Cardiac CT Scan for Calcium

[Dash man]

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

Pete

Thanks for the info!



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[Spokane2303]

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!

 

[MildlyEccentric]

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.

 

[Amethyst]

Great story - thanks for sharing.

Amethyst

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!

 

[psweath]

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

 

[razztazz]

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.

 

[Chris7]

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)

 

[big-papa]

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.

 

[Dash man]

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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[psweath]

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

 

[razztazz]

trained for hours a day, yet still nearly died.

That was probably the cause of it.

 

[razztazz]

"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.

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.

 

[braumeister]

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!

 

[razztazz]

I

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.

 

[txtig]

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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[Options]

I paid for this test two years ago, and all I remember is that I was in something like the 40th percentile risk factor. My PCP is also a cardiologist (lucky me) who recommended statins as a preventative measure against heart attack in the future (he meant 20 years into the future).

I thought it over and declined the statins. Fast forward to this year where through diet I have reduced my bad cholesterol by 10% and improved my good cholesterol by almost a third. My PCP this year said given my diet and exercise habits and my new results I didn't need statins. This goes to show you how things can change.

 

[Dash man]

Thank you for all the good input. Even though my cardiologist appointment is a month away, dietary changes started today and exercise tomorrow. Exercise is always a challenge because of my arthritis and neck/back issues, but I'll find a way.


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[Texas Proud]

Thank you for all the good input. Even though my cardiologist appointment is a month away, dietary changes started today and exercise tomorrow. Exercise is always a challenge because of my arthritis and neck/back issues, but I'll find a way.


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Find a gym with a pool that has water aerobics.... my 96 YO mom goes three times a week to exercise, but is hard pressed to walk a long distance...

It has helped out her arthritis... she said she can feel it if she does not do the exercises...

 

[zinger1457]

For those that had a CT Scan done. Did you have it done because of other symptoms that gave you concern or was it a preventive measure like getting a colonoscopy at 50?

 

[Amethyst]

No doubt you have consulted physical therapists about this?

I have read of ways in which weight control, strength training, and even therapeutic massage can help deteriorating joints do their job better. It is partly about taking the strain (weight) off them, and partly about strengthening the muscles/tendons that support them and cause them to move.

Still, each of us is individual, and needs individual advice from experts to avoid injury. Good luck!

Exercise is always a challenge because of my arthritis and neck/back issues, but I'll find a way.


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[razztazz]

For those that had a CT Scan done. Did you have it done because of other symptoms that gave you concern or was it a preventive measure like getting a colonoscopy at 50?

I was approaching 50 and was, quite frankly, sick and tired listening to the constant fear harassment of the whole cholesterol spew from doctors. With other diseases and conditions my doctors had racked up a pretty poor track record of diagnosing and convincing me they gave a hoot about my health or future.

My father had had heart attacks and strokes starting in his 40's but he was basically killing himself: 5 packs a day. Alcoholic. High stress life. High BP diagnosed in his 30's but never treated. I had exactly NONE of those risk factors and to this day still have LOW-end BP. 105-62 range. But of course my risk was the same as his according to the medical industry because we were related. Nothing else mattered to them. Of course they could only take money for cholesterol so that's what they treated.

So, I did my own research and got something at least resembling MEDICAL DATA instead of dishonest statistical surrogate data so that I couldn't be bullshat in the future.

 

[mpeirce]

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.

Just another comment on relative risk:

A typical modern chest X-Ray exposes you to roughly 10 millirem of radiation.

A flight from NY to LA exposes you to 2-5 millirem (less atmosphere shielding you from cosmic radiation).

Living in a brick house can expose you to an additional 7 millirem every year (from naturally occurring radioactive elements found in clay).

For perspective, the feds estimate that the average American absorbs 620 milligram each year.

Sure, less if better - all things being equal - but avoiding doctor recommended scans and x-rays isn't going to make much of a difference to your lifetime radiation expose.


This has some more comparisons

Patient Safety - Radiation Dose in X-Ray and CT Exams

 

[Dash man]

No doubt you have consulted physical therapists about this?

I have read of ways in which weight control, strength training, and even therapeutic massage can help deteriorating joints do their job better. It is partly about taking the strain (weight) off them, and partly about strengthening the muscles/tendons that support them and cause them to move.

Still, each of us is individual, and needs individual advice from experts to avoid injury. Good luck!

Yes, I've had quite a bit of physical therapy over the past ten years as new areas of my body flare up. It helps a lot and allows me to significantly reduce the meds I've been prescribed. But there are still times strenuous aerobic exercises are difficult, but I manage to do more than sit in a chair all day,


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[Dash man]

For those that had a CT Scan done. Did you have it done because of other symptoms that gave you concern or was it a preventive measure like getting a colonoscopy at 50?

I don't have any heart or stroke related symptoms, but my father had two strokes by the time he was my age and eventually died at age 72 from congestive heart failure. I had an ultrasound of my carotid artery from a group called Lifeline, along with some other tests that showed a mild buildup of plaque. I decided to get the calcium scan to see what was going on inside my heart.


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[razztazz]

Just another comment on relative risk:

A typical modern chest X-Ray exposes you to roughly 10 millirem of radiation.

A flight from NY to LA exposes you to 2-5 millirem (less atmosphere shielding you from cosmic radiation).

Living in a brick house can expose you to an additional 7 millirem every year (from naturally occurring radioactive elements found in clay).

For perspective, the feds estimate that the average American absorbs 620 milligram each year.

Sure, less if better - all things being equal - but avoiding doctor recommended scans and x-rays isn't going to make much of a difference to your lifetime radiation expose.


This has some more comparisons

Patient Safety - Radiation Dose in X-Ray and CT Exams

Thanks good info. And BTW I am not avoiding dr recommended scans etc All my scans including eh nuclear stress tests were recommended by ME because the doctor didn't have any information.