Gulp. This one is hard to swallow. Even though I was fully aware of my vulnerability to cardio vascular disease, the reality still lands hard. At 65 years old, I now square off with a threat that plays for keeps. The emotional and psychological burden ranks right up there with the seismic shock of my type 1 diabetes diagnosis so many years ago.
With nervous anticipation, I opened the MyChart test results from a coronary artery calcium scan I had performed last month. The bad news in the report shocked my sense of well-being.
The cold hard facts
The physician interpreting this scan did not mince words.
There is severe coronary artery calcification…. This corresponds to the 81st percentile for age and gender.
I’ve been aware for many years that the chief cause of death among people with diabetes is coronary artery disease. In the years leading up to this diagnosis, I took comfort in the fact that I received good reports ten years ago when I underwent a coronary artery stress test and five years later a carotid artery intima media thickness scan.
Family history and diabetes
With a family history of heart attacks and strokes and my long years living with type 1 diabetes, I knew the risk. Six years ago, I made drastic changes in my lifestyle primarily to regain control of my blood glucose but also with the secondary motivation to lower my risk of coronary vascular disease. I reduced the carbohydrates in my diet to a relatively low level, began walking every day, and started to closely monitor my blood glucose data produced by my continuous glucose monitor.
While I was painfully aware that I could not alter my genetics or the fact that I have diabetes, I could darn well do something about reining in my blood glucose numbers. My efforts paid off. With my reduced carb consumption, I cut my total daily dose of insulin in half, lowered my A1c, glucose variability, and my average glucose. My time in range skyrocketed. I was aware that this may not be enough given family history and diabetes, I took comfort knowing that I was doing the best I could.
Cardio vascular disease often leads to heart attacks and strokes. It is a killer. Its threat invaded my sense of well-being and shook me as much or more than my original diabetes diagnosis. In the early 1990’s, I watched my father endure a series of four strokes over several years. The consequences of the last stroke led to his death. It was a grim way to go.
Drugs and procedures versus lifestyle changes
My cardiologist is strongly urging me down a path of drugs and procedures. Even though I am just a patient, I harbor a basic mistrust of this “professional” advice. I know from reading studies that cholesterol lowering drugs do not extend the life of those who take them. I also know that the huge amount of money in the pharma and hospital industry can cloud the ethical judgment of the people involved.
My attitude is strongly informed by my five-year, three-endo diabetes crisis that finally ended when I took ownership of my diabetes. When I look back on those every 90-day doctor visits, I feel like the doc was simply documenting my demise without any useful guidance. I carry this history to my present view of doctors and their advice.
I have found a coronary artery disease on-line community that shares my views of this topic. They think that drugs and procedures should not be the first choice of treatment, even though that is appropriate in individual circumstance. Their main tools consist of elimination of dietary grains and sugars, optimizing thyroid blood test numbers, supplementing omega 3 fatty acids, vitamin D, and vitamin K2. They also think that optimizing gut health plays a role.
This stance buoys my hope, but I know all this effort may not help me. One comment made by another member of that community helped shape my point of view. He said that he had the same coronary artery score as me, but at five years younger than me, and he doesn’t have diabetes.
My path forward and the psychological challenge
So, I now dedicate myself full-time to trying to put the brakes on this looming cascade of events likely to end my life. I realistically realize that my success in this effort will be measured on my ability to slow this progression.
One psychological dimension I had never seriously thought about this diagnosis is the uncertain sense that I could die today, tomorrow, or maybe in ten years. I know this is the reality we all face from the moment we grasp our own mortality. But somehow, facing the details and possible very shortened timeline, does change how you look at it.
It took me a month to gather up the courage and perspective to write about this. I knew that I would write because I know that writing helps me process difficult problems. I also appreciate that many people here will read what I write and possibly put my experience to some good use in their lives. Thank-you all for that!
