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  #61   ^
Old Thu, Jan-26-17, 22:59
GRB5111's Avatar
GRB5111 GRB5111 is offline
Posts: 1,898
 
Plan: Ketogenic (LCHFKD)
Stats: 227/186/185 Male 6' 0"
BF:
Progress: 98%
Location: Herndon, VA
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When looking at the deltas between how you were when you started low carb and how you are today, I can't think of any physician who would not be encouraged by what you have accomplished in that time period in terms of embracing better health. To second guess and recommend a change in how you eat today would seem to me to be based on popular nutritional mythology rather than the solid results you've achieved in your N=1 experiments and course corrections. Whether it might come from your PCP or cardiologist, I'd be suspicious of any recommendation to make radical changes in your current WOE. The statin recommendations are certainly driven by the current standards of care and reinforced by concern over medical liability. In other words, the vast majority of today's doctors will make the same recommendation. I understand that this is an important decision you must consider, and my thoughts are with you on this. It could be the same for any one of us at any time.
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  #62   ^
Old Fri, Jan-27-17, 04:11
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 9,491
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
Default

You have a really good doctor...no panic over your chosen diet to lose weight, she follows high standards of care for her practice as a family physician, and has obviously learned about the "novel" CAC test if she had not used it before. If you have a choice of cardiologists, consider asking her to recommend one that may be more accepting of a LC Mediterranean Diet. Remember Dr Westman's tip...call it a Modified Mediterranean Diet.
http://forum.lowcarber.org/showpost...19&postcount=27

If you want to delve down into more information on the CAC to be ready with your questions for the cardiologist, none better than Ivor Cummins. You will see many photos of what the scans will look like to compare with the photos you have in his talks. Start with the widowmaker film you haven't seen it, so you understand the "other side" of the story, why so many cardiologist do not believe it shows all risks. Then Ivor's talks, some are very technical, and he gave a new one to doctors last week even more "hardcore" than previous. the new one is being edited, not posted yet. http://www.thefatemperor.com/blog/


http://www.thefatemperor.com/search?q=CAC
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  #63   ^
Old Fri, Jan-27-17, 04:54
cotonpal's Avatar
cotonpal cotonpal is offline
Posts: 3,224
 
Plan: very low carb real food
Stats: 245/128/135 Female 62
BF:
Progress: 106%
Location: Vermont
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You might want to check out Nina Teicholz on the Mediterranean diet on dietdoctor.com if you haven't already. She deconstructs the myth. I am sure it is unnerving (scary) to get those results but given how successful you have been in improving your health in so many different ways I would question whether any of your doctor's dietary suggestions can improve on what you are already doing. Of course I'm probably at the far end of scepticism when it comes to conventional medical advice and "standards of care".

Jean
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  #64   ^
Old Sat, Jan-28-17, 08:43
thud123's Avatar
thud123 thud123 is offline
Senior Member
Posts: 4,165
 
Plan: ~25NC/IF
Stats: 342.2/185.9/000 Male 72 inches
BF:
Progress: 46%
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Thanks for the detailed, level and positive update Ken. It helps everyone here. To me it is obvious that your recent diet and exercise regime have influenced your health in a positive way.

I'm not sure what I would do in your shoes but you never know until you are in those shoes, and they will be different shoes. It is my opinion you are being wise in finding a solution working with others whilst not changing tack completely from your previous course.

Small, consistent corrections corrections and a steady hand at the tiller. This is what helped make you half the man you were. Now to care for the half that remains

(I had second thoughts about hitting send but I care about you so here goes...)
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  #65   ^
Old Sat, Jan-28-17, 15:37
khrussva's Avatar
khrussva khrussva is offline
Posts: 5,864
 
Plan: My own - < 30 net carbs
Stats: 440/208/210 Male 5' 11"
BF:Energy Unleashed
Progress: 101%
Location: Central Virginia - USA
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Thanks for the support and condolences, everybody - and thank you Janet for your knowledge and at-the-ready links. I know it is hard to know what to say in these circumstances. Health issues happen on this forum and I've been in the same situation. This is definitely a new chapter in my life and there is a lot to absorb. I have a consultation with a cardiologist next Monday. I plan to go there with my size 56 pants for show-and-tell, along with some of the medical data that I have put together as I reclaimed my life over the past 3 years. I just want to make it clear to him where I was, how far I have come, and that I have completely transformed my lifestyle vs. what I had been doing for the first 50 years of my life. In other words, I have a health plan in place. It may need some tweaking, but - IMO - it does not need an overhaul. It has worked pretty well so far.

I did a lot of thinking on my 8 mile walk today. The walk felt good. It was relaxing & stress relieving; so I made it a long one. I don't know what I am going to do yet. I will hear what the doctors have to say, look up information on my own, and then put together a plan for the next year. I will do what I think is best for me to the best of my abilities. My goal is to be as healthy at this time next year as I am today. I've decided to hold my cards tight on the details. I may or may not comply with all "doctor's orders" and I may decide to try some unconventional remedies. All that is TBD. I don't want any copy-cats or arguments; so I won't be doing a blow-by-blow on this forum. I'll keep a private log of what I am doing and hope for the best on future exams.

My focus is now on my health like never before. I will be putting some effort into it. As a result, I may not be as active on the forum. That is TBD. But I do promise not to go away. I'll be around and at the very least I'll continue to log my food and challenge data.

Last edited by khrussva : Sat, Jan-28-17 at 18:22.
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  #66   ^
Old Sat, Jan-28-17, 19:27
SabreCat50 SabreCat50 is offline
Senior Member
Posts: 131
 
Plan: modified Atkins
Stats: 220/178/170 Male 6 ft 1 in
BF:
Progress: 84%
Location: Omaha, Nebraska, USA
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Does anyone know how the CAC score is actually determined? For example I have a score of 112 in my lower descending artery (the Widowmaker - oh my!). What does this actually mean? It's not a percentage, then what? An area?

Thanks
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  #67   ^
Old Sat, Jan-28-17, 20:03
DelaneyLC's Avatar
DelaneyLC DelaneyLC is offline
Posts: 1,993
 
Plan: Atkins '72
Stats: 188/143/144 Female 5'4"
BF:
Progress: 102%
Location: NV
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Ken, you know my story and I know your disappointment. I think it's a good thing you found out you have issues & can take care of what you need to before it progressed to worse. Like me. It's good you have a plan going forward.

Your success is still amazing, this doesn't take away from that. Moving forward you will adjust, right now you are going through another transition.

Life is good. You are great and will continue on your healthy path. There's just an unexpected fork in the road. I wish you well. I think you will come around to sharing more even though you are hesitant right now.
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  #68   ^
Old Sun, Jan-29-17, 03:43
Ambulo's Avatar
Ambulo Ambulo is online now
Senior Member
Posts: 773
 
Plan: No GPS/OMAD (23:1)
Stats: 150/123/120 Female 64 inches
BF:
Progress: 90%
Location: the North, England
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Just here to give you my best wishes, Ken. I hope things go well in your next meeting with the medics. I am somewhat sceptical of conventional medicine except where it comes to patching up after accidents or treating acute serious infections. I think you will come up with some good strategies on your walks.
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  #69   ^
Old Sun, Jan-29-17, 05:29
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 9,491
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
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Quote:
Originally Posted by SabreCat50
Does anyone know how the CAC score is actually determined? For example I have a score of 112 in my lower descending artery (the Widowmaker - oh my!). What does this actually mean? It's not a percentage, then what? An area?

Thanks


The Calcium Score is "A number reflecting the degree and extent of calcium deposits in the walls of the coronary arteries, as demonstrated by cardiac computed tomography." So yes, an actual area in your LAD.

(CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the image slices are reassembled by computer software, the result is a very detailed multidimensional view of the body's interior.)

http://www.radiologyinfo.org/en/inf...g=ct_calscoring

With my usual critical eye to medical procedures, I do wonder how the skill of the radiologist may impact the score, but also know that many image tests are now first "read" by a computer. When calcium is detected in a slice, likely its size, location and thickness is measured by computer for its degree and extent. The radiologist will then recheck those areas of calcium, but as you can see in samples, it appears those bright white spots would be hard to miss and simple to measure accurately by computer. Compare these to the 3D computer assisted diagnostic mammograms I discuss yearly with a chief radiologist....these seem easier to read to my completely untrained eye.

Last edited by JEY100 : Sun, Jan-29-17 at 05:57.
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  #70   ^
Old Sun, Jan-29-17, 05:46
cotonpal's Avatar
cotonpal cotonpal is offline
Posts: 3,224
 
Plan: very low carb real food
Stats: 245/128/135 Female 62
BF:
Progress: 106%
Location: Vermont
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Ken - I understand your wish to "hold my cards tight". Your own wisdom has got you this far. I am sure it will not fail you now. There are times when it is good to ask for help in figuring things out and times when it is better to keep our own counsel. I always wish you nothing but the best.

Jean
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  #71   ^
Old Sun, Jan-29-17, 14:55
SabreCat50 SabreCat50 is offline
Senior Member
Posts: 131
 
Plan: modified Atkins
Stats: 220/178/170 Male 6 ft 1 in
BF:
Progress: 84%
Location: Omaha, Nebraska, USA
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Quote:
Originally Posted by JEY100
The Calcium Score is "A number reflecting the degree and extent of calcium deposits in the walls of the coronary arteries, as demonstrated by cardiac computed tomography." So yes, an actual area in your LAD.

(CT imaging is sometimes compared to looking into a loaf of bread by cutting the loaf into thin slices. When the image slices are reassembled by computer software, the result is a very detailed multidimensional view of the body's interior.)

http://www.radiologyinfo.org/en/inf...g=ct_calscoring

With my usual critical eye to medical procedures, I do wonder how the skill of the radiologist may impact the score, but also know that many image tests are now first "read" by a computer. When calcium is detected in a slice, likely its size, location and thickness is measured by computer for its degree and extent. The radiologist will then recheck those areas of calcium, but as you can see in samples, it appears those bright white spots would be hard to miss and simple to measure accurately by computer. Compare these to the 3D computer assisted diagnostic mammograms I discuss yearly with a chief radiologist....these seem easier to read to my completely untrained eye.


Thanks for the response. I too wonder how the skill of the radiologist player s into this. Also does the CT scanner (old, new, software version, etc) have an affect?

If the score is proportional to an area, then what is the maximum score? Surely the size of a given artery must vary for different individuals.

The upshot is that I want to know how much of my proximal LAD is blocked? I doubt my GP is up on the test to know.

As always, thanks.
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  #72   ^
Old Sun, Jan-29-17, 15:32
JEY100's Avatar
JEY100 JEY100 is offline
To Good Health!
Posts: 9,491
 
Plan: IF Fung/LC Westman/Primal
Stats: 222/171/169 Female 5' 9"
BF:45%/25.3%/24%
Progress: 96%
Location: NC
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Quote:
Originally Posted by SabreCat50
Thanks for the response. I too wonder how the skill of the radiologist player s into this. Also does the CT scanner (old, new, software version, etc) have an affect?

If the score is proportional to an area, then what is the maximum score? Surely the size of a given artery must vary for different individuals.

The upshot is that I want to know how much of my proximal LAD is blocked? I doubt my GP is up on the test to know.

As always, thanks.


Phone the facility and ask to speak to the radiologist whose name is on your report. Probably happy to answer a patient's questions rather than reading computer print-outs and looking at X-Rays in a dark room.
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  #73   ^
Old Sun, Jan-29-17, 18:32
SabreCat50 SabreCat50 is offline
Senior Member
Posts: 131
 
Plan: modified Atkins
Stats: 220/178/170 Male 6 ft 1 in
BF:
Progress: 84%
Location: Omaha, Nebraska, USA
Default

Quote:
Originally Posted by JEY100
Phone the facility and ask to speak to the radiologist whose name is on your report. Probably happy to answer a patient's questions rather than reading computer print-outs and looking at X-Rays in a dark room.


Good idea. Thanks.
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  #74   ^
Old Sun, Jan-29-17, 18:43
eljohnw eljohnw is offline
Senior Member
Posts: 1,074
 
Plan: , LCHF
Stats: 259.6/222.4/130 Female 62 inches
BF:67.2/60.2/normal
Progress: 29%
Location: Hilton Head SC
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Ken, about your diet recommendation don't change anything. I did this. My so called heart healthy diet made my gain 50 lbs in 8 month. I followed the diet as prescribed and got yelled at by my cardiologist at every visit because in his mind I was the one who was cheating. My next appointment will be epic. Because I am back at my " crazy" diet. This time I just will tell him to get some information and then form an opinion about LCHF.
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  #75   ^
Old Mon, Jan-30-17, 20:18
khrussva's Avatar
khrussva khrussva is offline
Posts: 5,864
 
Plan: My own - < 30 net carbs
Stats: 440/208/210 Male 5' 11"
BF:Energy Unleashed
Progress: 101%
Location: Central Virginia - USA
Default Big sigh of releif...

I saw the cardiologist today. It went well. He spent plenty of time with me and allowed me 5 or 10 minutes to talk about the first 50 years of my life, the incredibly unhealthy place that I found myself in 3 years ago, and what I've managed to do about it since. He reviewed my data from my annual labs, including my A1c scores, NMR and cholesterol results. He did an EKG. He asked about my exercise habits. He seemed to have no problems with my diet as the labs and incredible weight loss results were proof that it was working. The only real issue he had was with my BP. I had white coat syndrome again (BP 170/100). While waiting for the doctor I noticed that the nurse had taken my BP with the large cuff and I told the doctor that I thought it was too big. He checked it out and it was too big. So he took my BP with the regular Adult cuff. It was better, but still not great. I had a log of BP results on my phone and I showed him a graph of my results over the past year. That seemed to pacify his concern, but he did suggest that I look into ways to keep my BP within reason (like giving up caffeine, for example).

Then we got to the Heart Calcium Scan results. To my surprise he was not all that concerned about it. He said that we all build plaque in our arteries from the time we are young. My results were higher than normal, but probably in line with what would be expected given the unhealthy state that I lived in for so many years. He asked me why I had even had the scan done given my current state of health and having no heart related symptoms. He almost had a "Why are you even here?" POV. I told him that the decision to have the scan was mine. I'd read that the calcium scan was a good predictor of CVD risk and wanted to know where I was at. I told him that my doctor was gravely concerned about the results, prescribed me statins, low dose aspirin, and was considering having a stress test done. Then she referred me to a cardiologist for a 2nd opinion.

The cardiologist then asked me if I was taking the statins. I said no and that I was trying to decide if I even wanted to. He then went back and looked at my more recent cholesterol results. I think he had made the assumption that those more recent results were taken while I was on a statin drug. He plugged the numbers into a calculator. He marveled at the Trigs, HDL and VLDL numbers. He grinned and said that these results are really good. He then looked back at my prior LDL results. He noticed that they are really all over the place and questioned why. I told him that I was actively losing weight at the time and that I was tweaking my diet trying to get those numbers down. I'd found some tips on-line, followed the recommendations, and ended up with positive results. He then took another look at my EKG. He said that it was normal; excellent in fact. He told me that he saw no need for a stress test. My description of my recent workouts on the elliptical indicated no need. He said that what I was doing was a stress test and that if I felt no ill effects from it then there is no more cause for concern.

From the conversation he gleaned that I was not all that comfortable with the pharmaceutical recommendation from my doctor. I told him that I wasn't happy with the idea of a statin. I told him that I thought my current diet and fitness regime was the healthiest thing I could be doing for my heart. I discussed the Ivor Cummins YouTube video that Janet pointed me too. I had printed a video snapshot of the chart at 37 minutes 46 seconds into the video. It shows that increased calcification at a rate of 15% or more per year indicates alarmingly high incidence of CVD events and a significantly lower risk of events if increased calcification is less than 15% per year. I told him that I wanted to know if my current regimen would result in a lower rate of calcification. I really wanted to know this without having the results confounded by a statin prescription. I was willing to take the risk. I told him that I planned on having another CT Heart Calcium Scan in a year and, depending on the results, after that I would consider statins. Then came the best part of the entire conversation... He said that he wouldn't bother having a second scan done that soon. He said that more than likely the results wouldn't be significantly different than they were last week. He said that the frequent 30% increase per year in calcification is for sick people who are still smoking cigarettes, poorly monitoring their diabetes, not exercising, and eating poor diets. He said that I was in perfect health and I had significantly improved my chances for continued heart health. He wouldn't expect much if any increase in my calcium score one year from now. He said that he would not recommend having another scan for at least 2 or 3 years. He said that if I continue to do what I have been doing (e.g. remain healthy) it would just be a waste of money.

Then to wrap up the conversation: He said that he had to rubber stamp my doctor's recommendation. My PCP did the right thing. It is standard procedure given the circumstances. He asked about the other recommendation about going on low dose aspirin. I said that I'd be willing to do that - and in fact, I had already started. He was pleased about that. He said that "officially" he had to go by the book and recommend the statin. But personally - he likes my plan, too. He said that my doctor's prescription was for a moderate dose of a strong statin. He was concerned about the side effects. I told him that my doctor had discussed them and that only about 5% of patients experience such side effects. He said that is true, but I would likely be one of the 5%. He said that sick people taking statins don't feel any additional ill effect. They are already sick. The ones that do are the healthy and active patients like me. He said that he was pretty sure that I would notice joint and muscle issues and that I wouldn't like it. So that conversation ended with an 'off the record' nod to my plan not to take statins at this time.

He ended this rather lengthy consultation by congratulating me on what I have accomplished with my health. He recommended that I continue to work on that LDL number. He said to keep it below 120 and that I should reconsider statins if I cannot do so. He suggested checking it quarterly with standard lipid tests until I'm sure I have it under control. I asked him if I needed to schedule a follow-up appointment. He said no. He saw no reason for me to frequent a cardiologist as this time. On the way out the nurse said to me "be sure and come back if I have any further issues." I told her that I hoped I'd never have to see them again. Some older folks nearby got a good laugh out of that.

Well, that's how it went. So much for holding my cards close on my action plan. It's just that the results of this visit were so positive that I felt compelled to share it. I'm a happy camper again. Where is my tent and sleeping bag?

Last edited by khrussva : Tue, Jan-31-17 at 11:17.
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