May Doctor's Visit

Good visit. Dr. confirmed I was doing as much as I could do. More statins might actually reverse plaque, but I would almost certainly not be tolerant of the dosages needed. I'm clearly in maintenance mode, however. This could be confirmed by going back to the same facility/machine (different machines "slice" in different ways). But there is still the issue of radiation. He suggested 5 years. Since last test was 2009 if I remember, that would make it 2014 or about three years from now. That's fine with me.

With the low 69 LDL it is not as important to get the HDL up to 60 -- virtually impossible for me. Anything over 45 should be adequate for maintenance however. I can tolerate 3 Niaspans and will plan to do so, though may backslide to two if my stomach is acid.

Before I returned from China I was not using any statins and still had a respectable profile: 165 Chl; 103 LDL; 39 HDL. (Triglycerides were in the normal range both times.)

That was with one Niaspan. With three Niaspan and 2.5mg Crestor, the LDL dropped to 69; Chl to 137 and HDL went up to 43. These are diminishing returns, but important.

Next tests in August.

Cumulative Lab Results

On a trial basis I'm posting my Excel spreadsheet collection of lipid watch results over the years. It can be viewed via Google Docs, even on an iPhone. Might be helpful.

Cross Training: Heart Rate Creep

I brought along my Polar 725 HRM and transmitter this last Saturday for a familiar run on Euclid Avenue in Upland, CA. My friends and I have been doing this since I started running in the late 1980's. On Saturday I ran up to the fire station on 24th from our start on 17th. That's 1.75 miles up. Then I ran back. I felt good so I ran down to 16th and back to 17th twice to add another mile. (The blocks are conveniently 1/4 mile each.) My total: 4.5 miles.

I made it a point to back off if my rate went over 140 going up. I'd walk until it came down to about 120 and would start again. I was pleased that the "creep" in heart rate was modest. See the sawteeth just before the peak. Many's the time in the past my rate hit about 180 here. My time up to the fire station was a little under 27 minutes, close to 15 minutes/mile or 4 miles/hour. Not bad for an old guy going uphill. My time back was a little over 19 minutes, about 9 min/mile or a little over 6 miles/hour. Both segments included walking to bring HR within the 120-140 range. I rested only 3 minutes at the top, 2 minutes at the bottom, and 5 minutes at the end. My average excluding these rests was almost exactly 4.5 miles/hour. Include them and the average is about 4 mph. Notice that there is some cardiac "creep" at the end and that my heart rate going downhill was greater than going uphill! (124 versus 139). And I had trouble keeping my rate in the targeted range. I think this fact has to do with training and would be true whether or not I was going downhill. But the fact that I was going downhill reaveals the creep more explicitly. If I went on a 10K training regime, I would expect to see less creep on the second half on this run as I built up my miles.

The 5 minute rest at the end shows the drop in heart rate which is good in the first minute dropping from 160 to 130, but it required another couple of minutes to get to 100. Still okay, I think.

Not shown here is the most recent OwnIndex of 40, equivalent to an O2Max without the hassles of actually doing an O2Max test. Excellent for my age, so they say. I'm glad I took my Polar along with me. Cross training occasioned a cross-check on my cardio, and it could be a lot worse.

This helps me with my conjecture about the best when to get to Pasadena from Claremont on foot. It's a walk/run combo like Euclid.

Low ALK PHOS

I looked back over my liver enzymes history and found nothing out of the ordinary. Some highs and lows, but not too far out of the envelope except for this last test result for Akaline Phosphatase. A quick look at the websites give the following as the usual causes of low ALK PHOs:

"Reduced alkaline phosphatase levels are associated with a number of conditions including zinc deficiency; folic acid deficiency; low levels of phosphorus; vitamin B6 deficiency; vitamin C deficiency; excessively high vitamin D intake; malnutrition involving inadequate protein assimilation (this can also be caused by hypochlorhydria – low production of stomach acid); Celiac disease; hypothyroidism; anaemia or inadequate parathyroid gland function."

I have been taking Vitamin D supplements, but only as a result of low Vitamin D which my endrocrinologist saw a couple of lab tests ago. I'm taking Folic Acid supplements. Maybe I need to add B6? The rest don't "hunt" in my opinion. I've had my thyroid tested and it is normal, unlike my brother's which is low. Will check this at next GP visit.

Read more: http://www.brighthub.com/health/conditions-treatments/articles/62899.aspx#ixzz1KSSbSaEq

Spring Lipid Results Are In

Picked them up this afternoon. Let's start with predictions:

• 149 CHL (within VitalImaging Recommendation)

The actual turned out 10% better. In fact, it is among the lowest overall CHL results that I have had at:

• 137 (Too Low?)

Trigycerides were not as good as I had thought, however. Prediction:

• 99 Trigycerides (within VitalImaging Recommendation)

Actual:

• 111 - well within the "Normal", which tops at 125. So far so good.

LDL was good, too. Predicted:

• 78 LDL (close to the recommended 70)

Actual:

• 69 - just below the VitalImaging recommendation of 70 and better than December.

Ah, but my HDL Cholesterol is still relatively low, given the Niaspan. Predicted

• 54 HDL - if I tolerate 4 Niaspans (ballpark with regard to the recommended 60)

Actual:

• 43 - up from 39, but with two more Niaspan! This one is hard.
  

Overall, this is a better result than December, but only marginally in my opinion, given the increase in medication. I think, however, that my doctor will point to the LDL at 69 as the key. If I can hold that, and the low overall CHL, then I'll be doing about as well as I can. I might even be able to cut back on some of the meds.

I suspect, however, that the 2.5/mg Crestor really helped bring the LDL down. (It may have retarded the increase in HDL, too.)

I doubt whether my doctor will recommend 4 Niaspan/day to get a small incremental result in HDL.

My liver functions are affected. SGOT (AST) is fine, but SGPT is high. 44 where 39 is the upper limit. I don't think this is significant, however.

But ALK PHOS at 35 is significantly low and below the 50-136 normal window. I await my doctor's input here. It may mean cutting back on one of the drugs, probably Niaspan.

I'll look at the historical range in the liver functions and will follow up after I have seen my doctor in May.

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.