If It's Successful, Nothing Happens. Keep Waiting.

1115701_13954916I knew the day would come when my existing medication regimen wouldn’t be enough for my diabetes. The reality check came when I got the results from my calcium score

and admitted that if I was a betting woman (which I’m not, for I’d be broke by now), my cardiologist would suggest putting me on a statin.

I would have won that one. I’m joining the millions of individuals who, along with a low-dose aspirin,  are part of the Crestor wave that’s sweeping the nation. 10mg for now and we’ll see what my liver is doing in about 5 weeks. The side effects that everyone has talked to me about (muscle pain and weakness) didn’t happen, so I’m thankful that I seem to be tolerating it. My cholesterol, while not being fabulous, wasn’t in the danger zone. (I love bacon and cream in my coffee. I avoid fried foods and red meat.) Will Crestor make a huge difference in my life? Much like everything else we do these days for diabetes, the only way we’ll know for sure is the absence of anything happening.

“If it’s successful, nothing happens. Keep waiting.”

The kind doctor also broached the subject of lisinopril as a protectant for my kidneys. I’ve been down that road before. In fact, I was one of the first subjects in the Captopril clinical trial that proved that ACE inhibitors can help people with diabetes protect their kidneys. My blood pressure has always been a little on the low side. Even the smallest dose of an ACE inhibitor sends me into dizzy world with an occasional “I’m going down, please clear a section of floor” moment. Until they can make an ACE inhibitor that allows me to keep upright, it’s not happening. (Don’t get me wrong. I’m very happy with having a low blood pressure, because I have friends who take ACE inhibitors because their blood pressure is high.)

I’m beginning to wonder what’s next on the list of diabetes complications that I should be tackling. I’m not being pessimistic or negative. After thirty years (almost 31!) of not always stellar control of diabetes, the reality is that I’ve been lucky. One incident of CSME (clinically significant macular edema), trigger fingers, frozen shoulders, slight gastric delay and really? I’m just as healthy as the next person.

But we can never let our guard down, can we? Diabetes doesn’t always follow the “If it’s successful, nothing happens.” philosophy. Kidney issues develop without symptoms. Retinopathy in early stages have no symptoms. Neuropathy happens slowly (until I am told it bears down like a freight train…). Nothing happens for a long time, then it’s there.

I want to know what I can do (and what I can’t, like taking an ACE inhibitor) to mitigate the risks of complications. I want to know what the latest research has proven and what clinical trials I can participate in to help myself and others.

So, in my case, if I’m successful, nothing happens. But I’m not waiting.

Diabetes & Calcium Scoring (Or, I'm A Heart Breaker)

1414426_86457786Ever hear of a cardiac calcium scoring? Me neither, up until a few weeks ago when my cardiologist suggested that I have one done to see how my heart looked.

What Calcium Scoring Is

Also called coronary artery calcium scoring or a cardiac calcium test, it measures the amount of calcium (plaque) build up in the arteries surrounding the heart. While not definitive, the score is a good predictor of future cardiac issues, including myocardial infarction (heart attack) and atherosclerosis (hardening of the arteries) and coronary artery disease. The higher the score, the more likely there’s a concern.

Calcium scoring isn’t for everyone. If you’ve already gotten a diagnosis of coronary artery disease (CAD) or had a cardiac event, you don’t need it. For those who are at “low risk”, it’s not needed.

It’s non-invasive. You lie on a table while a specialized CT scan takes radiological slices of your heart and arteries. (I got a chatty technician thrown in for free, who asked a lot of questions about Type 1 diabetes.)

As I’ve mentioned in past posts, I flunked an EKG a few years ago and have some fear over heart complications and diabetes. In November, I finally openly discussed my concerns with a cardiologist, who suggested a echo stress test, a calcium score, and a three week cardiac monitoring stint. I wore three leads attached from my chest to a device that looked like a pager. (This was not to be confused with the other thing attached to my body that looked like a pager called an insulin pump… or the other thing that looks like a pager but is called a CGM.)

I have a heart, for those of you who wonder about that. It’s neither made of gold nor coal, but I will tell you what part of it has… calcium.

The echo stress test was fine. No issues. No major issues with the cardiac monitoring stint. But I was expecting to hear that the calcium score was zero or, at the worst, a little above zero.

Ha.

My Score

Due to scheduling issues, my cardiologist appointment didn’t happen on Tuesday like it was supposed to. He was running so far behind that I had to reschedule, but I asked to have a nurse call me with results. When she did call at 6:45p that evening, it was rather perfunctory.

“Your calcium score is 128.

This puts you in the lower end of the moderate risk category. You’ll need to talk with the doctor about next steps when you see him at the end of January.”

Ever get off the phone with someone and realize you had a bazillion questions? That’s me. Dr. Google isn’t doing much to alleviate the noises in my head.

Score 101-400: Plaque is present in a moderate amount, which means you have CAD and plaque may be blocking an artery. Your risk for heart attack is moderate to high. Your physician may recommend additional testing.

From WebMD: People who score between 100 and 400 or higher, and who are at medium risk for heart disease, are more likely to have a heart attack in the next 3 to 5 years than people who score 0.

(There is a ton of scholarly information, but I’m not going to bore you. If you’re interested, I can send you the links from medical journals.)

So, what are my options?

I’m pretty sure that I’ll be adding a statin to my daily medication list as well as having a discussion about my exercise regimen. (I wasn’t on a statin in the past because of the baby train I rode for so many years, but that pulled into the station and isn’t leaving again.)

I will do more research and bring questions so I can be better informed. That’s the best thing that I can do, because my core competency is not cardiology. (I’m a pretty decent blogger, but I’m not a doctor. I never even dated one, nor did I stay at a Holiday Inn Express.) There’s little chance of me dropping dead in the next few weeks, so I’ll wait until I can sit face-to-face with my doctor and talk about what I can do to prevent further calcium from taking up residence in my arteries. (And no, drinking milk is not a reason for the build up. Thank goodness.)

I don’t eat a high fat diet, my blood pressure borders on the low side, and I’m already on a low-dose aspirin regimen, but my family history, my diabetes, and my creeping cholesterol level is showing me that I’m a heart breaker… my own.