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.