. Many's the time in the past my rate hit about 180 here. My time up to the fire station was a little under 27 minutes, close to 15 minutes/mile or 4 miles/hour. Not bad for an old guy going uphill. My time back was a little over 19 minutes, about 9 min/mile or a little over 6 miles/hour. Both segments included walking to bring HR within the 120-140 range. I rested only 3 minutes at the top, 2 minutes at the bottom, and 5 minutes at the end. My average excluding these rests was almost exactly 4.5 miles/hour. Include them and the average is about 4 mph. Notice that there is some cardiac "creep" at the end and that my heart rate going downhill was greater than going uphill! (124 versus 139). And I had trouble keeping my rate in the targeted range. I think this fact has to do with training and would be true whether or not I was going downhill. But the fact that I was going downhill reaveals the creep more explicitly. If I went on a 10K training regime, I would expect to see less creep on the second half on this run as I built up my miles.

The 5 minute rest at the end shows the drop in heart rate which is good in the first minute dropping from 160 to 130, but it required another couple of minutes to get to 100. Still okay, I think.

Not shown here is the most recent OwnIndex of 40, equivalent to an O2Max without the hassles of actually doing an O2Max test. Excellent for my age, so they say. I'm glad I took my Polar along with me. Cross training occasioned a cross-check on my cardio, and it could be a lot worse.

This helps me with my conjecture about the best when to get to Pasadena from Claremont on foot. It's a walk/run combo like Euclid.


I looked back over my liver enzymes history and found nothing out of the ordinary. Some highs and lows, but not too far out of the envelope except for this last test result for Akaline Phosphatase. A quick look at the websites give the following as the usual causes of low ALK PHOs:

"Reduced alkaline phosphatase levels are associated with a number of conditions including zinc deficiency; folic acid deficiency; low levels of phosphorus; vitamin B6 deficiency; vitamin C deficiency; excessively high vitamin D intake; malnutrition involving inadequate protein assimilation (this can also be caused by hypochlorhydria – low production of stomach acid); Celiac disease; hypothyroidism; anaemia or inadequate parathyroid gland function."

I have been taking Vitamin D supplements, but only as a result of low Vitamin D which my endrocrinologist saw a couple of lab tests ago. I'm taking Folic Acid supplements. Maybe I need to add B6? The rest don't "hunt" in my opinion. I've had my thyroid tested and it is normal, unlike my brother's which is low. Will check this at next GP visit.

Friday, April 22, 2011

Spring Lipid Results Are In

Picked them up this afternoon. Let's start with predictions:

  • 149 CHL (within VitalImaging Recommendation)
The actual turned out 10% better. In fact, it is among the lowest overall CHL results that I have had at:
  • 137 (Too Low?)
Trigycerides were not as good as I had thought, however. Prediction:
  • 99 Trigycerides (within VitalImaging Recommendation)
  • 111 - well within the "Normal", which tops at 125. So far so good.
LDL was good, too. Predicted:
  • 78 LDL (close to the recommended 70)
  • 69 - just below the VitalImaging recommendation of 70 and better than December.
Ah, but my HDL Cholesterol is still relatively low, given the Niaspan. Predicted
  • 54 HDL - if I tolerate 4 Niaspans (ballpark with regard to the recommended 60)
  • 43 - up from 39, but with two more Niaspan! This one is hard.
Overall, this is a better result than December, but only marginally in my opinion, given the increase in medication. I think, however, that my doctor will point to the LDL at 69 as the key. If I can hold that, and the low overall CHL, then I'll be doing about as well as I can. I might even be able to cut back on some of the meds.

I suspect, however, that the 2.5/mg Crestor really helped bring the LDL down. (It may have retarded the increase in HDL, too.)

I doubt whether my doctor will recommend 4 Niaspan/day to get a small incremental result in HDL.

My liver functions are affected. SGOT (AST) is fine, but SGPT is high. 44 where 39 is the upper limit. I don't think this is significant, however.

But ALK PHOS at 35 is significantly low and below the 50-136 normal window. I await my doctor's input here. It may mean cutting back on one of the drugs, probably Niaspan.

I'll look at the historical range in the liver functions and will follow up after I have seen my doctor in May.

Thursday, April 21, 2011

Spring Update

Just had my blood drawn today for the spring lipid panel, the last time being in December, or about 4 months. I'll be posting about the results when I get them, which might be as early as tomorrow.

In the meantime, I added a Twitter/Tweet panel on this blog. You can see it on the right hand side. This searches for recent tweets on lipid topics (like "LDL", "HDL", etc.) and displays them, looping through the six most recent. I plan to refine this when I have a better sense of who is updating lipid profile information and recommendations.

In February I posted a set of predictions if I could stay on my regime. Here are those recommendations:
  • 149 CHL (within VitalImaging Recommendation)
  • 99 Trigycerides (within VitalImaging Recommendation)
  • 78 LDL (close to the recommended 70)
  • 54 HDL - if I tolerate 4 Niaspans (ballpark with regard to the recommended 60)
My diet wasn't good the day before -- sausage links for starters, but I've stuck to my meds pretty well. Didn't feel like upping the Niaspan to 4 the night before, but I'm tolerating 3 okay. Took Zetia and 2.5/mg Crestor to complete the regime. I'd say 50 was more likely for HDL; 85 for LDL's; 100 for Triglycerides; 150 overall CHL. We'lll see. That would be good and I can up the Niaspan to 4 if need be and work more on my diet.

Another variable is weight. I was at least 10 pounds lighter in December. I had good numbers even though I was not taking Crestor - except in HDL - just 39. I was only taking one Niaspan a day. So my weight is up, but so is medication.

There is a very slight downward trend in BP since return from China due to more regular exercise. The baseline begins in July, 2010 before my departure to China in late August. See above.

Wednesday, February 2, 2011

Cardiologist: Year's Follow Up

Met with my cardiologist this afternoon. It's been a year since my last visit which included a stress test and a nuclear (thaliam) stress test. After the preliminaries (including an EKG), he was inclined to do another nuclear stress test. I asked whether that was necessary and after thinking about it a bit, recommended doing a stress test, and then the nuclear stress test, if indicated. I spent the next 10 minutes or so on the treadmill. This included 3 (possibly 4) levels. None was more demanding than a fitness club treadmill.

Got a clean bill of health and no nuclear test prescription. I asked for some sort of status report ('how am I doing?") and he said something like "no occlusion" for the blood flow. There is something of an oxymoron here in that there is calicification (occlusion) but "no occlusion" too. What I interpret here is that my body is making do the best it can. What that means in experiential terms, I think, is that my "pushing" so far (Cycle Oregon, 14 mile hike, etc.) can be accomodated by my heart and circulatory system.

There has been no pain, dizziness, fainting, or anything else I can feel at maximum O2Max. So far. My GP was more specific: "you want to prevent further buildup of plaque." In fact, I think this has been true, but perhaps could be confirmed by the nuclear stress test or the calcium scan. But in any case, the treatment would be the same.

I remember, though, my Kaiser doctor's warning that a stress test doesn't show as much for someone already in shape. In fact, with the exercises, the "hole" on the Wednesday ride, etc., one could predict the postive stress test. What this means is that exercise tests to this point haven't gone beyond the envelope developed by the body in copying with current plaque among other variables as well. [My Polar Fitness Index is currently 42, not much changed from June's 43. Top category for my age.]

My cardiologist thought that 4 Niaspans/day was doable. I'm now at 2 and will move to 3 by the end of February and hold, along with the other medication, for a month. If all feels good, then I might try 4 Niaspan towards the end of March for the next set of tests in April. I could have the best HDL score in recent years.

[Other medication: Trilipix (key), Crestor (2.5mg/key), Zetia, Lovaza (4 grams). In terms of metabolic ergonomics, maybe replace the Zetia with another Niaspan.]

It's interesting to predict scores for upcoming tests (a kind of biofeedback self-monitoring). Here they are:
  • 149 CHL (within VitalImaging Recommendation)
  • 99 Trigycerides (within VitalImaging Recommendation)
  • 78 LDL (close to the recommended 70)
  • 54 HDL - if I tolerate 4 Niaspans (ballpark with regard to the recommended 60)
It would be helpful to get back to my China weight by April. See if I can focus on vegetables and lay off snacks, maybe cut down on dairy. Doing pretty good on diet Coke.

It would also have been helpful to get the actual occlusion dimensions from my 2005 scan in Georgia, but I can't find that report. It is possible that it is with my LaVerne GP. I should also get the report (including pictures) from the 2010 nuclear stress test as data for monitoring actual physical occlusion. The VitalImaging summary indates my aorta size as 34 mm/Normal, but with a Calcium Score of over 400, which is 75%-tile for my ange. In fact, mine was much higher - and got my attention.

Friday, January 7, 2011

December Test Results In...

And better than I had hoped. Overall cholesterol: 165. This is better than the 180 I predicted. I was on 4 g of Omega-3 (Lovaza) , Trilipix, Zetia, and 500mg Niaspan just before the test. No statins.

LDL was 103; I predicted 100. Right on the money, not bad but up from my low of 77 and my goal of 75.

HDL was 39; down from my high of 47 (and from my prediction of 43). Nisaspan is most important here and I was taking only 1/3 of the recommended dose. So there's hope. I've restarted Niaspan and plan to build up to 3/day (1,500 mg). I was able to tolerate 2/day at one point with not too much flushing or stomach upset. I'll go to 2/day in about two weeks (with the aspirin). That's by the last week in January.

Triglycerides: 115 - Normal; predicted Normal. This is due to Trilipix, I think. Very powerful. Possibly also partly due to the 14 pound weight loss at the time the test. I will be continuing the 1/day Trillipix.

Had a good conversation with my GP. Highest priority is getting my HDL above 45. This is quite realistic using Niaspan.

Next priority is getting my LDL down in the 70's again. This is also quite realistic using Crestor and not much of it: 2.5mg/day. (I'll need to get that pill cutter.) This is a bit of a balancing act because Crestor, as a statin, can lower all lipids, including the good HDL. So this is a reasonable, incremental approach. 5mg did produce the LDL 77 before. 2.5 should get me close without affecting my liver enzymes. If it is worth it, I can restore the full 5mg/day.

I am happy to report that my liver enzymes, AST and ALT, are well within normal this time, so neither Crestor nor Niaspan is pushing these tolerances. This gives me confidence that if I hold the Crestor at 2.5/day and build up the Niaspan first, I won't drive up the liver enzymes too much. If all is good at my April test (with Niaspan at 2 or 3/day), and I want to push further, then I can consider 5mg/day Crestor, but I don't think this will be necessary. The upshot is that I will not be using any more medication than necessary to get the desired effect.

I'll try to keep from regaining the weight that I lost in China. I've regained about 4 of the 14 pounds that I lost. More vegetables and exercise. Maybe less dairy and cheese. I've cut down on diet drinks about 90% since the sweeteners my have some contra-weight loss triggering effect.

My GP reminded me that I have a follow-up appointment with my cardiologist. The thalium stress test showed some occlusion, as did the heart scan. He says that things could change in a year that might show up in the thalium stress test. He discouraged me from doing another heart scan to see whether I had arrested the progression of plaque buildup or even reversed it. Too much radiation, not enough time for the program to work (18-36 months the 1st time we discussed it last year). Also, the medication/program would be unaffacted. Still, it would be interesting to see the results of a program revealed in physical terms. I have a cardiologist appointment for early February.

Although not specifically lipid-related, it's been 5 years since my last colonoscopy, so I have that to be scheduled early in the new year.

So the next main post will be in April when those test results are in.