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.
Friday, January 7, 2011
Sunday, December 5, 2010
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.
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.
Tuesday, August 10, 2010
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.
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.
Wednesday, July 14, 2010
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:
In March:
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.
- Overall Cholesterol: 163
- LDL: 96
- HDL: 47
- Triglycerides: 130
In March:
- Overall Cholesterol: 145
- LDL: 83
- HDL: 46
- Triglycerides: 91
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.
Thursday, July 1, 2010
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:
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.
Friday, March 19, 2010
The Vap Test Results
Pretty good news. Overall Cholesterol: 145, a figure that 20 years ago I never imagined I could achieve. LDL: 83, just a bit up from 77, but very favorable. The goal is to get it down to 70, but my doctor told me that I was essentially there. Triglycerides: 91. Great. The goal was to come in under 100. HDL: 46. Alas, this was a bit of a downer. I had increased my 500mg Niaspan to two a day and hoped that there would be a significant difference, but there was not. The VitalImaging goal is 60.
When I discussed this with my doctor, he was not optimistic about the possibility of getting all the way to 60. Using two 500mg Niaspan a day did not drive the HDL up. 3 or 4 might. 4 is maximum. I'm tolerating 2 and 3 a day and will go to 3 and hold that for the next profile which will be in about 3 months. I'm prepared to try 4 Niaspan/day -- that's 2 grams! Years ago, I OD'ed on Niacin and got an HDL of 55, but the Niacin played havoc with my liver enzymes. Luckily, my enzymes were okay this time: the AST at 33 (the high end is 35) and the ALT is 38 (high end 60). But the 55 HDL from the distant past give me some hope that I can approach the 60 goal.
While not optimistic, my doctor did say that anything over HDL 45 is very good. It's not clear that the extra 15 points are "needed". This gets us into marginal effectiveness levels. He said also that with LDL's down, the "small LDL trait" is less important. This is because there are many fewer of the small, gritty, dense LDL lipids to infiltrate into the crevices of my vascular system. He also thought that a calcium heart scan in a year is too early, especially in regard to treatment which he thought was about as aggressive as it could be now. I would welcome the reinforement, however, and may do it as orginally planned during the summer of 2011.
He did defend doing the thalium stress test to check for obstruction. He did not think that the calcium heart scan tests for this, though it does show both a predicted size and volume. But I would have known if I had had an obstruction in the hills of Oregon, so it was to confirm that really that it was prescribed.
The VAP test identifies the "Real LDL Size Pattern" on a spectrum of "Pattern B (left) to Pattern A (right)" I've inched from the far left to about 2/3 of the way to the absolute center (Pattern A/B) which I've reached once before. The position of this scale is supposed to be one of the best predictors of heart/vascular health. It is a refinement of the the LDL count which is a refinement of the overall Cholesterol count.
These are all indirect tests. Previous correlations show them to be good indicators. I'd feel better if I could get to Pattern A, though being there is no guarantee of anything. The 5mg of Crestor and the Niaspan affect this reading most directly.
The Trilipix affects the triglyceride reading and appears to be quite effective. The VitalImaging goal of lower than 100 is already met.
The VAP tests shows subclass information of my HDL lipids. My overall reading is 46. This consists of HDL-2 and HDL-3. HDL-2 is "large, buoyant". My count is 7 and is in the low range. It should be 10 mg/dL. My HDL-3 ("small, dense") is 39 and is in-range by being greater than 30 mg/dL. Together these two subclasses add up to 46. I'll see whether more niacin can increase the proportion of HDL-2 and bring the HDL-2 into the normal range. (A "2-fer").
I asked about doing a Berkeley Heart Lab Exam. My doctor's response was what I expected. The Berkeley tests would tell us more, but the medical response would be the same. We know there is a familial predisposition in my case. The Berkeley tests would confirm it, and perhaps say more about it, but wouldn't affect the recommended response.
There is the issue of habituation also. My HDL didn't go up even with twice the niacin and my LDL crept up from 77 to 83 with the same amount of statin. It would be interesting to try to determine the "increase rate" of medication to maintain a desired level of effect.
So I'm upping my Niaspan to 3 a day from 2 and hoping to see some marginal improvements at least in 3 months. For the record, I'm taking 5mg Crestor; 1 Trilipix; 4 Lovaza (Omega-3), 1 Zetia; also, 1 Trandolipril for blood pressure. And a baby aspirin.
When I discussed this with my doctor, he was not optimistic about the possibility of getting all the way to 60. Using two 500mg Niaspan a day did not drive the HDL up. 3 or 4 might. 4 is maximum. I'm tolerating 2 and 3 a day and will go to 3 and hold that for the next profile which will be in about 3 months. I'm prepared to try 4 Niaspan/day -- that's 2 grams! Years ago, I OD'ed on Niacin and got an HDL of 55, but the Niacin played havoc with my liver enzymes. Luckily, my enzymes were okay this time: the AST at 33 (the high end is 35) and the ALT is 38 (high end 60). But the 55 HDL from the distant past give me some hope that I can approach the 60 goal.
While not optimistic, my doctor did say that anything over HDL 45 is very good. It's not clear that the extra 15 points are "needed". This gets us into marginal effectiveness levels. He said also that with LDL's down, the "small LDL trait" is less important. This is because there are many fewer of the small, gritty, dense LDL lipids to infiltrate into the crevices of my vascular system. He also thought that a calcium heart scan in a year is too early, especially in regard to treatment which he thought was about as aggressive as it could be now. I would welcome the reinforement, however, and may do it as orginally planned during the summer of 2011.
He did defend doing the thalium stress test to check for obstruction. He did not think that the calcium heart scan tests for this, though it does show both a predicted size and volume. But I would have known if I had had an obstruction in the hills of Oregon, so it was to confirm that really that it was prescribed.
The VAP test identifies the "Real LDL Size Pattern" on a spectrum of "Pattern B (left) to Pattern A (right)" I've inched from the far left to about 2/3 of the way to the absolute center (Pattern A/B) which I've reached once before. The position of this scale is supposed to be one of the best predictors of heart/vascular health. It is a refinement of the the LDL count which is a refinement of the overall Cholesterol count.
These are all indirect tests. Previous correlations show them to be good indicators. I'd feel better if I could get to Pattern A, though being there is no guarantee of anything. The 5mg of Crestor and the Niaspan affect this reading most directly.
The Trilipix affects the triglyceride reading and appears to be quite effective. The VitalImaging goal of lower than 100 is already met.
The VAP tests shows subclass information of my HDL lipids. My overall reading is 46. This consists of HDL-2 and HDL-3. HDL-2 is "large, buoyant". My count is 7 and is in the low range. It should be 10 mg/dL. My HDL-3 ("small, dense") is 39 and is in-range by being greater than 30 mg/dL. Together these two subclasses add up to 46. I'll see whether more niacin can increase the proportion of HDL-2 and bring the HDL-2 into the normal range. (A "2-fer").
I asked about doing a Berkeley Heart Lab Exam. My doctor's response was what I expected. The Berkeley tests would tell us more, but the medical response would be the same. We know there is a familial predisposition in my case. The Berkeley tests would confirm it, and perhaps say more about it, but wouldn't affect the recommended response.
There is the issue of habituation also. My HDL didn't go up even with twice the niacin and my LDL crept up from 77 to 83 with the same amount of statin. It would be interesting to try to determine the "increase rate" of medication to maintain a desired level of effect.
So I'm upping my Niaspan to 3 a day from 2 and hoping to see some marginal improvements at least in 3 months. For the record, I'm taking 5mg Crestor; 1 Trilipix; 4 Lovaza (Omega-3), 1 Zetia; also, 1 Trandolipril for blood pressure. And a baby aspirin.
Monday, February 22, 2010
Focusing on Blood Pressure -- Waiting for VAP
I'll be taking the VAP lipid panel in early March. That will give me a good sense of how I'm progressing towards my goal of reducing the point score of 835 on my next calcium heart scan in the summer of 2011. The VAP gives essentially the same information as the Berkeley Heart Labs panel.
In particular, I'll be look at any changes in the "Pattern A/B" score. This score is the one that shows how "bouyant" your lipids are. I've been mostly in the "B" area with those small, gritty lipids. But if I can tolerate 5mg of a statin -- remember, I've had problems with statins before -- then I have a chance of moving to the desirable "Pattern A," especially with the new Trilipix and niacin.
So far, I'm tolerating the time-release niacin (Niaspan) at 2 500mg/day. I will hold at this until the next VAP test. At my last test (referenced in the first posting) I improved in every area, but the remaining area is to up my HDL to 60. More niacin is the key here. I scored 45 (which is good for me, but not particularly high) previously taking only 1 500 mg niacin/day. If I can get my HDL up to 50 with 2/day, I have a shot at 60 with more niacin. I think I can tolerate 3/day (1,500mg), but more may be needed to get to 60.
Here I am concerned about the drug interactions. My overall cholesterol was 140 last time and it is sensitive to niacin as well. I don't want to go too low here! Also, the Niaspan, Trilipix, and Crestor (even at 5mg) may elevate my liver enzymes and/or have other consequences, so I'd like to see the lipid profile results before upping my Nisaspan over 2/day. (My specialist thinks I can do 3/day -- I hope so. It may take 4 to up HDL to 60.
So in the meantime, I've been watching my blood pressure with a neat, new iPhone App called HeartWise. You need to have your own monitor (mine is an Omron automatic blood pressure monitor, Model HEM-711), but it is very easy to enter data into the app and it produces very nice information. Here is a graph which it put into my photo library on my iPhone.
What became apparent seeing my data in graphical form was that my systolic scores were often over the 120 mark -- the beginning of the new "pre-hypertensive" range, even though my diastolic scores were fine. This meant that with a modest dose of a good ace-inhibitor (say, generic trandolapril), I might be able to stay under the 120 threshold for the most part. I'll keep you posted on my success (if any) here. I've been taking trandolapril for several days now, and at the beginning, my systolic pressure remained under 120. Too soon to pick up a real trend yet, though.
HeartWise charts your weight and pulse as well. I was surprised at how low my pulse is as a result of exercise over the years, often about 50 in the morning.
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