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!)