Garmin Again

Here are some Garmin links:

https://connect.garmin.com/modern/activity/4972506206 This is the "key" link.

https://connect.garmin.com/modern/activity/4983718012 This is the "hot" one.

These are done is essentially the same time, but the "hot" one has a 100 more in the Calorie count!

I'd like to get these in here!

Polar "Ownindex" Replaced by Fastbeat!

My 02Max has fallen from 41 to 29!

41 was Polar's answer, over many years, to the 02Max question. There were schedules showing the best there is. Mine was excellent. It has fallen to "fair," so this is an occasion for "research." The company which does Garmin (which got me) is Firstbeat. I immediately downloaded the "white paper" that Firstbeat had done, and read it. Very Impressive!

I looked for some examples where I could actually do an 02Max test. One possibility was to walk 1 mile on a track. I went to my regular track; 4 times around it and I'd have my answers. I was 160 pounds. Now I needed my heart rate and time.

I estimated that I would come in at 120 bpm and that my time would be 15 minutes. In fact, I came in at 20 minutes, but my heart rate was 98! What could this extra 5 minutes do? The second time through I came in at 19, the third 17:23. The third time, I actually ran about half of the 1 mile. Let's look at the 19. Firstbeat was actually giving me 10 (19+10)!

It was actually 19, not 29 that I got. Add 10 and you have 29. What Firstbeat did was figure and average amount of 02Max and I got it. This really reflected the averages. What I got was 29, even though I scored 19 on the test.

I then considered the "jogging" file on Brian Mac website. I was at 160 pounds. I jogged on the track 4 times in a row. My overall time was 16 minutes. My blood pressure was 148 bpm. There is some loss because of my age, but even so, I came out 45 plus! That's a good score, much better than the 29 given that day by Firstbeat.

Some thoughts on why this lipid profile is the best in 76 years.

My stroke happened November 21, 2016.

At that time I weighed close to 205 pounds and my BMI was way off. I was carrying the pounds around my middle.

I did some healthy cooking at home with my partner, who strongly urged me toward a more plant-based menu. But I also continued to eat a lot of fatty snacks, fast food, and diet coke. 

After my stroke I transitioned through intensive care, acute care, assisted care, then home.

My food menus at intensive care and acute care were healthy. But not so at assisted care. Mostly meat, fat, salt and starch. Sugary desserts. Green vegetables were scarce. Meal service was slow, so I ate whatever they could serve quickly.

My partner and my sister did their best to help me. They brought homemade healthy meals as much as they could and we visited vegetarian restaurants. This was a new path for me. Food that fit my healthy recovery goals. And tasted good!

When I got home, I could choose my foods freely. And I was ready to explore much more than before my stroke.  My partner urged me toward more plant-based recipes, and adding veg to my old meat-based comfort foods.

My partner and I also visited my doctors for information. We have always agreed that my health decisions, and especially my recovery choices, should be based on sound, scientifically-supported medical advice.  My bloodwork and I were ready to listen!

My GP and my cardiologist told me two important things:

1) Healthy diet plus proper medication is my most powerful tool to lower my risk of stroke.
2) My nutrition should come from healthy FOOD. Supplements can't substitute for a healthy diet, even with exercise!

Both of these things supported what my partner had been telling me all along. I had been reluctant to change my longstanding eating habits, but my stroke motivated me to stop dragging my feet!

So we got to work. My sister kept bringing vegan recipes. And we cooked together on her visits. My partner created simple healthy meals for me to learn to make. Breakfast, lunch, dinner. She taught me the FDA "My Plate" program. So I can really see what a healthy meal should look like! We chose a Mediterranean-Style food pyramid to help guide my food choices. We cook "from scratch." Not mixes.

There was  a lot of inertia. I didn't want to change my habits right away. It has taken so much time, energy, and diligence from both people.  And so much creativity, to keep it simple, tasty, and fun.
I'm so grateful for their loving help. And now I understand. Every meal matters!

My change in food habits has worked wonders and I am celebrating!
I'm learning so many delicious ways to use vegetables, less meat, and more variety in my eating.

My newest lipid profile (see May 20th post) was accomplished with diet and exercise and medication. I'm 40 pounds lighter, fitter, and trimmer and my BMI is right on!

Healthy eating works. Loving thanks to my partner and my sister for cheering me on.
I invite you to celebrate with me!

The A1c

My A1c is now normal! This indicates the sugars you have eaten over the past three months.

Non-HDL Cholesterol

My Non-HDL Cholesterol was 80. This is great.

Triglycerides

My Triglycerides came down to 83!

The LDL Cholesterol: The Key

The LDL Cholesterol is key! With the Zetia, I've been able to get this down to 63. This is an extraordinary number. It is by far the best I have had in all 76 years.

Total Cholesterol

This is my Total Cholesterol.
It is 127.

Cholesterol -HDL

I'm in a celebratory mood.




This file is, overall, the best that I have had in 76 years.

The best in my total life.

(It is one off, 47 to 48 earlier this year. But this one point I make up with the 63 LDL. It is remarkable.)

Since 2010, Good News!

Not for some time have I had such good news!

From the May 9, 2018 Quest Report:

Consider the first four numbers

Cholesterol, Total                                  127
HDL                                                          47
Triglycerides                                            83
LDL                                                           63

The LDL at 63 is down better than the 77 that was indicated for me in 2010.

The LDL has been helped by the Zetia, and is remarkably low at 63.

The LDL was down from 110 from last time in June 30, 2017.
And triglycerides were 163 last time, June 30, 2017. This is remarkable.

Cholesterol is down from 191, from June 30, 2017.

HDL down only one point from 48 to 47, from June 30, 2017.

All remarkable!

The weight was key. I weigh now 160 approximately. 205 was high. I'm down 45 pounds!

A New OwnIndex of 42

As of 11/27/17 I am a 42!

O2Max and What's Happening

41 is what I got when I rebooted this last week.

We should do an analysis of what's changed. I'm at 170 pounds! My HDL is 48.

I almost forgot. I'm nearer to 150 with only 163  to go on Triglycerides.

I am a ways from the ideal LDL. 110 is a little better than 113 from this last range. (Check the time frame since I've begun the two pills. Krista has it 4/15/17 - I can still go down from here but 70 is bit much.)

I can put the good charts on this blog.

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.

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.

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.

Second Cataract Surgery: January 6, 2016

Although the focus of this blog are issues associated with lipids and heart health, I'd like to bring in other topics as well, in particular, the choices one needs to weigh in choosing the best sight strategy for the kind of lens you choose to embed.

One can go for maximum distance vision in both eyes. But then one almost surely will need reading glasses.

Or one can go for the new "multi" lens, which go for both distance and reading. As with many other compromises, you don't get the best distance or reading correction. At least that's been the story on the street.

Or one can go for "mono-vision" (as I did). This choice takes off from the natural distribution of function your eyes already have. One eye tends to do the "up close" work, the other eye, the distance work. In my case, my left eye naturally gravitates to closer reading, my right eye is my distance eye. My optometrist and I discussed this and set this up with my last several contact lens prescriptions.

Instead of correcting both eyes to 20-20, he corrected my left eye to about 20-40, so that it was easy to read. He adjusted the right eye to the full 20-20 for distance. This worked very well. I could read small text (say on my iPhone) without reading glasses or even squinting. While driving, the brain combined the two different corrections into something like 20-20 (at least during the day). This worked very well and the idea was to continue it with similar embedded lenses when I had cataract surgery.

But cataract surgeries don't typically happen together. The cataract in my left (reading) eye matured faster than the one in my right (distance) eye. So the idea was embed a "reading" lens in that eye.

But I've left out the issue of astigmatism. Both eyes have some astigmatism, which needs to be corrected in some way. My left eye was a candidate for a "toric" implant, a lens which corrects vision, including astigmatism, but costs extra.

My surgeon, who is also a lasik specialist, suggested that he could embed a regular lens and adjust for astigmatism through lasik surgery  at the time of the implant. The idea was to come up with about 20-40 in the left eye to continue my strategy of mono-vision.. This translated to a "backing off" about 1.25 diopters. (There is not necessarily a one-to-one correspondence to the 20-20, 20-30, 20-40, etc. and the diopters of correction. 1.25, 1.50, 1.75, etc. This needs to be actually tested in a standard refraction exam at your optometrist.)

Long story made short is this: while my left eye started out at 20-40, it has continued to "back off" until, almost a year later, it is 20-80. This is no problem of course in terms of reading, but I do feel some strain in combining distance vision, say while reading labels in a museum or driving at night. On a bright day, because the aperture of the iris is contracted, you get the same "depth of field" advantage as you do with a camera, so that my left eye may be even 20-30 at that time and the illusion of a full correction in both eyes is very strong.

The optometrist at the surgeon's office said something like, "The original target was 1.50 but I see that it is 1.75 or more..." I thought the original target was 1.25 (about 20-40) and was afraid the result was more like 20-100 in that dark room, but it was later tested at 20-80, which I think corresponds to 1.75.

In retrospect, I probably should have had a toric lens for my left eye. But my current status is within the acceptable window - as I attested at the office visit.

For the future, however, especially if the left eye backs off further (a real 20-100), then I would get a contact lens for it. The question is then, "At what correction"? From a discussion with my regular optometrist, it would have to have at least 0.5 diopter correction to be worth it. For me, that would mean, I think, a 20-40 "net" correction in that eye.

The question then becomes, does that compromise reading vision. If so, it doesn't appear to be worth it. My optometrist was able to simulate what it would be to have this. I really liked how it helped my distance vision (in the relatively dark room). But I was slightly put off by how I would have to slightly distance (extend out further) my iPhone for optimum reading. A close call.

In the meantime, the surgeon is going for "the best distance" in my right eye and I will get the toric lens. ($$)

Bottom line, after the surgery  and things settle. I'll revisit this.

New Component: Diet

The Scramble

I had an hour-plus meeting with my new endocrinologist's dietitian. Our shared philosophy: "Eat as much as you want, but eat the right foods." Here I remember my experience in China vividly. I ate as much as I wanted, but still lost five pounds a month. At the end of my longest stay there - three months - I lost fifteen pounds. The trick, of course, is to do it here.

She gave me four pages of recommendations, about which I'll be posting in the future. I'd like to highlight here, however, the "Scramble."

This is a variation. I started with  about a half sliced white onion, garlic, part of a sliced yellow pepper, and some sliced green onions. To those I added some already stir-fried ground turkey (just an ounce or so). When those were cooked (but not over-cooked) I poured in enough egg whites (from TJ's) to cover, then waited for that to solidify. I added some chili flakes to warm things up, and some pepper. And just a little fish sauce in place of salt. I then rolled up the scramble, cut it in two and placed it on halves of a round flat bread that I had toasted. Awesome!

Tests Pending for February 2016 Assessment

Seeing my new endocrinologist has led to a variety of tests and consultations to establish diagnoses that my previous doctors suspected and prescribed for without necessarily testing for. For example, my excellent Kaiser doctor suspected that I might have "fatty liver syndrome" (NASH) but didn't test specifically for it, or made his judgment on the more standard tests. He also suspected some "insulin resistance" and talked of my being "pre-diabetic".  But my A1c test was typically normal, so those diagnoses were put on the back burner after attaining and holding a good lipid profile.

Often heard, "Yes it would be nice to have additional tests results, but because they would not change your treatment regime, there is no need to do them." A follow-up heart scan was not indicated because it wouldn't tell us anything we don't already know - and are treating for. (In addition, it would introduce additional radiation, something I did not need after the IMRT treatments at RCOG in Georgia for my prostate cancer.) The VAP test is expensive, and the results would be interesting, but they would not affect what we are already doing for treatment.And so on. I've continued to take my medications, exercise, and eat reasonably well.

Yet ferritin levels continue to be high. A younger family member has had two strokes. A cousin died in her forties from atherosclerosis. My Dad had this disease as well and suffered at least one very bad stroke. So it is perhaps not surprising that my new endocrinologist is specifically testing for these assumed diagnoses.

I've consulted a second specialist for the NASH - "fatty liver syndrome." There are a set of labs which are grouped under this heading "NASH". I've taken the test and will get the results back when the specialists reports back to my endocrinologist.

In January, I'll take the "VAP" lipid profile (equivalent to the Berkeley Labs lipid panel), then meet with my new endocrinologist. The VAP panel will help diagnose the "small-LDL-trait" - where one's LDL is small and gritty rather than large and buoyant. It is perhaps the best predictor of stroke. The smaller and grittier, the greater is the likelihood of a stroke or some other heart incident.

In the meantime, I've started shifting to the foods recommended by the dietitian in my endocrinologist's office. I'm intrigued with the possibilities. The idea is not to eat less food, but to eat different food. The result should be weight loss, the last piece of the puzzle. I am enthusiastic because this has worked for me in China where I lose 5 pounds/month eating all I want. More about this in a separate posting.

I'm taking milk-thistle, a supplement which is supposed to detoxify my liver. We will see from the VAP and liver tests in late January where this helps ferritin levels, or the slightly high/low scores of my liver enzymes.(See this earlier post.)  I'll have an ultrasound of my liver before Christmas to see whether there are any anomalies there. More about these tests later.

Nor have my kidneys escaped notice, though I haven't identified any tests specifically directed at them.

It is likely that the ferritin, NASH, insulin resistance, small-LDL-trait (and throw in Hyperlipoproteinemia Type IIb see this) are all part of the same syndrome that can be addressed by essentially the same medications, loss of 15 pounds, and a shift of diet.