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.

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