Very high Lp(a)
I recently measured my Lp(a) and it was 307 nmol/L, which is very high and I’m curious to know what if anything I should do to manage it. From what I read your site that puts me in about the 93 percentile with a hazard ratio of 2.2. I’m 71 years old with a history of Afib, which has occurred about once a year for over 10 years and required cardioversion. Because it was persistent I got hybrid ablation at Stanford 5 months ago. As part of that they did a CT angiogram with contrast and they found "Heart: Normal in size. No significant coronary artery calcification. No significant valvular calcification.” My lipid numbers are: total Cholesterol 137, HDL 58, triglyceride 56, LCL-C 65. ApoB is 73 mg/dl. I have white coat syndrome. My blood pressure when measured at home averages about 117/76, but was higher when I was younger, about 130/70. I have a family history of cardiovascular disease. My father had 2 bypass surgeries but lived to 90. My mother is 94 is very active but has mild dementia. My grandfather died of a heart attack at 76. One uncle died of a heart attack in his 40s. One very fit cousin just had bypass surgery at 73. Other aunts and uncles on my father’s side had cardiovascular disease. My medications are: amLODIPine 5 mg atorvastatin 10 mg losartan 100 mg aspirin 81 mg My BMI is 24. I’m a lifetime exerciser. I run, cycle, ski, backpack and am very active for my age. My diet has been high in fruits, vegetables, whole grains, low in red meat, high in oily fish, low in processed foods since my mid 20s.
Methylene chloride in decaf coffee
There's a movement to get FDA to ban methylene chloride, used in coffee decaffeination, because it may be cancer causing. I would love to know whether there is any data on this risk and generally how to think about the tradeoffs between regular and decaf coffee (which you touched on at a high level in a 1/14/23 newsletter).
HRT for Premenopause Females
Functional Medicine doctors are prescribing bioavailable progesterone to premenopausal women to help with stress and sleep. I am 34 years old and have been told I have unusually low progesterone levels and could benefit from progesterone supplementation. I am trying to figure out how I should think about this from a risk perspective. If the advice is to not use HRT beyond 15-20 years, shouldn't I save my HRT years for when I begin to experience symptoms of menopause to maximize the benefit? Also, given there aren't studies done with long term risks of bioavailable progesterone, what risks should I consider? I assume there is a slight increased risk of breast cancer. If so, does this risk increase the longer I use supplementation? On the opposite end of the spectrum, should I be worried about the risk of not having normal level of progesterone? If so, maybe supplementation can be a net positive? Is there a target level of progesterone I should be striving to achieve? There really isn't very much information about whether or not it is good for women to begin HRT in their 30s, yet I believe it is occurring at an increased pace and we are all being told there is no risk. After listening to your podcasts, that feels like an incomplete and unthoughtful answer and I would like to know how you would think about risk as a 35 y/o woman considering HRT to help with stress and sleep.
Flat feet and zero drop shoes
Great episode with Courtney Conley. I have flat feet and most podiatrists say that zero drop shoes are not good for individuals with flat feet. I wonder what Courtney would say about this. I have not had issues with plantar fasciitis and was a long distance runner for many years but no longer run just hike and cycle. Your podcast and diligence are great!!! Wish I had know a lot of this earlier. Now that I’m 69 I can see the effects of years of misinformation though I am still very active. Just doesn’t feel as good. Dave Hamilton
Framework for ligament reconstruction surgery
How do you approach the question of whether to go through ligament reconstruction when the lesion _currently_ does not keep you from doing anything? In other words how do you frame the trade-off between a long recovery vs. the possibility of the injury creating more issues as your patients grow older? I'll give my own example, but of course the answer does not need to specific to this: I dislocated my shoulder 15 years ago, tearing ligaments in the process. Though I did have repeat episodes (~5 since the first), that injury does not keep me from doing anything apart from very awkward movements I never do. But I'm concerned it might get worse as I get older (I'm 37). On the other hand, while an arthroscopy is a simple procedure, recovery time is long. Different physicians gave me different opinions about this, so I wonder if you have a framework to help patients in similar situations decide. Felt like an appropriate question given the recent episodes on shoulder, knees and foot.