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Old 03-24-2016, 06:43 AM   #21
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I've been googling around, trying to figure out what statins would do for calcified arterial plaque.

So far, i haven't found very clear information. It looks as if the statins would keep more plaque from building up...but statins can't get rid of what your arteries have already laid down.

Someone else must have better information on this.

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I considered having one when I decided not to take statins due to side effects, which I now believe I shouldn't have even been prescribed statins.
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Old 03-24-2016, 07:08 AM   #22
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OK Dash man - these are the tests. These are three options that all provide similar reporting. They are listed in order starting with the best/most comprehensive. Many insurance companies are not big fans of this advanced testing, so if the doctor agrees to order them, you may want to check on what your financial responsibility will be.

1. "Baseline Assessment" from True Health Diagnostics, OR
2. "NMR Lipoprofile" from LipoScience, OR
3. "VAP" from Atherotech

Note that NMR Lipoprofiles are available from other than LipoScience, and VAPs are available from other than Atherotech. Those places are just the ones who developed and "own" the rights to the tests and I thought your cardio might recognize them. The "Baseline Assessment" is unique to True Health.

If the cost turns out to be too high I can provide other less comprehensive but also less expensive options.

There are two types of Cardiologists: Preventive and Interventional. I'd say 90% are Interventional. This means they recommend "procedures", which means you're headed to the Cath Lab and there's a good chance you'll be stented. Hospitals love these guys, as they bring in minimum $25,000 per procedure and can do multiple procedures in a day. This is how hospitals build Cardio wings onto their facilities. The Preventive guys are renegades in the Cardiology world - they only recommend procedures based on specific symptoms, otherwise, they're recommending diet, exercise, stress management, some supplements (like Fish Oil and Niacin perhaps), and possibly a statin if indicated.

So...best of luck and interested to hear how it goes!

Pete
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Old 03-24-2016, 07:14 AM   #23
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Originally Posted by Amethyst View Post
I've been googling around, trying to figure out what statins would do for calcified arterial plaque.

So far, i haven't found very clear information. It looks as if the statins would keep more plaque from building up...but statins can't get rid of what your arteries have already laid down.

Someone else must have better information on this.
Amethyst, you're right...statins can't get rid of plaque, otherwise that would be the complete answer to a high plaque burden, and it's not. I am pretty much anti-statin, but I take a low-dose (5mg daily) of Lipitor as part of my plaque stabilization program. The reason is that one of the advanced tests has shown that I have high arterial-specific inflammation - likely one of the causes of my plaque to begin with. Statins do lower inflammation, so that's why I take it. Nothing to do with managing my cholesterol...I take it to try and reduce inflammation.

Pete
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Old 03-24-2016, 07:56 AM   #24
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There are two types of Cardiologists: Preventive and Interventional. I'd say 90% are Interventional. This means they recommend "procedures", which means you're headed to the Cath Lab and there's a good chance you'll be stented.
If the guy wields a hammer, everything looks like a nail.

My first thought was that if your EKG was alright and you only found out about it when they took a peek at your carotid, maybe things aren't that bad (yet?). Echocardiograms don't use X-rays, so are safer than even your calcium score test. Not cheap though, apparently. Check on false positive rates with any test they do.

My BIL has several stent patents so you'd think he'd sing their praise, but a few things he's said and some things I've read suggest that they don't have better outcomes. Look at the results of high quality studies, especially mortality, and they don't look like such a great deal. DW used to do angiography, and says to stay away from that (and associated angioplasty). Here are some Consumer Reports links. Do you really need that stent? How to Treat Heart Disease Correctly - Consumer Reports
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Old 03-24-2016, 08:05 AM   #25
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If the guy wields a hammer, everything looks like a nail.

My first thought was that if your EKG was alright and you only found out about it when they took a peek at your carotid, maybe things aren't that bad (yet?). Echocardiograms don't use X-rays, so are safer than even your calcium score test. Not cheap though, apparently. Check on false positive rates with any test they do.

My BIL has several stent patents so you'd think he'd sing their praise, but a few things he's said and some things I've read suggest that they don't have better outcomes. Look at the results of high quality studies, especially mortality, and they don't look like such a great deal. DW used to do angiography, and says to stay away from that (and associated angioplasty). Here are some Consumer Reports links. Do you really need that stent? How to Treat Heart Disease Correctly - Consumer Reports

I've heard the problem with stents is they take away the option for bypass surgery later on. The bypass extends life where the stents apparently don't have a good record of it.
I've had abnormal EKGs before that the cardiologists were not too concerned about.
I'll see what they say in about a month. That's when I have my appointment.


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Old 03-24-2016, 08:08 AM   #26
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So...best of luck and interested to hear how it goes!

Pete

Thanks for the info!



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Old 03-24-2016, 08:56 AM   #27
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Don't panic, everything I've read about calcium CT scans considers them only a "predictor" of heart disease. Somewhat questionable at best.

My own journey down the CAD rabbit hole started last November, during a routine annual visit with my MD, during which I mentioned that I was experiencing "caregiver" stress from providing the daily care for my 89 yr old mother. I mentioned to my doctor that I'd started occasionally waking up at nite in a cold sweet with the feeling of someone squeezing on my chest. I was dealing with it through controlled breathing and relaxation techniques but wanted to know if any medication was available that migh assist.

Because of my age, 2 months from 60, and a family heart disease history, he felt it was best to eliminate heart disease as a potential problem even though all my indicators (weight, lipids, blood pressure, daily exercise and a near vegetarian diet) were in my favor. He even performed a quick EKG in the office that day, which he said was normal.

Fast forward two months later, following a second more thorough EKG, a cardiac stress test (failed this one!), a chest X-ray, an echocardiogram and a complete updated lipid profile and I found myself in the cardiologists office being offered two treatment options: 1. Schedule an angiogram, which would more then likely lead to stents or bypass surgery, followed by ongoing medication and lifestyle adjustment. 2. Medication (statins, beta blocker and Nitrostat for pain), stress reduction, exercise and lifestyle (diet) adjustment.

Based upon everything my DW and I had researched, option #2 is considered the current most progressive way to treat CAD unless the patient is in severe pain or suffering a current complete or near complete blockage, in which case option #1 preserves the heart function; however, it does not lead to any additional length of life, which still requires the patient follow option #2 post surgery. So, with the incouragement of my cardiologist, we chose option #2 with an open invitation for option #1 if I started experiencing any increase in chest pain or in the frequency of my chest pain; or, if I just lost my nerve and wanted to definitively know the percentage of my blockage/s and wanted them physically treated.

Note: While I initially only recognized the squeezing feeling that I'd experienced upon waking some nights, I subsequently learned that I been suffering angina on an almost daily basis during strenuous exercise, work and times of heavy stress. The chest pressure I was feeling was very subtle and I thought it was just part of getting older! It was only after I started taking Nitrostat whenever I experienced chest pressure, and experiencing immediate relief, that I was finally able to recognize that I'd been experiencing angina for over a year! Scary stuff

150 days later on a very strict low fat vegan diet, daily Lipitor (generic), beta blocker twice a day, and a gradually increasing level of daily exercise (currently 45+ minutes a day on an elliptical trainer), I'm free of chest pain, 20+ lbs lighter and feeling great! My total cholesterol is now 94 (down from 204) and my LDL's are 34 (down from 138) My Dr. personally called me following my last lipid profile and told me to go have something to eat! My LDL level is that of a newborn, below what statins can achieve on their own and definitely a response to fully embracing all aspects of option #2 and a low fat vegan diet. Prior to my last lipid check, my Dr. was planning to increase my statin dose to the maximum level since I was tolerating the medication well without any side effects. Now she is considering reducing my statin level in 6 more months if I continue to maintain my current low blood lipid levels.

She did mention to me once again that MD's and hospitals really do like doing angiograms, stents and bypasses. Quote: "that's where the money is!" Patients like me don't pay for the new Cardiac wings on hospitals.

So be cautious, proceed slowly and read everything you can about treating CAD. Read the COURAGE trial results comparing medication/lifestyle adjustment vs medical intervention (stents/surgery). There are also a growing number of studies similar to the COURAGE trials with similar results. Read Dr. Ornish and Dr. Esselstyn's books on reversing heart disease through diet and lifestyle change. We all die of something. Very few of us have to die of heart disease if we choose not to early enough in our lives!
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Old 03-24-2016, 09:04 AM   #28
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Dashman, I was in a situation similar to yours, but somewhat worse. I went to the cath lab and was told by several cardiologists I needed bypass surgery (they offered to schedule me the next morning). Ultimately, I opted to manage my disease through diet, exercise and medication.

The diet I follow is considered extreme by most people. Essentially it is a low fat, no oil, vegan diet (See Sue's earlier post for a reference to the program I follow). Three years later, I am 30 lbs lighter with total cholesterol numbers in double digits. Only time will tell if I made a wise choice, but I think there is good evidence that coronary artery disease is primarily a result of dietary choices. Good luck in whatever path you choose.
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Old 03-24-2016, 09:19 AM   #29
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Great story - thanks for sharing.

Amethyst

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Originally Posted by Spokane2303 View Post
Don't panic, everything I've read about calcium CT scans considers them only a "predictor" of heart disease. Somewhat questionable at best.

My own journey down the CAD rabbit hole started last November, during a routine annual visit with my MD, during which I mentioned that I was experiencing "caregiver" stress from providing the daily care for my 89 yr old mother. I mentioned to my doctor that I'd started occasionally waking up at nite in a cold sweet with the feeling of someone squeezing on my chest. I was dealing with it through controlled breathing and relaxation techniques but wanted to know if any medication was available that migh assist.

Because of my age, 2 months from 60, and a family heart disease history, he felt it was best to eliminate heart disease as a potential problem even though all my indicators (weight, lipids, blood pressure, daily exercise and a near vegetarian diet) were in my favor. He even performed a quick EKG in the office that day, which he said was normal.

Fast forward two months later, following a second more thorough EKG, a cardiac stress test (failed this one!), a chest X-ray, an echocardiogram and a complete updated lipid profile and I found myself in the cardiologists office being offered two treatment options: 1. Schedule an angiogram, which would more then likely lead to stents or bypass surgery, followed by ongoing medication and lifestyle adjustment. 2. Medication (statins, beta blocker and Nitrostat for pain), stress reduction, exercise and lifestyle (diet) adjustment.

Based upon everything my DW and I had researched, option #2 is considered the current most progressive way to treat CAD unless the patient is in severe pain or suffering a current complete or near complete blockage, in which case option #1 preserves the heart function; however, it does not lead to any additional length of life, which still requires the patient follow option #2 post surgery. So, with the incouragement of my cardiologist, we chose option #2 with an open invitation for option #1 if I started experiencing any increase in chest pain or in the frequency of my chest pain; or, if I just lost my nerve and wanted to definitively know the percentage of my blockage/s and wanted them physically treated.

Note: While I initially only recognized the squeezing feeling that I'd experienced upon waking some nights, I subsequently learned that I been suffering angina on an almost daily basis during strenuous exercise, work and times of heavy stress. The chest pressure I was feeling was very subtle and I thought it was just part of getting older! It was only after I started taking Nitrostat whenever I experienced chest pressure, and experiencing immediate relief, that I was finally able to recognize that I'd been experiencing angina for over a year! Scary stuff

150 days later on a very strict low fat vegan diet, daily Lipitor (generic), beta blocker twice a day, and a gradually increasing level of daily exercise (currently 45+ minutes a day on an elliptical trainer), I'm free of chest pain, 20+ lbs lighter and feeling great! My total cholesterol is now 94 (down from 204) and my LDL's are 34 (down from 138) My Dr. personally called me following my last lipid profile and told me to go have something to eat! My LDL level is that of a newborn, below what statins can achieve on their own and definitely a response to fully embracing all aspects of option #2 and a low fat vegan diet. Prior to my last lipid check, my Dr. was planning to increase my statin dose to the maximum level since I was tolerating the medication well without any side effects. Now she is considering reducing my statin level in 6 more months if I continue to maintain my current low blood lipid levels.

She did mention to me once again that MD's and hospitals really do like doing angiograms, stents and bypasses. Quote: "that's where the money is!" Patients like me don't pay for the new Cardiac wings on hospitals.

So be cautious, proceed slowly and read everything you can about treating CAD. Read the COURAGE trial results comparing medication/lifestyle adjustment vs medical intervention (stents/surgery). There are also a growing number of studies similar to the COURAGE trials with similar results. Read Dr. Ornish and Dr. Esselstyn's books on reversing heart disease through diet and lifestyle change. We all die of something. Very few of us have to die of heart disease if we choose not to early enough in our lives!
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Old 03-24-2016, 09:32 AM   #30
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Wow, great to hear that folks have found some doctors for whom the cath lab isn't their only response! And yes, diet is (almost) everything! (actually I think it's about 80% diet/lifestyle, and 20% genetics). My diet differs than those above in that I embrace Low Carb/High Fat. I did Low Fat for years, and years, and years and my health didn't improve - but...we're all different - what works for one might hurt another.

And while I am aware of my Total Cholesterol number and my LDL-C, most in the preventive world consider TC by itself worthless, and LDL-C just too crude a calculation to guide a program. Obviously this flies in the face of The Standard of Care that all doctors have to follow some amount of. The Standard of Care for heart disease is a statin (get LDL<70), beta blocker, ACE inhibitor, and aspirin, and doctors who delve outside of that do so at their own peril. They have medical licenses, that can be revoked, by their medical boards.

But there are a brave few, who will step outside, and look for the cause first (advanced testing), then look for diet and lifestyle to address the cause.

And medication...if ABSOLUTELY needed.

Pete
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Old 03-24-2016, 10:17 AM   #31
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putting me in the greater than 95 percentile for men my age (59) and an extreme risk.
So what's the risk that you are in the 95th percentile thereof? The medical industry does this all the time. They just use scary buzz words like "risk" without associating it with 50-50? 99% chance? 4 out of 5? Risk to a doctor, especially when they are using "latest studies" is like T-shirts. Small-medium-large. Smaller than what....? Larger than what...?

I had my test done almost 10 years ago. Maybe they are more refined nowadays but one of the caveats then was -lots of false positives-. If you get a high score, don't panic. There were stories of guys getting the test and being rolled in to an emergency bypass only to find they didn't have any blocked arteries after all. (Some of that might have been revenue enhancement on the part of doctors and hospitals as discussed in another thread and not an actual false positive.) But in any event, 1057 in a non-smoker who's not that old, with no family genetic oddities seems a bit off the edge.

My report said a 54 score was "Moderate risk" (of course without defining risk, as usual) on a scale that used, I believe, 101 as high risk and 400 as severe risk...? but less than 2 yrs earlier I had had a thalium treadmill test and the cardio guy said "Oh you're doing great! That stuff takes decades to build up!

Do you normally eat any high calcium foods? Did you take anything like TUMS in the days before the test? Those were also listed as things that can cause an inaccurately high score.

Also, what they told me was there is little need to worry about calcified, stable plaque. That is not the cause of heart attacks. It's the softer, unstable plaque that ruptures and causes the sudden choking off of an artery. But, based on how much stable, calcified plaque you have that is an indicator of how much potential unstable plaque you might have but they are not necessarily a 1 for 1 comparison. A high calcium score does not necessarily translate into a high unstable plaque situation.
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Old 03-24-2016, 10:19 AM   #32
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Yes, be aware and yes make changes, but please also be careful. I good friend of ours was in his 40s when he had a heart attack and died. He had just had a physical, but it didn't show any problems. He was a pilot. Turns out he had 90% blockage. He was in great shape and training for a marathon.

Chris -- :O)
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Old 03-24-2016, 10:25 AM   #33
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I do one every few years given family history, mainly on my mother's side. Was $99 at the local heart hospital. I've had 3 so far. After the first one, I did a dietary change and waited for a couple of years then retested. Score increased, but below the "average" increase based on some research I did. Then got a cardiologist and went on a statin, started taking vitamin D and kept with the diet. Last increase was very small after 3 years. My doc recommends no more often than once per 3 years.
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Old 03-24-2016, 10:32 AM   #34
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Yes, be aware and yes make changes, but please also be careful. I good friend of ours was in his 40s when he had a heart attack and died. He had just had a physical, but it didn't show any problems. He was a pilot. Turns out he had 90% blockage. He was in great shape and training for a marathon.

Chris -- :O)

Yes, back in my Air Force days we had a Pararescue Jumper, the AF's version of special operations, who were always in top physical condition , who had a widow maker heart attack. Only the medical training of his brothers in arms saved his life. He was 38 at the time, had regular flight physicals that had shown no issues, trained for hours a day, yet still nearly died.


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Old 03-24-2016, 10:41 AM   #35
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So what's the risk that you are in the 95th percentile thereof? The medical industry does this all the time. They just use scary buzz words like "risk" without associating it with 50-50? 99% chance? 4 out of 5? Risk to a doctor, especially when they are using "latest studies" is like T-shirts. Small-medium-large. Smaller than what....? Larger than what...?

I had my test done almost 10 years ago. Maybe they are more refined nowadays but one of the caveats then was -lots of false positives-. If you get a high score, don't panic. There were stories of guys getting the test and being rolled in to an emergency bypass only to find they didn't have any blocked arteries after all. (Some of that might have been revenue enhancement on the part of doctors and hospitals as discussed in another thread and not an actual false positive.) But in any event, 1057 in a non-smoker who's not that old, with no family genetic oddities seems a bit off the edge.

My report said a 54 score was "Moderate risk" (of course without defining risk, as usual) on a scale that used, I believe, 101 as high risk and 400 as severe risk...? but less than 2 yrs earlier I had had a thalium treadmill test and the cardio guy said "Oh you're doing great! That stuff takes decades to build up!

Do you normally eat any high calcium foods? Did you take anything like TUMS in the days before the test? Those were also listed as things that can cause an inaccurately high score.

Also, what they told me was there is little need to worry about calcified, stable plaque. That is not the cause of heart attacks. It's the softer, unstable plaque that ruptures and causes the sudden choking off of an artery. But, based on how much stable, calcified plaque you have that is an indicator of how much potential unstable plaque you might have but they are not necessarily a 1 for 1 comparison. A high calcium score does not necessarily translate into a high unstable plaque situation.
Being in the 95th percentile equates to a >4.5% annual risk of a heart attack. Not bad for one year, but multiply that X10 for your 10-year risk, and we're at 45%.

"the cardio guy said "Oh you're doing great! That stuff takes decades to build up!"" .....I would run away from this guy. This is the old "hardening of the arteries" mentality - "no problem, we'll just wait 'till it's bad enough and we'll go in and roto-rooter it out."

You're spot on with your comments re. unstable vs. stable plaque, and that's exactly why we need to get a second scan at least one year after the first. That's how we know if the plaque is stable or growing.

Pete
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Old 03-24-2016, 10:50 AM   #36
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trained for hours a day, yet still nearly died.
That was probably the cause of it.
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Old 03-24-2016, 11:06 AM   #37
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"the cardio guy said "Oh you're doing great! That stuff takes decades to build up!"" .....I would run away from this guy. This is the old "hardening of the arteries" mentality - "no problem, we'll just wait 'till it's bad enough and we'll go in and roto-rooter it out."
Yes, so this is the ongoing story. Which doctor is the one who know's what he's talking about and which one is the moron who's going to get me killed? I'm supposed to know this? How would I know when I get a "the good one"? Because he's the one who always jumps towards diddling with stuff under the hood because.... "Ya never know..." something about "risk" (never defined or always re-defined),.... "latest studies show"... "a diet 'rich in' (never defined) some such material". Why wouldn't the smart guy also be the one who says "Hey, you're fine. Go to lunch"? Every single health problem I have, and nearly all my medical bills since the late 90's have been due to doctors "intervening". Treating me for problems I didn't have, or might have 30 years in the future! (NO, do't worry about my current health and well-being) OR treating the bad results of the previous treatments.

Forgive me if I am skeptical when they tell me I am sick. The medical record has proven, not "suggested, or "indicated" like in those latest studies, proven: I am right,. They are wrong. The end. If I have to roll the dice on somebody's opinion, it'll be mine. At least I have some statistical evidence to support the diagnosis. Like 100%. I only pay them for their second opinion and access.

Quote:
You're spot on with your comments re. unstable vs. stable plaque, and that's exactly why we need to get a second scan at least one year after the first. That's how we know if the plaque is stable or growing.
Pete

I have been wanting an updated scan but have been holding off due to the radiation. As I recall 10 yrs ago they said it was the amount in TWO chest x-rays. Not exactly enough to turn me into the Incredible Hulk but my rule is: Less radiation is better than more radiation. Have the radiation levels they used dropped? I was surprised that some people mentioned they have had several in just a few years.
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Old 03-24-2016, 11:14 AM   #38
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So what's the risk that you are in the 95th percentile thereof? The medical industry does this all the time. They just use scary buzz words like "risk" without associating it with 50-50? 99% chance? 4 out of 5? Risk to a doctor, especially when they are using "latest studies" is like T-shirts. Small-medium-large. Smaller than what....? Larger than what...?
I don't want to blame doctors who are just doing what they think is best, but there is a very common paradigm that you see in many scientific studies that is so misleading as to be worthless, IMHO.

What I mean is the use of relative risk instead of absolute risk.

If 3 people out of 100 die from a condition, but a daily dose of Wonderstuff allows only 2 out of 100 to die from it, then Wonderstuff is marketed as cutting your risk by a third.

Well, yes of course there are side effects from use of Wonderstuff, some of them severe in some people, but look at the huge benefit!
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Old 03-24-2016, 11:31 AM   #39
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f 3 people out of 100 die from a condition, but a daily dose of Wonderstuff allows only 2 out of 100 to die from it, then Wonderstuff is marketed as cutting your risk by a third.

Well, yes of course there are side effects from use of Wonderstuff, some of them severe in some people, but look at the huge benefit!
Another disingenuous use of stats is: They do a study and say 25% of the people died from X. Ergo YOU and everyone else has a 25% risk of X. No. group aggregate outcomes cannot be used to diagnose risk in any single specimen. It's just the group outcome. But they want you to think you are at the same risk all the time. My doctors always seem to think a person of good weight, good diet, excellent blood pressure, who exercises is at the same catastrophic risk of a heart attack as a fat guy, who smokes 5 packs a day, is an alcoholic and has high blood pressure. Ya know why? Because my cholesterol is 210! That's all that matters. When I ask so, what's the death difference between cholesterol of 210 or even 250 and 199? He can't say because he knows it won't hold up. Even if he gave me an exact precise number it wouldn't be --MY--- risk. He cannot know ---MY--- risk. It would be a group outcome risk from some study.

I will also throw in at this time that I don't think all doctors are azzh*les. Some of them really were in their own minds trying to do the right thing. but all they were doing was pumping the ever-changing study crap and drugs drugs drugs! I liked them They seemed like dedicated people. But they were killing me with the best of intentions, and never wanted to listen to me.
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Old 03-24-2016, 12:42 PM   #40
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Thanks to Dash man for bumping this thread. It's pretty timely for me too. I had a scan done about two weeks ago. My score was about 2200. Doc says that's about as high of a score as he has seen. Next step is to do some additional testing. I'm wearing a blood pressure monitor today, recording BP every 20 minutes for 24 hours. I've got a stress test scheduled for next week. Stress test is supposed to determine if any near-term intervention may be required. Assuming that is negative (fingers crossed), Doc wants to treat by making changes in diet and by stepping up exercise regimen. DW and I sat down with a nutritionist yesterday and got recommendations for changing the way we eat. Both Doc and nutritionist believe that diet makes the biggest difference. I think our pending retirement (later this year) will make it easier to make the changes we need to make.

Good luck to you Dash in dealing with your condition.


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