First Visit to Cardiologist

What is LAD?

I would never counsel a person who asks the question to forego a second opinion...............................................but....................................................is he wrong about the weight and pre-diabetic? If you know he isn't wrong, I would have to say, matter-of-factly, that you have your answer. And your marching orders. Lose the weight, get off the diabetes/metabolic syndrome wagon, and start walking!

It sounds to me as if you have an endocrine problem, or you're not getting out and exercising, even walking 30 minutes each day, or you're eating the wrong stuff. One of those, or a combination, maybe all three, has your LPa and calcium score higher than someone on 40 mg of atorvastatin or equivalent for the past 20 years should have.

I don't know if you'll like my response, but sure, get a second opinion. Just be working subconsciously on a cold, hard solution that buys you another 15 good years meantime. That second opinion might be as unpalatable as the first.

@jlharsh - I am getting a second opinion on the stress test. My PCP ordered the calcium scan based on a finding on a PMSA scan (prostate cancer). She made a cardio referral and told me that if it was going to take too long, she could order a stress test. So I am going to get her opinion too.

I really felt the doctor was very knowledgeable. He did an EKG, pointed to the peaks, noted how "sharp" they were, and said that if there were serious blockages, it would not look like that. (Although my knowledge base is very limited. He could have told me anything, I wouldn't have known better) Couple that with the fact that I have been asymptomatic, and I guess he felt comfortable adding Zetia and monitoring.

As for Zepbound, he is the second doctor who has made that recommendation. My oncologist also did a few weeks ago. My PSA numbers tend to be odd, and he ordered the scan to ensure that there was no further cancer. (It was negative, so I'll take that win). He believes the weird numbers are from post-radiation inflammation and said that he has noticed his patients on Zepbound have far less. He also knows I could lose weight and am pre-diabetic, but he was more interested in the anti-inflammatory effect. And the fact that having your blood sugar under control shows better outcomes for prostate cancer patients. So yes, I will meet with PCP this week. I will probably use a compounded version due to cost.

As to Pop Tarts, it's the Chocolate Fudge that I am too weak to walk past. Although I now make sure there are none in the house.

@bearcat998 Thank you for coming back with an update. It sounds like you’re approaching this thoughtfully. Getting your PCP’s perspective on whether a stress test would add useful information seems very reasonable, especially since she was the one who initially suggested it if needed.

One thing that has helped me when thinking about additional testing is asking, “What question are we hoping this test will answer?” You might ask your PCP, “If the stress test is normal, what would that tell us? If it’s abnormal, how would it change my treatment plan?” Understanding how the results might influence next steps can make it easier to decide whether the test would be helpful.

I also think it’s encouraging that both your cardiologist and oncologist are looking at the bigger picture—not just your calcium score, but your weight, prediabetes, and overall cardiovascular and cancer health. It will be interesting to hear what your PCP recommends regarding Zepbound and whether it’s a good fit for you.

And congratulations on the negative PSMA scan. That’s wonderful news after everything you’ve been through.

😊 I had to smile at the Chocolate Fudge Pop-Tarts. Sometimes the best strategy really is making sure they never make it into the shopping cart in the first place!

When will you check how well ezetimibe is working?

@jlharsh
I think some of it is that I hate “incomplete information “, if that makes sense. I’m getting to an age where a couple of friends have had heart attacks and heard how blocked their arteries are.
While I do exercise in the sense that I walk my dogs about 2 miles each night, I haven’t really pushed myself a lot to get in higher heart rate zones. So if I am going to do that I would like to find out if there is a big problem during a test.
Although today I hit 30 minutes on the treadmill at 3.3 mph for 30 minutes and that is definitely not pace my dogs set.
I did speak with my PCP and she was comfortable with a 2nd opinion. She is also fine with Zepbound, but not comfortable with a compounded version.
I have not treated my body well over the years and I am paying for it now.
I took my first dose of ezetimibe last night. I think we are checking in 3 months.

@bearcat998 My doctor says he likes to have as many "data points" as possible, so although he knows I'm a runner and I have no symptoms. he still wants me to have a stress test and a carotid ultrasound. I'm happy to do it because I, too, like to have as much data as possible. I've already had a CAC scan, an angiogram, and an echo.

@njx58
I’m the same way. He told me that a hug calcium score doesn’t necessarily mean a blockage. Well to me it means IT COULD!
I was diagnosed with prostate cancer a few years ago. I had so many tests. In that case the doctors wanted to know everything about it. Probably 10 different tests.
So I guess the assuming the best makes me uncomfortable.

@jlharsh
I think some of it is that I hate “incomplete information “, if that makes sense. I’m getting to an age where a couple of friends have had heart attacks and heard how blocked their arteries are.
While I do exercise in the sense that I walk my dogs about 2 miles each night, I haven’t really pushed myself a lot to get in higher heart rate zones. So if I am going to do that I would like to find out if there is a big problem during a test.
Although today I hit 30 minutes on the treadmill at 3.3 mph for 30 minutes and that is definitely not pace my dogs set.
I did speak with my PCP and she was comfortable with a 2nd opinion. She is also fine with Zepbound, but not comfortable with a compounded version.
I have not treated my body well over the years and I am paying for it now.
I took my first dose of ezetimibe last night. I think we are checking in 3 months.