Defining a Cure for Heart Disease

When can I be considered "cured" of heart disease or, more accurately, Coronary Artery Disease (CAD)? This is a subject that has plagued me for years and especially since I became involved with Track Your Plaque (TYP).

It seemed so simple at first. If I reversed or halted the progression of coronary calcium then I was "cured" (note that TYP does not make this hard claim of a cure - but you DO dramatically reduce your risk of a heart attack and I need a frame of reference to start the conversation).

The subject becomes even murkier when you consider the independent clinical experience of heart attack prevention pioneers Dr. Davis and Dr. Blanchet. Davis seem to feel that there is considerable risk reduction even if coronary calcium progresses but is held under 10% per year. Blanchet pushes the limit to about 15%. Both doctors rarely see heart attacks in their practices and other leading heart docs like Dr. Arthur Agatston (the doc of South Beach Diet fame and inventor of the gold-standard Agatston coronary calcium scoring system) made this statement.

"I'll let you in on a big secret. Physicians who practice aggressive prevention have seen heart attacks and strokes practically disappear from their practice. It's that simple — this approach [plaque reduction] can literally prevent heart attacks and strokes and save lives."

So when can I consider myself "cured" of heart disease and why is it so important to define a standard for a cure? Let's tackle the second, and easier, question first.

It is no secret I am a numbers guy. I need a target a goal. More selfishly (my competitive neurosis is showing) I need to know when I am winning and when I am losing. Put more simply, I need to know how to "keep score!" What number and unit of measure signals that I am “cured.” Even more importantly, I need a method of comparing and ultimately selecting the different heart disease treatments and programs available in my search for a cure.

To answer the first question, I believe there is a spectrum of possible standards in defining a cure for heart disease. At one end we have a practical definition, "No heart attacks." At the other end of the spectrum we have a far more complex definition, “No detectable coronary plaque.”

Without tipping my hand I’d like to ask those who read my blog to answer a simple poll question, “Under which condition would I consider myself "cured" of Coronary Artery Disease (CAD)?”

I’ll follow-up later with more thoughts on the subject of what constitutes a cure and we can begin to debate the issue!

Looking out for your heart heath (and a cure),


HeartHawk

More Healthcare Hijinks!

As a healthcare consumer advocate I always marvel at how little knowledge - even common sense - exists among so-called "health professionals." I think I'll devote series of blogs to some of my most recent "healthcare hijinks" experiences.

I get a great deal of my healthcare at a local clinic which in the past six-months has really taken great strides to improve customer service. They are very friendly, aggressive about getting back to patients about their healthcare (they even have a new online system where you can check test results as they become available), and the improvement is noticeable. But this is more a tale of inability to think on your feet - a skill that I feel is basic to the notion of healthcare.

I had some crazy TSH readings (typical of anyone with early Hashimoto's Thyroiditis) so my endocrinologist was tweaking my meds over a series of weeks. It is common for a doctor to relay information to one of their nurses who, in turn, (keep in mind these are college graduates experienced with medications and patient care) interfaces with the patient on issues such as dosage adjustments.

Let me first preface my diatribe with the fact that the nurse I am about to take to task was friendly, courteous, and worked hard to follow up with me (I am often difficult to reach because of my crazy schedule). Maybe it was just a "bad day." Nonetheless, I was left wondering just how competent the person on the other end of the phone was.

The nurse called to say the doc wanted to up my dose of Armour thyroid from 1/2 grain to 3/4 grains twice per day and the nurse asked if I wanted a new prescription. I said we could proabably still use my current prescription but would have to renew it much earlier as I will be using a 50% bigger dose. This is where the keystone cops episode begins.

The nurse remarked, "But your prescription is for 1 grain." I explained that since my dosage changes so frequently (and because it is far cheaper to do it this way) I use 1 grain pills that I simply split into 1/2 grain doses. At that she remarked, "But the doctor wants you to take 3/4 of grain." My retort was, "Yes, but I can also split the 1/2 grain pieces into 1/4 grain pieces. I could even take three 1/2 doses three times per day (which I believe would be the superior way to take any thyroid preparation containing T3)." At that point she was completely befuddled. After a short course in remedial math (which I am still not certain she comprehended) I convinced her that 1/2 grain plus 1/4 grain equaled 3/4 grains and that three 1/2 grain doses was the same amount of medicine as two 3/4 grain doses.

Afterwards, we laughed it off and she ended with,"Well, I am really not familar Armour Thyroid". What a shame for the doctor's thyroid patients! Now, even in the "far out" world of Armour Thyroid (sarcasm intended) basic math (like 1/4 plus 1/2 equals 3/4) still holds true!

As I mentioned, perhaps it was just a bad day with a little brain fog (I guess that is scary in itself). But it made me both laugh . . . and think! Of course this is not as bad as when I went to the pharmacy with a prescription for therapeutic vitamins and walked away with a prescription for coumadin - but that's another story (i.e. always read your labels)!

Looking out for your health,


HeartHawk

Finally, No More Begging and Conniving for Blood Tests

If you have heart disease or just about any serious health issue you have probably been in this boat. You don't feel right, there has been a change in you treatment, or, dammit, your just plain curious - you want a blood test. The old way was to call your doctor, wait for an appointment, then beg or connive your way into getting your doc to order the test (I have gotten REALLY good at conniving over the years). And, of course, this is no guarantee you will actually GET the test. You are at the complete mercy of the medical establishment.

BUT NOT ANYMORE!

A new technology called liquid chromatography/tandem mass spectrometry allows accurate blood assays with a single drop of blood and a paper-like carrier medium keeps the sample stable for extended periods of time and can be easily transported via mail.

BREAK YOUR BLOOD TESTING CHAINS AND BEG NO MORE!

Now you can get common blood tests ANYTIME YOU WANT! I was skeptical at first but Doc Davis finally, after his own test (that's TYP Nurse Dawn's hand in the photo - talk about giving blood for the cause), convinced me - so here is my SHAMELESS PLUG for TYP - you can review and order kits by clicking here. Oh, and one more thing, TYP members get a discount!

Regards,

HeartHawk

Common Sense: $1 Million Per Ounce

Now just how much do you think this little observation cost?

The obesity epidemic in the US is due solely to increased food intake

That's right, this "revelation" is based on reporting at the 2009 European Congress on Obesity and the combined genius and interpretation of no less than:

Deakin University, Melbourne, Australia
World Health Organization Collaborating Centre for Obesity Prevention
US Department of Agriculture
National Health and Nutrition Examination Survey
American Heart Association
American College of Cardiology

But, look at it this way. There was probably no chance McDonald's, KFC, Burger King, and Taco Bell were gonna break the news!

Would you like fries with that? Somtimes, ya just gotta laugh!

HH

Anti-Platelet Ad Nauseam

Why do I torture myself? Number 1 answer: I am a masochist, of course! I read a fair number of medical journals and reports and lately all I hear about are anti-platelet medications like clopidogrel, prasugrel (see my last post) and now ticagrelor (where the hell do they get these names - sounds like anime' characters - Ticagrelor, ruler of all Mythica!) . As I punned earlier - it's starting to get thin.

Like prasugrel, ticagrelor is not even out of trials, yet they are hyping the hell out of a product you cannot even buy. It's claim to fame (should it be determinined in Phase 3 that it does not kill more people like torcetrapib did) is that its effect is reversible - SO YOU CAN HAVE HEART BYPASS SURGERY FASTER AFTER STOPPING IT! I kid you not. Oh, and while it does not contribute to "major bleeds" to any greater extent than other agents it does show an increase in "minor bleeds." I don't know about you, but whenever I bleed I consider it a major event.

Given that the market for clopidogrel alone is $8 billion we can expect more of the same with everyone scratching for a piece of the action. Here is a clue for the rest of us.

YOU DON'T NEED ANY OF THIS STUFF IF YOU DO NOT HAVE HEART DISEASE!

Let me put it this way. An ounce of heart disease prevention (or a half ounce of heart disease reversal) is worth $8 billion of clopidogrel! Practice informed, self-directed healthcare instead of uninformed drug and surgery healthcare (Time to plug Track Your Plaque).

HH

Clopidogrel vs Prasugrel: The Arguments are Getting Thin

Watching drug manufacturers duke it out over competing products is like watching a tragic comedy - you don't know whether to laugh or to cry. Witness the latest antics in the fight over the wildly profitable market for anti-platelet drugs currently dominated by clopidogrel.

Clopidogrel (Plavix most notably) has been around for years as a first line anti-thrombotic with indications for use in numerous cardiovascular conditions including post-surgically after stent implantation. Given its age it has also been studied extensively and all its warts are well-known.

Most comic is the fight for dominance between clopidogrel and prasugrel. I say comic for one major reason - prasugrel is still under investigation - you can't even get it in the US at this point. But this hasn't stopped the marketers from attempting to pit it against clopidogrel which goes off-patent in 2011.

The latest "hit job" on clopidogrel comes from analysis based on the TRITON-TIMI 38 trial. Researchers dicovered that there are several common gene variants among patients receiving clopidogrel that may reduce its effectiveness thereby increasing the risk of subsequent heart attack, stroke, and mortality. What was conveniently NOT CONCLUDED was whether simply taking more clopidogrel could overcome this reduced response.

Now guess who is a major sponsor of the TRITON-TIMI 38 trial? If you guessed Daiichi Sankyo and Lilly, the two co-developers of prasugrel, you win today's Sherlock Holmes award! Now, do you suppose anybody has studied whether certain gene variants affect the efficaciousness of prasugrel - not yet - but you have to wonder what the folks at Bristol-Meyers (the holder of the Plavix patent) are working on.

Now, don't get me wrong, I love a good fight. Let the druggies battle it out. But as consumers we need to cast a watchful eye over the message. Prasugrel is not even FDA approved yet and there are no long-term studies on it. Who know what warts may pop up. Your genetics may indeed sway you away from clopidogrel one day but don't think it is without its own, at present, hidden warts.

The devil you know may be better than the devil you do not. Of course, here is where I plug informed, self-directed health care programs like Track Your Plaque which offer tangible results in preventing and reversing heart disease. The ONLY real solution is to never need clopidogrel OR prasugrel in the first place!

Looking out for your heart health,


HeartHawk

I'm Baaaa ... aaack!

Yes, the reports of my demise are greatly exaggerated. I'd like to say something artsy like, "I was taking a sabbatical to 'rediscover my voice'." - but that would be a load of crap. The truth is more akin to being really busy and not sure what to write. But, "being busy" is nothing but an excuse. People MAKE TIME to do what they like! And how can an arrogant and opinionated guy like me not know what to write? Here's my answer.

I write a lot. But every forum has it's boundaries and rules of decorum. Also, it is a little dishonest to post the same material on multiple blogs (not to mention that sites that have you under contract get a wee bit upset if you repost paid for material on free sites). So, where am I going with this - back to my roots!

On other blogs I have to be the "good cop." This blog is my outlet to be the "bad cop!" Expect my prose to be biting, opinionated, edgy, and designed to draw both complements and criticism. It is done from my heart (pun intended) and without apology. I may go after third parties but am ALWAYS respectful of commenters - so let's debate. If you are one of those third parties then comment back and watch my tone change. My opening shots are intended to get your attention - not wound! We may not always like it but we are in this together.

When I started this blog it was to be a no holds barred comment on the state of heart health care. I promised, "a hell of a ride" so hold on tight - be mad, be glad, be anything but but bored!

Regards,


HeartHawk

More Customer No-Service

There was recent post on the Track Your Plaque Member Forum about hand-held body-fat analyzers that piqued my interest. I wondered if they really work. So, I attempted to contact the company in question. Their on-site customer service e-mail form did not work so I went "under the hood" of their website (it's great to know these tricks) to get the internal e-mail address (which they do not publish) used by the form so I could send it myself. Here is what I sent.

Your website contact form did not work – it kept asking to supply a “referrer” for which I saw no field to enter. Here is my question

What is the difference in technology and accuracy of your products that offer "two point" versus 'full body" sensing. I’d like to understand the technical difference before I select which of your fat analyzer products to buy.

Thanks

I got this curious reponse.

Dear Mr. Hearthawk:

Thank you for the email this morning and the opportunity to address this issue with you. I am happy to assist you in getting this situation resolved.

I certainly apologize for the issue you describe in your email. Unfortunately, there are some issues that need more intervention than email provides and I believe this is one of them, simply in the interest of time for you. In order to best serve you, please call our Consumer Support team, toll-free at 800-634-4350. Our trained representatives are available Monday through Friday, 830a to 430p CST to assist you over the phone and try to resolve your issue without sending your unit in for repair. If repair is necessary, we can set up your file to start the process or provide valuable options to your particular situation.

Please have the following information available in order to expedite your call:

1. Model number (from the sticker on the back/bottom of the unit)
2. Serial number (from the sticker on the back/bottom of the unit)
3. Proof of purchase
4. Your case number of 1205305

We appreciate your interest in our products, thank you for contacting Omron Healthcare and look forward to hearing from you soon.

Jennifer Kelly Customer
Service Representative
Consumer Support
Omron Healthcare, Inc.

Ahhhh, this e-mail is so obtuse in so many ways.

1. I did not send the e-mail "this morning." I sent it weeks earlier.
2. I did not have any complaint. I asked a simple question. What are they apologizing for?
3. I do not own any Omron products. I trying to determine whether the hand-held model would serve my purposes.
4. Aren't they even a tiny bit interested in why their customer support form doesn't work?

I did call the representative who agreed that neither the hand-held or foot-scale models would be accurate given they only measure half your body. They suggested that for accuracy you buy their more expensive model with both foot and hand sensors.

Brilliant! They were late, clearly never read my e-mail, droned on in a non-repsonsive way, never bothered to inquire about their non-functional web-form. All the hallmarks of a company who pretty much doesn't give a damn about their customers.

HH

A CETP Phoenix Rising from the Ashes of Torcetrapib?

Gene investigation and pharmaceutical research may be working together to revive cholesterol ester transfer protein (CETP) inhibition as a means of combating heart disease. The failure (both therapeutic and financial) of Pfizer's novel CETP inhibition agent "torcetrapib" literally pushed Pfizer off the heart drug development cliff and with it perhaps the finest heart drug research team in existence.

But recently, the Women's Genome Health Study led by Dr. Paul M Ridker has discovered variants in the gene for CETP that impact heart attack risk. They note that the risk is partially but not completely reduced by a rise in HDL. Torcetrapib was found to raise blood pressure (BP) along with other adverse effects such as effects on aldosterone. It was thought that these effects overwhelmed the postive effect of raising HDL. This new study raises the hope that the negative effects were only peculiar to torcetrapib but not other similar agents.

Merck's anacetrapib and Roche's dalcetrapib are two potentional CETP inhibitors in Phase 2 and Phase 3 trials repectiviely that do not exhibit the toxic effects found with torcetrapib. Dr. John Kastelein, who is involved with both trials added, "When you have a number of patients in different clinical studies and there is still doubt about whether the mechanism works at all, research such as this by Ridker et al is good . . . torcetrapib was about the worst choice Pfizer could have made. They thought a few millimeters of mercury were nothing compared with the immense power of a 70% increase in HDL-C. But everyone was lulled to sleep—no one understood at the time that the elevation of blood pressure was only the tip of the iceberg and below that was a whole metabolic derangement that was extremely harmful."

The Women's Genome Health study was divided into two parts. First, they looked for common genetic variants associatied with HDL. Baseline HDL was measured among the 18,245 particpants (caucasion females at or above 45 years of age) who were followed for ten years. They discovered nine locations in the genome with at least one genetic variant or SNP (single nucleotide polymorphism) that were associated with HDL. Eight of these locations were already known to influence HDL, but one was new.

The second and most important part of the work found that among all the SNPs associated with raising HDL, all those linked to lowering heart attack risk were found on the CETP gene sequence. Whenever a CETP SNP raised HDL it also reduced heart attack risk. One such CETP SNP (rs708272) was associated with a 3.2 mg/dL increase in HDL and a 24% lower risk of heart attack. Such as small HDL increase should not produce such a profiund reduction in risk. Something else is clearly going on!

Perhaps this is not the end of the line for CETP agents that some had predicted. The Phoenix may be rising!

Looking out for your heart health,


HeartHawk

A Fabulous, Fascinating, Fortuitious Forum: The 2008 Top Ten

As I sit back and think about all the things that have happened on the Track Your Plaque Forum in the last year I am truly amazed. So much so I have come up with a Top Ten list (in no particular order) of all the things we have done together on the Forum this year. Here are several interesting or important (IMHO) posts that started or were further developed by Members over the past year (they can be accessed by clicking the links).

Dr. Davis was right: Framingham Researchers say Lack Of Vitamin D May Increase Heart Disease Risk
We were saving many lives through the early recognition, adoption, and use of Vitamin D. The rest of the world is just now catching up to where we all were over one year ago. Happy New Year and please pass another bottle of sunshine!

Hypothyroidism as a driver of artherosclerosis?
Soon after Vitamin D we embarked on a discussion of the role of thyroid disease a powerful co-factor in heart disease. Once again we were well-ahead of the curve (and still are) on thyroid issues and heart disease and are pushing the envelope ever further. Until now, who knew thyroid was an issue for so many of us?

Lp(a) studies for discussion
Lipoprotein(a) is the scourge of many TYP Members. Everything from new drugs under study to treatments such as niacin, nuts, and NAC has been covered in the TYP Forums.

New here-- question #1 regarding Fish Oil
Everyone knows (or should) about the numerous therapeutic effects of fish oil. From question #1 to #1000 the TYP Forum has covered everything from allergies and accelerated dosing to its use with Xenical and Zetia. If it’s about Omega-3s and fish oil you are likely to find an in depth discussion here.

Question regarding Blood Glucose Readings and Dr. Davis's new report on BP
These posts are remarkable in that they attracted a fair amount of attention for subjects that I thought would have been so thoroughly hashed over that they were dead. However, it proves that the simplest concepts are deeply intertwined with heart disease prevention and often misunderstood.

Wheat is evil
This one was a killer – almost literally. If you had to pick something that was so endemic to American lifestyle and yet so eminently dangerous it would have to be eating wheat. This was one of the first posts that started the brushfire that has erupted into an inferno and continues in many similar posts today. Put that piece of bread down or TYP’s resident pharmacology guru Dr. BG (Member Nickname “ggglll”) may have to keep you after school and write “I will not eat wheat” 100 times!

SPLENDA: good or bad?
Once again, something so simple and common sparked an extremely erudite discussion. What was most remarkable about these posts is how it adroitly displayed the vast amount of knowledge (even about subjects as arcane as artificial sweeteners) of TYP Members and their willingness to share. It is this very feature of the TYP Forum that makes it the best of any in its category.

Boswellia and 5-Lipoxygenase Pathway Inflammation
Wow, 144 posts and 1043 views (and counting) on the subject. We added the “Emerging Medicine” Forum for this exact reason and we were treated to a treatise by “wccaguy” on a subject that is just now beginning to be seriously studied by researchers. Want to stay on the “bleeding edge” of heart disease prevention and reversal? Read the TYP Forum!

Very stubborn plaque!
This post exemplified how a first-time poster dipped their toe into the TYP Forum “Fountain” and was showered with help from Members. Equally important is the number of Members who, although they didn’t post, viewed the posts to glean information to aid their personal efforts. That is what the TYP Forum is all about!

OK, so I lied. I DO have a Number 1 item!
But it is not any specific post. What is happening on the TYP Forum is something special and it is not just the thousands of posts. Quantity is one thing but it is the quality of the posts that is so impressive and it is a sentiment I have heard Dr. Davis express frequently. It is truly outstanding and a distinct pleasure to meet so many people intent on beating heart disease and willing to help others do the same. Thanks again on behalf of our small (but committed) team at TYP. It was a heck of a year with another great one planned for 2009.

Keep Tracking and Talking . . . and have a HAPPY (and healthy) NEW YEAR!

HeartHawk

Now What?! It Pays to be Paranoid? A Panic over Panic.

The European Heart Journal recently reported that heart disease is more common in patients with panic attacks than in the general population. Moreover, they found the risk in person under 50 years of age. But curiously this same group was found to be less likely to die from heart disease. Researcher Dr. Kate Walters opined, "The symptoms of panic attacks can closely mimic those of a heart attack or acute (heart) disease, and it seems that there may be a complex relationship between them."

The study compared 58,000 patients aged 16 and older who had been diagnosed with panic disorder against a random sample of 347,000 persons without panic disorder. Panic disorder was associated with a 38% increase risk of heart attack in the under 50 group. Even more startling was the finding the risk for women under 40 was more than three times the risk for the general population

Now here is the REAL kicker. As I mentioned earlier, while the risk for heart disaease was higher, researchers determined that death from heart disease was actually LOWER in patients with panic disorder. When asked what could account for this seemingly paradoxical finding researchers suggested, "people with panic present earlier or more frequently to their doctor and therefore have their (heart disease) identified and treated."

So let me get this straight. Because panic attacks can mimic heart attacks, those with panic disorder tend to present for clinical testing more often thus catch their heart disease at an earlier stage and therefore live longer! So, where heart disease is concerned, it pays to be paranoid?!

Seriously, as a person who is prone to paranoia (just because your not paranoid, it doesn't mean "they" are not still after you) I sympathize with those who have full blown panic attacks. But if this means living longer I say better safe than sorry. For those with a lower state of anxiety, I simply suggest.

1. Get a heart scan - know your score
2. Get on the Track Your Plaque program - the remarkable clinical results achieved by Dr. Davis have been independently corroborated by cardiologists like Dr. Bill Blanchet. The best part is the program keeps getting better.
3. Rest easy in the knowledge you are enploying the latest, cutting edge medical science available and have put yourself in population that appears to significantly reduce its heart attack risk at any calcium score!

'Nuff Said,


HeartHawk

Pfizer Drops Bomb on Heart Health Pipeline

Research on drugs for heart disease does not always translate into a pipeline for cures but it certainly is a pipeline for hope. As much as I beat up drugs and drug companies they do provide useful tools for combatting heart disease if properly used. Well, Pfizer just dropped a bomb on that pipeline when an internal memo was leaked stating that Pfizer will drop development of drugs for hyperlipidemia, atherosclerosis, and heart failure

According to a memo obtained by Forbes magazine, Pfizer is exiting a number of areas described in this excerpt as:

"We intend to exit these Disease Areas: Anemia, Atherosclerosis/Hyperlipidemia, Bone Health/Frailty, GI, Heart Failure, Liver Fibrosis, Muscle, Obesity, Osteoarthritis (disease modifying concepts only) and Peripheral Arterial Disease."

Recall that Pfizer had invested billions and recruited leading heart disease researchers to produce blockbuster heart-related drugs such as the cholesterol-lowering drug atorvastatin (Lipitor) and the blood pressure drug amlopidine (Norvasc). No doubt their decision was fueled in part by the multi-billion dollar flop of what they thought would be their next blockbuster drug, torcetrapib, a CETP inhibitor that promised to raise HDL cholesterol by 50% or more. While it did indeed raise HDL dramatically it exhibited side-effects that increased mortality during testing.

Although long-term effect of this loss of talent and capital to heart disease drug research is murky the announcement certainly signals a delay in heart-drug development as research teams are disbanded or reassigned into other areas and new investment capital is sought. To say this is a teribble loss to heart disease sufferers is an understatement. Dr John Kastelein an investigator in several Pfizer-sponsored heart trials referred to Pfizer as "a real powerhouse" in the CV drug arena. Kastelein added, "I think this is very, very significant both for the company itself and for the whole field of CV drug development. Pfizer had truly excellent people in the development arm of their company for CV and metabolic drugs. And if they're stepping out now, that not only signifies their own problems, but it also signifies the problems in CV drug development, and how incredibly difficult and costly it has become to bring new drugs forward. And that's not good for patients."

The moral of this story is that we as heart disease sufferers must lean even harder on the weapons we have today rather than waiting for new "magic bullets." The take way message here is to stop betting on tomorrow and start working with what you have today. Fortunately, the Track Your Plaque progam works exceedingly well with the arsenal at hand. Use it!

Looking out fot your heart health,


HeartHawk

Hypothyroid Update: Common Sense Triumphs over Bureaucratic Boobs

As you know, I was recently diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism. I dug deep into this condition as a cause for my recent increase in lipoprotein(a) and homocysteine (it seems both are affected). Dissatisified with the first two Endocrinologists I saw I did some research and found the best local endo I could. I used the following criteria.

1. I wanted someone on the staff of a research and teaching hospital. I figured these were the types who saw the most varied and largest patient load and had an interest in the unusual as opposed to the "crank turners" who follow standard procedure.

2. I wanted someone who had graduated no less than 10 years ago and no more than 15 years ago. I wanted someone who was experienced yet was exposed to modern concepts and not yet set in their ways.

3. I wanted someone with an expressed interest in lipids, not just diabetes as most are.

4. It would be nice if the doc was in my insurance plan!

Well I found my guy at the Medical College of Wisconsin where they are actually doing research on the endocrine system's effect on lipids. It took some arm twisting and a little rule bending but I not only got in to see the doc I wanted but lucked into a cancelled appointment the following week (instead of having to wait 6 weeks).

The doc was excellent. He told me things the other two endos never covered.

1. My TPO and TG antibodies are indeed above the reference range but nowhere near what they see in bad cases and, most importantly, far below what they see for those suffering polyglandular auto-immune disease. That little tidbit was never mentioned before and would have been nice to know earlier.

2. He will treat me based on my symptoms not just my TSH level. How about that for forward thinking.

3. He was not opposed to Armour Thyroid although he did specify a preference for T4 only therapy. That is what is known as "open-minded."

4. My thyroid is actually small for my height and weight and is consistent for mild Hashimoto's Thyroiditis and subclinical hypothyroidism. Another little tidbit never mentioned.

5. He understood the difficulty in adjusting for sporadic hyperthyroid hormone spikes as my thyroid deteriorates and explained how we will ignore the "noise" inherent in any feedback system and focus on the trendline. Not much you can do about it but at least we had the discussion and I felt secure that the doc understood and appreciated my predicament.

Wow, I finally found the thyroid equivalent of a Track Your Plaque doc like Bill Davis! But it gets even better on the non-technical end.

Seems the Medical College has all kinds of strict rules about who the bureacratic "gate keepers" will allow in to see the docs even with an appointment. Seems the computers would not acknowledge my existence even though they had a record of me from 30 years ago when I was in for migraine headaches (those actually cleared up years later). Apparently, their auditors had not yet verified my new insurance. I was told I would not be allowed to see the doctor until I was "in the system." Just then a nurse appeared to tell the recalcitrant clerk, "The doctor wants to see this patient." When the clerk refused she gave a stern look and said, "I am taking this patient!" After additional objections from the clerk the nurse leaned in and in a forceful tone repeated, "I am taking this patient!" I thought it might come to blows.

Wow again. The nurse took me (minds out of the gutter please), the doctor saw me, and after being interrupted several times by a bevy of disturbed bureaucrats the computer gods were placated. Thank God there are still doctors and nurses who are not only competent but caring enough to put people over procedure. Outside the staff at Track Your Plaque, I was beginning to think the breed was nearly extinct!

Regards,


HeartHawk

Another Reason to Lose Weight - YIKES!

Like many of you, I read a tremendous volume of online medical journals trying to keep abreast of the latest advances and atrocities in heart medicine. In yet another classic, "I don't know whether to laugh or cry" moment I stumbled across this report:

Extremely obese a cath lab problem: Some turned away because of weight restrictions on tables

In what has to be the one of the most incredulous statements ever uttered by a doctor, lead investigator Dr. Thomas Vanhecke (William Beaumont Hospital, Royal Oak, MI) offered, "It is a paradox. New research is showing us that patients are dying younger with more cardiovascular disease, and yet there are no cath lab guidelines for how to treat those who are morbidly or massively obese."

Is the good doctor worried about people getting fat and having heart attacks at an alarming rate at progressively earlier ages? No, he dithers over the fact there are no guidelines on how to treat morbidly obese patients. Hell, wouldn't want to smush any of that shiny new cath lab equipment or have the guy topple over on you! Where was the good doctor when these folks were shoving their faces full of cream pie? Here's a paradox for you doc, if not utter irony. Can you imagine being so overweight that when the inevitable angina or heart attack comes the hospital might turn you away because they fear you will break the cath lab table?!

Vanhecke also said that when faced with obese patients they are typically told to exercise and diet before they can undergo the procedure. Huh?! I'm having a heart attack and you want me to go exercise for six months then come back? Yowza!

Now, I hate to go off the deep end (not really) but if you link to the actual article you will see the quotes I lifted are not radically out of context. I've had my fun at the doctor's expense over some (ahem) rather dubious statements and it is time to get serious. These types of pronouncements speak loudly about the mindset of traditional medicine whose position appears to be "let people get morbidly ill while we invest in better "guidelines" and technologies to fix them." This might give you an inkling as to why medicine is becoming so expensive.

At the risk of being accused of using bad puns, what ever happened to the old axiom, "an ounce of prevention is worth a pound of cure?" Perhaps 500 pounds in some cases.

Excuse me while I finish my Diet Coke!


HeartHawk

OMG! Vitamin D Lowers Death Risk? No Kidding!

Heh, slowly but surely the traditional medical community is beginning to realize what Track Your Plaque observed almost two years ago, low Vitamin D levels increase mortality risk. Now, I must admit, even I was slow to come around but when the overwhelming evidence of plaque reduction and Vitamin D poured in to Dr. Davis' practice I had to believe the data.

Now, years later, another study has found that that low levels of Vitamin D lead to an increased risk of death. The big difference here is that it was a rather large (13,331 persons) study that followed participants and average of 8 years (see Arch Intern Med. 2008;168(15):1629-1637).

There was one interesting fluke to this study for the numbers geeks like me. The study population statistics were striking. If you were in the lowest quartile (25%) of Vitamin D levels your morality risk was 1.26 (26% higher) within a 95% confidence interval (CI) where the CI was 1.08 - 1.46. Stats geeks realize that what this means is that if you ran this same test 100 times you would find the calculated mortality risk somewhere between 1.08 and 1.46 in 95 of the tests (but always higher than 1). The other 5 times the risk would be less than or greater than the CI range meaning you might actually find the risk to be LOWER (>1). This is enough to statistically link Vitamin D to reduced all-cause death but the similar analysis for CVD and cancer mortality only, while higher, did not meet this stringent statistical standard. I am just going to hedge my bets and keep taking Vitamin D armed with just the all-cause mortality results which this study proves and the overwhelming clinical practice experience of Dr. Davis. Melamed also offered sound advice when suggesting people should know their Vitamin D levels before pounding down supplements.

Of course, Dr. Melamed had to go and ruin everything by going off the deep end with the opinion that the most sensible advice for those wanting to ensure their levels remain optimal is to "spend 10 to 15 minutes per day in the sun and to eat vitamin-D-fortified foods, such as milk and oily fish." DOH! That, my friends, is down right malpractice in my opinion. Let me count the ways!

1. Sunlight to vitamin D conversion varies from person to person.
2. Sunlight to vitamin D conversion decreases with age.
3. Sunlight to vitamin D conversion varies with clothing, sunscreens, etc.
4. Sunlight to vitamin D conversion varies by latitude and season.
5. Sunlight to vitamin D conversion varies by race.
6. Most milk is fortified with D2 not D3 which is the more active form and what the good doctor ACTUALLY STUDIED! DOH! 25(OH)D (the study variable) is produced in the liver from the metabolism of vitamin D3.
7. Dietary sources of any kind generally will not provide enough D3 to signficanly raise blood levels.

Here is my personal regimen. Get my blood tested and take an oil-based D3 supplement. Repeat the cycle until I achieve 60ng/mL! I am now at 62ng/mL but it took a dose of 10,000IU a day. That's a lot of milk and oily fish, LOL!

It is so darn easy. What do they make it so hard?!

Regards,


HeartHawk

Dangerous Thinking about CT Radiation!

I recently completed a web-based Continuing Medicial Education (CME) course on emerging strategies to combat heart disease. It was full of the standard fair of old school risk factor treatment and some novel approaches on increasing HDL. Pretty typical stuff not worth mentioning. But what really caught my attention was a comment left by - how can I say this nicely (why start now) - A DANGEROUS IDEOLOGUE! Here it is.

"In all of the discussions of risk factors there is an avoidance of primary causation. The Japanese A-bomb Life Span Study has linked ionizing radiation with an increase in cardiovascular events. Radiation in co-action with chemicals has been implicated in genetic effects in utero but few investigators have done studies in this area. Cardiologists should place less reliance on drug therapies and begin to focus on these primary causes."

Lynn Howard Ehrle, M. Ed., Senior Biomedical Policy Analyst, Organic Consumers Association and Cahir, 41-member International Science Oversight Board (an OCA project)"

As readers of my blog know I too am no fan of drugs and embrace prevention wholeheartedly. However, Mr. Ehrle has gone overboard in my not-so-humble opinion. My reading of his earlier literature leads me to believe commenters of his ilk are anti-radiation ideologues who can suffer no level of radiation exposure.

Does radiation, at any level, impose a risk as Mr. Ehrle implies in his published offerings impugning CT scans (e.g. heart scans)? Of course it does. But so does crossing the street or driving your car to the store. The only real question is does the risk outweigh the benefits? None of us would buy into the notion that we should stay in our homes refusing to cross a street or drive a car. Why attack CT scans in this manner? Heart disease is the number one killer of U.S. adults. If people were dropping over dead because of CT radiation induced heart disease (for which their is little direct evidence) at a similar rate as naturally induced heart disease Ehrle might have a point.

The real danger here is the spectre of old-school "cut and drug" cardiologists grasping at Ehrle's rhetoric to assail modern prevention strategies that employ CT heart scans (I am speaking here of CT calcium scoring not CT angiography which appears to be of dubious benefit at this point). Should we avoid unecessary radiation whenever possible? Absolutely! Should we continue using CT heart scans? Absolutely! It is a risk/reward decision we must all make individually. As for now, it seems imprudent to throw the baby out with the bathwater.

Regards,


HeartHawk

AHA Builds Another Shrine to Heart Disease Promotion

I like to visit the American Heart Association (AHA) website from time to time as it is always a good source of bad advice to blog about. I mean, if the AHA practiced heart disease prevention instead of heart disease promotion I would have little to blog about. You might retort, "What do you mean 'Hawk, the AHA is trying to fight heart disease, you know, prevent it, not promote it." To which I would reply, "Read their screed!" The AHA appears to be most interested in giving you the best REPAIR medicine after you have crashed and burned rather than giving you the best crash prevention medicine so you won't need any repair.

Their latest shrine to heart disease promotion is their new web tool "Heart Profilers." It is an extensive and exhaustive piece of programmed "cyber-medicine" that purports to ". . . help you understand different treatments that may be appropriate for you based on your diagnosis, symptoms, and test results. Using this tool will help you better evaluate your options and make informed decisions with your doctor and health care team." Hardly, read on!

I decided to enroll, gave them all my personal info (so they can market to me) and answered an extensive questionnaire about my health, what drugs I take, etc. To say it was slanted toward doing invasive procedures is an understatement. When the entire process starts with the statement, "The chest pain known as angina is usually one of the first symptoms of CAD." you know you are dealing with neanderthal medicine. Yeah, I suppose if you have never had a heart scan it might come to that but by then it is too late - you're hooked into the "cut and drug" assembly line. See what I mean about their repair versus prevent mindset?

The questionnaire tacitly assumes that heart disease is first diagnosed by chest pain. Apparently, unable to take "No" for an answer as to whether I have chest pain, they go on to ask numerous questions about my non-existent angina, heart attacks, angiograms, stents, stress tests and other interrogatives that have little to do with prevention and presuppose extensive heart disease. I mean, how do you answer questions like (and there are many), "Has your doctor said you are a candidate for coronary artery surgery?" when it has not and hopefully never will be an issue? Catch the drift here? Think they are pushing invasive procedures?

Now comes the best part, the recommendations! Here are mine. "Your answers to the questions about risk factors indicate that you have no risk factors for coronary artery disease that need to be managed. " WHAT?! ARE YOU KIDDING ME?! What about the need to raise my HDL above 40mg/dl and further reduce my LDL below their 100mg/dl cut-offs. They never even asked about my sky-high Lp(a) or what my LDL particle size and particle count was (fortunately mine is fine). The fact is I have a high calcium score for my age and it is growing (thankfully not as fast as it would under AHA care). I am a heart attack waiting to happen and the AHA, after taking an exhaustive heart health history says I, "have no risk factors for coronary artery disease that need to be managed." Are they nuts?! Heck, they even HAD a question regarding thyroid disease but the results remained the same no matter if I answered I had no thyroid disease, hyperthyroidism, or hypothyroidism (which I have). Perhaps they need to read the upcoming Track Your Plaque report on hypothyroidism and heart disease! It is a HUGE factor.

It seems the bottom-line here is that the AHA is only interested in heart disease if it is so advanced that you need a procedure or drugs (no mention of supplements like fish oil or Vitamin D at this AHA shrine). I have heart disease that requires aggressive treatment yet the AHA thinks I have "no risk factors for coronary artery disease that need to be managed." What they really seem to mean is I do not need an invasive repair procedure yet. That is what I mean when I say the AHA is a heart disease promotion organization and not a heart disease prevention organization. Sign up, select the "Coronary Artery Disease" option and take the test yourself. It is the best way to experience their stunning ignorance.

Regards,


HeartHawk

Your Doctor Just Might Be a Gol-Darn Fool If . . .

With apologies to Jeff Foxworthy . . . your doctor just might be a gol-darn fool if he or she still does not believe in the predictive power of heart scans. The latest piece of evidence, found in the Archives of Internal Medicine, is based on data from the Multi-Ethnic Study of Atherosclerosis (MESA). Researcher Dr. Aaron Folsom remarks "our data suggest that in asymptomatic 45- to 84-year-old US adults, CAC score may be the better choice over IMT." This is a powerful statement as IMT or CIMT (Carotid Intima Media Thickness) as it is sometimes known, has long been an acknowledged "gold standard" for judging global heart attack risk by the American Heart Association (AHA), National Cholesterol Education Program (NCEP), and in the widely heralded ATP-III report.

So, if you are a 45 to 85 year old US adult and your doc gives you any heat about using heart scans to quantify your heart attack risk, look them in the eye and say, "SEE YOU LATER FOOL," and calmly walk out the door - then find a doc who is not just another gol-darn fool.

Oh and by the way if they should ask for more proof than just this study, smack 'em with these studies as well

Raggi P, Gongora MC, Gopal A, et al. Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 2008; 52:17-23.

Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358:1336-1345.

Weintraub WS and Diamond GA. Predicting cardiovascular events with coronary calcium scoring. N Engl J Med 2008; 358:1394-1396. (Note this is a comment that shows how even traditionalists are starting to face the truth)


As Bugs Bunny might say, "What's up doc!"


HeartHawk

Calling Dr. Wikipedia! Stat!

You just knew this had to be coming but I never would have believed it had I not seen it with my own two eyes! As many readers of my blog know, I have been diagnosed with Hashimoto's Thyroiditis and subclinical hypothyroidism (elevated TPO and TG antibodies, low normal T4/T3 and high normal - depending on who you ask - TSH).

Yesterday, I submitted to an ACTH Stimulation Test to examine if I have adrenal insufficiency as a cofactor in my hypothyroidism. In this test, an initial blood draw is taken to establish a baseline serum cortisol. Then, you are injected with synthetic ACTH, the pituitary hormone that signals your adrenal glands to produce cortisol, and your levels are rechecked every 15-30 minutes for a period of time (usually an hour). I guess I had my first reservations when making an advanced reservation to have the test done. I was actually at the testing hospital for another blood test (free testosterone) but, unbelieveably, they had no method for taking a reservation in person. I called the number they gave me and it was clear the nurses and techs I spoke with were unfamiliar with the test. Finally, I convince someone to meet me in their lobby and after 15-20 minutes of private consultation, paging through 3-ring binders, and calls to other staff I had my appointment.

I show up for my test and they take me to a nice room where they have numerous vials and solutions, IV's, etc. ready for me but they are still not certain about how to do the test. I suggest they simply call the doc who ordered the test for me as he has an office right in the hospital. He faxes some additional info and we are off to the races. About 45 minutes into the process I get bored. So, I saunter outside the testing room with an IV dangling from my left arm to retrieve my chart which I know will invariable be sitting in a chart holder on the wall outside the door. I always love the " how dare you" look I get from the docs and nurses who happen to see me grab my chart but there is really nothing they can do to stop me. As I begin paging through the notes I come upon the "magic" set of faxed instructions that got things moving. My eyes roll and I can barely contain my astonishment - it is a printout of the Wikipedia entry on - you guessed it - the protocol for the ACTH Stim Test. The doc had simply crossed out the optional 45 minute interval draw and accentuated the need to heparinize the blood sample.

So, the moral of the story is, the next time you feel guilty or inadequate about doing battle against an arrogant doctor armed with nothing but web research - DON'T! You may both be practicing Wikipedia medicine!

Regards,


HeartHawk

Give Me a Freakin' Break: Need I say More?

You know, you work so hard to inform people about dealing with issues like plaque and calcium and then you stumble across this crap.

I found this on WrongDiagnosis.com. Have these people no shame? This is pure, unadulterated BS! Perhaps they should change the name of the site to just plain Wrong.com.

I wish there was a nutrient that was 100% effective in flushing rogue con artists away!

Sheesh!

HeartHawk