Annual Checkup

Met with Doctor Yasser Mikhail today for my annual checkup.   I was a little disappointed that I couldn't convince him to reduce my dosage or eliminate some of my medications.    After my initial consultation with my cardiologist Dr. Shaym Bhakta, he wrote this to my then primary care physician Dr. Anil Patel.

"I agree with the medical therapy that you are doing.   I would continue aspirin indefinitely in him.   I would recommend that his beta blocker be continued primarily for blood pressure control.   Given that William's blood pressure is well controlled and he is currently asymptomatic, I would recommend against up titrating his beta blocker to avoid causing side effects.    

I would recommend treating his hypercholesterolemia to an LDL of less than 70.   I would recommend increasing his astorvastatin as needed to achieve the goal LDL"

Since my current LDL level (54) has dropped well below the target of 70, I felt that at minimum we would start weening me off the statins.    I am convinced that my rising HDL (good) and dropping LDL (bad)  is mostly the result of my lifestyle changes where the good doctor is of the opinion that it is the result of the medical (drug) therepy.

If my own research is correct that statins can lower cholestorol levels 30% over a 5 year period then my potential would be to reach a level of 110.   My LDL levels have dropped from 157 to 54 (66%) in only 28 months.  

Of note in my latest blood work.

TSH levels have almost doubled since July.   TSH is a indicator of thyroid function.

Also taking a big jump is my AST levels an indicator of liver function.    One of the potential side effects of statins is damage to the liver.   Generally the alarm isn't sounded unless AST levels rise to 3 times the upper limit.   It is also common for AST levels to be unusually high for distance runners, especially after intense workouts.    Since I had a very intense interval workout immediately prior to having my blood drawn, I'm not going to be too alarmed over the higher AST levels.   

Here's an excerpt from a Running Times article addressing high AST levels

AST and ALT are enzymes that are evaluated by many of the multiple blood panels commonly ordered by physicians. Although they are considered to be “liver tests”, these enzymes are produced by a number of tissues, including muscle. A hard workout or long run will commonly increase the level of a number of blood tests, sometimes to very significant levels. I recommend that runners do not have routine blood tests performed within a few days of a hard workout or race. This can prevent a lot of unnecessary worrying.

The complete article can be read here. 

Sadly, my cardiologist that I liked so much, left for a new position and I need a new one who supports my choice of treatment plan.    I called Dr. Esselstyn's office for a recommendation and he called back to refer me to Dr. Curtis Rimmerman at the Cleveland Clinic.   I have an appointment to see him on January 2nd.

2 Year Progress

Haven't met with the doctor since December but did have bloodwork done and numbers continue to look very good.

Total Cholesterol rose 5 points but the bad (LDL) dropped 4 points and reached the target level of 70.   Good (HDL) increased 4 points and is now only 9 points from exceeding the LDL>

TSH levels which we have been monitoring closely dropped slightly.

On the running front.   No new PR's this season yet but times in all races have improved over the same races of a year ago.   

Completed my first full marathon in May and plan on running another in Detroit in October.

One thing I've noticed this year is that most of my races are averaging a heart rate of 159.   Don't know how to interpret that, but thought it noteworthy to mention here.

Meeting Dr. Esselstyn

Last night,  I attended a speaking engagement of Dr. Caldwell Esselstyn.    Dr. Sprouts as his colleagues have fondly named him, is the author of the book "Prevent and Reverse Heart Disease".   His work at the Cleveland Clinic has earned him quite a bit of notoriety and he was even consulted by President Bill Clinton after the president's 2nd heart attack.    After listening to him speak and seeing the evidence he provided, I am even more convinced that my heart disease is the result of a half century of eating the traditional western diet that gets over half it's calories from fat.

Initially I had adopted a modified version of Dr. Dean Ornish's heart disease reversal diet which like Dr. Esselstyn's program restricts fat calories to 10% of total calories.    Dr. Ornish's program allows fish and small amounts of oil.   Dr. Esselstyn's program is oil free and strictly plant based.   Nothing from anything that has a face or a mother.   According to Dr. Esselstyn's research, it is his opinion that oils (which derive 100% of it's calories from fat) damage  the endothelium (the lining of the arteries) making them like Velcro for collecting plaque.

You can learn more about preventing and reversing heart disease at the good doctors website at http://www.heartattackproof.com