Spring Update

Just had my blood drawn today for the spring lipid panel, the last time being in December, or about 4 months. I'll be posting about the results when I get them, which might be as early as tomorrow.

In the meantime, I added a Twitter/Tweet panel on this blog. You can see it on the right hand side. This searches for recent tweets on lipid topics (like "LDL", "HDL", etc.) and displays them, looping through the six most recent. I plan to refine this when I have a better sense of who is updating lipid profile information and recommendations.

In February I posted a set of predictions if I could stay on my regime. Here are those recommendations:

• 149 CHL (within VitalImaging Recommendation)
  
• 99 Trigycerides (within VitalImaging Recommendation)
• 78 LDL (close to the recommended 70)
  
• 54 HDL - if I tolerate 4 Niaspans (ballpark with regard to the recommended 60)

My diet wasn't good the day before -- sausage links for starters, but I've stuck to my meds pretty well. Didn't feel like upping the Niaspan to 4 the night before, but I'm tolerating 3 okay. Took Zetia and 2.5/mg Crestor to complete the regime. I'd say 50 was more likely for HDL; 85 for LDL's; 100 for Triglycerides; 150 overall CHL. We'lll see. That would be good and I can up the Niaspan to 4 if need be and work more on my diet.

Another variable is weight. I was at least 10 pounds lighter in December. I had good numbers even though I was not taking Crestor - except in HDL - just 39. I was only taking one Niaspan a day. So my weight is up, but so is medication.

There is a very slight downward trend in BP since return from China due to more regular exercise. The baseline begins in July, 2010 before my departure to China in late August. See above.

Cardiologist: Year's Follow Up

Met with my cardiologist this afternoon. It's been a year since my last visit which included a stress test and a nuclear (thaliam) stress test. After the preliminaries (including an EKG), he was inclined to do another nuclear stress test. I asked whether that was necessary and after thinking about it a bit, recommended doing a stress test, and then the nuclear stress test, if indicated. I spent the next 10 minutes or so on the treadmill. This included 3 (possibly 4) levels. None was more demanding than a fitness club treadmill.

Got a clean bill of health and no nuclear test prescription. I asked for some sort of status report ('how am I doing?") and he said something like "no occlusion" for the blood flow. There is something of an oxymoron here in that there is calicification (occlusion) but "no occlusion" too. What I interpret here is that my body is making do the best it can. What that means in experiential terms, I think, is that my "pushing" so far (Cycle Oregon, 14 mile hike, etc.) can be accomodated by my heart and circulatory system.

There has been no pain, dizziness, fainting, or anything else I can feel at maximum O2Max. So far. My GP was more specific: "you want to prevent further buildup of plaque." In fact, I think this has been true, but perhaps could be confirmed by the nuclear stress test or the calcium scan. But in any case, the treatment would be the same.

I remember, though, my Kaiser doctor's warning that a stress test doesn't show as much for someone already in shape. In fact, with the exercises, the "hole" on the Wednesday ride, etc., one could predict the postive stress test. What this means is that exercise tests to this point haven't gone beyond the envelope developed by the body in copying with current plaque among other variables as well. [My Polar Fitness Index is currently 42, not much changed from June's 43. Top category for my age.]

My cardiologist thought that 4 Niaspans/day was doable. I'm now at 2 and will move to 3 by the end of February and hold, along with the other medication, for a month. If all feels good, then I might try 4 Niaspan towards the end of March for the next set of tests in April. I could have the best HDL score in recent years.

[Other medication: Trilipix (key), Crestor (2.5mg/key), Zetia, Lovaza (4 grams). In terms of metabolic ergonomics, maybe replace the Zetia with another Niaspan.]

It's interesting to predict scores for upcoming tests (a kind of biofeedback self-monitoring). Here they are:

• 149 CHL (within VitalImaging Recommendation)
  
• 99 Trigycerides (within VitalImaging Recommendation)
• 78 LDL (close to the recommended 70)
  
• 54 HDL - if I tolerate 4 Niaspans (ballpark with regard to the recommended 60)

It would be helpful to get back to my China weight by April. See if I can focus on vegetables and lay off snacks, maybe cut down on dairy. Doing pretty good on diet Coke.

It would also have been helpful to get the actual occlusion dimensions from my 2005 scan in Georgia, but I can't find that report. It is possible that it is with my LaVerne GP. I should also get the report (including pictures) from the 2010 nuclear stress test as data for monitoring actual physical occlusion. The VitalImaging summary indates my aorta size as 34 mm/Normal, but with a Calcium Score of over 400, which is 75%-tile for my ange. In fact, mine was much higher - and got my attention.

December Test Results In...

And better than I had hoped. Overall cholesterol: 165. This is better than the 180 I predicted. I was on 4 g of Omega-3 (Lovaza) , Trilipix, Zetia, and 500mg Niaspan just before the test. No statins.

LDL was 103; I predicted 100. Right on the money, not bad but up from my low of 77 and my goal of 75.

HDL was 39; down from my high of 47 (and from my prediction of 43). Nisaspan is most important here and I was taking only 1/3 of the recommended dose. So there's hope. I've restarted Niaspan and plan to build up to 3/day (1,500 mg). I was able to tolerate 2/day at one point with not too much flushing or stomach upset. I'll go to 2/day in about two weeks (with the aspirin). That's by the last week in January.

Triglycerides: 115 - Normal; predicted Normal. This is due to Trilipix, I think. Very powerful. Possibly also partly due to the 14 pound weight loss at the time the test. I will be continuing the 1/day Trillipix.

Had a good conversation with my GP. Highest priority is getting my HDL above 45. This is quite realistic using Niaspan.

Next priority is getting my LDL down in the 70's again. This is also quite realistic using Crestor and not much of it: 2.5mg/day. (I'll need to get that pill cutter.) This is a bit of a balancing act because Crestor, as a statin, can lower all lipids, including the good HDL. So this is a reasonable, incremental approach. 5mg did produce the LDL 77 before. 2.5 should get me close without affecting my liver enzymes. If it is worth it, I can restore the full 5mg/day.

I am happy to report that my liver enzymes, AST and ALT, are well within normal this time, so neither Crestor nor Niaspan is pushing these tolerances. This gives me confidence that if I hold the Crestor at 2.5/day and build up the Niaspan first, I won't drive up the liver enzymes too much. If all is good at my April test (with Niaspan at 2 or 3/day), and I want to push further, then I can consider 5mg/day Crestor, but I don't think this will be necessary. The upshot is that I will not be using any more medication than necessary to get the desired effect.

I'll try to keep from regaining the weight that I lost in China. I've regained about 4 of the 14 pounds that I lost. More vegetables and exercise. Maybe less dairy and cheese. I've cut down on diet drinks about 90% since the sweeteners my have some contra-weight loss triggering effect.

My GP reminded me that I have a follow-up appointment with my cardiologist. The thalium stress test showed some occlusion, as did the heart scan. He says that things could change in a year that might show up in the thalium stress test. He discouraged me from doing another heart scan to see whether I had arrested the progression of plaque buildup or even reversed it. Too much radiation, not enough time for the program to work (18-36 months the 1st time we discussed it last year). Also, the medication/program would be unaffacted. Still, it would be interesting to see the results of a program revealed in physical terms. I have a cardiologist appointment for early February.

Although not specifically lipid-related, it's been 5 years since my last colonoscopy, so I have that to be scheduled early in the new year.

So the next main post will be in April when those test results are in.

Looking Towards the December Test Results

I'll see my specialist on December 16th. There have been some interesting changes as a result of being out of the country for three months. I've lost 15 pounds! I think this is simply as the result of eating a ton of vegetables in China and not snacking between meals. I want to continue eating lots of vegetable here. In terms of exercise, I trained a lot less, though I was active and walked quite a lot. In the first month I did the Xinjiang trip which involved quite a lot of exercise, especially in the Kanas Lake area.

The result is that my base heart rate in the morning is higher by about ten beats: 60 rather than 50. I suspect I have less HRV as well, though I scored 41 on my Polar fitness test as opposed to 42 in July. I suspect that reading is optimistic.

My weight has gone down, but so has my general fitness level, I think, so that the weight-loss probably won't translate into lower cholesterol. I hasn't translated into lower BP. My systolic is about 10 points higher than before China. I'm getting readings of 130 and even 140 when I got 120 and 130 before. The diastolic remains about the same however.

My GP counseled cutting the Crestor (5mg) in two and taking only 2.5mg/day. I did that for a couple of weeks but found the cutting hard to do without a tool (which I may get today). Nor did I take the Niaspan until a couple of weeks before the test. So I would not anticipate the best results profile this time. I would say 180 overall cholesterol. Maybe 100 LDL and normal Triglycerides due to the Trilipix. 43 for the HDL reading.

A bit of recidivism here, but perhaps now with the weight loss, 2.5mg/day Crestor and at least 1 500mg Niaspan/day I can get back to where I want to be. No problem taking the 4g/day Lovaza, trandolipril, and Trilipix. I'll be eating more vegetables and oat and oat bran for breakfast. And increasing exercise.

There is still the training effect, but with weight loss, may I could get to the 150 overall cholesterol, 75 LDL, 125 Triglyercides and 45 HDL by March. Will do a lifeline screening on December 15th as well.

More on the July Tests

The July liver enzymes panel was held up and I've just got the results now. One of my liver enzymes is elevated at 67 rather than 60. The doctor recommened cutting the Crestor 5mg/day in half, which I will do. Another source of the elevation might well be the Niaspan, which played havoc with these same enzymes in 1984, but a conservative approach would be to cut back on the Crestor and not to go above 2 Niaspan/day when I am in China.

Overall, the doctor was quite positive about my July lipid profile. He asserted (as did Dr. #1, the endrocronologist) that a 60 HDL was unrealistic (as set by the Orange County folks -- the ones who did my heart scan), but that the profile was near-optimal anyway -- low LDL (most important), normal triglycerides, low over-all cholesterol, good ratio of Cholesterol/HDL, etc. And my current HDL at 47 is very good for me (it would be normally 36 or 37). So this is a maintainance mode.

Doctor #2 lamented that we hadn't done this 10 years ago, but the advent of new drugs like Trilipix I think are key -- and I lost a couple of years with the problems I had with Zocor. Anyway, maintaining this lipid profile should prevent further calcification. (There's a temptation to check in a year or so to see whether there has been a rollback, but Doctor #2 says it is not worth it since the treatment would be the same.) The next goal is really losing 10 pounds -- which might happen on the China trip from travel rigors and different food.

July 8 VAP Test: Preliminary Report

Darn! I've just barely held my own, but I haven't been able to increase my HDL much. Here are the most recent results:

• Overall Cholesterol: 163
• LDL: 96
• HDL: 47
• Triglycerides: 130

In March:

• Overall Cholesterol: 145
• LDL: 83
• HDL: 46
• Triglycerides: 91

There is obviously a "habituation" effect. I've upped the Niacin to over 1 500mg/day since March, often 2, but not 3. That's still a goal. Note increase in LDL from January of this year.

The LDL has gone up from the 77 when I started this regime then. It included Trilipix,for the first time, a key. Still one a day on that.

The HDL is a point higher at 47, which is high for me. Nowhere near the 60 recommended though. I will take 2 Niaspan (1,000mg)/day and if I tolerate it, I'll try for 3. That might get me to 50 which would be rewarding.

Triglycerides have moved slightly over normal (125) at 130, but much lower than in the past - 191 in March of last year.

I didn't get a chance to catch the "Pattern A/B" score on the phone. Will check that when I get a copy of the VAP results in the mail.

So "staying even" is a good summary. Maybe the Vitamin D can help, but I'm puzzled why there should be a deficiency, given the time I'm in the sun biking.

My cardio-vascular program has remained pretty much the same, a little under 100/miles/week, about 2,000-3,000 calories per week, sometimes a lot more.

July - Before next VAP Test

I met with my specialist yesterday and got excellent advice about the timing of my medications. I will be taking the Crestor 5mg in the evening rather than the morning. I suspect that this is the better time to take it anyway and that I should have been doing so all along. In the morning I can add the Citrus Pectin supplement for additional fiber, which may bind (or sequester) some cholesterol. Taken with the Crestor, it would bind with it and make it less effective.

Since I am tolerating 4 grams of Lovaza, I will try a 5th, starting today. But we agreed that increasing the Niaspan would help HDL in particular. I'm averaging about 2/day (1,000mg) at this point. I am going to try to build up to 3/day (1,500) within the next week prior to the next VAP test, which will I'll take in the July 5-13 window.

She advised me that it would be good to add a source of alphalipoic acid, so I've laid in a supply of Trader Joe's 100mg Alphalipoic Acid as well as a 250mg Milk Thistle. I'll start with one a day of each so that I'll have at least a week on these, too, before the next VAP. Key metric: HDL -- will it be higher than 45? Important metric: Pattern A rather than Pattern B. Will there be substantial movement from B to A?

Recap:

• Take Crestor in evening rather than morning
• Start Citrus Pectin in the morning
• Up Niaspan to 3/day
• Up Lovaza to 5/day
• Add 2 sources of alphalipoic acid
• Keep rest as usual (see earlier posts)

Trader Joe's also has a Reservatrol supplement which I'll try if I don't have a pill overload. Wal-Mart now stocks a Reservatrol liquid in their fruit juice section, but it is pricey at about $7/half gallon.