Tuesday, October 29, 2013

Familial Hyperlipoproteinemia

My daughter was very kind to share some of her recent lab reports with me. They confirm that she shares the same lipid dysfunction that my brother and I have. I used to know the exact name from my time at Kaiser, but needed to review the options at Wiki. I am virtually certain that we have

Hyperlipoproteinemia IIb.

[Note: I have reported elsewhere in this Blog that is is "IIIb" whereas it appears to be IIb. Type III has no "b".]

The link is the Wikipedia article is here. The symptoms as reflected in my lab results are 1) elevated overall cholesterol (but not necessarily by very much 200-240 without medication, 2) low HDL (under 40 which is the low threshold for normal), 3) elevated triglycerides (over 125 according to the current threshold), and 4) elevated LDL's (over 100 where 75 is ideal). 

The type IIb description is spot on except for the how HDL's, though this could be a consequence of the other conditions described. Only 1% of the population has this.

Having low HDL's is a bummer. They are the "good" lipids that can dissolve/control the bad lipids (LDL's in particular). I have a 91 year-old biking companion whose HDL's are also in the 90's. At least one sister has HDL's in the 50's - so she doesn't share this syndrome. Omega-3 supplements can help here. Also possibly Niacin, though there is apparently some discussion currently on the efficacy of niacin.

Having high LDL's is a bummer. LDL-level is probably the best predictor of heart incidents, particularly strokes. After exercise and diet, statins are the best defense here. Small amounts of Crestor have reduced my LDL's from over 125 to the mid-70's. This is encouraging, but I am still a candidate for heart attack, stroke and mini-strokes. Even with treatment the "official" likelihood of a cardiac event in the next 10 (72-82) years is about 1/3. This gets one's attention. A recent stroke (thankfully not debilitating) within the family gets my attention. How best does each family member deal with this kind of lipid dysfunction?
  • No question. Start with diet and exercise. The loss of even 10 pounds can help  -- lower overall cholesterol for one. 
  • Omega-3 for sure. I take 4 grams of prescription Omega-3/day. That's Lovaza.
  • High fiber supplements can help. ("sequestrants" fibrous materials that can bind up lipids in the bowel). Psyllium on occasion. Lot's of fruits and veggies, less dairy, salty snack foods, etc.
  • But  low doses of statins are a necessary part of the response to this lipid problem. Even 2.5 mg/day has had a big effect on my LDL's, getting me to as low as 77 (but currently 89).
  • Trilipix has been a big help as well. It has brought my triglycerides down to below normal and has helped with respect to overall cholesterol (and maybe LDL/s) as well. It's not a straight-out statin (rather a fibrate I think) -- I'll check it out, but for now I need it.
That's about it. I take Ubiquinol (COQ10), the new form ("ol" rather on "one") which is more readily dissolved and effective. The statins remove Q10 from the system so that it needs to be replaced. I wish more doctors said this to their patients.

Finally, I take Zetia which binds with lipids in the gut (and has been shown to have virtually no side effects). 

And a baby aspirin (very important). :)

CPAP Steady State

I just returned from a visit with my sleep doctor yesterday. He signed off until next mid-May. My usage has stabilized to the compliance level as I become accustomed  to the new full face mask. I feel very encouraged. I'm also getting used to the ResScan software and how to set up and interpret reports. I notice that last night I had virtually no apnea or near-apnea events. And today I feel quite rested. But I did notice that there were several events on the report of yesterday. This leads to the question of whether you can have these events if the CPAP is configured optimally. I'll be researching this.

In any case, the events were far smaller than the events during my sleep test. I said "14" to my doctor. He replied, "but 22 when you were sleeping on your back." I think the maximum number I have seen with the machine is 9 and they may in part be artifacts. I'm convinced the machine is preventing most of the events I remember hearing when my Dad was snoring in the Ozarks.

When the CPAP is functioning normally, the O2 levels don't drop below 90%. My Oximeter confirms this. This reassures me about losing neurons due to oxygen deprivation. The Snorelap app shows that I'm no longer snorking (the sound samples show this), but the decibel level of the CPAP is non-trivial. (The Darth Vader effect.) Still, this is a real improvement both sound-wise and health-wise.

Tuesday, October 1, 2013

Heart and Sleep Apnea

I've been diagnosed with OSA Obstructive Sleep Apnea and have been getting used to a CPAP machine. This has led me into a whole new area of health maintenance, but it connects closely with heart health.

Apnea events decrease the oxygen in the blood and increase blood pressure causing additional stress to the system. A good CPAP machine can prevent both the OSA and snoring. I'm waiting for a full face mask to replace the nostrils-only one I was originally prescribed. With the nostrils-only mask I find I breath snore and have apnea events even so. The full-mask should correct this. A chin strap did not.

I also ordered a wonderful small gadget that records oxygen levels and heart rate. Both identify apnea events at night. I can test various remedies and see how they fare. The CPAP machine can't prevent apnea events when I breath through my mouth. The O2 device shows this. I still have these events even if I am using the machine.

Snoring can be sampled and recorded on my iPhone SnoreLab, so I can check how the devices affect snoring. I can cross check the SnoreLab results with the O2 device results and also the ResMed results. This has been fun to do.

The SnoreLab inventor also recommends a mouthpiece which helps with snoring. I checked it out and bottom line it does prevent apnea events completely (in the time frame I checked) and reduces snoring but not completely. I checked the apnea events on the O2 device and the snoring on SnoreLab. Very cool.
I'll check the full face mask in this way. I'll also max out the adjustment on the mouthpiece and see if I can reduce snoring further. If I can do this, then I may not need the CPAP machine. I think a combination of "side-sleeping" (triggered by a tennis ball, for example) may work, or work for travelling.

The principle here is to cause the lower jaw to extend a quarter of an inch or so forward. This opens the airway which, kinked, causes the blockage and apnea. It may be uncomfortable to do this however, so I may be optimized already. With side sleeping that may be just fine. The key is to monitor oxygen and if the mouthpiece prevents any events, well and good - no oxygen loss.

Fall 2013 Status Update

Haven't yet posted my last set of numbers from (roughly) six-month cycles. In fact, everything is settling down.

Cholesterol holds steady at 154 as of the August 2nd tests. I'm quite happy with this. Took me a long time to get here. Have been holding since January of 2010 when I resumed using statins. First at 2.5 on the recommendation of my cardiologist. Upped it slightly this past year (2013) by alternating 2.5 versus 5mg/day. My GP is quite happy with this as well.

LDL is also okay at 89 last test. It's been creeping up. I've had it in the 70's and the Orange County Institute recommends 77. Still, this is much better than without statins. This would appear to be the key contribution of statins. It's important, since LDL levels are taken more seriously than overall Cholesterol levels or the ratio between over all cholesterol and HDL.

It's HDL that I am concerned about. Couldn't quite muster 40 this last round. 40 is the threshold of normal. The Rx Omega 3 helps here, but according to my GP, Niacin no longer works. I am not convinced of that but I haven't been taking it. I may start on 500mg/day and work up. I think that has helped in the past. I don't think I can get any further increase from exercise. The Dr. says that more Omega 3 is not a good thing, so no help there. The Dr. is not worried about this. For him that is close enough. He thinks that I'm optimized in terms of medication. Losing 10 pounds would be the next step. A longer term goal would be to maintain 195, then move to 185. That seems pretty tough considering my interest in cooking and gormandizing.

Triglycerides are good. The Trilipix is key here.

CHL/HDL ration is about 4, which is average.

Good news that my liver enzymes are okay. I can tolerate the slight increase in statins (Crestor alternatiing 5 and 2.5/day)

And my Vitamin D deficiency is almost rectified 29 where 30 is the threshold of normal. I upped my intake here to 5,000 units/day. I understand that particularly good things happen in the upper part of the normal window. 5,000/day will keep me moving into that good zone (high normal) but I need to be sure not to edge too far above normal where there could be toxic effects. Given the slow rise, that won't be for several months. Hopefully, the next Vitamin-D3 test should show me in the 50's or above. There are some general immunity boosts there and some metabolism and heart-health benefits.

The results from the metabolic panel are consistent with earlier ones. Pretty steady-state here.

Today in a particularly relaxed moment was able to do the Polar OwnIndex on both watches. Came out 40 in each case, which is in the "Excellent" category for my age. Also, this year's results were consistent with last year's also at 40. This number correlates quite closely to my O2Max reading were I to do one.

So "Holding my Own" would be the way to sum this up. Whether there is an actual rollback from the plaque buildup detected at the OC Institute is another question. My gut feeling is that is would be pretty mucfh the same if I did the $300 or $600 (all organ) test. If I got some really low LDL readings, lost 20 pounds, had an OwnIndex of 50, I bet there would be some rollback. I wonder, though, whether I could ever meet those goals.(Canute has just run a Half Marathon at my age at 1:47!)

Sunday, June 30, 2013

Meeting with GP, June, 2013

I'd expressed my concern that statistics from both the Orange County Heart Center and LifeLine have projected something like a 30% chance of a heart incident in the next 10 years. I didn't want to be fatalistic and wondered whether given all that I was doing, that was still the risk probability. The response was "don't worry about LifeLine's stats!"

Yet there wasn't another number that he could substitute for the 30%. Again the line was "you are doing all that you can...". Right, right.

In fact, the LifeLine page made a distinction between things that could be controlled and things not. Weight is a factor - and was mentioned by my GP as well. You can take aspirin (which I am). But the genetic predisposition to arteriosclerosis in my family is significant. And it's not likely that I've rolled back much plaque buildup. I have set a goal of losing 10 points by mid-October (205-195).

There is a minor concern in my SGPT (ALT) liver enzyme reading. It is 55 where the outer limit of normal is 39. I checked earlier liver results and find them not out of range. The ration between the two has remained constant for example. I've had a high or 70. Mostly, though, the readings have been in the 30's. I wonder whether some resavatrol or an extra Niaspan before the last-but-one test may have caused the spike. If the trend continues I'll alternate 2.5 with 5 mg doses of Crestor. If not, I'll cut back down to 2.5/day.

Sunday, May 12, 2013

Life Line Take Action Risk Factors

The modifiable risk facotrs are

  • Overweight
  • Taking Aspirin Daily (which I am)
The non-modifiable risk factors (finally!)

  • Cardioovascular Disease (pretty general though)
  • Family History of Stroke or TIA (sure enough)
  • Atherosclerosis (I have some -- assumed non-reversable -- but maybe not)
  • Asthma
  • Age
  • Family History of COPD or Emphysema (Dad had it)

Life Line Discussion 6 For Life Health Assessment: Lifestyle Choices

This is helpful. I've been depending on about 3-4 days of biking per week. But exercise at least 5 days a week is suggested by the AHA. I'd like to do something at least 6 days a week: harder on some days and less so on the others. Walking an hour on the Mills trail, jogging with Van can be included.

In addition, activities can be split into several short periods of 10 minutes, 2-3 times a day. This may be the mode that can provide the BP-exercise-protection. But what would they be? Wii? Walk? Chin ups?

Monday and Wednesday rides; Tuesday VG; Thursday jog with Van, Friday Mills Trail; VG on Saturday. This looks good.

But some short, intense exercises might be good on week days also. Need to think them out. And space them out so that the BP protection is maximized.


Will revisit this with the "China Diet Here"


Will be within the 14 drinks for me per week. No problem.


Avoid 2nd hand smoke (and smog)

These are all points that are noted in this section. Just on lifestyle.

Life Line Discussion Lung Cancer

Low Risk at 5 but having a history of asthma and bronchitis predisposes one to lung cancer. Also, growing up in a smoking environment predisposes.

Life Line Discussion Chronic Obstructive Pulmonary Disease (COPD)

A surprising (for me) score of "Moderate" at 35

I do have a family history, am 71 years old, and have had asthma. This may account for the "Moderate". But I'll ask my GP if there is anything else that he hears when he listens to my lungs.

I did get that bronchitis for a day or so in Istanbul which took a week or so to fully recover from. It's possible I had some phlegm at the time of the Life Line Screening but my impression is that this result is based

Life Line Discussion Diabetes

Page 11. Risk at 20 is Low.

The lifestyle indication is better diet. Portions, vegies (3 greens/meal), tofu more often, less dairy, that sort of thing.

Life Line Discussion Stroke

79 is "Very High" (and very troubling). See earlier post.

The folks at Orange County Heart Institute said that 70% is "in the genes" leaving only 30% for medication and lifestyle. I've maxed out on drugs for lipids, so that leaves only lifestyle. I've maxed out pretty much on exercise (except for frequency), so that leaves diet. Everything is coming down to diet.

In China, I lose 5 pounds/month. Can I institute the "China Diet" here? Maybe the Vegan Before 6 would work.

I like categories. Dairy? Snacks? Bread? Salt?

I certainly can cut down on salt by cutting out open-ended salty snacks.

But what would be an associated goal? 15 pounds over the next three months; plus less salt. Also, exercise every day to diminish BP spiking. Could that translate into a "High" rather than "Very High"?
Shoot doing this by Fall. If I go to China there could be additional benefits.

Life Line Discussion Congestive Heart Failure (CHF)

Page 10 has a little more material than the result page. But the score of 15 is "Low".

With CHF the chambers of the heart become weak. If it is in the left ventricle, blood and fluids collect in the lungs or heart. If it is in the right ventricle, fluid collects in the legs and feet.

CHF is the number one cause of death in people age 65 and older. With CHF, the cause of death is either acute pulmonary edema (fluid in the lungs), or an arrhythmia (irregular heart beat.

Dad's CHF involved fluids in his lungs.

Life Line Discussion Coronary Heart Disease (CHD)

58 is the result (on a scale of 100). See earlier post on CHD. The question is whether lifestyle changes, in particular diet, can lower this. Can this be lowered to "Moderate" for example?

Life Line Discussion Waist

41 where 40 is upper limit of Normal. Make getting this to 40 a goal. By Fall, 2013.

Saturday, May 11, 2013

Life Line Discussion: Blood Pressure

168/83 is of course high, but my average of the last couple of years is 120/67. Spiking is the issue. I'll be commenting more on that.

It may not take much cardio to affect BP. A ride back today from the Farmer's Market may have done it. After a shower and watching golf, my BP was 109/59; lower than the 173/73 which I got this morning in bed.

Life Line Discussion BMI

Two risk factors including this one indicate weight loss. I should shoot for 185. Keep exercise and improve diet.

My height was measured at 5' 10". I was six feet. The BMI would be affected a bit if I were a true 5" 11".

Life Line Heart Risk Assessment

The explanation on page 8 is helpful. It is based on the Framingham study. I'll quote it.

"Your Heart Risk Assessment Score, reported as "10-Year CHD Risk", is greater than 30%. That means about 1 out of 3 people with this level of risk will have a heart attack or die of heart disease within the next 10 years. Although this level of risk is high, there are many things you can do to reduce your risk, such as diet and exercise in addition to medications that can help you proactively reduce your risk. We recommend you speak with your physician about what you can do to reduce your heart disease risk."

It seems that we are left with lifestyle choices since drugs are giving the desired lipid profile.

Question: is this locked? Or would lifestyle changes bring this down to say 20%? What would it take to do that?

Life Line Lipids & Metabolic

The good lipid profiles are confirmed by the pin-prick tests adjusting for my not fasting.

Glucose of 107 is high but is accounted for by my not fasting. Same with tryglycerides.

C-Reactive Protein is a low-risk indicator for cardiovascular disease. It is part of my immune system which seems to be working well. A caveat is that it is non-specific.

Life Line Discussion of Results: Carotid to Osteoporosis

Life Line prepared a 20 page report. Beginning on page 5, there is a narrative account of the results. I'll remark on sections of interest.

Carotid Artery Disease - "Your screening revealed minor plaque buildup which does not affect blood flow."

Atrial Fibrillation - Normal, but an "Important Note" says "A possible abnormality has been identified: At the time of your atrial fibrillation screening, your heart rhythm indicated a possble conduction abnormaility." I wonder if this is the PAC that has been identified before. I left the EKG with my GP.

Abdominal Aortic Aneurysm - Normal. But that means 3 cm or greater. There could be small ones?

Peripheral Arterial Disease (PAD) - Inconclusive. Normal is with an ABI (Ankle-brachial Index) of between 0.90 - 1.3. The ultrasound device measures systolic pressures in arms and legs. A ration of less than 0.90 indicates plaque buildup. Mine at greater than 1.3 could suggest that small arteries of the legs are calcified. You see this with people with diabetes or chronic kidney disease. This could be a falsely high ankle to brachial index. (I need to know more about the ratio.)

Here is a Wikipedia account. The ratio is between the systolic BP of the arms and the legs. Lower blood pressure in the legs would indicate blockage. My reading is higher. Could be inconclusive. Could be worse. :) I should be able to reproduce the results and will post back. There is some indication that exercise can increase sensitivity of this test, so I can try it just after exercise.

I ran my own tests of BP on left arm and let, then right arm and leg with my monitor. On the left the ration was 1.34 which was outer limit of normal. With some exercise of the ankle, it might be within normal range. On the right arm and leg the ratio was 1.2 or in normal range. This is important since it was the right side only that was inconclusive in the last Life Line screening. I would seem that my GP was right in not worrying about the finding last time.

  • The left arm: 128/68; leg: 171/73; ratio   171/128 = 1.34
  • The right arm: 122/67; leg: 147/65; ratio 147/122 = 1.20

Diabetes, heavy smoking, kidney problems can all give elevated ABI ratios. (Not a happy thought.)

Osteoporosis. Low Risk at -0.3.

Expected, but calcium, Vitamin D and weight-bearing exercise are all recommended.

Life Line Lung Cancer

"Low" (0-20) at 5. Good news.

I suspect that this is a result of my not smoking and that my parents didn't have lung cancer I suspect that if you factor in Uncle Baker and Cousin Allen, this indicator would go up.

Life Line Chronic Obstructive Pulmonary Disease (COPD)

"Moderate" (21-40) at 35. This is a cause of concern.

This was not a direct test. I didn't blow into anything. It would be helpful to know what it's based on. The gap between 35 and low is 15 which appears appreciable.

Given my level of exercise I suspect this may be a false positive. Will check with GP.

Life Line Diabetes

"Low" (0-20) at 20. Good.

In fact my glucose result was a little high 107 but I had not been fasting. My ACT's have been in the normal range. Gridley thought I might have some insulin resistence, but this doesn't appear to be the case.

I do have some indication of a "fatty liver" and my ferretin levels have been high in the past.

The scale is the same for all six Life Disease Conditions.

Life Line Stroke

"Very High" (71-100) at 79 - This is very troubling.

Again, the gap between the measure (79) and "Moderate" seems immense. (79-40=39). I would have to descrease this measure 50%.

Again, with this measure change with lifestyle changes? Could I shoot for say a "35" in a year? Six months? Two years?

Mom had small strokes (MID) which resulted in Alzheimer's-like symptoms.

Life Line Congestive Heart Failure

"Low" risk (Green - 0-20) at 15.

This is a good result. Again it appears to be a 0-100 spectrum with the same thresholds as the CHD scale. "Congestive Heart Failure" was on Dad's Death Certificate.

Low 0-20
Moderate 21-40
High 41-70
Very High 71-100

Life Line Coronary Heart Disease

"High" (41-70). 58 is my risk score. It would help to know the units. It looks like a spectrum from 0-100.

0-20 Low
21-40 Moderate
41-70 High
71-100 Very High

It looks like a big leap to get from 58 back down to 40 which is moderate. According to the Orange County Heart scan, I'm in a "High" category. Check back to the beginnng of this blog or click here to see their results. Although I don't remember the time line, there was a 1 in 5 chance of a heart incident with it. Another measure suggested I was 21 times more likely to have a heart attack if left untreated. Again, time frame and specific treatment need to be specified. The heart risk assessment of Life Line showed a 30% chance of heart risk in the next ten years.

My GP (and others) hold the position that some reversal can occur with plaque build up in the heart. But the test to establish that is both expensive ($300 last count) and adds more radiation, of which I have probably had my share. I remain curious. My GP did suggest a full body scan (to look for hidden issues that he can't feel directly) and that would include a retest of the heart scan. That's about $600.

But whatever the scan would show, the current medication would still be prescribed. In other words, since the results would not affect the treatment, the tests are not medically indicated.

Of course lifestyle including diet are still variables. Losing 15 pounds would be a good thing. A still better diet would be a good thing. A question for my GP is if I lost those pounds and became a vegetarian would the "58" change? In six months? In a year?

Even if there is no reinforcement, a response to that number might well involve weight loss and diet changes.

What if I lost an inch on my waist and reduced the BMI 10%? Would the CHD indicator come down? That would be a nice reinforcement.

Life Line 6 for Life Disease Condition

Life Line uses a "proprietary Life Line Screening ...algorithm" to identify disease conditions which they call "6 for Life Disease Conditions." My question is whether these are "locked in" or whether the measures on which they are based can be improved. I'll take them up in order. (Reverse the order if you are reading postings sequentially in this blog.)

They are:
  1. Coronary Heart Disease (CHD)
  2. Congestive Heart Failure (CHF)
  3. Stroke
  4. Diabetes
  5. Chronic Obstructive Pulmonary Disease (COPD)
  6. Lung Cancer

Life Line Waist

A nice feature of the Life Line tests is that they are all markers of risk. I know the circumference of one's waist is a good indicator however humble its origins. Mine is 41 where "Normal" maxes at 40. This is a good goal.

Friday, May 10, 2013

Life Line Blood Pressure

168/83! This was the 3rd try and it was on my wrist. The left and right arms didn't yield a result. My average, resting and lying down is 120/67. See my post on spiking earlier.

Life Line BMI

"Moderate" risk. 25-29.9. "Normal" is 18.5-24.9 It is a reasonable goal to get this to normal. I probably was normal at 189 pounds in Hangzhou in the Fall of 2010.

Life Line Heart Risk Assessment

"High Risk" (Red) at "Greater than 30" where that's percent. As I read it, I have a 30% chance of a heart incident in the next ten years. I will come back to this. The Orange County Heart Institute also gave this as a result. It comes from correlating know risk factors from the Framingham Study with my known risk factors, including heart issues in the family. The question is whether this is still 30% given my response including medication, exercise and diet. I'm hoping to hear my GP say that my risk is now lower than 30%. This may be tantamount to checking to see whether there has been a roll back of heart plaque from my last test at the Orange County Heart Insitute. My GP may say "You clearly have risk but we are addressing it in every way possible. It is less than it would otherwise have been. Surely, but is it less than 30% over the next ten years?

Life Line C-Reactive Protein

"Low Risk" (Green) at 0.10. Good news.

Life Line Glucose

"Pre-Diabetic" (Yellow) at 107. In fact, fasting, I typically get less then 100. Previous results have been in the low 90's. This is an anomaly.

Life Line Complete Lipid Panel

I had already had a panel done the previous day (see earlier post). But this came with the package so I went with it even though I had not fasted. This elevated some of the readings.

Total Cholesterol: 156 which is "Desirable" (Green).
HDL is only 34 (and lower than the 39 of the earlier test) and is reg-flagged.

This of course is the familial predisposition (hyperlipoprotenemia type ????) which I share with my brother. Low HDL, average overall Cholesterol, elevated triglycerides, elevated LDL's -- and probably small trait LDL's - the small, gritty kind. Omega3 can help bump that up to 40 and slightly more, but the 50's are probably out of reach, though maybe niacin can do it.

But I've shown 40's previously and the last result was 39 and my GP though the profile was fine.

Triglycerides are shown as borderline here but probably because I wasn't fasting. With the Trilipix they are typically within the "Normal" range which is shown here as <150 .="" p="">
So the lipid panel can yield a "Desirable" result. The lingering question is whether this reflects the same state was the same test finding without drugs.

Life Line Osteoporosis

"Low Risk" (Green) less than -1.2; Actual reading -0.3

Thought so.

Chronic Venous Insufficiency

Not tested but recommend NOW. Deals with venous refill time in seconds, right and left sides.

Life Line Peripheral Arterial Disease

"Inconclusive" on both sides with "2.11" entered. The clinical measure is the "Ankle Brachial Index".

Previously, I had gotten an inconclusive on my right ankle (which was the one which had been broken) but not the left. My GP didn't seem concerned. But I'm puzzled there is an issue here with peripheral arteries given the amount of exercise I have given them (or maybe not!).

Life Line Abdominal Aortic Aneurysm

"Normal" - Less than 3 cm. Good news and same as last screening a couple of years ago.

My Did had a ruptured aortic aneurysm and was pulled through it. My Aunt Cay also had one and didn't get by it.

Life Line - Atrial Fibrillation

"Normal" - as expected. Heart Rate 61 beats per minute.

I do have a mild PAC - Premature Atrial Contraction" or "missed beat" that has been diagnosed on several occasions. But that was not identified here.

An associated EKG however was flagged (more on that later).

Life Line Screening Tests Carotid Artery Disease

My GP thinks highly of the relatively inexpensive Life Line Screening tests for identifying risk area early. These are not covered by Medicare (why not?) but are based on finding risk areas and correlating them to the Framingham Study for  risks identified there. I had a set done on April 26, 2013 and have just gotten back the results. The first is for Carotid Artery Disease.

The result is a "Mild" risk. I was obviously hoping for "Normal" but at least did not get "Moderate" or "Significant' finding. The "Mild" risk is associates with a PSV flow volume of less than 110cm/s on both the left and right side. Here is a learned discussion about velocities, age, and hypertension.

The Screening Results report define the risk as "Mild - Small amount of plaque. Blood flow still normal. Blood velocity  less than 110.This also gets into the question of how a stress test can mask issues with conditioned athletes. The regular test doesn't get them to where there may be an issue. 

Blood Pressure Spiking and Exercise

On the Life Line testing April 26, 2013 I had a BP count of 168/83, quite high for me. The helpful attendant suggested it might be the "white coat" syndrome, and it might be, but I've noticed that my BP tends to show high if I have not had recent excercise. This morning, for example, it was 128/81 where the latter was much higher than my long time average of 68. I'd remarked earlier in this blog about spiking.

I tested it a few minutes after and found it 129/67, essentially my average (120/68 is the year's average in Hearwise). I do take BP readings lying down and after a few minutes wait. So when things settle, my Blood Pressure is fine.

But there is a lot of time when I am not relaxed and lying down. I suspect that my BP is significantly higher then.

Still later today I took my BP after hiking up to the water tank on the Cobol side of the Mills Wilderness Trail. After my shower and lunch I took my BP relaxing on the couch. 104/51! Quite clearly exercise has a profound effect.

The moral of the story? Exercise is good and can protect against BP spiking. But how long does the effect last? What about the period before exercise and after. When does the BP creep up?

In particular, how often is it a good idea to do excercise to keep one's readings low?  For example, it is worth doing a 45 minutes walk in the morning, and then one in the afternoon? Each day? Or is it a good idea to do a bike ride in the morning and then a walk in the afternoon? Each day? 

These questions are testable. I'll have a 26 mile bike ride on Saturday in the morning. I can check my BP an hour before and an hour afterwards. Then I could do a walk in the afternoon and check my BP before and after at similar time intervals.

What would I project?

My BP tends to be low in the morning, so at 7am I'd project 120/70

After the ride, shower, etc., I would project a low reading 105/60

In the early afternoon my BP may indeed creep up. 120/80?

After a half-hour walk, relaxing on couch, etc., I'd project 105/65. (In other words, I wouldn't expect the disastolic number to be quite as low as earlier. I see some higher reading in previous afternoon checks.)

If the numbers check, then the afternoon walk would some some protective effect on BP, which would otherwise have a slighter higher diastolic and an appreciable higher systolic reading.

But these numbers may not be significant overall in terms of protection against cardiac events. In other words, the "extra" afternoon walks  may lower BP a little but not be significant in terms of preventing actual cardiac events.

But I suspect that some exercise each day would be useful. It couldn't be heavy exercise each day like a 4 hours bike ride to the beach. The idea would be to find the level of "recovery" exercise (say every other day) that will just produce this beneficial effect. It would vary for fitness levels, but for me I image it would be a 45 minute vigorous walk, maybe the Mills walk to the water tank. Maybe it could be my 8 miles Thompson Creek bike ride.These are testable obviously. I can check and post separate entries on them.

Tuesday, April 30, 2013

Liver Enzymes Down

My GP wanted me to follow up a month after tests showed a 70 SGOT. That's now down to 55. The medication was the same with a slight rise in Crestor, so that's good news.

In fact, the lipid profile was quite close to what it was before. I had a peek into what would happen if I didn't fast (since I didn't anticipate a lipid profile on LifeScreening tests I took the next day). Tryglycerides were higher and was my glucose (107 instead of in the 90's).

Will follow up this summer.

The lipids were 146, 39, 85, 125 by PVH

156, 34, 158, 90 and 4.5 by Life Line (pin prick).

Wednesday, February 27, 2013

Preliminary Results

My GP called with the results of the tests I took yesterday. Quick! Numbers are good, but liver enzymes are rising.

But first the results. Here is what I predicted:

"I'll take one a day [Niaspan]until my test next Tuesday. I'll also maintain the 1000 unit D and may intersperse 2.5 and 5 of the Crestor to see whether I get a good bump. Maybe overall Cholesterol around 150; HDL maybe 45; LDL maybe around 80 or less. That would be great. Triglycerides less than 125. An overall ratio of about 3.5 between Cholesterol and HDL. That would be better than the 5 or more I had last time."

Nailed the overall cholesterol which is 151!

HDL was 42 rather than 45, but that's good and my GP is fine with these numbers.

He didn't mention the LDL. I'd be surprised if it were much under 100. We'll see.

Triglyserides were right at 125 if I remember. Another "Nailed!"

Ratio: 3.59; Again, "Nailed!"

If the LDL comes in under 80 I will be within the OC Heart Institute specs and may actually have rolled back some plaque build up.

It's possible that the increase in liver enzymes was due to an increase in Crestor from 2.5 to 5 AND that Niaspan.

The plan is for me to alternate daily 2.5 and 5mg Crestor and then retest in a month. That would be after I get back from Africa. During that time I would NOT take Niaspan.

I'll continue 1,000 units of D daily; increaed on the 20.3 or so from 17. Need to get to 30. I'm not overdoing the D intake! :)  Maybe increase this dosage to two a day.....

I'll look for the LDL when I receive the hardcopy of the lab test results.

Thursday, February 21, 2013

Spikes and Triggers

It took some time for me to get my blood pressure down when I met with my cardiologist on Feb 7th. He was late and I was a bit irritated. When he first took it, it was something like 142/88. Very much different from my average of 121/67. Of course, I take my BP lying down and when I am lying down. To his credit, my cardiologist waited to take it again. In fact, after my stress test.

There was no problem on my stress test. It went on for some time, then he stopped it. After I rested for several minutes, he took my BP again and it was 119/80 or so, which is what both of us expected. What was interesting to me was that my BP didn't come down earlier and needed the "reboot" of exercise to do so. One has to watch out for the "spike" which stays up after the stress goes away. Hence the warning about stress at work.

The "make fat" trigger then came to mind. In insulin-resistent patients, carbohydrates can cause the "make fat/store fat" response instead of burning that carbohydrate. Again, exercise is helpful here. In the absence of exercise, one's metabolism can "spike" or "be triggered" in unexpectedly adverse ways. If one can control these triggers, a lot of good will result.

GP Follow Up

Today was the day for my yearly physical. Also a chance to talk with my GP about some cardiology issues.

First off, I had a good exam. That included the DRE to confirm that my prostate was flat, intact and not growing.

I raised the issue of an ideal LDL in the mid-70's rather than 100. My GP said that if you have had heart surgery, the mid-70's is the recommendation. Otherwise, 100 is okay. Less is better, but perhaps not worth the side-effects. He is satisfied with my last lipid profile.

My cardiologist wanted me to consider raising the Crestor from 2.5 to 5 mg. I told him I was not inclined because of the side effects, but that I would consider using Niaspan. That satisfied him but not my GP. His view was that I might alternate 2.5 with 5 mg every other day. Essentially what I've been doing with vitamin D. I'll take one Niaspan a day until I have my next lipid profile next week. Then I'll see what the results are.

My GP discouraged Niaspan because it could elevate liver enzymes and he thought that could be an issue. I found on the other hand that with a slow build up I could tolerate as many as 3/day (1,500 mg) and that the AST?SGOT were only mildly elevated - and I wouldn't be using MORE of a statin.

I'll take one a day until my test next Tuesday. I'll also maintain the 1000 unit D and may intersperse 2.5 and 5 of the Crestor to see whether I get a good bump. Maybe overall Cholesterol around 150; HDL maybe 45; LDL maybe around 80 or less. That would be great. Triglycerides less than 125. An overall ratio of about 3.5 between Cholesterol and HDL. That would be better than the 5 or more I had last time.

My GP helped solve another puzzlement. My cardiologist had talked about blockage. Yet the stress test didn't indicate blockage. So I have blockage, and I don't. My GP used a sludge analogy. There is crud in my pipes but the blood is free-flowing enough that there are no stenosis symptons.  That is, there are no negative effects -- chest pains, dizziness, clammyness, etc. . So there is sludge build-up but no adverse blockage at this time. As shown by the stress test.

This is helpful because the OC Heart Institute showed the crud. My cardiologist said however that stenosis determination is hard because the crud can be on the outside and the inside of the vessels and that is why he does the thalium stress test. He finally said something like "no obstruction."

My GP said there was no problem with "going all out" and not holding back on a bike ride or hike. He seemed to encourage it. I'm glad he said it because that is my reading too. He did caution me with regard to travel however.

Thursday, February 7, 2013

Yearly Visit to my Cardiologist

I'd forgotten my yearly appointment until I got the reminder call yesterday. Today I talked with my cardiologist, had my blood pressure checked and had a stress test.

First off, my cardiologist was less then impressed with my last lipid profile. He explored whether I would be willing to increase the Crestor dosage from 2.5mg. I declined citing the side effects that I had suffered previoiusly on an increased statin dosage - skin eruptions (which hint of return currently). There a a couple of spots on my left hand which I will discuss with my dermatologist in a few weeks.

I did say that I would starting taking Niaspan again. I did that this evening starting with 500 mg (one tablet)

Looking at my lipid results from last November, I, too, am less than impressed. All were in normal range except the CHLOL/HDL ration which was 5. My LDL was 126 after having been as low as 77 earlier. I can see why my cardiologist wanted to up the statin.

Off course, I've been on a bread-making kick and have indulged in cheese, dairy, snacks, and red meat. Maybe I can cut back. I certainly did in China. Maybe make only one loaf a week; cut down on open-ended snacking. Try to reproduce the China environment.

I think I see Sharma in 4-5 months. Maybe get the Niaspan to 2-3 per day by then. Maybe cut down on portions or cut out a meal every 3-5 days. Substitute soup or fruit.

See if I can get a 165 CHOL; 45 HDL, and 100 Triglycerides. Maybe 85 for LDL. That would be a good result. 3.67 would be the ratio. Better than the  187; 35; 153, and 126 for LDL's last November.

My Blood Pressure was up to 142/88 even after some waiting. I did the stress test, which got me breathing pretty well. I rested after that and the Dr checked again. Sure enought it had dropped to 119 or so. But it took exercise to do that. Otherwise, it would have stayed up there. It had spiked and didn't come down until coaxed. I appreciated the Drs patience on this. No need for further BP medicine. But this shows the importance of light exercise. It would be good to get into the cardio zone at least once a day to deal with the "spike."  I need to think aboutt this.