KidDoc said:

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Lucky they picked that up before it launched to your lungs! Hopefully it Will slowly melt away with your med.

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Yeah. Considering all the experience doctors have had with blood clots and dissolving them, I'm pretty optimistic.

About twenty years ago, a friend of mine had a pulmonary embolism. He said that it was very painful and still shows up on x-rays.

Zinc deficiency can also cause something called dysgeusia. Not sure how useful zinc testing is, but zinc supplementation is cheap and studies show it can help.

Still though, I didn't see anything in your post that indicates why you got the blood clot. You might need referral to hematology for a workup. At your age, unlikely to be a primary clotting disorder that just presented. I'm sure your doc has you covered though. The fact that he was able to start anticoagulation himself, and didn't just send you to the ER (like many do), makes me think he's got this.

bigtruckguy3500 said:

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Zinc deficiency can also cause something called dysgeusia. Not sure how useful zinc testing is, but zinc supplementation is cheap and studies show it can help.

Still though, I didn't see anything in your post that indicates why you got the blood clot. You might need referral to hematology for a workup. At your age, unlikely to be a primary clotting disorder that just presented. I'm sure your doc has you covered though. The fact that he was able to start anticoagulation himself, and didn't just send you to the ER (like many do), makes me think he's got this.

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I keep zinc gluconate on hand. I mainly use it whenever I'm coming down with a cold (melt in my mouth and drain down my throat).

I am quite curious about what caused the blood clot. My intention has been to ask the doctor about it after we get the clot under control.

I think that our emergency room doctors and clinic doctors are largely the same doctors. I know that I have been in the emergency room under the care of the same doctor.

I had wondered whether I would need to be hospitalized. If it comes to that, they usually ship people down to Amarillo. I don't think that they admit many patients to stay at our local hospital for inpatient treatment any more.

With the lower ability of the blood to coagulate while on blood thinners (Eliquis), does that affect getting shots such as the Vitamin B-12 injections?

Vein disease is something often under treated. Blood thinners like Eliquis are the baseline treatment. But there are interventional treatments indicated for the right scenarios. Not sure how symptomatic you are, but in general you need a Hematology evaluation for a hypercoagulable disorder. And given that you have common femoral vein involvement you need evaluation for May Thurner syndrome. Typically I would order a CT venogram.

Recently had a more detailed cholesterol test completed, all of my LDL numbers seem pretty high compared to what the range is supposed to be, and googling it just says to eat better, exercise, etc. Any thoughts on how to lower these numbers? I turn 45 in a couple months, 5'11, 180 lbs, do cardio 4-5 days a week for 30 minutes on the stair stepper, lift 3 days/week, walk the dog for 20 minutes a day, and don't eat much sugars. Do IF most days as well, so not sure what else I can do, and would like to avoid taking meds. Here are my numbers:

Cholesterol 192
Trigs 92
LDL 110 (Range <100)
LDL Particle Number 1583 (range <1138)
LDL Small 398 (Range <142)
LDL Medium 338 (Range <215)

My tests from June 26:

Cholesterol: 68 mg/dL (for the last three years, this had been in the 89-100 range)
Triglycerides: 98 mg/dL (barely changed)
dHDL: 23 mg/dL (the highest I've seen this is about 40)
cLDL: 25 mg/dL

DeepintheHeart06 said:

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Vein disease is something often under treated. Blood thinners like Eliquis are the baseline treatment. But there are interventional treatments indicated for the right scenarios. Not sure how symptomatic you are, but in general you need a Hematology evaluation for a hypercoagulable disorder. And given that you have common femoral vein involvement you need evaluation for May Thurner syndrome. Typically I would order a CT venogram.

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Any recommendations for people with Reynaud syndrome? My feet and hands are constantly cold and my doctor hasn't given me much other than wear socks/gloves and/or move to a warmer climate.

You would also want ApoB

I was always taught calcium channel blockers like Amlodipine or nifedipine (BP meds). But cold avoidance and triggering situations is supposed to be first line.

OasisMan said:

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You would also want ApoB

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ApoB was 89

Sorry if this is out of left field, but has anyone incorporated polyphenol rich olive oil in to their diets as a response to their high cholesterol? I've been on resuvastatin for years and finally got tired of the muscle aches and opted for 2000 mg of krill oil plus the olive oil to see if there's a positive difference. I feel 20 years younger but I'm not sure the numbers will bear this out.

Any thoughts on this approach?

I assume you spoke with your doctor about this, yes? And that you knew your numbers before switching?

I'd follow up with blood work 6-8 weeks after stopping the statin and again at 3-4 months to confirm whether changes are holding or shifting further.

I've never taken EVOO for that purpose but the research is pretty solid. You might also want to look into taking fish oil instead as krill oil can cost about 3-5 more to achieve comparable omega3 intake (if that matters to you).

Bazooka Joe said:

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Sorry if this is out of left field, but has anyone incorporated polyphenol rich olive oil in to their diets as a response to their high cholesterol? I've been on resuvastatin for years and finally got tired of the muscle aches and opted for 2000 mg of krill oil plus the olive oil to see if there's a positive difference. I feel 20 years younger but I'm not sure the numbers will bear this out.

Any thoughts on this approach?

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Do you just drink the olive oil like a shot or something?

1 fl oz every morning. I fill a shot glass about 3/4 full.

Annual physical today. Late 30s.

CHOLESTEROL, TOTAL: 247 H (mg/dL)
HDL CHOLESTEROL: 65 (mg/dL)
TRIGLYCERIDES: 40 (mg/dL)
LDL-CHOLESTEROL: 170 H (mg/dL (calc))
CHOL/HDLC RATIO: 3.8 (calc)
NON HDL CHOLESTEROL: 182 H (mg/dL (calc))
LDL PARTICLE NUMBER: 1907 H (nmol/L)
LDL SMALL: 265 H (nmol/L)
LDL MEDIUM: 449 H (nmol/L)
HDL LARGE: 6084 L (nmol/L)
LDL PATTERN: A (Pattern)
LDL PEAK SIZE: 223.1 (Angstrom)
APOLIPOPROTEIN B: 112 H (mg/dL)
LIPOPROTEIN (a): <10 (nmol/L)
HS CRP: 0.2 (mg/L)
LP PLA2 ACTIVITY: 166 H (nmol/min/mL)

CAC score was 0.
Rest of the labs were great.

MRB10 said:

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Annual physical today. Late 30s.

CHOLESTEROL, TOTAL: 247 H (mg/dL)
HDL CHOLESTEROL: 65 (mg/dL)
TRIGLYCERIDES: 40 (mg/dL)
LDL-CHOLESTEROL: 170 H (mg/dL (calc))
CHOL/HDLC RATIO: 3.8 (calc)
NON HDL CHOLESTEROL: 182 H (mg/dL (calc))
LDL PARTICLE NUMBER: 1907 H (nmol/L)
LDL SMALL: 265 H (nmol/L)
LDL MEDIUM: 449 H (nmol/L)
HDL LARGE: 6084 L (nmol/L)
LDL PATTERN: A (Pattern)
LDL PEAK SIZE: 223.1 (Angstrom)
APOLIPOPROTEIN B: 112 H (mg/dL)
LIPOPROTEIN (a): <10 (nmol/L)
HS CRP: 0.2 (mg/L)
LP PLA2 ACTIVITY: 166 H (nmol/min/mL)

CAC score was 0.
Rest of the labs were great.

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I'm no expert with lipids but I think you may have drawn a bad genetics card, sucks but treatable.

A somewhat higher number isn't bad if your body is using it to make hormones or proteins and isn't just piling it up on the walls of your arteries and veins.

Mine used to be 250+ total
I made substantial diet and fitness changes over a few years and got it well below 200 with tri's around 60. No drugs. Not great, but in the acceptable range. I prefer to stay off meds but if a healthy lifestyle isn't enough I would consider minimum levels of a statin.

These look pretty good. My guess is you're a pretty fit individual. Just curious what is the context of you getting an extended lipid panel and CAV score done?

It's not genetics. I went mostly carnivore/fruit 2 years ago and this was expected because of my diet.

I exercise 5-6 days a week, 23-24 BMI, 10-12% body fat. I've read enough about it to be convinced that cholesterol, and saturated fat by extension, in and of itself is not the bogeyman most think it is. My physician doesn't have my conviction but isn't going to push too hard so long as the other metrics we track stay where we want them. I'm going to get CACs done every 2-3 years and a CTA when I hit 40.

I was interested to see the LDL particle size broken out and my insurance covered it.

The CAC was my physicians recommendation after seeing the lipid profile. Just a precaution.

Agree 100%. You're doing great.

I feel great. Are you a physician?

MRB10 said:

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It's not genetics. I went mostly carnivore/fruit 2 years ago and this was expected because of my diet.

I exercise 5-6 days a week, 23-24 BMI, 10-12% body fat. I've read enough about it to be convinced that cholesterol, and saturated fat by extension, in and of itself is not the bogeyman most think it is. My physician doesn't have my conviction but isn't going to push too hard so long as the other metrics we track stay where we want them. I'm going to get CACs done every 2-3 years and a CTA when I hit 40.

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Agree completely. The current lipid guidelines are outdated and incorrect as are the current dietary guidelines. I'm a big fan of the Deep Nutrition book and guidelines over the current low fat nonsense that has proven to be ineffective.

I read Deep Nutrition during Covid and it made a lot of sense to me as well. I'm more focused on the metrics that measure inflammation and insulin sensitivity. I won't start thinking about making changes unless those start getting out of whack.

I'm no expert, but I will say that plenty of people feel great while their arteries are clogging. Same with high blood pressure, just because you feel great doesn't mean anything.

Also, a coronary calcium score doesn't show atherosclerosis, or flow. It only shows calcified plaques. Plaque calcification tends to occur later in life. It is possible that you are stuffing your arterial walls with plaque but won't see it on a CAC. Now a CTA will show flow, which will give a better idea of whether you have coronary artery plaques. But being in your 30s, there's a question of how sensitive it will be to annual changes. Can it pick up 0.25mm difference each year? Or will you have to wait 4+ years before the CT resolution and radiologist will be able to see narrowing?

But, all that aside, another thought is about the radiation from all these CTs you want. The amount of radiation in coronary CT is equivalent to roughly 1 year of background radiation all at once. The amount in a coronary CTA is about 2.5-3 years of background radiation. The risk of cancer from a CT scan is much higher in kids, and decreases as you get older, but it is estimated that current CT utilization practices account for about 5% of cancers. I probably over think it, but I prefer to avoid as much radiation as possible.

I personally prefer to eat a diet that keeps my LDL/ApoB and triglycerides low and my HDL high (mostly via exercise). I think avoiding processed foods in general will do this for most people.

The comment about CT radiation isn't something I've thought through. That's a good take away for me.

Just ordered Deep Nutrtition. Thanks.

Anyone have experience with repatha injections?

I've been on Repatha for about a year. My overall cholesterol had been about 130 on Crestor, with my LDL around 55-60. I had to address some blockages with stents. I had a full cholesterol panel and it showed a significant problem with cholesterol size, even with what looked to be a reasonable cholesterol level. Apparently, the smaller size is more atrributible to blockages. Repatha immediately dropped my overall levels to about 75, with LDL being about 15. My size dropped from about the 85th to 90th percentile to about the 30th percentile. My PCP thinks my cholesterol is too low and my cardiologist is pleased with the results. No immediate side effects. One of the long term impacts can be memory loss, so I'm watching that.

FourAggies said:

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I've been on Repatha for about a year. My overall cholesterol had been about 130 on Crestor, with my LDL around 55-60. I had to address some blockages with stents. I had a full cholesterol panel and it showed a significant problem with cholesterol size, even with what looked to be a reasonable cholesterol level. Apparently, the smaller size is more atrributible to blockages. Repatha immediately dropped my overall levels to about 75, with LDL being about 15. My size dropped from about the 85th to 90th percentile to about the 30th percentile. My PCP thinks my cholesterol is too low and my cardiologist is pleased with the results. No immediate side effects. One of the long term impacts can be memory loss, so I'm watching that.

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Thanks for the input, that is a REALLY low cholesterol, and our brain is made up of cholesterol which is why your PCP is probably concerned.

KidDoc said:

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FourAggies said:

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I've been on Repatha for about a year. My overall cholesterol had been about 130 on Crestor, with my LDL around 55-60. I had to address some blockages with stents. I had a full cholesterol panel and it showed a significant problem with cholesterol size, even with what looked to be a reasonable cholesterol level. Apparently, the smaller size is more atrributible to blockages. Repatha immediately dropped my overall levels to about 75, with LDL being about 15. My size dropped from about the 85th to 90th percentile to about the 30th percentile. My PCP thinks my cholesterol is too low and my cardiologist is pleased with the results. No immediate side effects. One of the long term impacts can be memory loss, so I'm watching that.

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Thanks for the input, that is a REALLY low cholesterol, and our brain is made up of cholesterol which is why your PCP is probably concerned.

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true,
But the brain makes ~90+% of it's own cholesterol, meaning not dietary

Also, plasma cholesterol has a very hard time crossing the BBB,

So lower plasma cholesterol, in theory, shouldn't negatively affect brain health

But as you are aware, there are some studies which argue that "too low" of cholesterol can raise mortality and there are some camps that worry about cholesterol being too low.

Some of my vascular Neuro attendings were in that camp, some weren't

Good information. I finally got the cardiologist to take me off of statin, so he wants to see how repatha will work. I'm just waiting for approval at this point. Thanks

MRB10 said:

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Annual physical today. Late 30s.

CHOLESTEROL, TOTAL: 247 H (mg/dL)
HDL CHOLESTEROL: 65 (mg/dL)
TRIGLYCERIDES: 40 (mg/dL)
LDL-CHOLESTEROL: 170 H (mg/dL (calc))
CHOL/HDLC RATIO: 3.8 (calc)
NON HDL CHOLESTEROL: 182 H (mg/dL (calc))
LDL PARTICLE NUMBER: 1907 H (nmol/L)
LDL SMALL: 265 H (nmol/L)
LDL MEDIUM: 449 H (nmol/L)
HDL LARGE: 6084 L (nmol/L)
LDL PATTERN: A (Pattern)
LDL PEAK SIZE: 223.1 (Angstrom)
APOLIPOPROTEIN B: 112 H (mg/dL)
LIPOPROTEIN (a): <10 (nmol/L)
HS CRP: 0.2 (mg/L)
LP PLA2 ACTIVITY: 166 H (nmol/min/mL)

CAC score was 0.
Rest of the labs were great.

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Can I ask my doc to order the blood test with the different sizes? Mint just says HDL, LDL and Lipids.