Regressing atherosclerosis

[Eddy Edson]

Ha! The LDL prong of my cunning plan is working - LDL down to 1.0, from 1.6. So like a neonate human, even if not yet down to baby bunny levels. It's where I was hoping it would be, though actually I was expecting a bit higher.

Cutting out animal sat-fats + upping statins really does lower LDL.

If I don't see some atherosclerosis regression from here I'm ditching the plan and going on a KFC + Krispy Kreme diet or maybe keto or something equally stupid (j/k).

HbA1c down to 4.6% from 5.4%. In the 4's - wasn't expecting that!

BFD, really, but I've decided to feel smug about it anyway. And keto and LCHF are really not the only ways of getting low BG levels.

 

[Northerner]

Ha! The LDL prong of my cunning plan is working - LDL down to 1.0, from 1.6. So like a neonate human, even if not yet down to baby bunny levels. It's where I was hoping it would be, though actually I was expecting a bit higher.

Cutting out animal sat-fats + upping statins really does lower LDL.

If I don't see some atherosclerosis regression from here I'm ditching the plan and going on a KFC + Krispy Kreme diet or maybe keto or something equally stupid (j/k).

HbA1c down to 4.6% from 5.4%. In the 4's - wasn't expecting that!

BFD, really, but I've decided to feel smug about it anyway. And keto and LCHF are really not the only ways of getting low BG levels.

HbA1c in the 4% range very unusual - I have seen a 4.3% and a 4.7% here in the past (both T2s). At least you won't have got the 'How many hypos are you having?' question! 🙂

 

[Eddy Edson]

HbA1c in the 4% range very unusual - I have seen a 4.3% and a 4.7% here in the past (both T2s). At least you won't have got the 'How many hypos are you having?' question! 🙂

On the phone the nurse did start on about it being too low, but I shut her down pretty quickly (in a nice way) 🙂

To the extent it's not just a random-whatever, I guess it probably has a lot to do with upping walking to 12km-13km per day.

 

[Eddy Edson]

So I have my delayed 12 month review with doc this week. Obviously things are looking OK on the BG front & I'm expecting doc to cut off the Metformin. I'm more interested in the atherosclerosis piece. I want him to refer me for an ultrasound on the leg to see how that's doing, and also I want my carotids checked out.

I still get thwacked by brain fatigue every few days. There's nothing out of order in any of my blood tests, my EKG is just fine, no shortness of breath, lung function normal, doc doesn't think there's anything wrong with my heart - so why shouldn't it be something to do with carotid artery disease? After all, I have atherosclerosis. I don't recall doc ever listening for bruits or whatever, and really I think it's a bit odd that I haven't had them checked by ultrasound when my leg was done? Then a referral to the vascular guy for more in-depth grilling. If there is a prob, I suppose the advice would probably be just to continue what I'm already doing - diet, exercise, BP, BG, cholesterol, no smoking - but I'd really like to know, whatever.

Not hopeful, but also maybe one of them has some ideas for upping my HDL. It's stuck on 1.0 despite giving up smoking, virtuous diet, exercise, thinking goodly thoughts etc. The atherosclerosis regression studies I'm working from suggest that getting it up to around 1.5 might be important.

 

[mikeyB]

The brain fatigue won’t be due to your carotids. Some folk get it with Metformin. Just carry on doing what you’re doing, and don’t obsess about numbers too much. You’re likely to have a bit of atherosclerosis in your carotids, but what would you do if you knew? Get a rebore? Can be done, but it’s very risky. The only reason to do it would be to monitor regression, but you know that’s working already.

 

[Eddy Edson]

The brain fatigue won’t be due to your carotids. Some folk get it with Metformin. Just carry on doing what you’re doing, and don’t obsess about numbers too much. You’re likely to have a bit of atherosclerosis in your carotids, but what would you do if you knew? Get a rebore? Can be done, but it’s very risky. The only reason to do it would be to monitor regression, but you know that’s working already.

Sensible, thanks!

 

[Eddy Edson]

What a hero my doc is. He's come to be totally on board with attempting to get it all regressed via new-born herbivore LDL levels (and of course continuing with the lifestyle stuff). Also, with the value of monitoring stenosis via periodic ultrasound so we can see how it's going. He's actually a bit excited - visions of a case-study publication prancing in his brain, I do believe. We had a little man-tussle over who gets to be the Youtube hero if it all works out, but quickly settled amicably on joint-co-Youtube-hero status.

So he was fine with upping Rosuvastatin to the max 40mg dose. LDL target: 0.7. Peripheral ultrasound booked for Fri, and also carotids - why not? he says; it's not a dumb idea, and it fits with the plan to monitor stenosis regression over time. No fresh ideas on HDL.

Also a referral to exercise physiologist to work out best plan for putting some muscle on my upper-body scrawn, and maybe work on how much walking is enough/not too much.

As a bonus, in the general feel-good glow he agreed to renew my Metformin prescription. I'd really prefer to keep taking it, for all the benefits beyond BG control.

 

[Northerner]

What a hero my doc is. He's come to be totally on board with attempting to get it all regressed via new-born herbivore LDL levels (and of course continuing with the lifestyle stuff). Also, with the value of monitoring stenosis via periodic ultrasound so we can see how it's going. He's actually a bit excited - visions of a case-study publication prancing in his brain, I do believe. We had a little man-tussle over who gets to be the Youtube hero if it all works out, but quickly settled amicably on joint-co-Youtube-hero status.

So he was fine with upping Rosuvastatin to the max 40mg dose. LDL target: 0.7. Peripheral ultrasound booked for Fri, and also carotids - why not? he says; it's not a dumb idea, and it fits with the plan to monitor stenosis regression over time. No fresh ideas on HDL.

Also a referral to exercise physiologist to work out best plan for putting some muscle on my upper-body scrawn, and maybe work on how much walking is enough/not too much.

As a bonus, in the general feel-good glow he agreed to renew my Metformin prescription. I'd really prefer to keep taking it, for all the benefits beyond BG control.

All sounding very positive Eddy 🙂 I'm a scrawny upper body person too, so am trying to get into using the rowing machine more. I've also got an 'Iron Gym', worth a try if you can get them in Oz 🙂

 

[Eddy Edson]

All sounding very positive Eddy 🙂 I'm a scrawny upper body person too, so am trying to get into using the rowing machine more. I've also got an 'Iron Gym', worth a try if you can get them in Oz 🙂

Thanks - I'll check it out. My prob with upper body/strength work is that it's tedious, unlike walking. But I have to do something or I'll end up looking like Popeye, inverted.

 

[Northerner]

Thanks - I'll check it out. My prob with upper body/strength work is that it's tedious, unlike walking. But I have to do something or I'll end up looking like Popeye, inverted.

I know exactly what you mean 😱 I can go out and run for an hour without any boredom setting in at all, but sitting on an exercise bike or rowing machine for 10 minutes seems like an eternity! 😱 I usually try watching a few music videos and try to avoid glancing at the timer/counter 🙂

 

[Eddy Edson]

What I've learned about vascular ultrasonography: measurement is highly sonographer-dependent and interpretation is highly radiologist-dependent. Within the same practice, people may use different terminology and even standards. Do not expect a lot of precision.

Anyway, the results:

- Carotids clear. Not imaged previously so no idea if any change, but this time: at most minimal plaque, no significant stenosis. Cool!

- Abdominal aorta: Unchanged; no signs of aneurysm.

- External iliacs: Not reported previously. This time: "Plaque was noted". How much? Who knows? I assume that without any further notes it's not significant.

- Right leg: Not imaged previously, but obviously affected. This time: Stenosis of "at least 50%" in the SFA above the knee, with a peak systolic velocity of 319 cm/second and a ratio of ~2.5 for bad segment vs proximal segment. No surprise there. "Dampened monophasic flow" in the 3 arteries below the knee. Ditto.

- Left leg: The big one, and the most annoyingly ambiguous part of this study, particularly for the superficial femoral artery.

Previously there was a "5cm occlusion 13 cm above the knee" in the SFA. This time: "The occlusion demonstrated previously was not visualised". Has it gone away? Did the previous guys see something that wasn't there? Did the guys this time miss it? My doc thinks it very unlikely that it actually went away, and I suppose I have to agree, I guess ... But actually I don't really understand how there could be that much uncertainty over a 5cm occlusion - it's not a tiny little thing?

Further, this time "there was extensive plaque in the SFA" but no stenosis estimate given. And no velocity measurements apart from, "No major velocity increase detected in the SFA". Compared to what? Last time? Bad segment versus adjacent segment?

Previously, one major collateral vessel bypassing the SFA occlusion was noted. This time, "collateral vessels were seen in the distal thigh". A couple, a bunch? I guess this is really the main clear positive change from this study: more collaterals = better flow and no doubt a big part of why I can walk a lot better. Conversely, promoting their development is a main rationale for walking therapy. But it would be nice to have a bit more precision.

For the left profunda femoral artery: Last time it was "50% - 75% estimated stenosis" vs this time "peak systolic flow of 214 cm/sec consistent with a stenosis" but there was no velocity measurement for an adjacent segment and no stenosis estimate. So what's the comparison? No particular difference? I think > 200 cm/sec is generally a diagnostic for 50%+ stenosis, but I thought that needed to be combined with a 2+ ratio between adjacent segments? Would be nice to have some more consistency.

Finally, "Dampened monophasic flow in all 3 below-knee arteries". Last time: "Scant, monophsaic flow through all 3 vessels". Is there any difference between "dampened" and "scant"?

Anyway, bottom line is that there is significant PAD in both legs, no surprise, but maybe some hopeful signs of improvement, certainly in collateral formation, and every reason to keep on doing what I'm doing. I'll get another study done in 6 months or so.

 

[everydayupsanddowns]

Sorry it has been so difficult to compare results against each other. Must be very frustrating!

Glad there seems to have been some improvement and you are finding it easier to walk though!

 

[Eddy Edson]

Sorry it has been so difficult to compare results against each other. Must be very frustrating!

Glad there seems to have been some improvement and you are finding it easier to walk though!

Thanks! Just seems sloppy - how dare they get between me and data?? 🙂 Kind of thing which would have me thumping the table anywhere I had table-thumping rights.

 

[mikeyB]

The collateral circulation is the key, Eddy. The slower the athero develops in the main vessels, it gives secondary routes plenty of time to develop.

Great news about the carotids, there are no secondary routes to the brain.

 

[Eddy Edson]

Previously there was a "5cm occlusion 13 cm above the knee" in the SFA. This time: "The occlusion demonstrated previously was not visualised". Has it gone away? Did the previous guys see something that wasn't there? Did the guys this time miss it? My doc thinks it very unlikely that it actually went away, and I suppose I have to agree, I guess ... But actually I don't really understand how there could be that much uncertainty over a 5cm occlusion - it's not a tiny little thing?

A doc friend agrees that a possible explanation is that the sonographer had been drinking. It was late on a Fri afternoon, and he had the rubicund nose of a day-time tippler.

 

[Eddy Edson]

The collateral circulation is the key, Eddy. The slower the athero develops in the main vessels, it gives secondary routes plenty of time to develop.

Great news about the carotids, there are no secondary routes to the brain.

Thanks, Mike. Keep on walking, then!