Thursday, November 17, 2016

O2 Max and Maximum Heart Rate

I retested the Own Index/O2Max on my Polar i810 and came up this time with 45 - as high as it has ever been. I was pretty relaxed when I took it, but the average of 43 is good. Tops for my age group.

The i810 projects a maximum heart rate of 146 or so, down from the 168 or so from just a year or so ago. I thought this was too low. On this morning ride I got up to 165, so I was right. I'm leaving the set maximum at 160 in the Garmin Vivoactive though.

That leads to these five heart rate zones.

50% - 80-95
60% - 96-111
70% - 112-127
80% - 128-143
90% - 144-159
100% - 160

More accurately, based on 165:

50% - 83-98
60% - 99-115
70% - 116-131
80% - 132-148
90% - 149-164
100% - 165

Today, I was in zone 2 on the uphill of the GoWalk group's Thursday walk.

That Monday, I topped out at 165 at the top of K2.

My Monday rides put me in 2-3 a lot of the time, with a couple of 4's and on occasion, a 5. No 5 on the Wednesday ride.

An average HR of 110 on that Monday would equate to zone 2 on both sets above. Fatburner.

Sunday, October 16, 2016

Holding Steady - 10 Pounds Lighter

I saw my endocrinologist October 11th and was released to my GP. In effect, there was nothing more that she could add at this point. Bottom line: I need to lose another ten pounds at least. There is no medication than can improve my current state.

That's not so bad. My cholesterol is in the 160's. My HDL's are too low - 37 this past time around, only off 3 from normal. My LDL's could be lower - I'm remembering the 77 I achieved earlier. However, I did have some issues with skin allergies to the statin I'm taking - now a generic form of Crestor at 2.5mg/day. There may be some sun sensitivity there. I'm hoping that if I cover up that I won't see the eruptions on my arms and hands and I can keep the current medication. Maybe in the winter, I can alternate between the 2.5 and 5 mg/day. That would help directly with the LDL's. If I lose another ten pounds, I might be able to dispense with the finofribrate that has kept my triglycerides (almost) in the normal range.

I feel good. My heart rate recovery is good as shown by my new gadget, the Garmin Vivoactive. The heart rates dovetails with the starting and stopping on my bike rides perfectly. I got a new battery for my Polar 810 and checked my Ownindex. It is down to 41 from 43 about a year ago. Still excellent for my age. It predicted a maximum heart rate of 146, however, way down from the 168 last time. I think I will use 160 as the maximum for my Vivoactive.

I'll update my spreadsheet of test results, but it has remained remarkably consistent. My endocrinologist said that I had a shot at the A/B (the buoyant versus the dense, grity lipids). But that could only come from weight loss. There is a big convergence here, so I am working on the next 10 pounds, maybe by early next year. I achieved a recent "low" of 193 a day or so ago. That would be 12 pounds from earlier this year.

I'm now counting calories - at least for now. I can avoid the 1,000 calorie dish if I know I can feel as good with a 200-300 calorie substitute.

I've meant to add some LA Fitness workouts during the week as well, to strengthen my upper body and to continue strengthening the muscles around my left knee. I need to practice going up and down stairs. Today, though, I'm planning to do the Mills loop.

"Steady as she goes" is the tag line of the day. That and counting calories.

Friday, February 5, 2016

The Gluten-Thyroid Connection

There is some evidence of a connection. See this article. But it is hard to sort out what it all means. The "Wheat Belly" syndrome, and more. Luckily, I've tested negative for thyroid problems, though my brother has not. In my endocrinologist's notes, I see "normal, no evidence of AITD," which is the AutoImmune Thyroid Disease.

Added Note: So far the treatment is not different from what my GP has been recommending. If I qualify, and if I go with the PCSK9 regime, it would be different. (I think I would have discussed and gone with the increase in Crestor. But the testing has increased the sense of urgency...)

A Note on Diabetes Type II

I note that among my carefully organized medical "problems" as diagnosed by my endocrinologist, "Type 2 diabetes mellitus without complications" has appeared. Will check to see whether the A1c put me over the threshold.

This has long been on the back burner and is associated with "metabolic syndrome," "insulin resistance" (for which my Kaiser doctor actually treated me), and NASH, the "fatty liver" syndrome. Maybe also "gluten belly.

The key question is how they bear on my LDL and liver weakness. (No kidney weakness, yet.)

All of these can be helped by weight loss. I'll enter my lab work into my excel file and take a look. My impression though is that there are not dramatic changes.

My endocrinologist's take on the high ferritin is "long standing-therefore unlikely due to malignancy." We'll see what diet and the cleanse from milk thistle will do.

She also noted a slight improvement between my last two lipid panels and suggested it just might be because of the diet and liver cleanse.

Instruction on Understanding Calcium Scans

Yesterday I had a good conversation with my cardiologist. I have been concerned with my "High" risk scores. See earlier post. He listened to my concern and read the Orange County and Millennium Imaging results and agreed that my risk factor had not changed appreciable, or rolled back, but he showed me why he believes his stress tests get closer to the truth. He sketched the following diagram:
At the top there is a blood vessel with an effective  diameter of 3 centimeters. There is no plaque and the blood flows freely.

Just below there is the same vessel, but the swirls indicate obstructive plaque. The effective diameter is now only 1 centimeter.

But below it, there is still another vessel, with the plaque on the OUTSIDE of the vessel. The vessel is unobstructed and continues to have the full 3 centimeter diameter. A calcium scan may not be able to distinguish between the second and third case. (Now it may be that I should say "calcium" instead of plaque - the scan picks up the calcium with is found with plaque. This is the nature of the indirect measure here.)

So the point is that you could have an unobstructed - or less obstructed vessel - with the same "high" risk score. My cardiologist's point is that it is important to test the blood flow for obstruction. This is done with a stress test or a thallium stress test, both of which I have had. He offered to give me an angiogram, which would test obstruction directly, but I politely declined.

Here is one article that looks at the predictive value of so called risk factors and also for calcium heart scans and finds that neither are as accurate as has been hoped. In fact, neither is "clinically useful." Hmm.

Medicare funds stress tests once a year, so I'll have mine later, in April. That will also be in time to add my cardiologist's recommendations to those of my endocrinologist.

In the meantime, I will up my dose of Crestor slightly, alternating between 2.5 and 5 mg/day. I am now doing 2.5/day. The immediate goal is to reduce my LDL to 75 - again the recommendation of the Orange County Institute five years ago. I had achieved it, but on a greater dosage of Crestor.

He had suggested resuming Zetia, but deferred that until after a lipid profile in April. My endocrinologist wanted me to defer increasing the Crestor dose as described above until I me with my cardiologist, who she hoped would consider the inject-able PCSK9. He was not interested in doing that at this time. If the increased statin-based Crestor can bring my LDL down to the mid-seventies, that would be it. The question is whether I can tolerate that. It's worked before.

I offered to leave lab slips, etc., with my cardiologist, but he was interested only in my last LDL result, which was 99. Talk about getting down to essentials. That is the best predictor of heart incidents I do believe.