Today was an odd appointment with my cardiologist, to say the least. It was my 3-month appointment (this is routine for me), where we were supposed to discuss the recent tests that he had ordered (a heart echo, a carotid ultrasound, recent blood work, and the results of my neurological tests) and, as always, assess if there are any changes needed in medication.
Right off the bat, he admitted that he didn’t
review my tests before he walked in the room. He said he did see them when they
were done (in September), but he had not reviewed them this morning before he
walked in the room (intern in tow) to see me. So, he needed a minute. (My
appointment was at 8:40 AM and he was already an hour late, so I guess: busy
morning!)
My cholesterol went up slightly, as you can
see below, but he said he will consider it a “lab error”. Well, which one was
the error: the last one that showed it the lowest I have ever had it? Or this
time, which is more in line with everything else we’ve done for the past year? No
answer.
My heart echo write-up mentioned for the
first time “diastolic disfunction”. I asked him about this and he explained
that what this means is when the heart fills up with blood, it increases in
volume but it should not increase in pressure. In my case, there is some
pressure that is measurable, but that it is “mild”. He said this is “normal”
and “almost expected” in my case, having had a heart attack, open-heart
surgery, and coronary vascular disease for many years. He said he is not extra
concerned about it, as long as my aortic valve is clear (which it is) and my
ejection fraction is good, which at 55% it is.
The narrowing of all my carotid arteries is
increased compared to the measurements of two years ago, but the percentage is
all the same – between 50-69%. This seems like a huge range to me, but that’s
where they place my numbers.
For those more curious, here are my measurements
for both the right (first) and the left (second) carotid arteries:
MEASUREMENTS – Right/ Left
------------------ -------------- --------------
Central Carotid Artery
CCA Proximal 249/ 19 cm/sec - 216/ 23 cm/sec
CCA Mid 168/ 21 cm/sec - 230/ 23 cm/sec
CCA Distal 141/ 19 cm/sec - 199/ 24 cm/sec
Internal Carotid Artery
ICA Proximal 136/ 24 cm/sec - 191/ 22 cm/sec
ICA Mid 189/ 36 cm/sec - 134/ 21 cm/sec
ICA Distal 160/ 30 cm/sec - 157/ 22 cm/sec
CCA/ICA Ratios 1.340 - 0.960
External Carotid Artery
ECA 550 - 260
Vertebral 93/ 16 cm/sec - 115/ 15 cm/sec
Subclavian 305 - 327
He said that the worst narrowing is in my
External Carotid which is of least concern, because it’s the one that
vascularizes the face which gets blood supplies from a “million other places”
(his words), so there is no concern for no blood supply there.
I have an appointment with a vascular
surgeon and he asked me to follow up with him for a second opinion on the
carotid findings.
If it were not for me to mention the
neurological test that he ordered to diagnose peripheral neuropathy, he would
not have discussed it. I told him that the test showed that I did not have
peripheral neuropathy. He was glad about that. He had suspected there was
something neurologically wrong because my dizzy spells. Well, not sure what
worked, but my dizzy spells are very mild now and very infrequent, and my muscle
spasms and cramps are also much better, too. The dizziness definitely does not
last for a whole day anymore. I started taking CoQ10 (my decision) which I guess
must have made my muscle cramps less frequent, but I don’t think that it had
anything to do with fixing the dizzy spells. In addition, my primary doctor
diagnosed me with possibly anemia (low red cell count) and a B12 deficiency, so
I started taking B12 vitamin supplements at about the same time as the CoQ10 –
about 2-3 months ago. He agreed that this deficiency and the anemia could have
caused the dizziness for sure. So, we’ll just continue with this treatment and
the regular doctor is planning to check the B12 levels again at our 6 month
follow-up.
We also talked about the heart symptoms:
how’s the blood pressure, how’s the chest pain, how is the shortness of breath?
How do I get along with the newest drug he put me on to treat all these
(Amlodipine). I told him that the chest pain and shortness of breath are
stationary, but I have more stamina when I walk (I can go further and on steeper
inclines through the shortness of breath and the angina because I feel like my
heart is getting enough blood supply). My neck still cramps, but after a longer
walk. The blood pressure is medium-high (in the yellow-orange range on the
machine) a lot more often than mostly high (red range), like it was before the
Amlodipine. My gums are still very sensitive because of the Amlodipine but I am
working with the dentist to use softer brushes, better paste to not irritate
them too much.
After the physical consult, he said he
thinks “I have more fluid than what he would like for me to have” and to back
off the salt. This is the first time in my “heart-patient career” that anyone
has said anything about salt, because typically my fluid is under control. He
said my legs look fine but that my chest shows signs of too much fluid. He gave
no reason as to why all of a sudden my fluid retention is higher, and no recommendation
on what to stop or start doing (other than salt intake) to help with this.
As for the FH treatment, he said he would like
to try the “twice a year siRNA PCSK9 inhibitor which might come out in the US
sometimes next year” – his guess - (he
was referring to Inclisiran - https://www.novartis.com/news/media-releases/novartis-receives-eu-approval-leqvio-inclisiran-first-class-sirna-lower-cholesterol-two-doses-year)
to replace the twice-weekly Praluent injections that I take now. I have asked
him again (http://livingwithfh.blogspot.com/2021/07/who-knows-more-about-fh-you-or-your.html)
about adding Evkeeza to the current treatment and he said “that would be
another option as well”, but he made no recommendations about it. About this, I
am puzzled: my LDL is nowhere near the “target” number of 70 mg/dl or lower,
but he did not recommend adding anything else to my current drug regimen.
So, a mix of findings and if I were to
summarize, I would say:
-
Heart function is stationary
(no idea what the coronary arteries are doing because we would need a cath
angiogram for that)
-
Arteries are showing advancing
disease
-
Cholesterol (LDL) is still
elevated, not at ideal levels for my disease and my history
-
Liver function a bit modified
-
Quality of life/ symptoms (dizziness,
muscle cramps, chest pain and shortness of breath) somewhat improved.
I walk gently towards The Holidays with kind
of a mixed bag and lots of unanswered questions. But … it’s better than six
years ago when I was walking in with “you must have open-heart surgery in one
to three months at the longest.” So, I’ll take it.
