Good point
20 times over
Novavax 3 weeks ago.
But I still mask with an elastomeric âDarth Vaderâ mask to go to the Supermarket, or take the train into town.
People can be a bit dense when reality doesnât agree with their desire for ânormal.â
Having observed responses to this pandemic from the earliest days here in the US (my husband saw what heâs now pretty sure was his first case of Covid-19 on or around 27th January 2020) the notion that this virus is/was very different from what weâd dealt with before has almost followed a sort of Gaussian/Bell curve distribution. Denialism of the serious nature to realisation (always with a few denialists festering away to make life difficult for the rest of us) and now a trend back to denialism/couldnât care less again.
I was a very early masker. Worked a treat as folk really gave me a wide berth in stores etcâŚassuming that I was the one with something catching, I suppose. Back to masking whilst shopping etc again simply as an extra precaution. Iâm not such an unusual sight nowadaysâŚwhich for personal protection in the here and now is a double edged sword.
Edit: Just a small selection of the masks I turned out in the early days when personal protective wear wasnât available for us regular folk (or even some medical/dental/veterinary offices, come to that). A reminder that precautions override convenience in this household
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Great pic VN! 
They are a mobile!
ralph
For the most part the cardiologist was pretty unconcerned about the arrhythmias, but because of my deep family history with CVD, he is having me do more tests to establish a baseline. I guess we will talk more after that, and I am just not going to speculate. Squeezing in a nuclear stress test tomorrow, since we have already met our deductible for 2023, and doing an echocardiogram and calcium score in January.
Feels good to get data.
IP
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Now I look closely, this is a very small collection compared to how many I made for ourselves and othersâŚalong with various false starts and design âtweaksâ. This became quite an absorbing project in the early months of the pandemic.
'Twas my good fortune that Iâm something of a Fiber Fiend and that we have both a quilt museum (with a small fabric selection for sale) plus a store dedicated to quilting supplies here in town. I had a pretty extensive stash of good quality, high thread count âfat quartersâ that Iâd purchased with furure projects in mind (not this one, though) Although, once decent quality masks became available and I slowed down production, I still got requests for masks that folk wanted to wear over their disposable stuff.
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Sounds promising. I had the nuclear stress test back when I had my first episode of AfibâŚas a workup to see if it was the result of âsilentâ heart attack, I guess. I thought it was overkill at the time but, on reflection, find it reassuring that it showed normal perfusion and whatever else it is that folk who know what theyâre looking at were comfortable with.
Sort of amusing tale (I guess you had to be ther) but since the test itself requires you to do a steady ramp up to a pre determined heart rateâŚso your second PET scan shows cardiac function and perfusion while under a workloadâŚactually being fit can work against you. Obvious really, if you think about it, since heart rate response at any sub max effort drops with increasing fitness. I was starting to get a bit uncomfortable from a safety POV as, due to longstanding endurance training, my heart rate was staying lower than the testing crew were used to seeing as the test progressed and I was having to run at a decent clip and incline. The feeling mustâve been mutual as there was mention of cutting the test short and giving me the drugs that are used on the feeble and unfit who can only shuffle on the treadmill. That did itâŚthe idea that I had to suffer that indignity ticked me off enough that I hit the magic number and dodged that bullet.
Like I always say, I know enough now about this topic to realise I donât know enough to have a worthwhile opinionâŚbut sharing the one I have, it looks to me like youâre on the logical time-line to get the info you need for decent decision making.
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LOL. Sounds about right.
Dr. cautioned me that people receiving calcium scores can trigger panic, giving the example of two people heading out to a dinner that gives them indigestion and the one who had the calcium test heading to the ER with fear that it was a cardiac event. I told him I probably needed some of that, as I was an eternal 18 year old at heart, more prone towards ignoring warning signs, rather than blowing them out of proportion! I love making informed decisions and a fan of getting data.
IP,
a planner, not a panic-er
Me too. I went the CAC route electively because I was pretty much expecting it to show a zero to minimal, ânothing to worry aboutâ score and be reassured. Oddly enough, I find that itâs almost equally reassuring to know that I was right not to be as complacent as my doctors had beenâŚespecially since I have an intervention cardiologist whoâs reassuring and positive about how much changes in understanding of lipidology and associated developments can put me on a track that that I thought I was on 2 years ago.
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And another thingâŚmy husband has had to actually admit that I was right. About both my decision to do some DIY doctoring based on stuff I read/heard on the internet and, more importantly, that it was a pretty good idea to have spent most of my 50s and 60s doing what he called my âfitness stuffâ somewhat dismissively.
Given that I was able to handle a teaching schedule of upwards of 6 classes a week plus the training for them and my own stuff, Iâd say itâs a) as good a diagnostic of decent cardiac perfusion as any nuclear stress test would show and b) was in no small way responsible for building the collateral circulation thatâs compensated/will continue to compensate for what, on first blush, looks like Iâd be a prime candidate for a stent or threeâŚor maybe worse.
Gotta love physiology and knowing how to manipulate it.
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Sis being physically fit is what allowed her to survive her 100% blocked circumflex artery, for which she just got a stint this month. (She is 11 years older than I.) Unfortunately they still triggered a small heart attack when collapsing the collaterals during the stint placement, but she would have never even gotten to the table without the collaterals.
The surgeons in her area were not willing to touch the surgery, but she was able to go up to Boston to get it done. Even then, it was a much bigger job than anticipated, both in terms of length and blockage.
IP,
never wanting to make it to the table for stint placement either, but for a lack of need thereof
In the context of screening, genetics/family history and primary prevention, weâve just finished listening to this over breakfast. Interesting discussion on value in preventing premature mortality/morbidity (and whether much of the whatâs being offered has any)
Doesnât really apply to âourâ situation (and probably more than a handful of other readers who arenât awareâŚdonât want to be aware, TYVM!) as, late to the party as I am in getting to grips with the basic science etc, none of this is new news to the folk with knowledge and expertise in the field.
Whatâs struck me, though, is that in the context of investment, there are likely set to be umpteen future hugely successful medications, diagnostic strategies etc already in the pipeline. I really wish we had access to older posts on the boards that are still open. Iâm thinking back to around 2004/2005 (when I
was still unaware of my so called borderline high cholesterol) and a series of hugely popular threads on the Foolish Collective board called The Cholesterol PlaysâŚthread starts by a poster called edmiller. The collection (I think about 4 or 5 threads) ended with a discussion of what was coming along back thenâŚitâd be interesting to see how some (any?) of them panned out. I do recall that using hs-CRP measurement as a risk predictor was in its early stages as there was a bit of a discussion on that and âinflammationâ in general.
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Finally got around to listening to this broadcast on The Screening Dilemma. Thanks for the link.
One interesting thing they mentioned was that only about 30 something % of your chance to get something is genetic, with the rest being life exposure.
Sis and I have very different diets. I have low carbed for decades while she has been a sugar-addict. We both are very active with sports. Sis is 11 years older than I, and recently diagnosed with 100% blockage of the circumflex artery and 28% blockage of the LAD. A doctor in Boston successfully put in a stint in the Circumflex and she is recovering.
This long covid and the arrhythmia that was picked up by the ordered heart monitor, in conjunction with the family history, recent and past, caused me to go to a cardiologist and get testing done. I am happy to say that the nuclear stress test and Ca scan showed no problems. My Ca score is zero, giving this 60 year old a heart rating of that of a 39 year old. Happy dance, but still no clue as to what caused the arrhythmia. Perhaps it was Covid related. Will talk with the cardiologist to see if he still wants me to do the echocardiogram, and what the next steps are, if any, but right now am pretty happy. I have long believed that our high veggie low carb diet is heart healthy, and see no reason to avoid that meat and cheese that go with the veggies. That said, am not thrilled about the escalating total cholesterol and LDLs, but as long as I continue to have a Ca score of zero, does it matter?
IP,
looking forward to a dose of reality from you
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Great news! A score of zeroâŚeven with excellent diet âŚis quite unusual in Real Grown Ups. Hereâs the article that tipped me into getting the CAC done. I was reasonably sure that I would match the flaneur with the zero. No chanceâŚa big fat 700+ for me. No messing around or subtle nuance to understand.
My first meeting with my intervention cardiologist was the eye opener WRT family history. I have no siblings so he moved onto mumâs generation. Apart from her oldest brother, whoâd been a prisoner in Japanese POW camp and died shortly after the end of WWII of the consequences of malnutrition and malaria, her 4 other brothers had died suddenly and her older sister of similar peripheral artery disease like her. I actually felt a bit of a chump as the lightbulb started glowing. I had to explain that, as she was the youngest by quite a long way and I was born when she was 35, I was quite young when all this was going on. Besides, back then and there, when someone died, first words out of peoplesâ mouths were condolencesâŚnot âwhat did he die of?â
It turns out that my cardiologistâs wife is similarly afflictedâŚpossibly worse as sheâs younger. Her mother had her first hesrt attack at 40 and the sevondâŚwhich killed herâŚat 47. Sheâs also on the same aggressive lipid lowering therapy that I am. Iâm still amazed that Iâm absolutely symptom free. I think itâs the lack of smoking, early adoption of a heart healthy diet before the term was ever coined and my exercise regimen being sufficient to build up a strong collateral circulation.
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Dang, Vee. Thatâs scary. But you are right that your score does not seem to allow for questioning meds.
Sisâ Ca score when she was about 65 was that of an 89 YO man. Perhaps itâs simply a need on my part to be able to have impact on my health, but I seriously believe in low carbing when done all the way. Itâs detrimental to your health to do in half measures, and it is a permanent change in way of eating for me and DH. DH had a score of 6, or that of a non-diabetic 10 years younger. He was 63 at the time and had been a type 1 diabetic since the age of 13, which tends to be a push point to get on statins, though the cardiologist could not tell him if it mattered that he was an insulin non-producing vs insulin resistant type 2. He finally caved into his cardiologist to take LDL lowering meds, though not statins, since his score of 6 does show some accumulation of plaque.
An interesting note on how to ask the insurance company to approve of a Ca scan is the difference between DH and I. DH pushed the insurance co to approve the test because he was using it to try to determine whether or not to take meds to lower LDLs. His cardiologist refused to even try for insurance approval, but he got it. Getting the hospital to submit the paperwork to the insurance company was another hurdle, but DH can be like a dog with a bone and I suspect they have simply caved in to him to get him off their back. My cardiologist submitted it to the insurance company under the guise of trying to establish a baseline for me given my family history. Aetna clearly stated family history is not an acceptable reason to approve the test. He probably should have only mentioned my elevated LDLs and need to explore statins.
IP
Hereâs how anomalous multifactorial diseases can be. So, weâre coming up to the 5 year anniversary of my husbandâs open heart surgery. Not for coronary artery disease but a congenital aortopathy that he was totally unaware of âŚuntil the aorta started to expand (and dissect) with no symptoms but a sudden onset murmer from the aortic valve incompetence. Daughter diagnosed that with her portable ultrasound and it was strsight off to the ER and immediate admission based on the images she captured on her cellphone.
During his surgeryâŚwhere the ascending aorta was dissected out and replaced by dacron and the aortic valce replaced by a pig vavle. A bio-Bentall procedure if you want to Google/YouTube it (Iâm too scared to!)âŚcoronary arteries wrre dissected out and sent along to pathology with the aorta. Post mortem report, so to speakâŚthe gold standard! Husband eats wellâŚbut without my absolute commitmentâŚand exercised a bit but not like me. Not so much as a whiff of atherogenic plaque. He has CT angiogram every 6 months as follow up. Still nothing. Go figure. Daughter has also inherited this so theyâre both members of the Big Aorta Club at the university hospital and have constant monitoring.
Had a longish thread on this back on the Running Fools board. One of the regulars and quite a presence on the New England running sceneâŚInstrideâŚhad the same procedure done a short time before dh. Again, a chance finding on âroutineâ physical. You never know whatâs going on under the hood. Rude good health until almost 70 and thenâŚwallop!
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Yeah, the body is complicated!
IP
glad everyone is doing well
Oops I just realised that I didnât post the article about CAC score and risk stratification
I really think that I was expecting something similar for myself. My lipid profile wasnât so different⌠LDL-C just a bit higher at around 125-130. I started reading this blog a few years ago purely out of academic interest and because Anthony Pearson is an engaging author.
My CT angiogram was the real decider thoughâŚ3 coronary arteries with >80% blockage and Fractional Flow Reserve showing figures that tend to be decision makers for stent placement. Or rather did. These newer lipid lowering meds (PCSK9 inhibitors etc) seem to be real game changers. My cardiologist is very upbeat about the future of intervention cardiologyâŚreal intervention tools that make a difference rather than just slowing down the inevitable
Also worth noting the advances in technology that allow for better, non invasive diagnostics. It doesnât seem that long ago that âangiographyâ meant catheterisation with attendant risks. Now itâs starting to look like even stents and other revascularisation procedures are set to become a quaint historical footnote for a good many
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@inparadise âŚthe bit of practical advice Iâd offer is to print out the report of your CAC score if youâre thinking of traveling in the coming years. Itâs a mistake to think every relevant piece of medical information will follow you to various physicians by virtue of there being electronic medical records containing it. If you have a lipid profile thatâs aroused interest in the past, itâll do so in the future and being able to demonstrate your outlier status in this context could save you a lot of wasted explanation.
I worked myself up into quite a lather getting âclearanceâ for my lapiplasty now Iâm suddenly âhigh riskââŚchecking and double checking that it"d reached the right place. As I left yesterday morning I wondered if I ought to take a hard copy with me but decided not to in case I looked a bit OCD. You can guess where this is going, right. No one could find it. Neither the orthopod or anesthesiologist were getting worked up but the mid level âbox checkersâ certainly were. In the end, dh had to offer a few suggestions on how to navigate to the right place and it was located quite literally as I was being wheeled into the ORâŚfound in a cyber equivalent of âslipped down the back of a deskâ!
Thanks, Vee. Yes, sometimes itâs great to have physical printouts, assuming you can find them. DH has a file started already.
We are indeed going to hit the road, assuming further testing is coming in with a green light. Cardiologist still wants me to do the echocardiogram, and may have some additional blood tests for me to do. I hope to continue with him even after we move 2 hours away, assuming that greenlight happens. If he finds something that triggers a less than good health alert, we may find ourselves staying put and forgoing the move to the cabin as a home base for 4 or so months, with 8 months of full time travel in the other times. Being a hopeful kind of gal, we continue to perfect the staging of our house for sale in February, but wonât pull the trigger until we get that greenlight.
Educated guesses, or more optimistically informed decisions, trump sticking your head in the sand, particularly when it comes to health. We are currently living in an excellent area for medical, in a house we love, but a town we are not thrilled about. 2 out of 3 isnât bad, though my gypsy blood is ready to hit the road and look for that 3 for 3!