"Normal" - as expected. Heart Rate 61 beats per minute.
I do have a mild PAC - Premature Atrial Contraction" or "missed beat" that has been diagnosed on several occasions. But that was not identified here.
An associated EKG however was flagged (more on that later).
Friday, May 10, 2013
Life Line Screening Tests Carotid Artery Disease
My GP thinks highly of the relatively inexpensive Life Line Screening tests for identifying risk area early. These are not covered by Medicare (why not?) but are based on finding risk areas and correlating them to the Framingham Study for risks identified there. I had a set done on April 26, 2013 and have just gotten back the results. The first is for Carotid Artery Disease.
The result is a "Mild" risk. I was obviously hoping for "Normal" but at least did not get "Moderate" or "Significant' finding. The "Mild" risk is associates with a PSV flow volume of less than 110cm/s on both the left and right side. Here is a learned discussion about velocities, age, and hypertension.
The Screening Results report define the risk as "Mild - Small amount of plaque. Blood flow still normal. Blood velocity less than 110.This also gets into the question of how a stress test can mask issues with conditioned athletes. The regular test doesn't get them to where there may be an issue.
The result is a "Mild" risk. I was obviously hoping for "Normal" but at least did not get "Moderate" or "Significant' finding. The "Mild" risk is associates with a PSV flow volume of less than 110cm/s on both the left and right side. Here is a learned discussion about velocities, age, and hypertension.
The Screening Results report define the risk as "Mild - Small amount of plaque. Blood flow still normal. Blood velocity less than 110.This also gets into the question of how a stress test can mask issues with conditioned athletes. The regular test doesn't get them to where there may be an issue.
Blood Pressure Spiking and Exercise
On the Life Line testing April 26, 2013 I had a BP count of 168/83, quite high for me. The helpful attendant suggested it might be the "white coat" syndrome, and it might be, but I've noticed that my BP tends to show high if I have not had recent excercise. This morning, for example, it was 128/81 where the latter was much higher than my long time average of 68. I'd remarked earlier in this blog about spiking.
I tested it a few minutes after and found it 129/67, essentially my average (120/68 is the year's average in Hearwise). I do take BP readings lying down and after a few minutes wait. So when things settle, my Blood Pressure is fine.
But there is a lot of time when I am not relaxed and lying down. I suspect that my BP is significantly higher then.
Still later today I took my BP after hiking up to the water tank on the Cobol side of the Mills Wilderness Trail. After my shower and lunch I took my BP relaxing on the couch. 104/51! Quite clearly exercise has a profound effect.
The moral of the story? Exercise is good and can protect against BP spiking. But how long does the effect last? What about the period before exercise and after. When does the BP creep up?
In particular, how often is it a good idea to do excercise to keep one's readings low? For example, it is worth doing a 45 minutes walk in the morning, and then one in the afternoon? Each day? Or is it a good idea to do a bike ride in the morning and then a walk in the afternoon? Each day?
These questions are testable. I'll have a 26 mile bike ride on Saturday in the morning. I can check my BP an hour before and an hour afterwards. Then I could do a walk in the afternoon and check my BP before and after at similar time intervals.
What would I project?
My BP tends to be low in the morning, so at 7am I'd project 120/70
After the ride, shower, etc., I would project a low reading 105/60
In the early afternoon my BP may indeed creep up. 120/80?
After a half-hour walk, relaxing on couch, etc., I'd project 105/65. (In other words, I wouldn't expect the disastolic number to be quite as low as earlier. I see some higher reading in previous afternoon checks.)
If the numbers check, then the afternoon walk would some some protective effect on BP, which would otherwise have a slighter higher diastolic and an appreciable higher systolic reading.
But these numbers may not be significant overall in terms of protection against cardiac events. In other words, the "extra" afternoon walks may lower BP a little but not be significant in terms of preventing actual cardiac events.
But I suspect that some exercise each day would be useful. It couldn't be heavy exercise each day like a 4 hours bike ride to the beach. The idea would be to find the level of "recovery" exercise (say every other day) that will just produce this beneficial effect. It would vary for fitness levels, but for me I image it would be a 45 minute vigorous walk, maybe the Mills walk to the water tank. Maybe it could be my 8 miles Thompson Creek bike ride.These are testable obviously. I can check and post separate entries on them.
I tested it a few minutes after and found it 129/67, essentially my average (120/68 is the year's average in Hearwise). I do take BP readings lying down and after a few minutes wait. So when things settle, my Blood Pressure is fine.
But there is a lot of time when I am not relaxed and lying down. I suspect that my BP is significantly higher then.
Still later today I took my BP after hiking up to the water tank on the Cobol side of the Mills Wilderness Trail. After my shower and lunch I took my BP relaxing on the couch. 104/51! Quite clearly exercise has a profound effect.
The moral of the story? Exercise is good and can protect against BP spiking. But how long does the effect last? What about the period before exercise and after. When does the BP creep up?
In particular, how often is it a good idea to do excercise to keep one's readings low? For example, it is worth doing a 45 minutes walk in the morning, and then one in the afternoon? Each day? Or is it a good idea to do a bike ride in the morning and then a walk in the afternoon? Each day?
These questions are testable. I'll have a 26 mile bike ride on Saturday in the morning. I can check my BP an hour before and an hour afterwards. Then I could do a walk in the afternoon and check my BP before and after at similar time intervals.
What would I project?
My BP tends to be low in the morning, so at 7am I'd project 120/70
After the ride, shower, etc., I would project a low reading 105/60
In the early afternoon my BP may indeed creep up. 120/80?
After a half-hour walk, relaxing on couch, etc., I'd project 105/65. (In other words, I wouldn't expect the disastolic number to be quite as low as earlier. I see some higher reading in previous afternoon checks.)
If the numbers check, then the afternoon walk would some some protective effect on BP, which would otherwise have a slighter higher diastolic and an appreciable higher systolic reading.
But these numbers may not be significant overall in terms of protection against cardiac events. In other words, the "extra" afternoon walks may lower BP a little but not be significant in terms of preventing actual cardiac events.
But I suspect that some exercise each day would be useful. It couldn't be heavy exercise each day like a 4 hours bike ride to the beach. The idea would be to find the level of "recovery" exercise (say every other day) that will just produce this beneficial effect. It would vary for fitness levels, but for me I image it would be a 45 minute vigorous walk, maybe the Mills walk to the water tank. Maybe it could be my 8 miles Thompson Creek bike ride.These are testable obviously. I can check and post separate entries on them.
Tuesday, April 30, 2013
Liver Enzymes Down
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).
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).
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.
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