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.