<p>MOWC, you’ve really hit the nail on the head with your comment. With the typical sedentary person, symptoms of blockages are often easily detected in activities of daily living. Shortness of breath, chest pain, fatigue, etc. in daily life activities. With highly conditioned athletes like yourself and your friend, that’s often not the case because the person’s level of conditioning results in efficiencies of cardiac and respiratory functioning so that blockages may not result in the typical detectable symptoms in activities of daily living that are seen in less conditioned individuals. You know your body better than anyone else. If you feel enough concerns about a noticeable decline in your performance, then have the stress test, particularly if you don’t have a current test baseline to compare against if you decide that you want to have testing done every couple of years or so.</p>
<p>MOWC. I agree with Michael. I think if you have any concern at all I would seek out an appointment with an extremely reputable and thoughtful cardiologist. There is no downside especially if you’ve noticed declines and are concerned. </p>
<p>I’m not concerned as much as just wanting some sort of baseline and assessment. Of course I’m noticing declines- but what I don’t know is whether they are just due to age/demanding life and job or if there is something else going on. No real reason to think there is- but I don’t want any surprises. My friend with the blockage is the guy who ran Vol State (314 miles in 7 days) last year! </p>
<p>There is a flip side to pushing for insurance coverage of tests. To get some tests covered, the doc has to make a specific diagnosis (with a code). Every diagnosis with a code that is entered on your computerized health record is now a permanent diagnosis. An example of how this works:</p>
<p>I have to pay out of pocket for medical treatment until my annual deductible is met. The annual physical and blood tests are “preventative” not subject to the deductible, and supposed to be free, right? Oh, but wait … my doctor coded a diagnosis of “hypercholesterolemia” (high cholesterol) four years ago. My cholesterol dropped and is now so low that I qualified for the prefered healthy rate on my insurance. But, the code is still there. So, now, the cholesterol test as part of my annual physical is not “preventative”. It’s medical treatment. Likewise, my colonoscopies are no longer “preventative” because they found a polyp on my first one and that code is now on my permanent record. From now on, colonoscopies are “medical treatment”, not preventative. So, be careful about having the doc come up with a diagnosis of this or that in order to get a test covered.</p>
<p>This nonsense is why I get the NMR cholesterol test. I’m going to get billed ($17 or whatever) for the standard cholesterol test that my doc orders, because it’s now “treatment” even as part of my physical… If I’m going to pay for a test that tells me absolutely nothing interesting to me (the last thing I care about is a calculated LDL number!), I might as well pay $10 or $20 more (or whatever it is), to get the test that is at least interesting to me. </p>
<p>So, anyway, if you want one of these optional tests, it might make sense to just pay for it. – and not have the doc enter a diagnosis code in an attempt to get it covered. To get it covered will probably require “symptoms” and symptoms mean a diagnostic code and gratuitous diagnostic codes for coronary artery disease may not be what you want on your permanent health records (unless you actually have coronary artery disease!) Especially in an age of overtreatment with drugs and coronary bypass operations and so forth. I’d be wary of what I could be setting in motion! :)</p>
<p>Good point, iDad, but I don’t want to pay hundreds (or thousands) of dollars. I’ll see what I can find out.</p>
<p>4 miles with a horrific head wind starting out. I hate wind, and knew I was NOT going to be able to stand it for 2 miles, so I turned around at 1.3. Plan was to come home and finish on the dreadmill. Somehow I managed to wind around enough to get the 4 miles for my 35 mile week and did it all outside. 46 and nice except for the gale force north wind! </p>
<p>I’m heading to the west coast Wednesday and it’s a little bit of a packing challenge (work-wise AND exercise-wise). I’m going to be in Napa, Prescott, AZ, Vegas and LA over the course of a week. It looks like it is pretty chilly in Napa and Prescott (by my standards), nice in Vegas with cool mornings, and LA is 10 days out so who knows? </p>
<p>MOWC–you can get a stress test if you go to a spa like Canyon Ranch that has a medical component. That’s what I did. I paid for a physical and the stress test myself–talked to the physician about having the test. I don’t have a history of heart problems in my family, but I was concerned because my blood pressure was borderline high. My health insurance has a $2K deductible. The only thing I submitted to the insurance was the blood work (I had to pay, but I got the BCBS rate). I worked with a physician at CR to come up with a diet/exercise plan and that’s how I lost 40 pounds. It wasn’t cheap, but for me, the peace of mind I got was worth it. </p>
<p>Bromfield2, At least for the several thousand dollar cost you had a wonderful vacation thrown in :).</p>
<p>Bromfield- was it a max stress test! That is, did you go until exhaustion or did they stop you when they thought you had done enough. Unfortunately, I don’t think Canyon Ranch is in my future.</p>
<p>Hah. I would have completed the normal stress test the first time I walked the steep hill up from the old mill house down by the river. That was the time I ended up bent over panting like a dog next to the road. I think my heart rate was something like 93% of my age predicted number. Actually, I first hit 100% of my age predicted number at around the same time when I pumped up the tires of my bike, went for a ride, ended up in the wrong gear, going up a steep hill, and was too stubborn to stop until I got to the top! When those early attempts at exercise (at 250 pounds) didn’t kill me, I figured I was probably good to go!</p>
<p>At the time, my 60 second heart rate recovery was something like 12 beats per minute. That’s correlates with odds of men my age keeling over dead in the following five years. Now, my 60 second heart rate recovery is often 30 beats per minute, which puts me solidly in the lowest 25% odds for dropping dead.</p>
<p>BTW, Thomas Dayspring says to use the triglycerides and HDL measurements from the cholesterol test to screen for coronary artery plaque risk.</p>
<p>30% of people with Triglycerides (TG) of 100 have large numbers of LDL particles and are at risk of coronary artery disease.</p>
<p>50% of people with TG of 130 are at risk.</p>
<p>80% of people with TG of 150 are at risk.</p>
<p>You want your ratio of TG/HDL to be 3.0 or less.</p>
<p>Same risk factors for insulin resistance, metabolic syndrome, and type 2 diabetes.</p>
<p>If your TG and HDL is good, you are at very low risk for artery plaque issues, leaving only the possibility of some kind of genetic heart defect.</p>
<p>Here’s a terrific podcast where Dayspring runs through everything you need to know about cholesterol testing and evaluating coronary artery disease risk:</p>
<p>[Thomas</a> Dayspring podcast](<a href=“http://livinlavidalowcarb.com/blog/the-llvlc-show-episode-585-lipidologist-dr-thomas-dayspring-explains-the-truth-about-cholesterol/14485]Thomas”>Home - Tasty & Healthy Recipes)</p>
<p>Here’s hoping you/we are mostly heart healthy! My 80 yr old mother is having issues with her carotid - had me done less than 2 years ago and now both are slowing clogging up again. Scary.</p>
<p>Does give me some thought to really paying attention to how I feel during exercise. Never worth it to push so hard as to feel truly exhausted or to the point of just not feeling good overall.</p>
<p>30 min treadmill run + 10 mins rowing. Wow, that rowing really works some different muscles!! 25 degrees today with MOWC 's winds made it a no-go-outside day for me.</p>
<p>MOWC – I think if you go in a ask for a consult saying what you posted above – you are feeling a decline in performance, there is some family history, and you want it checked out because your overall fitness may be masking a problem – you will get it, no problem. My primary is a long-time transcontinental cyclist and marathon runner and I think he’d know exactly why you are concerned. </p>
<p>For those new to the thread…I am the poster child for getting healthy before it kills you.</p>
<p>I had a cardiac echo six weeks and an EKG ten days before before my full cardiac arrest. The echo can tell you if your ejection fraction (measurement of the heart’s efficiency in pumping) is low, among other things, in which case further testing would be warranted. An angiogram would be definitive for a blockage, but it’s invasive so is not a first step in the evaluation process. If there were a suspicion of valve issues or arrythmias, there are lot of other tests.</p>
<p>I had a 100% blockage in the left anterior descending artery – the “widowmaker” (same thing that killed Tim Russert). Had no idea I was about to drop dead. Had some jaw pain two months prior, went to dentist, primary and cardiologist. Echo was normal 6 weeks prior, EKG was normal 10 days prior. Walked all over Eastern Europe and Israel (including climbing Masada) three weeks prior. Apparently the day of the heart attack I had gone into my former office to visit, fell asleep, complained that evening of indigestion and then keeled over in the kitchen while posting on CC. It was a series of miracles that I had this event at home, even though the survival rate for a full cardiac arrest outside of a hospital is on the order of 10%. I had just returned from lengthy travel overseas, in places where no medical facilities were available, S2 happened to be home (and knew CPR), he and DH were awake when it happened (vs. DH’s usual early bedtime compared to my night owl hours), etc. I have seen pics of full blockages online and they were scary enough – I saw mine and they were much worse. </p>
<p>I have no memory of the two weeks before the heart attack – it would make sense that I was not getting enough oxygenated blood to my brain, but I was also placed in an induced coma afterwards to minimize brain damage and that may have factored in. Cholesterol was 130, triglycerides 145, HDL 33 and LD 53. Mom and Dad had cardiac issues, but no heart attacks. Was overweight (though had lost 45 in the year prior because my glucose was creeping up) and way too sedentary. Also had polycystic ovarian syndrome, which ties into metabolic syndrome. Lots of little things which added up to disaster.</p>
<p>DH is morbidly obese, diabetic and has extremely severe sleep apnea. His eating habits are horrendous and he has not exercised in the 32 years I have known him. He gave up sugared sodas when he was diagnosed with diabetes, but that is pretty much the only concession he has made to healthier living. He would be happy to drop dead one day and mot have to worry about getting old and (especially) losing his mental faculties. Our primary just sent him off to get a cardiac eval. (The doc and I are in unspoken cahoots.) 
DH is waiting for the reports but said noone seemed alarmed. I hope to read them, too and see what they actually tested. I can’t change his behavior, but I’d like to know how far down the road he has gone.</p>
<p>Done with my long run. Overdressed for the weather (lulu running tights and tee) and felt crappy by the end of the run. It was almost 60 degrees and sunny. Gorgeous day! Now off to see what sorts of demanding emails piled up in my inbox while I was running. </p>
<p>CD- thanks for the recap. What an incredible story and SO lucky you were at home. You are a miracle!</p>
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<p>The Dr, Thomas Dayspring podcast I linked above describes your exact scenario. By conventional thinking, healthy test results because of the very low LDL and total cholesterol. Same thing with Tim Russert. Dayspring says his last test before his heart attack killed him was a statin-assisted LDL of 67.</p>
<p>In reality, it’s a VERY high risk scenario (as you discovered). The liver is in overdrive trying to dump excess triglycerides, which it loads up in massive numbers of VLDL particles and sends into the blood stream. The VLDLs are short-lived and become massive numbers of LDL particles (really bad artery disease risk), but the simple LDL measurement looks very low. Not because it’s a good scenario, but because the metabolism is so broken that the LDL particles are carrying more triglycerides instead of the cholesterol they usually carry. The NMR particle test captures this problem by showing an abnormal number of LDL particles – “discordance” with large numbers of LDL particles carrying a small amount of LDL cholesterol.</p>
<p>It’s really just another aspect of metabolic syndrome. The PCOS, the elevated blood sugar, the abdominal fat, the high blood pressure, and the coronary artery disease are all part of the same equation. The red flag is the high triglycerides and the bad triglyceride to HDL ratio – an almost universal indication of insulin resistance and metabolic syndrome. As Lustig points out, this is a problem that is not just for fat guys, but one that afflicts a significant percentage of skinny people (who really have no clue of the risk). Lustig hypothesizes that the fat people may be at lower risk because the storage of the triglycerides in fat cells is actually a protective defense mechanism not enjoyed by skinny people with metabolic syndrome.</p>
<p>Conventional wisdom misses the heart attack risk (by focusing on the admirably low LDL) and gives the wrong dietary advice (less fat, more heart healthy grains) when the underlying culprit is the liver dumping triglycerides into the bloodstream because it can’t metabolize sugar and carbs as fast as they are being consumed. Dayspring is a big believer in statins to reduce the number of LDL particles, but only after (or along with) getting patients to cut their carb consumption to fix the triglyceride problem.</p>
<p>Thank you for the Podcast, Idad. Also, I’ve been following your advice and have added some hills to my walking. It is definitely pushing me a little harder and making my walks more satisfying.</p>
<p>It was a beautiful day here. H and I walked for five miles and enjoyed the sunshine. The fitbit continues to be awesome and motivating. I could do a much better job in the clean eating department. I enjoyed a bag of Haro Gummy Bears at the movies last night and I had ice-cream filled bonbons for desert at dinner tonight. SIX of them (they weren’t that big AND they were covered in dark chocolate!!!) </p>
<p>If you prefer a visual presentation, here is a multl-part YouTube discussion on these issues with Thomas Dayspring and Gary Taubes at a health practice in California that handles the city contract to provide health services to police and fire fighthers. This link should play the first part and continue automatically to play the subsequent parts in order. These start with discussions of food and diet and end with consideration of specific cases of coronary artery disease risk. This is eye-opening stuff.</p>
<p>[Thomas</a> Dayspring and Gary Taubes](<a href=“Sugar - Dr. Thomas Dayspring and Gary Taubes - YouTube”>Sugar - Dr. Thomas Dayspring and Gary Taubes - YouTube)</p>
<p>Gummi Bears (and their cousin, sour gummy worms) were one of my favorite ways of mainlining sugar. Took a long time to wean myself off that stuff (except for what seems to be an annual binge at Halloween!).</p>
<p>I will watch these first thing tomorrow morning. Thank you!</p>
<p>All the discussion about ratios made me curious so I pulled out my last 2 blood reports.</p>
<p>March 2013 - total Cholesterol 161, HDL 85, LDL 66, Triglycerides 52</p>
<p>October 2013 - total 189, HDL 98, LDL 80, Triglycerides 53</p>
<p>Wonder if the changes can be explained by a season of full riding coupled with eating a lot more carbs during the riding season causing certain numbers to go up but my ratios improving?</p>