Monday, June 17, 2013

I Scored a Big Fat Zero

I had a CT Heart Scan this morning.  These scans are designed to detect calcium build-up in plaque along walls of the coronary arteries.    

[My heart]


How did I do?  Despite my “alarming” cholesterol (LDL – “bad” cholesterol – of 172), it turns out I have no plaque – 0% - the arteries are clean.  

You may ask, “Why was I even a candidate for such a procedure?”  That’s an interesting story. 

Every year at my annual physical my blood is drawn for a lipid profile – the test to determine your cholesterol score.  My total number is high, the LDL (bad) cholesterol is 172, my HDL (good) is 82 (also very high).  My primary care physician’s clinic requires treatment at 170.  She explained that it’s like standardized tests in schools.  It’s all about numbers.  She gets “dinged” when she doesn't treat people with certain numbers.  My number required treatment. 

I wasn't convinced I needed treatment.  My HDL was great, my Triglycerides are very good (66), so I dragged my feet, avoiding the meds.

During last year’s scare with dizzy spells – which was eventually diagnosed as Atrial Tachycardia, a cardiologist looked at my cholesterol numbers (LDL 191 at that time) and asked me – in a rather patronizing tone of voice, “Is there any reason you’re not treating this?” 

I should have pushed back – but felt like citing Wikipedia and other web sources would have been met with the usual medical scorn.

According to Wikipedia 

Research has found that statins are most effective for treating cardiovascular disease (CVD) as a secondary prevention strategy, with questionable benefit in those with elevated cholesterol levels but without previous CVD.[2][3] Statins have rare but severe adverse effects, particularly muscle damage, and some doctors believe they are overprescribed. 

In the end I caved and started taking Simvastatin.   Within a few days, the usual side effects appeared, aching muscles – so bad it was hard to sleep.  I called to report the side effects and the nurse cheerfully informed me that I could take a “Statin Holiday”, two weeks off the drugs to determine if the side effects would go away.  The side effects disappeared. 

Next we tried Pravastatin.  That was a bit better and a test showed my LDL went down (by over half to 91) – but then the side effects started again.  Rather than reporting the side effects and asking for the next drug, I just took myself off that medication without consulting the docs.


This year’s physical came – and low-and-behold – my LDL is still high, my 172 rating.  This time my doctor referred me to a new cardiologist.  He was a jolly fellow.  He recommended the heart scan, telling me that LDL alone is not indicative of plaque build-up in coronary arteries.  Some folks live long, healthy lives with LDL over 200, while others drop dead with LDL far below mine.  There are lots of factors; everyone’s body is different, etc. 

Now I am waiting to discuss my zero (0) score with the cardiologist.  Before the test he indicated that if the score was low enough, he would do nothing – and then run another scan in 10 years.

Hope my primary care doctor doesn't get “dinged” by the insurance companies or whoever dings doctors who don’t treat patients.

2 comments:

amy said...

What a story! Did anyone mention checking your small vs large particle LDL?

John G. said...

I brought up the small v large particle LDL test. The cardiologist sort of ignored me. He's big on these scans.