I have coronary artery disease


#182

I don’t have all the answers… I do hope you’ll give good consideration to the professional advice you’re given, as well as your own experiences and research. Your cardiologist has likely managed the cardiac health of thousands of patients and had a lot of continuing education of the highest caliber on the subjects you’re pondering… to me the frustration is that they have almost zero time to explain to patients why they recommend what they do… tending to leave us as patients rather unsatisfied


#183

At this point, I don’t understand my current heart health status to be an acute situation. If true, that will give me time to make some decisions and set out on a near-term treatment path. I think traditional medicine has long advised, when possible, to make lifestyle changes first, before taking any drugs or other medical procedures.


#184

You already know that statins not only help reduce cholesterol, but also help stabilize plaque, right?


#185

I’m sure I won’t tire of reading your progress and discoveries. Your BG numbers are amazing, and a low carb/no grain diet has many benefits, including reducing inflammation in many people. I eat about 80-100 carbs/day still. Continuing to reduce, but not ready to go as low as you.
I have very high cholesterol, but my ratio is good and when I do those risk tests it still shows me low enough risk that I choose not to take statins. It’s complex issue, and I hope to learn more as you share more. Thanks!


#186

Thanks for the links, @Eddie2. I followed and read both of them. I am pursuing knowledge accumulation at this point, resisting making conclusions too quickly. I am skeptical about using statins, for sure, but I’m hoping that my dietary and other measures can accomplish the same plaque stabilization benefits.

One thing that caught my eye reading the first linked study is the mention of using 80 mg/day of Lipitor. When I was on Lipitor, I was taking 40 mg/day. I am concerned about this high dose and the possibility of increasing risk for bad non-reversible side-effects.


#188

I agree that anything somebody can accomplish with lifestyle and diet changes is normally preferable to taking any medicine. I try to limit what I take.

But I just wanted to share the other possible benefit of statins, because often times doctors will speak only of the cholesterol reduction, but don’t even mention the other possible benefits. So I wanted to share that.


#189

That is my understanding as well, that they can disrupt the plaque forming mechanism as well as just generally lowering cholesterol…


#190

My cardiologists emphasized this point and I had not heard it before then. Getting a diagnosis, for me, tends to focus my attention in new directions.


#191

Terry,
I was at my doc a couple weeks ago and asked him about justification for statin use seeing how there are some people saying they would prefer not to use. He referred me to this study for my enlightenment: http://care.diabetesjournals.org/content/diacare/39/6/996.full.pdf . Maybe you have already read this study, I found it convincing enough to stay on my prescribed dose of 10 mg of Zetia which is susposed to help the 40mg of Zocor work that I am on. In following the entries on statin use I have not seen mention of using Zetia but I must admit I have not searched for it either.
Good Luck!
Mel


#192

Thank-you, @Mel22, for bringing this study to my attention. I’ve read through it and the conclusion seem to point to the benefits of using statins to improve the risk of people with T1D of avoiding heart attacks and strokes. The study specified that this benefit accrued to people who used statins before any heart attack or stroke, in other words as primary prevention.

I think I need to increase my skill with discerning the strengths and weaknesses of any study. Maybe I need to find a “health studies for dummies” resource. When we, as patients, depend on secondary sources, like our doctors, to weigh the relative merits of any health issue in the scientific literature, we open ourselves to the subjective bias of the interpreter/doctor. Some people just trust the doctor. I am more inclined to be in the trust but verify camp. I’m struggling to identify quality alternate resources for this.


#193

If I’m to strategically use scientific research to better inform my decisions going forward, I need to increase my skill level in reading and interpreting these info sources.

I quickly found this resource that squarely addresses my interest.

Taken from the article linked below.

So how do you distinguish hyperbole from scientific evidence? By reading the papers yourself.

That’s not easy, even for scientists, who readily admit that reading these papers can be akin to torture. (A recent article in Science , enumerating the steps of reading a paper, included “fear,” “regret,” “bafflement,” “distraction,” and “rage.”) Rather than charging headfirst into several thousand words of science-speak, follow this plan of attack for primary research articles. With a little practice, you can do more than just understand them: you can replace conventional wisdom with knowledge, make more informed decisions in the areas of life that concern you most — health, fitness, and diet, for example — and better understand and participate in the public debate about important scientific issues.

Here’s a link to this promising article. I’m off to read it in full.


#194

Hi Terry,
I’ve not been here in a while because…well…I just had a coronary artery disease diagnosis in August when I had a very mild heart attack. It didn’t surprise me, I did have an extensive paternal history of heart and blood disorders but like you…I didn’t really anticipate how I would feel about it.
I had been finding myself slightly short of breath upon exertion and had been upping my walking routine. When I finally admitted to myself that I felt really crappy, I called my endo to go in early for my 3-month appointment. My endo is also my Primary Care doc. Upon arriving and describing my symptoms, he sent me immediately to the ER which was just across the street.

They did an electrocardiogram and compared it to one they had on file from five years earlier. There was no change. BUT, when my blood work came back, there was a tiny bit of the protein troponin present, indicating that some heart cells had been damaged. Before I had much time to process that, the head of the Cardiology Department stepped in and said she had time to do a cardiac catheterization on me and assess the damage, and by the way, the lab was available at that moment.

I was pretty nervous, but she assured me I could keep my pump and cgm and I was already familiar with the proposed anesthetic, Versad, and felt comfortable with it, knowing I would be relaxed and awake but feel nothing.
The cardiologist herself took my phone, which had my cgm reading and handed it to the anesthetist. I also showed him how to unplug my pump in an emergency. I’ll say right now, I’d never fear to have a cardiac cath procedure again. Even though they took a lot of pictures they did not feel the need to place a stent. The artery that was blocked was relatively small, and better yet, my body was already building collateral arteries to get more blood to that area of my heart. (Everyone is capable of this to some degree, it’s well worth researching if you have coronary artery disease and with or without stents.)

Jump to recovery. I have kept the cardiologist, she is young, informed and gave me her personal cell. She was trained at a world-famous heart center. Her approach is the reserved one that I prefer. She explained that exercise would help the collateral arteries grow and advised me to work back up to my previous level slowly, resting when necessary.

This is nearly four months out. I’ve returned to my volunteer job, am gaining in my ability to exercise without getting short of breath which keeps my insulin working correctly, and feel a little clearer on my approach to life.

And now to address your (above) quote.

I’ve always preferred simple and quick meals, I shop so that I have plenty of vegetables (steamed and raw), condiments, salad dressings, tasty cheeses and a meat for flavor now and then. I have to be careful of overdoing it with dairy products because of the lactose, but I do include them.

Simple meals that I know how to dose for are my way of dealing with earing when I really don’t want to think too much.

I eat many salads. For any meal. Last night’s was lightly cooked green beans, halved grape tomatoes, green onion,
swiss cheese and cucumber in small cubes, six large croutons (10 g) and a spoonful of Litehouse Poppy Seed Dressing.) I know for me, that’s a 3 unit meal.

I eat deviled eggs, ham and cheese roll-ups and cheese spreads on veggies and the occasional cracker. My spouse has mastered the art of the very thin crust pizza, and we also make cheese and veggie crust pizzas.

Knowing I’m living with coronary artery disease has caused me to re-evaluate my priorities. I’m also one of those old-timers who heard the doc telling my mom I’d never see 40. I just turned 71. To me, every day is a gift.

I wish you well on your journey, and thank you for sharing your story and prompting me to write this.

Splash


#195

Thanks for telling your story, @Splash1. One paradox that I’ve learned with all the heart health I’ve been learning about is that the degree of coronary artery plaque does not predict the rate of adverse events. In other words, people like you, who have relatively little plaque often experience the same rate of heart attacks as people with more measurable plaque.

As to diet, I have successfully eliminated all grains. That includes crackers, bread, croutons, noodles, pasta, and rice. I’m now eating kimchi 4-5 times per week. I also eat dairy, veggies but avoid any salad dressing made with vegetable oils. I favor oils such as olive oil and coconut oil.

I attended an initial visit with a naturopath last week and will address optimizing my thyroid labs. I am hypothyroid. I understand that thyroid health plays a significant role in the development of coronary artery disease for many of us.

I like reading about similarly situated people and what they are doing to address their heart disease. It seems like you have adjusted nicely and were lucky to get the tests you needed right away. I wish you continuing good health.


#196

Over the years I can easily slip into simple meals that I can quickly make in 5-10 minutes. I eat repetitive meals and don’t get bored easily.

I’m seeing now that this is an area I can kick it up a gear and help contribute to better health.


#197

@Terry4 I’ll preface this post by saying I mostly hate discussions of recipes on diabetes message boards. But I had to tell you that I was motivated to order an Instant Pot when you mentioned that you ordered one. I thought I was the only person in the world who didn’t have one. I’ve had mixed results with it so far. My best success was hard boiled eggs and I also have done well with steamed veggies. Other than that I’ve ended up with mushy stuff but think it is a matter of getting experience on how long to cook things.

But I wanted to tell you that I am making yogurt today and thinking of you (and Norm!). I used to have a yogurt maker in the 1970’s and wish that I still had those glass jars with the seals and white lids.

Have you had success with the Instant Pot?

And how are you doing? :blue_heart:


#198

Hi @Laddie – I hear you. All the internet chatter about cooking and recipes has always been a mystery to me. I knew there was something real about it but I just couldn’t get excited.

I just finished an excellent bowl of delicious tumeric chicken soup. I am astounded that I made it. It’s flavored with tumeric, ginger, garlic, and full-fat coconut milk.

I also made the chicken stock used in that recipe from the bones and remnants of a store-bought rotisserie chicken. I’m thinking of making and drinking bone broth on a regular basis now. I think it genuinely fits into the “food as medicine” category.

There’s nothing like a threat to your life to clarify and boost one’s motivation!

I love the aroma that good cooking creates. I mostly enjoyed that second-hand in the past from being invited over to someone’s home for a nice meal.

I just finished my third successful batch of yogurt today using the instant pot. I hope your yogurt turned out well, too.

I am doing well. I see a naturopath for my initial 90-minute visit tomorrow. I’m hoping to change my thyroid medication and start shooting for optimal thyroid lab tests instead of simply in-range.

I’m experiencing some success working on my gut health and I’ve started meditating again. It’s all a long-term project but I’d like to think there’s more ways to treat heart disease than drugs and procedures. I may very well need some drugs or procedures in the future but I’m giving this lifestyle campaign my full attention and effort!

I enjoy reading your helpful comments in the various Facebook groups. It’s nice to read comments like yours that are focused, logical, and clearly stated.


#199

Finally, I received the results of the stress exercise echocardiogram test I underwent three weeks ago. I take hope with these results as it seems I’m in no immediate threat of an adverse cardiac event. This will allow me to undertake lifestyle changes to see if I can stabilize and maybe even reverse some of the coronary artery plaque.

I am copying the body of the report and will redact names and other personal info.

Pt Name: [redacted] Study Date / Time 10/25/2018 / 11:25:36 AM
MRN: [redacted] Most recent prior: -
Acc #: [redacted] No. previous echos: 0
DOB: [redacted] Age: 65 years Gender: M
Height: 68.0 in BSA: 1.87 m2
Weight: 162 lb Order ID: [redacted]
Current medications: Diuretic, ARB and Beta-Blocker (Taken within past 24 hours).

Sonographer: [redacted]

Referring Provider: [redacted]
Study Location: [redacted]
Modalities Performed: Definity contrast and Exercise stress echo.
History: 65 y.o. man referred for combined hyperlipidemia in the context of type 1
diabetes for 35 years, a family history of MI and stroke and, severely elevated CAC
score of 489 (LAD 223, LCx 187, RCA 79) involving three major coronary arteries.
Patient history has been obtained from the EHR

Exercise Stress Echocardiographic Report

±-----------------------------------------------------------------------------+
Final Impressions:

  1. At rest there is normal left ventricular systolic function.

  2. There was no chest pain reported with exercise.

  3. The blood pressure response was normal.

  4. EKG portion of stress test is normal.

  5. Echo negative for ischemia.

  6. Low risk stress echo in a patient who achieved > 85% MAPHR or > 25,000
    peak DP, and no inducible ischemia.
    [my emphasis]
    ±-----------------------------------------------------------------------------+

Exercise Capacity: Above average for age.
Symptoms: The patient developed leg fatigue during the test.

Procedural Findings: The patient exercised on Supine bicycle, 25 watt stages for 10
minutes and 54 achieving a work level of 125 Watts. The patients resting blood
pressure was 128 /86 mmHg. The peak blood pressure during stress was 180/87 mm Hg.

The blood pressure response was normal. The peak heart rate achieved was 133 beats
per minute, which was 85% of the age predicted maximal heart rate of 155 beats per
minute. The peak double product was 23940 (beats/min x mm Hg). The test was stopped due to The target heart rate was achieved and patient fatigue. There was no chest pain reported with exercise.

Resting ECG Findings: Resting ECG showed normal sinus rhythm at a rate of 80 beats
per minute, with no abnormal findings.

Peak Stress ECG Findings: EKG portion of stress test is normal. There were non-specific ST T wave changes during stress. 0.5 mm ST depression in the inferior leads.

Echocardiographic Findings: The quality of echo imaging is good (with contrast).
There were no stress-induced wall motion abnormalities. Echo negative for ischemia.

There is normal left ventricular ejection fraction. At peak stress the LV function
augments normally. At recovery the LV function returned to baseline. Due to poor
endocardial definition, ultrasound contrast was used (Definity).

Baseline All segments are normal. 0=Unable to score, 1=Normal, 2=Hypokinetic,
3=Akinetic, 4=Dyskinetic, 5=Aneurysmal

Intermed All segments are normal. 0=Unable to score, 1=Normal, 2=Hypokinetic,
3=Akinetic, 4=Dyskinetic, 5=Aneurysmal

Peak All segments are normal. 0=Unable to score, 1=Normal, 2=Hypokinetic,
3=Akinetic, 4=Dyskinetic, 5=Aneurysmal

Recovery All segments are normal. 0=Unable to score, 1=Normal, 2=Hypokinetic,
3=Akinetic, 4=Dyskinetic, 5=Aneurysmal

Supervising RN: [redacted]
Supervising Physician: [redacted]
Report electronically signed by: [redacted]. (10/25/2018,
1:58:45 PM)
Fellow participating in diagnosis: [redacted]

*** Final ***

I received this report in person and had the opportunity to get all my questions answered by my cardiologist. I told the doctor that I favored treating my heart artery plaque using lifestyle choices. (More on that later.) He told me that this was a reasonable approach but that he recommending starting on a statin right away. He said that he thought the benefits of statins accrued over time, therefore starting sooner would bring the cumulative benefits of the out-years sooner.

I told him that I was till highly skeptical of the efficacy of statins. He printed out two studies for me to review that support the benefit of statins for people in my situation. Overall the doctor was professional in his presentation and he fully respected that this is my decision. I appreciated that.

I have now established myself as the patient of a local naturopath doctor. I love how she is taking a holistic approach to my health. We are addressing my heart disease across many treatment fronts:

  • Optimizing thyroid health. For the time being I am supplementing iodine and also eating three Brazil nuts every day for the thyroid-supporting selenium content.

  • I will continue the complete elimination of grains and all added sugars in my diet. I will also continue my daily intermittent fasting by limiting my eating every day to a seven-hour window.

  • I am supplementing magnesium, vitamin K2, fish oil, and vitamin D3.

  • I am taking probiotics for gut health, eating fermented vegetables, and adding vegetables to every meal.

  • I am trying to drink 80 ounces of water each day, harder than it sounds!

  • I will continue my daily walking exercise – I was encouraged to read in the above report that my exercise capacity was above average for my age.

  • We will work at improving my sleep as I take over-the-counter sleep meds. She hopes to be able to eliminate these meds.

  • We will work towards reducing my blood pressure and hopefully withdrawing my current blood pressure medication.

  • I want to establish a daily habit of meditating.

So, my work is cut out for me. I’m grateful that I am not in any immediate and urgent health crisis and that I have the time needed to positively impact both my heart and overall health. I realize, however, there are no guarantees when it comes to health, especially heart health.

My intention with posting so much detail is that it might help someone who follows my path at some point in the future and might benefit from by my experience.

Thank-you to everyone for your kind and genuine support!


#200

Been meaning to ask you, did they do analysis of your oxygen consumption during your stress test? Did you have the breath analyzer mask on for the test?


#201

No. I may have had on the oxygen saturation sensor on my fingertip, but I’m unsure if that was just a single measurement and then removed. I definitely did not wear a mask.


#202

I’ve been type 1 insulin dependent for the better part of 61 years now. Diagnosed in 1957 at age 9. In 1994 I was diagnosed with CAD after my first ever stress test; I had no symptoms The results also showed calcification. Now 24 years later I have 3 stents, but have never had a heart attack. Angina is very infrequent, but does develop if I become overly stressed or outside for any length of time in very cold weather (as in snow at Lake Tahoe). Thankfully I live in FL. I dutifully take my 81 mg. aspiring and Crestor daily. I see my cardiologist every 6 months and he thinks I’m doing great. I treat my CAD as a chronic illness like my Type 1 and have never let either one define me. As a child, right after my diagnosis, getting use to the injections, diet, etc., I remember thinking, if I don’t take my shots and eat right I won’t be able to go out and play. Same thought all through my adulthood also. Very simplistic, but my way.