Thursday, February 21, 2013

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.

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