Negotiating upcoming labs

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Negotiating upcoming labs


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Old 08-22-2012, 23:46   #1
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Default Negotiating upcoming labs

Asked my doc today to request a VAP test. She has wanted me on statins, but knows Iím not open, so asked what I would do differently with the information from the VAP. Would I take statins then if LDL turns out to be mostly small/dense? No, I told her, but I want to know whatís going on in my body and can make no decisions in the absence of information to assess in context. This seemed to satisfy her and she ordered it.

She asked about my diet. Asked her to hold on tightly to her seat Ö and she of course said it was the exact opposite of what she would recommend. I thanked her for working with me in spite of my going against convention. I said I was getting results: consistently good bp (94/59 today), decent fastings on just 500 mg metformin (she actually likes my pending going off met and managing w/ just diet/exercise), good energy, freedom from gnawing hunger. She asked where I got the diet from, that it sounded like a healthier Atkins without all the bacon (I just smiled!), and how long I had been on it. Told her Iíd been in ketosis for a long time but only extreme high-fat for the last month or so. She likes that we have somewhat of a baseline and is willing to work with me on my (to her) crazy experiments and see where it takes us. I canít ask more than that from a doc who thinks I should be curbing my egg appetite for the sake of my cholesterol!

Iíll go in for labs later in the week Ö major curious about the VAP .

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 08-23-2012, 00:05   #2
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Wouldn't it be great if she were open to learning something from all of this? Good for you in your 'negotiations'!

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Old 08-23-2012, 00:09   #3
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You know, Shanny, if she sees results, maybe she will. But if I have small/dense like Marty, then it will be a tougher fight.

But - she was listening, and when I told her again why not on the statins, she didn't argue based on my fibro and how I'd be unable to recognize the pain of muscle destruction ... that part resonated.

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 08-23-2012, 00:34   #4
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I think I am going to ask for a VAP test too when I have my next labs in Dec. I know my dr is statin happy and not happy with me that I quit it. A good result on that test might just shut him up, if I get a good result!! Can't see why I wouldn't by then. I quit the statin at the beginning of June. By Dec, hopefully things will have settled down.......



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Old 08-23-2012, 02:04   #5
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I agree with you that she will come around based on your results. If there are no other issues then you should expect large and fluffy LDL. Good Luck.

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Old 08-23-2012, 04:38   #6
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Good for you, getting your doctor to at least keep an open mind. It's so hard to find a doctor willing to work with you...

I'm not trying in any way to deter you from your current course. But I thought I would share some new information that I have heard about in the world of cholesterol. I haven't digested it yet but in case you feel like doing more research here it is.

From the most recent lectures at the LowCarb Cruise and Ancestral Health Symposium, I got the impression that the latest theories on cholesterol is that particle size isn't as important as previously thought. They are now looking at LDL-P (LDL particle number, not to be confused with LDL-C which has been thoroughly debunked). I know that the NMR test measures LDL-P but I am not sure about the VAP.

I haven't read it completely but this concept is discussed in this series "The Straight Dope on Cholesterol". It's a long series, they don't get into LDL-P until part III.

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Old 08-23-2012, 07:16   #7
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Thanks much, Daytona - I've got some reading to do, and attempts at partial comprehension. But by all means, should you further distill this before I'm finished, I'd not for a moment object you sharing ...

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Dx'ed Feb 2011 w/ BS > 600
A1C: . . . . . . . . . . . . . . . Other Stuff
2/13/11 .. 14.7 . . . . . . Trig/HDL ratio .. 5.5 to 2.2 in 6 mo
5/23/11 .. 6.2 . . . . . . . Low-carb/high healthy-fat diet
9/8/11 .... 5.6 . . . . . . . No meds, No statin
2/24/16 .... basal/bolus insulin 2-3 days/wk due to steroids

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Old 08-23-2012, 08:13   #8
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Thanks for the links Daytona! I'll add them to my reading list on Evernote. I copy things there I want to read and save. I have "The Cholesterol Delusion" by Ernest N. Curtis, MD on my iPad to read after I finish "Diet 101" and "The Art and Science of Low Carb Performance". Not enough hours in the day!!

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Old 08-23-2012, 13:57   #9
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Make sure your VAP gets correctly processed by the phlebotomist! I got screwed out of mine after convincing the doc ....

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Old 08-23-2012, 14:34   #10
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I don’t think the science about number and size particle, inflammation, oxidation and glycation on heart disease is yet definite.

From theheart.org:

They assessed the relationship of LDL-P and particle size as measured by a relatively new technique—nuclear magnetic resonance spectroscopy—with the risk of future CAD in more than 25 000 subjects with moderately elevated LDL-C in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk.

They matched 1003 cases of individuals who developed CAD during a six-year follow-up with 1885 control subjects and calculated the odds ratios (ORs) for future CAD. They also evaluated whether LDL-P could improve upon the Framingham risk score to predict CAD.

LDL-P (OR 2.00 for top vs bottom quartiles) was more closely associated with the occurrence of future CAD than LDL-C (OR 1.73) and was related to CAD on top of the Framingham risk score even after adjustment for LDL-C.

But after adjustment for HDL-C and triglycerides, LDL-P was no longer more predictive than LDL-C. Nor was LDL particle size associated with CAD risk, following adjustment for LDL-P.

ION MOBILITY ANALYSIS OF LIPOPROTEIN SUBFRACTIONS IDENTIFIES THREE INDEPENDENT AXES OF CARDIOVASCULAR RISK

Lipoprotein Particle Profiles by Nuclear Magnetic Resonance Compared With Standard Lipids and Apolipoproteins in Predicting Incident Cardiovascular Disease in Women

Super-sticky 'ultra-bad' cholesterol revealed in people at high risk of heart disease

When it comes to cholesterol particles, size AND number matter. ę Diablo Clinical Research's Blog

The Cholesterol Delusion And Why LDL Particle Size (and Trig/HDL Ratio) Is So Important

The NMR LipoProfile cholesterol particle size test more accurate measure of heart health risk - National Low-Carb Lifestyle | Examiner.com

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