Why not you...

To my 7 faithful readers (that's what the Google Blog Follower Sidebar Reporter Thing says, anyhow - seems high to me).  I'm sorry.

I actually have content.  Ideas.  Words.  Things I want to say.  But time and focus are lacking.

I am not dead yet.  Neither is this blog.

Please bear with me.

Got away with one...

This year, I got away with one.

So, Happy Birthday to me.

I thought the tibial stress fracture last summer was a bummer.  It just goes to show, I guess.

Here's to getting away with one more.

And the weird photo?  A tradition.

Medical Numbers and Medical Arts

Here I am, approaching five months of living with a stent.

Because there's no peeking back inside my heart, everything is measured with, at best, a secondary view.  Often it's not even that close.  And I think the path from a lot of those measurements back to the health of my heart is filled with a lot of forks, branches of which are chosen for reasons that aren't always based in any sort of firm science.

Recent numbers are along these lines:

  Bad cholesterol: 54 - that's a nice low number, yay for Lipitor
  Good cholesterol: 43 - that's a nice high number, yay for exercise and moderate alcohol consumption
  Fitness as measured by VO2 Max: 56 ml/kg/min - that's also a nice high number
  Calories consumed per day: 1700-ish - this is a low number, but I'm still supposed to be losing weight
  Cholesterol consumed per day: 180mg-ish - this is about 100mg/day less than the recommended allowance

All of that, I'm told, bodes well for heart health, mortality, and other things we're all supposed to want.

And this is where the art of medicine comes in.  Like any art, it's subject to the skill, desires, and motivations of the artist and left open to interpretation by whatever audience the artist can muster to look at her art.

What makes 54 a good or bad number for LDL cholesterol?  Some guidelines say under 100 are good.  My hospital seems to think the people who think that are pikers, and that under 70 is better.  But there is no published science just yet that supports that.  So we're rapidly away from numbers and squarely in the realm of art.

What makes 43 a good or bad number for HDL cholesterol?  As far as anyone has told me, nothing makes it good.  In fact, it seems to matter so little that there isn't even a drug to raise it (and if the drug companies can't find a way to promote it and make a profit, that's surely an indicator of something).  HDL apparently "clears out" LDL cholesterol, so there is no upper bound on how much of that you should have.  Yet.  (Also, I have this mental picture of little fatty blobs wearing white hats racing around my blood stream rousting out other little fatty blobs wearing black hats and sending them away to my gut where they are expelled ignominiously and sent to perish in the waste water treatment plant, where I'm sure they are ganging up and plotting against me, one day to come to my house while I'm sleeping and clot every artery in my body all at once the night before something good was going to happen.)  Anyhow, stories aside, alcohol raises HDL, but don't have too much.  One to two drinks a day is good for me, so that's 8oz of wine, two cans of beer, a few shots of liquor.  The American Heart Association tells me to drink 14 drinks a week.  Family Doctor says that if I drink more than 14 drinks per week, I'm at risk for alcoholism.  Apparently it's a fine line between being heart healthy to being a drunk.  Choices, choices.  If only we had some science to help us... alas, we're still in the realm of art.

I think the calories and fitness are "real" numbers, because they are so distant from my heart health that they stand alone.  Eat fewer calories, lose weight.  That actually is sort of like science, or its big brother, math.  Weight loss seems to be a third or fourth order measure of heart health - carrying less weight makes your heart work less.   But so does Atenolol, evidently; being in shape keeps your heart rate low (which no one can say is good or bad, so there's that), but so does Atenolol.  So fitness is nice, and raises your HDL levels, but it seems like no one can attribute longevity to either of those things directly, so big whoop.  Speaking of the, in my mind dubious value of Atenolol,  cardiologists love beta blockers.  My pharmacist once said "If cardiologists had their way, there would be low-dose beta blockers and loop diuretics in the tap water."  I've mentioned that to a few doctors, and they all generally agreed that it does, indeed, seem like a thing cardiologists would do.

My favorite art, though, is the art of proscribing diets.  I am on a reduced cholesterol diet - not much cheese, easy on the eggs, most of what I get comes from meat.  With the help of LoseIt I can tell you roughly how much cholesterol I ingest, which is right about where I'm supposed to be.   However, recent studies and articles in the popular press suggest that dietary cholesterol doesn't affect blood cholesterol, at least not as much as what the guidelines were based on.  I asked a nutritionist about this, and she said that's pretty true, and some eggs and cheese probably wouldn't kill me on the spot (although the saturated fats in the cheese probably would).  So I asked why I was on a reduced cholesterol diet.  She said "we put all heart patients on a diet like that".  But it doesn't seem to matter.  Art.  And in this case, it sounds sort of like amateur art.

Next time you feel bad and go to the doctor, don't expect an answer.  Get over it, there is no answer.  And almost no amount of numbers or data or statistics or measurements are going to help.  It's art.  With luck, you'll get a good artist.  Another MRI isn't going to help the artist any more than a digital camera would have helped Ansel Adams.  The tools are useful and necessary, but the interpretive art is what you're going to get.  Like all art, it takes time and adjustment.  It doesn't take the greatest new tools, but good application of reasonable tools.  So stop expecting an answer firmly based in science, and hope for a pretty picture.  It will reduce your stress, which is good for your heart, or so they say.

Well, that's just great...

I read in the New York Times that the F.D.A. just announced that they "... sent warning letters last week to two drug makers ordering them to stop marketing unapproved nitroglycerin tablets. But the drugs are still being sold at pharmacies while the order takes effect."

Well, that's just great.

I've never used my nitro, and of course never hope to, but it would be nice to know that it would actually help.

To the F.D.A.: better late than never, thanks.

To Konec and Glenmark: I hope it was worth it to you, and I hope you get what you deserve.

diet coke!

I love Diet Coke.  I drink way too much of it.  My nutritionist asked me how much Diet Coke I drink.  I asked her how much there was.  My cardiologist suggested that since the caffeine raises my heart rate, it might be good to cut back.  However, that would make the list of things I "cut back" on untenable.  The things already on the list:

• Cheese (and its all-important delivery method: pizza)
• alcohol (and its vectors: beer, wine, and gin)
• chocolate (in all its glorious forms: cake, brownies, -chip cookies, injected)  

are very nearly enough to risk a heart-attack (note, Cute Doc disagrees with this.  However, she's washing down chocolate-covered pepperoni pizza with a martini as she says that (ok, not really, but she could)).

So at this point, changing my Diet Coke consumption isn't open for discussion. 

Happily, I am not alone in this sentiment.  My artificially-caramel-colored overlords at the Coca-Cola company are on my side.  Diet Coke and The Heart Truth have joined forces because

A healthy, happy heart is essential to staying extraordinary and making the most of every moment.  Diet Coke and The Heart Truth are partnering to raise awareness for women's heath programs.

So every time I drink a Diet Coke (like now!) I am supporting the National Heart, Lung, and Blood Institute, who, I assume, are working very hard on my behalf to figure out how, not only women, but I, too, can eat more pizza, drink more wine, and celebrate every day with a brownie (and/or chocolate cake).

So, Dr. Smarty-Pants Cardiologist, this Diet Coke is for you.

... just like Bill Clinton.

That's my new line.

When someone asks about it, I can say it's the same thing Bill Clinton had done.  So anyone watching CNN (here or here), reading Newsweek, or the New York Times will know.

I, not being a former President, did not get two stents.  I only got one.

Also, I am not 63, I'm 38.

Nor did I ever have any, much less quadruple, by-pass surgery.  So there's that.

The idea is the same, but I wouldn't have minded waiting a few more years.  Like until I was 63.  That would have been 25 more years of eating cheese.  Dammit.

I wonder if the ex-President got a copy of his imaging so he, too, has a picture of his ribs and heart and the catheter.  I did.  So there.

I now return you to our regularly scheduled rambling.  Thanks for reading.

medicine

Other than a brief run of Prilosec (a freaking miracle drug, as far as I'm concerned) more than a decade ago, I've never taken any medicine regularly.

Now:

• Lipitor, forever.  Keeps the cholesterol down.
• Baby aspirin, forever.  Yeah, it's not recommended any more- unless your doctor says it is.  Mine does.
• Metoprolol, for 3 months, or forever, depending on who you talk to.  Blocks the Betas, keeps the heart rate down, and generally mellows me out.  I don't know why exactly this is needed, but in this case, I'm doing what I'm told.  Transient effects include dizziness, lightheadedness, drowsiness, tiredness, and unusual dreams. It may also reduce blood flow to the hands and feet, causing them to feel numb and cold.  Word.
• Plavix, for a year.  Reduces blood clotting.  Apparently, clotting off that stent is Bad.  This works to prevent that.  Also, adverse effects include hemorrhage.
• Omega-3 capsules, 2 a day for the "slippery fats" to keep the blood moving.
• A daily multi-vitamin, mostly for the Vitamin D.  400 IUs. 

The bad part: That's quite a change, going from zero medicine to 7 pills per day.  Most of the change is in my routine - don't forget to take the medicine.  Various doctors, physician assistants, etc. have said (and this is a very, very light paraphrasing) "If you stop taking the Plavix, you will die".  So that's some sort of motivation.

The OK part: As far as I've noticed, I've suffered no side effects.  All that stuff you hear on the TV ads - not for me, at least not in the first month or so.  So, yay.  Except for the lightheadedness from the metoprolol, but even that is getting better.

Thanks for reading.  Next week: food.  Maybe.