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Thursday, December 12, 2013

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.

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