My GP wanted me to follow up a month after tests showed a 70 SGOT. That's now down to 55. The medication was the same with a slight rise in Crestor, so that's good news.
In fact, the lipid profile was quite close to what it was before. I had a peek into what would happen if I didn't fast (since I didn't anticipate a lipid profile on LifeScreening tests I took the next day). Tryglycerides were higher and was my glucose (107 instead of in the 90's).
Will follow up this summer.
The lipids were 146, 39, 85, 125 by PVH
156, 34, 158, 90 and 4.5 by Life Line (pin prick).
Tuesday, April 30, 2013
Wednesday, February 27, 2013
Preliminary Results
My GP called with the results of the tests I took yesterday. Quick! Numbers are good, but liver enzymes are rising.
But first the results. Here is what I predicted:
"I'll take one a day [Niaspan]until my test next Tuesday. I'll also maintain the 1000 unit D and may intersperse 2.5 and 5 of the Crestor to see whether I get a good bump. Maybe overall Cholesterol around 150; HDL maybe 45; LDL maybe around 80 or less. That would be great. Triglycerides less than 125. An overall ratio of about 3.5 between Cholesterol and HDL. That would be better than the 5 or more I had last time."
Nailed the overall cholesterol which is 151!
HDL was 42 rather than 45, but that's good and my GP is fine with these numbers.
He didn't mention the LDL. I'd be surprised if it were much under 100. We'll see.
Triglyserides were right at 125 if I remember. Another "Nailed!"
Ratio: 3.59; Again, "Nailed!"
If the LDL comes in under 80 I will be within the OC Heart Institute specs and may actually have rolled back some plaque build up.
It's possible that the increase in liver enzymes was due to an increase in Crestor from 2.5 to 5 AND that Niaspan.
The plan is for me to alternate daily 2.5 and 5mg Crestor and then retest in a month. That would be after I get back from Africa. During that time I would NOT take Niaspan.
I'll continue 1,000 units of D daily; increaed on the 20.3 or so from 17. Need to get to 30. I'm not overdoing the D intake! :) Maybe increase this dosage to two a day.....
I'll look for the LDL when I receive the hardcopy of the lab test results.
But first the results. Here is what I predicted:
"I'll take one a day [Niaspan]until my test next Tuesday. I'll also maintain the 1000 unit D and may intersperse 2.5 and 5 of the Crestor to see whether I get a good bump. Maybe overall Cholesterol around 150; HDL maybe 45; LDL maybe around 80 or less. That would be great. Triglycerides less than 125. An overall ratio of about 3.5 between Cholesterol and HDL. That would be better than the 5 or more I had last time."
Nailed the overall cholesterol which is 151!
HDL was 42 rather than 45, but that's good and my GP is fine with these numbers.
He didn't mention the LDL. I'd be surprised if it were much under 100. We'll see.
Triglyserides were right at 125 if I remember. Another "Nailed!"
Ratio: 3.59; Again, "Nailed!"
If the LDL comes in under 80 I will be within the OC Heart Institute specs and may actually have rolled back some plaque build up.
It's possible that the increase in liver enzymes was due to an increase in Crestor from 2.5 to 5 AND that Niaspan.
The plan is for me to alternate daily 2.5 and 5mg Crestor and then retest in a month. That would be after I get back from Africa. During that time I would NOT take Niaspan.
I'll continue 1,000 units of D daily; increaed on the 20.3 or so from 17. Need to get to 30. I'm not overdoing the D intake! :) Maybe increase this dosage to two a day.....
I'll look for the LDL when I receive the hardcopy of the lab test results.
Thursday, February 21, 2013
Spikes and Triggers
It took some time for me to get my blood pressure down when I met with my cardiologist on Feb 7th. He was late and I was a bit irritated. When he first took it, it was something like 142/88. Very much different from my average of 121/67. Of course, I take my BP lying down and when I am lying down. To his credit, my cardiologist waited to take it again. In fact, after my stress test.
There was no problem on my stress test. It went on for some time, then he stopped it. After I rested for several minutes, he took my BP again and it was 119/80 or so, which is what both of us expected. What was interesting to me was that my BP didn't come down earlier and needed the "reboot" of exercise to do so. One has to watch out for the "spike" which stays up after the stress goes away. Hence the warning about stress at work.
The "make fat" trigger then came to mind. In insulin-resistent patients, carbohydrates can cause the "make fat/store fat" response instead of burning that carbohydrate. Again, exercise is helpful here. In the absence of exercise, one's metabolism can "spike" or "be triggered" in unexpectedly adverse ways. If one can control these triggers, a lot of good will result.
There was no problem on my stress test. It went on for some time, then he stopped it. After I rested for several minutes, he took my BP again and it was 119/80 or so, which is what both of us expected. What was interesting to me was that my BP didn't come down earlier and needed the "reboot" of exercise to do so. One has to watch out for the "spike" which stays up after the stress goes away. Hence the warning about stress at work.
The "make fat" trigger then came to mind. In insulin-resistent patients, carbohydrates can cause the "make fat/store fat" response instead of burning that carbohydrate. Again, exercise is helpful here. In the absence of exercise, one's metabolism can "spike" or "be triggered" in unexpectedly adverse ways. If one can control these triggers, a lot of good will result.
GP Follow Up
Today was the day for my yearly physical. Also a chance to talk with my GP about some cardiology issues.
First off, I had a good exam. That included the DRE to confirm that my prostate was flat, intact and not growing.
I raised the issue of an ideal LDL in the mid-70's rather than 100. My GP said that if you have had heart surgery, the mid-70's is the recommendation. Otherwise, 100 is okay. Less is better, but perhaps not worth the side-effects. He is satisfied with my last lipid profile.
My cardiologist wanted me to consider raising the Crestor from 2.5 to 5 mg. I told him I was not inclined because of the side effects, but that I would consider using Niaspan. That satisfied him but not my GP. His view was that I might alternate 2.5 with 5 mg every other day. Essentially what I've been doing with vitamin D. I'll take one Niaspan a day until I have my next lipid profile next week. Then I'll see what the results are.
My GP discouraged Niaspan because it could elevate liver enzymes and he thought that could be an issue. I found on the other hand that with a slow build up I could tolerate as many as 3/day (1,500 mg) and that the AST?SGOT were only mildly elevated - and I wouldn't be using MORE of a statin.
I'll take one a day until my test next Tuesday. I'll also maintain the 1000 unit D and may intersperse 2.5 and 5 of the Crestor to see whether I get a good bump. Maybe overall Cholesterol around 150; HDL maybe 45; LDL maybe around 80 or less. That would be great. Triglycerides less than 125. An overall ratio of about 3.5 between Cholesterol and HDL. That would be better than the 5 or more I had last time.
My GP helped solve another puzzlement. My cardiologist had talked about blockage. Yet the stress test didn't indicate blockage. So I have blockage, and I don't. My GP used a sludge analogy. There is crud in my pipes but the blood is free-flowing enough that there are no stenosis symptons. That is, there are no negative effects -- chest pains, dizziness, clammyness, etc. . So there is sludge build-up but no adverse blockage at this time. As shown by the stress test.
This is helpful because the OC Heart Institute showed the crud. My cardiologist said however that stenosis determination is hard because the crud can be on the outside and the inside of the vessels and that is why he does the thalium stress test. He finally said something like "no obstruction."
My GP said there was no problem with "going all out" and not holding back on a bike ride or hike. He seemed to encourage it. I'm glad he said it because that is my reading too. He did caution me with regard to travel however.
First off, I had a good exam. That included the DRE to confirm that my prostate was flat, intact and not growing.
I raised the issue of an ideal LDL in the mid-70's rather than 100. My GP said that if you have had heart surgery, the mid-70's is the recommendation. Otherwise, 100 is okay. Less is better, but perhaps not worth the side-effects. He is satisfied with my last lipid profile.
My cardiologist wanted me to consider raising the Crestor from 2.5 to 5 mg. I told him I was not inclined because of the side effects, but that I would consider using Niaspan. That satisfied him but not my GP. His view was that I might alternate 2.5 with 5 mg every other day. Essentially what I've been doing with vitamin D. I'll take one Niaspan a day until I have my next lipid profile next week. Then I'll see what the results are.
My GP discouraged Niaspan because it could elevate liver enzymes and he thought that could be an issue. I found on the other hand that with a slow build up I could tolerate as many as 3/day (1,500 mg) and that the AST?SGOT were only mildly elevated - and I wouldn't be using MORE of a statin.
I'll take one a day until my test next Tuesday. I'll also maintain the 1000 unit D and may intersperse 2.5 and 5 of the Crestor to see whether I get a good bump. Maybe overall Cholesterol around 150; HDL maybe 45; LDL maybe around 80 or less. That would be great. Triglycerides less than 125. An overall ratio of about 3.5 between Cholesterol and HDL. That would be better than the 5 or more I had last time.
My GP helped solve another puzzlement. My cardiologist had talked about blockage. Yet the stress test didn't indicate blockage. So I have blockage, and I don't. My GP used a sludge analogy. There is crud in my pipes but the blood is free-flowing enough that there are no stenosis symptons. That is, there are no negative effects -- chest pains, dizziness, clammyness, etc. . So there is sludge build-up but no adverse blockage at this time. As shown by the stress test.
This is helpful because the OC Heart Institute showed the crud. My cardiologist said however that stenosis determination is hard because the crud can be on the outside and the inside of the vessels and that is why he does the thalium stress test. He finally said something like "no obstruction."
My GP said there was no problem with "going all out" and not holding back on a bike ride or hike. He seemed to encourage it. I'm glad he said it because that is my reading too. He did caution me with regard to travel however.
Thursday, February 7, 2013
Yearly Visit to my Cardiologist
I'd forgotten my yearly appointment until I got the reminder call yesterday. Today I talked with my cardiologist, had my blood pressure checked and had a stress test.
First off, my cardiologist was less then impressed with my last lipid profile. He explored whether I would be willing to increase the Crestor dosage from 2.5mg. I declined citing the side effects that I had suffered previoiusly on an increased statin dosage - skin eruptions (which hint of return currently). There a a couple of spots on my left hand which I will discuss with my dermatologist in a few weeks.
I did say that I would starting taking Niaspan again. I did that this evening starting with 500 mg (one tablet)
Looking at my lipid results from last November, I, too, am less than impressed. All were in normal range except the CHLOL/HDL ration which was 5. My LDL was 126 after having been as low as 77 earlier. I can see why my cardiologist wanted to up the statin.
Off course, I've been on a bread-making kick and have indulged in cheese, dairy, snacks, and red meat. Maybe I can cut back. I certainly did in China. Maybe make only one loaf a week; cut down on open-ended snacking. Try to reproduce the China environment.
I think I see Sharma in 4-5 months. Maybe get the Niaspan to 2-3 per day by then. Maybe cut down on portions or cut out a meal every 3-5 days. Substitute soup or fruit.
See if I can get a 165 CHOL; 45 HDL, and 100 Triglycerides. Maybe 85 for LDL. That would be a good result. 3.67 would be the ratio. Better than the 187; 35; 153, and 126 for LDL's last November.
My Blood Pressure was up to 142/88 even after some waiting. I did the stress test, which got me breathing pretty well. I rested after that and the Dr checked again. Sure enought it had dropped to 119 or so. But it took exercise to do that. Otherwise, it would have stayed up there. It had spiked and didn't come down until coaxed. I appreciated the Drs patience on this. No need for further BP medicine. But this shows the importance of light exercise. It would be good to get into the cardio zone at least once a day to deal with the "spike." I need to think aboutt this.
First off, my cardiologist was less then impressed with my last lipid profile. He explored whether I would be willing to increase the Crestor dosage from 2.5mg. I declined citing the side effects that I had suffered previoiusly on an increased statin dosage - skin eruptions (which hint of return currently). There a a couple of spots on my left hand which I will discuss with my dermatologist in a few weeks.
I did say that I would starting taking Niaspan again. I did that this evening starting with 500 mg (one tablet)
Looking at my lipid results from last November, I, too, am less than impressed. All were in normal range except the CHLOL/HDL ration which was 5. My LDL was 126 after having been as low as 77 earlier. I can see why my cardiologist wanted to up the statin.
Off course, I've been on a bread-making kick and have indulged in cheese, dairy, snacks, and red meat. Maybe I can cut back. I certainly did in China. Maybe make only one loaf a week; cut down on open-ended snacking. Try to reproduce the China environment.
I think I see Sharma in 4-5 months. Maybe get the Niaspan to 2-3 per day by then. Maybe cut down on portions or cut out a meal every 3-5 days. Substitute soup or fruit.
See if I can get a 165 CHOL; 45 HDL, and 100 Triglycerides. Maybe 85 for LDL. That would be a good result. 3.67 would be the ratio. Better than the 187; 35; 153, and 126 for LDL's last November.
My Blood Pressure was up to 142/88 even after some waiting. I did the stress test, which got me breathing pretty well. I rested after that and the Dr checked again. Sure enought it had dropped to 119 or so. But it took exercise to do that. Otherwise, it would have stayed up there. It had spiked and didn't come down until coaxed. I appreciated the Drs patience on this. No need for further BP medicine. But this shows the importance of light exercise. It would be good to get into the cardio zone at least once a day to deal with the "spike." I need to think aboutt this.
Friday, November 30, 2012
Took my most recent lipid profile after getting back from two months in China. I'd lost ten pounds, as expected, so I was curious to see what my results would be.
I hadn't made a projection this time but it would have been along the lines of Overall Cholesterol - 150; HDL - 45; Triglycerides - 125; LDL - 100. I had not been taking Niaspan but had been pretty conscientious with the 2.5 Crestor. I had run out of Trilipix for a few days, though restarted it before the test on 11/21/12.
In fact, I did not do as well. Overall Cholesterol was up to 187; HDL a mere 35 (lower than it had been for some time), while Triglycerides were up to 153. LDL: 126!
My doctor, however, thought these were just fine and didn't recommend any changes of medication. However, I doubt that I was at the "reversal" level that I had hoped for. I still toy with the full body scan at Orange County, but that's $600 and a lot of radiation. But it is the only way to "see" whether the medication is actually working.
Decisions: I'm most surprised about the 35 HDL. It could be because I was light on the Trilipix. But it could also be the "training" or habituation effect that I've been expecting at some point. I think I will start taking 500mg of Niaspan at night. That will at least begin the build-up process and may be enough to have an effect.
I won't take more Omega-3. I'm tolerating 4 grams well. I had been skimpy on the Zetia before the test. I don't think that was the difference but it couldn't hurt and may be good for bowel health (results similar, but less, to psyllium).
No more Crestor than 2.5/day. I'm glad 2.5 has an effect. I'd rather not be on statins at all.
Same with Trilipix. Glad my prescription is only one/day.
That leaves Niaspan, so I'll give it go.
Psyllium as a sequestant might be helpful, too. Maybe I can start with a low dosage, say a tablespoon a day with half a Kalenite pill. Build up to 2 tablespoons/day (in juice) by the time of the next test, which will probably be in eight months, or some time in July, 2013.
Monday, February 13, 2012
Yearly Meeting with Cardiologist
Last Thursday I made my yearly visit to my cardiolgist. I've been seeing him yearly since my GP got me to do the heart scan a little over two years ago. I've had a thalium stress test with my cardiologist about that time also.
He did take the initiative to put me back on Crestor at 2.5mg/day. That was a key, along with my GP's recommedation of Trilipix, also about two years ago. Along with Omega3, I've had the best lipid profile for years and it has been consistent over the past two years. Nor has this caused real problems with my liver enzymes. Thus I can hold back a bit on Niaspan and use it when (and if) I need to; for example, when the system becomes habituated with the current levels.
The outcome of my visit? Ok EKG, stress test next year. He also discouraged me from doing the full bodfy scan. Not on the basis of radiation, but general need. He drew a diagram on the exam-table paper showing calcium both on the inside and outside of an artery. He says that with the calcium scan, you don't know which side. That is why he gave me the thalium test to check for obstruction.
The weekend before the visit I did the 35 mile Cal Poly ride, then a 5K on Superbowl Sunday. It's my conjecture that a stress test wouldn't have shown anything that wouldn't have shown up on those events. This is the issue of predictability. This is not to say that there couldn't be real problems to be discovered, only that the stress test isn't a good predictor with individuals who have a certain level of fitness.
I asked what the obstruction level was with the calcium stress test, and he didn't answer, saying that it doesn't show real obstruction. I asked for the results of the thalium stress test hoping for millimeters dialation of some such, but only got "not obstructed". I also asked for the "picture" generated with the thalium test, and got something like "noted" and "I don't see a picture in your file." Yet the results were based on a picture. I'd like to see it and may follow up. VitalImaging faxed the results directly to my cardiologist and said they would mail be hard copy. Need to look at their point system again.
Ownindex now 36 on 725; 40 on 810. Biggest disparity between the two that I've seen. Will check again with the 725 today. I want to see if I can detect any consequences of the Palm Springs ride or my increased exercise level over the past month or so.
He did take the initiative to put me back on Crestor at 2.5mg/day. That was a key, along with my GP's recommedation of Trilipix, also about two years ago. Along with Omega3, I've had the best lipid profile for years and it has been consistent over the past two years. Nor has this caused real problems with my liver enzymes. Thus I can hold back a bit on Niaspan and use it when (and if) I need to; for example, when the system becomes habituated with the current levels.
The outcome of my visit? Ok EKG, stress test next year. He also discouraged me from doing the full bodfy scan. Not on the basis of radiation, but general need. He drew a diagram on the exam-table paper showing calcium both on the inside and outside of an artery. He says that with the calcium scan, you don't know which side. That is why he gave me the thalium test to check for obstruction.
The weekend before the visit I did the 35 mile Cal Poly ride, then a 5K on Superbowl Sunday. It's my conjecture that a stress test wouldn't have shown anything that wouldn't have shown up on those events. This is the issue of predictability. This is not to say that there couldn't be real problems to be discovered, only that the stress test isn't a good predictor with individuals who have a certain level of fitness.
I asked what the obstruction level was with the calcium stress test, and he didn't answer, saying that it doesn't show real obstruction. I asked for the results of the thalium stress test hoping for millimeters dialation of some such, but only got "not obstructed". I also asked for the "picture" generated with the thalium test, and got something like "noted" and "I don't see a picture in your file." Yet the results were based on a picture. I'd like to see it and may follow up. VitalImaging faxed the results directly to my cardiologist and said they would mail be hard copy. Need to look at their point system again.
Ownindex now 36 on 725; 40 on 810. Biggest disparity between the two that I've seen. Will check again with the 725 today. I want to see if I can detect any consequences of the Palm Springs ride or my increased exercise level over the past month or so.
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