CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 16 0000. ref SDS 15 0000.
040502 -
040503 -
040505 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - While walking to the stairs from the ER on the ground floor of
040902 - building 200, to the Radiology Department on the 2nd floor, met in the
040903 - hallway Doctor Judith Wisneski. Have seen her over the past years
040904 - talking with Doctor Stewart in the hallways, but have never been
040905 - introduced.
040907 - ..
040908 - None-the-less she knew my name. Doctor Wisneski advised that she
040909 - works in Cardiology and is aware of the meeting scheduled with Doctor
040910 - Simpson on 151014, and which was set up on 151001 1200. ref SDS 15
040911 - PP5N
040913 - ..
040914 - The doctor had her back to the door leading to the stair well. While
040915 - we talked somone opened the door abruptly, striking her in the back,
040916 - including her head. Of course she was startled, and immediately said
040917 - she must lay down to recover from this blow. Doctor Wisneski went
040918 - through door, and I followed to render assistance. However, she
040919 - leaned against the wall of the stair well, and continued discussion.
040921 - ..
040922 - Later was told that Doctor Wisneski is Chief of Cardilogy at the VA.
040924 - ..
040925 - We had a long discussion in the stairwell, perhaps 30 minutes, about
040926 - performing coronary CT angiography (CCTA) with calcium score for the
040927 - purpose of...
040928 -
040929 - 1. Evaluate level of atherosclerotic plaques following CABG +4 on
040930 - 091022 0700. ref SDS 4 JF9K
040932 - ..
040933 - 2. Low levels of atherosclerotic plaques shown by CCTA with low
040934 - calcium score provides standard of care testing response to
040935 - treatment with extended endurance exercise through hiking 11
040936 - miles per day, 300 miles per month at the rate of 13 - 17
040937 - minutes per mile, and over the past 4 years which raised HDL
040938 - from 30 to 70, as shown in spreadsheet previously submitted to
040939 - Doctor Rao...
040940 -
040941 - F:\05\00003\SM\CC\BNKG\120216cc\130101cc\hiking_miles_3.xlsx
040943 - ..
040944 - General summary of hiking correlated with improved HDL and
040945 - Triglycerides is shown in case study of patient history on
040946 - 140101 0600. ref SDS 12 TTQS (see line 107069)
040948 - ..
040949 - 3. Low levels of atherosclerotic plaques shown by low calcium
040950 - score may occur from rapid regression and repair of lesions in
040951 - the endothelium lining of blood vessels with high levels of HDL
040952 - (> 60) cholesterol and EPCs, indicated in research on 131125
040953 - 0005, ref SDS 11 6O9M, and further at ref SDS 11 XY7L, both
040954 - produced with extended endurance exercise through hiking 11
040955 - miles per day, 300 miles per month.
040957 - ..
040958 - 4. Low levels of atherosclerotic plaques shown by low calcium
040959 - score supports reduced reliance on statin drug treatments,
040960 - since atherosclerotic plaques take years to regenerate.
040962 - ..
040963 - 5. Low levels of atherosclerotic plaques shown by low calcium
040964 - score that supports reduced reliance on statin drug treatments,
040965 - thereby reduces onerous side effects of statin drugs.
040967 - ..
040968 - Reduced dizziness increases effectiveness performing daily
040969 - work.
040971 - ..
040972 - Reduced urination reduces dehydration, which reduces feet
040973 - injuries of blistering, scaling, peeling, bleeding. Healthy
040974 - feet enables more hiking to increase HDL and EPCs maintaining
040975 - low levels of atherosclerotic plaques, lowering risks of
040976 - negative cardiovascular events, and thus extending chances of
040977 - longevity with a quality of life worth living.
040979 - ..
040980 - 6. Low levels of atherosclerotic plaques shown by low calcium
040981 - score supports reduced level of effort performing extended
040982 - endurance exercise through hiking, perhaps to 4 or 5 miles per
040983 - day, thus enabling investing 1 - 2 hours saved per day in
040984 - other necessities.
040986 - ..
040987 - The doctor was aware of pending meeting with Doctor Simpson scheduled
040988 - on 151014 0900. She seemed to say that Doctor Simpson feels this
040989 - upcoming meeting is unnecessary, and that nothing can be accomplished.
040991 - ..
040992 - Doctor Wisneski was generally aware that extended endurance exercise
040993 - hiking 300 miles per month over the past several years has increased
040994 - HDL 30 up to 70, shown in patient history submitted to the VA in case
040995 - study on 140101 0600. ref SDS 12 XY4M She indicated this lipid profile
040996 - significantly improves coronary health, reducing risks of CVD. She
040997 - encouraged continued efforts, and also noted the VA has no records of
040998 - anyone else making this level of effort nor increasing HDL by 140%.
040999 - Therefore, it seems beyond reach for mainstream cardiology care.
041001 - ..
041002 - Doctor Wisneski was sympathetic with objectives for reducing side
041003 - effects of statin medications, in this case mainly dizziness and
041004 - frequent urination, which in turn causes dehydration that injures the
041005 - feet, preventing hiking to raise HDL. She suggested continuing to
041006 - take statins but at reduced levels. There was not enough time today
041007 - to consider reducing current low dose of Atorvastain 10 mg and
041008 - Ezetimibe 10 mg to 5 mg.
041010 - ..
041011 - Doctor Wisneski further proposed changing use of statins from daily to
041012 - every other day, thus lowering the concentration in order to reduce
041013 - side effects. This would seem to be trial and error finding level of
041014 - statins that maintain favorable lipids with minimum side effects.
041016 - ..
041017 - The doctor asked about patient history taking statins?
041019 - ..
041020 - Simvastatin was started in 2010. Disabling side effects of severe
041021 - myopathy in left shoulder caused treatment with Simvastatin to end on
041022 - 110817 1030. ref SDS 8 QF6W At that time on 110817, switched to
041023 - Rosuvastatin. ref SDS 8 DG36 It was ended on 121206, due to side
041024 - effects of frequent urination with consequent dehydration injuries to
041025 - feet, dry mouth, etc. ref SDS 9 OS5L Since 131015, have been taking
041026 - low dose Atorvastatin and Ezetimibe 10 and 10. This worked well until
041027 - progressive side effects of frequent urination with dehydration began
041028 - causing blisters, peeling, cracking and bleeding feet, which prevented
041029 - hiking. So paused the protocol on 150427, shown in case study on
041030 - 140101 0600. ref SDS 12 AS5J After about 3 weeks, feet seemed fully
041031 - recovered, so resumed Atorvastatin and Ezetimibe 10 10, reported on
041032 - 150516. ref SDS 12 P84G Frequent urination recurred within 3 months,
041033 - with dehydration effects on feet that prevented hiking, so paused
041034 - statin treatment again on 150809 (see case study on 140101 0600.
041035 - ref SDS 12 GH3G).
041037 - ..
041038 - Additionally, On 150819 also paused Proton Pump Inhibitor (PPI -
041039 - Omeprazole), ref SDS 12 X07H, because research found taking PPI 80 mg
041040 - previously caused signficant dehydration, reported 5 years ago on
041041 - 101218 1642. ref SDS 7 8Q5I
041043 - ..
041044 - With medications paused, frequent urination then declined. On 150918,
041045 - report feet seem substantially recovered. ref SDS 12 4W9N
041047 - ..
041048 - Doctor Wisneski seemed to say the medical team cannot support standard
041049 - of care in this case because there is no protocol for using coronary
041050 - CT angiography with calcium score to test for response to treatment
041051 - with extended endurance training hiking 11 miles per day and 300 miles
041052 - per month.
041054 - ..
041055 - The doctor seemed to mention that some years ago UCSF had a protocol
041056 - for testing response to treatment with extended endurance exercise.
041057 - She further indicated that testing only 1 person would not justify
041058 - publishing results. She noted there would be difficulty attracting
041059 - people to participate in a trial of extended endurance exercise at
041060 - levels 7 - 8 miles per day and only 250 miles per month, likely
041061 - required to raise HDL above 60, sufficient to regress atherosclerotic
041062 - plaques. May turn out that level of effort varies according to
041063 - patient baseline HDL. Some patients may have baseline HDL 40, rather
041064 - than 30. This may take less effort to get to 60, but only testing
041065 - can identify actual requirements.
041067 - ..
041068 - The implication seemed to be that if patients choose to avoid effort
041069 - that regresses athersclerotic plaques, which may in turn extend
041070 - longevity and quality of life, this preference justifies not testing
041071 - to see if benefits in this case, as set out above, ref SDS 16 HE5Y,
041072 - support reducing drug side effects by reducing treatment with statin
041073 - medications.
041075 - ..
041076 - Doctor Wisneski at one point noted patients are free to stop taking
041077 - statin drugs to control atherosclerotic plaques at any time, so there
041078 - is no need to perform coronary CT angiography test to determine that
041079 - former high concentrations of atherosclerotic plaques have been fully
041080 - or otherwise significantly regressed, which justifies ending treatment
041081 - with statin drugs, and also reducing treatment and time time
041082 - performing extended endurance exercise, thus reducing wear and tear on
041083 - the body, i.e., side effects of endurance training. (see point 6,
041084 - ref SDS 16 IL4I)
041086 - ..
041087 - There was not enough time today, to consider similarities between
041088 - pausing treatment of atherosclerosis with statins based on favorable
041089 - results of CT testing, and pausing chemotherapy, so that cancer
041090 - patients avoid debilitating side effects of treatment, when radiology
041091 - testing finds NED, i.e., cancer has been regressed, shown by Millie's
041092 - case fighting stage 4 cancer for nearly 10 years, e.g., on 051121
041093 - 1640. ref SDS 2 AW5G
041095 - ..
041096 - Doctor Wisneski seemed to say that, even if coronary CT angiography
041097 - (CCTA) testing finds only a single 10% lesion, this would not justify
041098 - reducing statin drug treatment, because the next day after the test,
041099 - that single 10% lesion could become a 100% blockage.
041101 - ..
041102 - Advised this theory has not been encountered in cardiology and lipid
041103 - management literature, reviewed for example on 131125 0005.
041104 - ref SDS 11 JV5O It sounds similar to blood clot events from pulmonary
041105 - embolism, which was diagnosed for Millie at Kaiser on 041104 1030.
041106 - ref SDS 1 RZ4I As well the medical team treated me with Coumadin to
041107 - resolve DVT following CABG +4 surgery, and arising from Cordis
041108 - catheter, reported on 091030 0810. ref SDS 5 1N6L That treatment was
041109 - ended by the CT team, when radiology testing showed DVT was resolved,
041110 - reported on 091208 1300. ref SDS 6 D24G
041112 - ..
041113 - Today, there was no discussion of how statin treatments would avoid a
041114 - catostrphic event of a 10% lesion suddenly expanding into a 100%
041115 - blockage. Of course time was very limited, so understandings may have
041116 - been incomplete. Doctor Simpson may be able to clarify the matter
041117 - during the meeting next week on 151014.
041119 - ..
041120 - We discussed cardiology literature reporting high concentrations of
041121 - HDL, i.e., above 60, remove LDL lesions, and return them to the liver,
041122 - something called "Reverse Lipid Transport" (RLT), reported on 131125
041123 - 0005. ref SDS 11 Z49G Similarly, high EPCs repair lesions in
041124 - endothelial lining of blood vessels caused by HDL removing plaque,
041125 - also reported on 131125 0005. ref SDS 11 R44O Both HDL and EPCs are
041126 - increased with exercise above a threshhold level.
041128 - ..
041129 - Doctor Wineski seemed to say at one point that while coronary CTA is
041130 - not a reliable test for evaluating regression of atherosclerotic
041131 - plaques, this can be evaluated effectively with conventional and
041132 - invasive cardiac catheterization angiogram tests. The procedure was
041133 - performed by Doctor Shunk in this case on 091021 0716. ref SDS 3 7L43
041135 - ..
041136 - Indicated objective to avoid invasive procedures, for reasons
041137 - presented by Doctor Shunk on 131121 0930. ref SDS 10 8D6N There was no
041138 - time today for discussing why finding no evidence of disease (NED),
041139 - i.e., no atherosclerotic plaques - calcium score 0, with invasive
041140 - procedures is any more helpful than making the same finding with
041141 - non-invasive radiology methods using CCTA with calcium score.
041143 - ..
041144 - Further suggested that the meeting with Doctor Simpson scheduled for
041145 - next week on 151014, can be cancelled, based on extensive time Doctor
041146 - Wineski has generously granted today, presenting views of the
041147 - Cardiology Department.
041149 - ..
041150 - Doctor Wineski seemed to indicate the meeting should take place.
041152 - ..
041153 - Thanked Doctor Wisneski for sharing ideas on managing atheroslclorsis
041154 - risks.
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