Tuesday, November 26, 2024

2x300m tempo / more cardio discussion

Sunny, breezy, dry, low 50ºs today in Sewanee.  Did a brief workout on the track, very brief.  Simply accomplished what I failed to do last time in more harsh conditions, 2x300 w/ 3 min rest.  Wasn't fast, but baby steps.  

Hoka trainers on

stretches, drills, 100m, bands

50m on turf 

Hoka rocket X2s on

2 x 300m w/ 3 min rest - 51.65, 51.96

Just wanted to get it done and actually complete the workout.  Definitely felt the lactic afterward, pushed hard on the last one to get it under 52.  HR hit 174 on the first one but recovered quickly to 110 in a minute, then hit 181 on the second one and took much longer to recover... was 153 after 3 min.   I don't foresee myself graduating to the unholy trinity (3x3w/3) for quite some time.  

A very quick workout, 5 min, after a 20 min warmup.  I was going to do more but instead, I may come out tomorrow and do the same exact workout since my foot is feeling ok, then take Thurs and Friday off.  I have to winterize my boat on Friday, nasty job in the cold.   Friday, winter arrives.  For the following week, it will be highs in the low 40s and lows as cold as 18º.   

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Cardio discussion on CAC

I happened across a video by Peter Attia on CAC scoring.  Now, I don't agree with everything he says and have openly called him a fraud at times, but this was interesting.  I sent the video to Dr. Gary (heart surgeon) for his reaction.   In essence, Attia says CAC scoring is looking backward at your body's reaction to disease that already exists, and it is not a great prognosticator for the future of potential CVD.  Most troubling he said,  "Nearly 50% of fatal MI’s occur in non-calcified areas of coronary arteries." ...  Qualified by the disclaimer, "This data is also a bit misleading because many of those patients had calcifications elsewhere."

OK then.  Gary had a different perspective: "The doctor [Attia] is correct.  Any visible coronary calcification on a CT scan signifies established, albeit often mild coronary artery disease. He is incorrect to say it does not predict risk of future events. In large populations, calcium scan number most certainly does."

Dr. Gary went on to say regarding me:  "Given you have zero calcium on TWO scans, a coronary CT angiogram would only show non-calcified plaques....if you have any.   And, the only use for this information in your case given your lipid numbers is to help you make a decision about starting a statin drug.  If you do not want to pursue a statin even if you have plaque....then there is no reason to get this scan.   In current medical practice, we would NOT get a coronary CT angiogram study on an asymptomatic patient with two zero CT calcium studies.  Unfortunately, the simulations have been run to show that if you were to offer scans to a 1000+ people in your situation, there would be statistically more unnecessary and potentially risky further testing or even interventions than if the scan was not ordered."  

In other words, I took this to mean that I need not be in an obsessive hurry to radiate my chest again with further testing anytime soon. Perhaps in a year or two, especially if the advanced lipid tests show risk. 

I found this website called MDsave.com that is a search for medical procedures for out of pocket payers.  Seeks out the cheapest rates.  Totally legit.   I found a coronary CT angiography procedure for only $311 near where I live.  As I said, at some point I'll get it. 

Attia's video was filled with interesting case studies and analogies.  For example: he likened bad lipid blood work as "living in a dangerous neighborhood."   CAC score above zero as "how many times your house has been broken into."    He highlighted one case study of a late 50s woman, presumably an athlete with rocking metabolic fitness but terrible blood lipid levels.  Attia had her do both a CAC scan and and angiogram due to her "dangerous neighborhood".   If clear on both, she was "living in a dangerous neighborhood but had a pit bull to keep the bad guys away."   I assume the "pit bull" was her lifestyle routines.  I'd like to believe I have a pit bull too.  

Here's the video:  https://youtu.be/Z7MrZRInjvI?si=qLqGZRAFne-NeJfp  


11 comments:

  1. He just knows context matters and was trying to teach. For instance he points out modest scores on old people are meaningless but young people signifies risk and he specifically said he would be more aggressive in treatment with certain CAC scores at certain ages. That means he reacts as if it is predictive, depending on the context. Attia is very current on research nearly all doctors aren't. Because of his business he has at least one full time employee doing nothing but searching and reading papers to provide him content. Trust him.

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  2. Once again I’m going to stress that instruments, labs, and tests have variance associated with them. For instance the liver cancer marker test sensitivity is known to be low with high false positive rates. Almost useless in your case. And that is known variance from the test itself not related to quality control. Handling and procedures for some tests are critical and lowest cost bidder may not have the best lab. It’s not like you can pick the lab based on a SPC quality control chart. So mature frequently done tests are fine. Or if it is done at a major medical center. But you often won’t know where it is done until you get the results. Cheap CT scans might be because the equipment is old. There is a lot behind CT scan technology- hardware, software, various test standards. You can trust that your Dr will send you to a reputable center but do research on the facility and methods they use. What is their accreditation, what models do they use, do they use dual energy and low dose protocols. Research the model type to see if it has latest technology. Again if it is done at a major medical center it is probably fine. But you might get what you pay for.

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    1. Recommend any supplements? In addition to niacin and bergamot, I'm going to try CoQ10

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    2. For many reasons I'm very critical about supplements. One is human psychology - we are somehow wired to try various modalities that may be beneficial. How else did our ancestors discover plants with medicinal properties. So I take a very critical view as supplements don't have the same development scrutiny as drug development and aren't controlled well. For instance therapeutic levels of niacin have a worse safety profile than statins. High dose of vitamin c can trigger neogenesis of oxalate leading to crystals deposits in nephron ruining kidneys. Even juicing or very heavy black tea consumption can lead to the same. A common supplement, glucosamine, for joint health uses compounds harvested from shell fish which often has heavy metals. Cocoa extracts cadmium from the soil. So many ways to screw up trying to supplement to heath.

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    3. Low dose statins have a better safety profile than niacin and bergamot combination therapy. There are significant risks of long term use of liver toxicity and for suseptible individuals short term risks. This combo would be too risky for me to consider. Low dose statins safer and much more effective as they not only lower lipid levels but restructure non calcified plaques so they are less likely to rupture. As I understand it no other lipid lowering therapy has demonstrated that effect.

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  3. In reality you have no medical reason for the scan. A small percentage of people have a reaction to the contrast. I mean you won’t take statins, which are well understood and have an excellent safety profile, but you are willing to have a contrast injected? Can have an allergic reaction, possible kidney related issue (depending on contrast type). Get an ultrasound of your carotid artery. No radiation no contrast and it will detect non calcified plaque. Or just rely on your upcoming lipid tests for risk refinement. Or just start a low dose statin.

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    1. My friend Dr. Jeff and I went to his medical facility a few yrs ago after dinner and for fun, scanned each other's carotid arteries with the ultrasound. I had 0% calcium in one and 1% in the other. He said it was good for my age. He has his own medical facility and rents space to numerous Drs.

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    2. I had a CT scan of my chest with contrast in Feb '19 when I thought I might have a blood clot after surgery. I should try to get the written report, they just told me it showed negative for clots but it may have showed other things.

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    3. That's good data. (US) Are you certain it was calcified? Non calcified is also visible on ultrasound not sure how obvious the difference is or if there are different modes or software reprocessing that has to be done. So you are not 100 percent clean probably the calculation of 5% or so risk over the next 10 yrs is about right. Let's see how your upcoming lipid tests come out. Yes go to the medical facility where the scan was taken and get the radiologist report. They will remark on heart and arteries. Ive read that trace plaque can sometimes be visible even with zero CAC score.

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    4. Having said that there is a wide range in how radiologists report. I'm still followed yearly with urogram MRI and chest CT (bladder cancer patients who had RC are followed for life ) and sometimes that call out trace plaque and sometimes they say normal. Maybe it is scanner to scanner variation or maybe trace is normal for a 65 or old so they call it that way,

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