ISO medical advice (lipids) - hoping @melissa might weigh in

I'd keep my appointment with the cardiologist and go in with a lot of questions. It's really wonderful that your new NP is being so proactive about your health, but this is what the cardiologist deals with day in and day out. He will know what tests to run and be able to make sense of all of your results, order others and check out your family history. And if you need statins he can prescribe them.

So, I would educate myself more about heart health, lipid panels and other routine tests he might run, get my family history and all my previous labs together, and be ready with questions for a productive appointment. I know you're worried and want to know more right now. I'm the same way. I'm trying to remember my appointment with my cardiologist and what he looked at. There is another blood test, I believe it is CRP, that he ran. This and the ratio are common indicators of issues IIRC. My CRP as is not great due to systemic inflammation if I understood correctly. Fortunately my cholesterol ratio is good. I'll go look for my notes and verify.

By all means not a medical professional, but are you asking if you should go on your trip?  The bp is getting a bit high, and the cholesterol is getting high as well. Both need to be addressed, but I would not worry in the least about them and go enjoy your trip and then find you a cardiologist when you get back. Meanwhile, try to do the things that help with this issues such as taking fish oil, many doctors prefer Megared, cut back on the dairy, meats, etc and maybe do some breathing/relaxation exercises. And of course, if you smoke, that's needs to be reduced/stopped.  Go have fun!

Oh, sorry. If I recall correctly. Or remember. I've seen both used.

We monitor DH’s bp by taking it at the same time each morning. He waits until he hasn’t coughed or gagged or sneezed for at least 5 minutes, then sits up straight with both feet on the floor. It’s amazing how just slumping, talking, or moving his feet around can cause a big change in the top number. He uses a wrist cuff so he can take it himself with no help. We have taken it with us when we got to his dr and have used it right after the nurse manually takes his bp, and we know that it is fairly accurate. Strangely enough, it is really difficult for a standard office BP machine to get an accurate reading on DH. Those machines, even with a bigger cuff, usually either return a Can’t read error or are significantly higher than what the nurse will get taking it manually.

DH’s dr gave us the range for DH’s bp as well as when to be concerned. When DH has numbers in the upper 130’s a couple days in a row, we start looking for excess salt in his diet, dehydration, or stress. His numbers also go up if he misses his nightly walk or if he is really sore. When he suffered from dehydration recently, his morning BP shot up above 156 and we went right on to the urgent care. Even with all the care they gave him there, it still took a month for his numbers to consistently come down.

My lipids had been creeping up for the past few years, but last year’s numbers at my annual were drastically higher. My dr retested and the 2nd set of numbers were much better, but, again, had creeped up from the previous year’s. I usually follow DH’s renal diet, but i do have a few cheat areas where what I have won’t affect his diet. I made some very simple changes, like swapping out half and half for heavy cream in my coffee, using Pam and butter flavored Pam instead of butter, and whipping my cream cheese (makes a little go a long way!). These changes really showed up on my next screening.

I was also diagnosed diabetic about that time, so I made some even bigger changes in my diet.

I went from eating Mexican food drenched in heavy cheeses to eating fresh Mex, using a lot of Rick Bayless’s recipes and sauces. Instead of Alfredo, I do very moderate portions of pesto or marinara. I still eat cheese, but now it’s a treat, on a cheese plate, accompanied by lots of fresh fruit.

I also started back making kombucha, water and milk kefir, yogurt and sourdough bread. The kombucha, flavored with no sugar added fruit puree and agave to taste, satisfies my craving for carbonation and keeps me hydrated as well as keeping my gut happy. The kefir does the same. I make low-fat yogurt and i use it to make cream cheese and sour cream. I make sourdough because DH can’t have foods with baking powder in them and sourdough starter and baking soda combined give a similar rise. being able to do this means I can make English muffins and French toast at home with no dairy and little fat added.

I also started copying DH and his hall walking. LOL He does sets of laps up and down our long hall way, about 3/4 of a mile each night. This might not seem like a lot of walking, but with his CKD and bad knees, it takes him all night to do it. If he misses it, his morning bp reflects it. Two nights not doing it and we see a significant rise. I started doing laps, more and faster, and it really showed up in my morning blood sugar readings as well as in my weight. Not having any excuse not to get up and walk down the hall helps, too. LOL It’s just too easy for us to decide it’s not worth it to get dressed and go for a walk, but there just isn’t an excuse not to walk down the hall.

You asked what to do? Make the appointment with the cardiologist, but start making some of these changes before you see him. If you really don’t want to go on a statin drug, then start educating yourself on what will bring your numbers down. Start with small changes, but be consistent with them. Once you get used to avoiding add-ons that you know aren’t good for you, you can consider which bigger changes you might want to try. Develop a no-excuses exercise plan and stick to it. These might not solve the problem, but they may help lower the dosage you have to take.

Marcy

I'd just like to weigh in on bringing down your cholesterol levels without medication.

I posted several months ago that I had a physical done after putting it off for at least 5 years. (I know. Life got crazy and I don't intend to do that again.) I was shocked when my total cholesterol level came back at 321. The last I remember it was maybe 220, but very high HDL, so my doctor was unconcerned.

Anyway, I knew that my diet was horrible. My weight is in a good range, and so I've never been too concerned about what I eat as far as that goes. I love cheese. I love ice cream. Going out for breakfast was worthless without a side of bacon. Chocolate was a daily thing...... you get the picture. So when the labs came back and my doctor said we needed to look at treatment I asked her if I could try to change my diet first before resorting to medication. She agreed to give me 3 months of diet change before retesting.

I won't go into too much detail on my diet changes, but I did visit a nutritionist who highly recommended the mediterranean diet, and this website: Oldways. I cut out almost all cheeses, ice cream, red meats, chocolate, etc., and started eating salmon a couple of times a week, and adding avocado and olive oil wherever I can. I also switched to almond milk, and I have oatmeal for breakfast a few times a week.

Long story short, I retested about a month ago and I brought my total cholesterol down 85 points by diet alone. It is now at 236, and because of my high HDL and other factors, my doctor says I don't need medication.

One side effect which I'm trying to figure out how to manage is the fact that I'm continuing to lose weight - almost 20 pounds at this point - and I really didn't have that to lose. If I would stop at the weight I am I would be o.k. with it, but as I said, the loss has been pretty steady and I don't want to go much further. [If anyone has any suggestions on how to add weight without adding fat to a person's diet, I'm all ears.]

Fat has gotten a bad rap. We have to have some fat in our diet - like monounsaturated and polyunsaturated fats. My nutritionist says the guideline for good fats is they should make up 30% of you total daily calorie intake.

flanz to be honest, most cardiologists prefer primary care to deal with lipid and bp management. It certainly doesn't hurt to meet with one willing to see you to discuss concerns and order any appropriate tests, but generally cardiologists only want to deal with known cardiac issues and leave the maintenance to PC.

I say that both as a cardiac nurse and as one who's worked in a PC office for the last few years. sometimes we can't even get the specialists to order an EKG for their own patient--they'll tell them to call us--but not every cardiologist is that hands-off. So go meet with the new Dr to ease your mind and like i said, enjoy your vacation. When you get back you can start monitoring your BP.

flanz have you watched Forks Over Knives about using a plant based diet to improve health? It is an excellent documentary. I am a firm believer that the Western diet of processed foods is the worst thing that was ever marketed. I am not full on plant based, but for the most part if God didn't make it, then I don't eat it. 

The results of the studies of folks who switch diets is phenomenal.