Update 11.27.25 Cardiology appt, new cholesterol med, ENT

Saw Dr Bagheri and he doesn't want to order me a CT angiogram.  Says it's 'unnecessary' and insurance doesn't care. My cholesterol is high so he's going to put me on Ezetimibe which is supposed to block cholesterol absorption in the small intestine.  So if the high cholesterol is due to diet, this should work.  He thinks its genetic since Jiji had his heart attack in his 50s.  Hide sight, Baba may of had high cholesterol too, related to pancreatic cancer.  We'll see at my lab follow-up in March.  In the meantime, getting a Stress Test 12/10 and Carotid Ultrasound 12/17.   The stress test is supposed to give an idea of how much blockage there is.  That's kinda my main concern, how bad is it?

He said a drink a day is ok, so feel a little better there.   Had a tequila soda last night, felt it in my head and then slept 9+hrs.

ENT said no need for septoplasty since I can still breathe out of my nose, it's not completely obstructed.  Using nasal spray and Flonase before bed has been helping.  Necessary surgery is not a good thing.  Tho I kinda wanted it done so maybe my oxygen level might improve.  But I see his point.  Things can go wrong during surgery too, and probably not worth the risk.

Update 10.20.25: Coronary Calcium Score, Thoracic Outlet Syndrome, BP doing well, upcoming appts with ENT, Endo

 With BP still high, cardiologist NP tried putting me on a Clonidine patch.  Reading about it kinda scared me, especially the fast that I can't just stop since the patch stays on.  Decided to go back to bystolic/hctz and see if they'll start working again and it did.  Except that I noticed my max heart stayed before 130, even when hiking hard.  And also felt lightheaded, tho not sure if it was related to the lower heart rate.  Talked to cardiologist NP and said I wanted to lower dose from 20mg to 7.5mg.  Something about being less than 10mg has a lighter effect on max heart rate.   New dose started Sept 27, 2025.  BP still staying somewhat low and max heart rate's gone up a little to about 140.   Until the body gets used to this and stops responding, I think I'll stay with current med combo (with Amlodipine at night as well. )  

Went and got a Coronary Calcium Scan, my score was a little high, 166 in the Left Anterior Descending (the one that goes into the heart), the other three were ZERO.  Being 100-400 means I could have a coronary event in the next 3-5 years unless something changes.  Statins being the first line of treatment, but we'll see.  BP has been somewhat low, dunno if its because I've been hiking more, and really haven't been drinking since Abby left end of May.  Maybe a handful since then.  My next follow-up with Dr Bagheri isn't till January 2026, will call and see if there's any other tests they want to run to do it this year.  This score scares me. 

Went up to Kernville last week and my left shoulder arm started hurting on the drive up.  I've noticed it happening in the past when I drive at least 45min.  I think it might be thoracic outlet syndrome.  I have a chiropractor appt on Monday, I'll see what Chip says. Could also be related to that rib that's popped up.  I had Election Officer training today and after sitting in the chair for may 40 min the left side started to hurt.   Sitting at the table on the laptop now, there is mild pain.  I think it has something to do with sitting and how I sit.  

I have an endocrinologist appt coming up on Nov. 6, will ask about Primary Aldosternism.

Dec. 9 - Upper Endoscopy, I have low ferritin (iron storage) and iron deficiency with anemia (RBC and hemoglobin high).  Will see if I'm bleeding inside?  This is resulting from talking to Taylor from GI about my last lab work which still showed antibodies for Crohn's without symptoms so she thinks I'm the 5% who does this.  

Tomorrow is ENT appt, will see if my chronic sinusitis is still there (been regularly using Flonase and nasal saline spray) and feel like my nose breathing is better.  When on CPAP, I usually only have 1-2 events/hr.  Less than 5 is good.  And if surgery is still recommended and if so I can opt out of the caudal part. 

Sept 30:  routing mammogram.  All good.

Period was 10 days late this cycle.  Dunno if I'm getting closer to menopause or all the hiking has been affecting it.

Colonoscopy - Nov 2024

 Saw a different GI, Taylor Altun, who ordered some tests.  Fecal test (fat, pancreatic elastase, calprotectin), all normal. Celiac Disease (negative), t-Transglutaminase (tTG) IgA, total IgA (normal), C-reactive protein (normal).   And a colonoscopy even tho I tested negative with the Cologuard, because of the Crohn's Disease antibodies that showed up in the IBD panel two years ago.  Overall, colonoscopy was normal, no polyps, etc, however the biopsy taken at the top (toward the small intestine) showed "prominent lymphoid aggregates" none in the middle, and some towards the end.   She says they are 'white blood cell clusters'.  So she is ordering an MRI of the small intestine, just because of the Crohn's Disease antibody.   Appt on December 23, 2024.  I don't have any symptoms of Crohn's Disease, tho it says it won't go away.  So maybe it'll be something I'll have to deal with as I get older.   It may be in its 'early stages', 'silent,' or 'asymptomatic.'  We'll see what the MRI says. 

Prominent lymphoid aggregates are lymphoid tissue in the gastrointestinal (GI) mucosa that are larger than normal. They can appear as polyps during an endoscopic exam. 

Prominent lymphoid aggregates can be associated with:

• Infections and immunodeficiency disorders

  These include Giardia infection, celiac disease, Helicobacter pylori infection, common variable immunodeficiency (CVID), and selective IgA deficiency. 
• Ulcerative colitis, Crohn disease, or lymphoma

  When lymphoid aggregates are accompanied by other specific features, they can indicate these conditions. 
Chronic lymphocytic leukemia (CLL)
A colono-scopic appearance of prominent lymphoid aggregates in the colonic mucosa is called the "red ring sign". 

In the colon, lymphoid follicles and aggregates are usually considered a normal component. However, when they are present in increased numbers, they can be a sign of one of the conditions listed above.   

SI Joint Flare-up?

 Lower back had been tight.  Some aches along the spine.  Stretched some and did some upper body twists to loosen lower back tightness.  That night I wake up with hip pain on both sides and ache on SI joint.   I think that's what it is, it's the area where the spine connects to the pelvis.  Flare-up can be caused the repetitive twist motion (golfers) so I think that's what caused it.  Pain can radiate down butt, leg, hips.  Putting Salonpas on it for now, seems to be getting a little better.  Just need to remember for next time.  This area gets tighter with age so as with most things, exercise, stretching, avoiding sugar seems to keep it in check. 

Woke up with Pinched Nerve 2.4.24

Slept downstairs Saturday night.  Slept on my side as usual when I sleep with Pa.  Woke up with pain with movement in hip and left leg.  First thought was my hip misaligned.  Pain was tolerable, still walk Roscoe.   Next day pain is way worse.  Still go to work, luckily it was just for ROV so I could take it easy.  Pain all day.  Decide to see Chip, something told me it was not a hamstring strain but possible nerve issue.  And it was.  He said it was "rotated and tight"  I'm guessing lower spine.  He cracks me and says to come back if not feeling better in 2 days.  His guess was that my left leg came across when I was sleeping and because I may have staying in that position for a long time that it caused the pinch.  Next time, I can try rotating my body the other way.  For now, "light exercise and moist heat."  Tues, Susan tells me about this stretch she did when same thing happened to her.   So I try at night and get a 'pop' which along with pain pills, Tiger Balm, and finding a good position for sleep, I feel better the next day.  It gets better each day.  Now about 10 days later, feeling 95% normal.  Some tightness, and a feeling my leg length is uneven, feeling like I wobble when I walk.  Have another chiro appt in 1.5 weeks, hopefully he will fix then.   The first five days were really painful, no fun at all.   

Getting the GI checked

 Went in for the GI consult.  He ordered three tests.   Two stool (H. pylori and Cologuard/colon cancer) and a home SIBO breath test.  H.pylori came back negative.  I think cologuard will be negative as well.  I guess they now do colon cancer screenings starting at age 45, so they ordered this test when I told them I've never had a colonoscopy, and I prefer the poop test.   If it comes back positive, then I'll go in for a colonoscopy.  

Did the SIBO test today.  In preparation, yesterday was a restricted diet.  Meat, seafood, rice, egg, salt, pepper only.  Then 12-hr fast and water only day of until I took the lactulose.  I had already pooped in the morning, and had to go again about 15 min after the lactulose, which was soft.  Then maybe 15 min later just water came out my butt.  Same again about 15 min later.  I guess it's called "anal discharge" when just water comes out.  It got a little better as the day went on, but still more water than more, plus some leakage.  I guess lactulose is also used for constipation, it pulls water from the body and directs it to the colon which then softens the stool.  But since I ate nothing with carbs and fiber yesterday, I think most of it had come out this morning.   Tummy feeling a little funky still after dinner.  

Lactulose...  Also can be used for colon cleaning, as well as to improve gut health. NLM/NIH

Those data indicate that lactulose potentially improves gut health by stimulating mucin production to maintain the mucin‐SCFA balance. Lactulose intervention increased the abundance of some hydrogen‐producing bacteria such as Prevotellaceae and Rikenellaceae.

Should have results within a couple weeks.  

UPDATE:  No SIBO.  Results back on Jan. 31, 2024.

2.13.24   So I'm guessing I still have low stomach acid so I am going to proceed with that in mind.  Started taking VitC, VitD, VitE, Cal/Mag/Zinc, CoQ10, and Fish oil when I remember.  Started taking a probiotic first thing in the morning on an empty stomach which seems to be helping.  Also trying to have a protein first and will eventually pick up some digestive bitters after I do more research.   It's been about two weeks now, and seems like I have less bloating/burping/farting overall.  Haven't had a painful bloat since.  Also been trying to get in more fiber.  Less white refined carbs. BP has been higher lately tho.  140/89.  I also have been drinking less water with meals as to not dilute the stomach acids.  But not doing a good job drinking more water in between.  I might be dehydrated.   Also been sipping on leftover morning green tea at work.  That's probably not helping.  I've been good about not drinking everyday.  Strange how my mind still craves it but when I take a sip, my body almost cringes (not every time tho.)

Trying CPAP

 Sleep Center recommended trying the CPAP first for I've been trying it since 11.1.2023.  At firs I had the nose mask, but the puddles inside the mask kept waking me up.   And it was weird that I can't open my mouth cuz the air comes out the mouth while on the CPAP for I can't really breathe in.  Which was also awkward when I had to cough.  The forced air down the nose then throat made me want to cough until it settled down about 15min later.  (hindsight, I probably should of increased the humidity and temperature.)  The times I was able to sleep, I felt like I was sleeping better.  And I enjoyed being able to sleep on my back.  Sleeping on my side tires my back and shoulders and I don't feel rested.   

There was a mention that I can't use the nose mask when my nose is stuffy. Winter is coming so I know I'll have stuffy nose days.  So I opted to get the full face mask also, except this one doesn't completely cover the nose so it's a little less bulky.  I think I'm on 4 nights, last night probably went the best with waking up just two times.  The mask moves and leaks air.  The air is also cold so the first couple times with the face mask, I felt cold and slept poorly.  

Learning to heat up the CPAP prior to using it.  Having the Climate Control at AUTO (80 degrees, humidity lever 3) has been keeping most of the moisture out of the mask.  I may try this setting with the nose mask one of these days.   Couple nights ago I didn't use the CPAP, it was nice being "free" while I slept.  The next day I went down to the desert to grocery shop.  Dunno if I was tired from the shopping but on the drive home I experienced the sudden tiredness I used to get.  The intensity of the tiredness wasn't as strong but it was definitely there.

Some bad side effects I've read about the CPAP...  Something called a CPAP cough.  For now it doesn't seem to last all day, just when  I first put on the mask and in the morning, (tho I didn't have any this morning).  Need to be careful to keep everything clean, mold growth can mess with my lungs.  

Seems like I've developed Central Sleep Apnea from using the CPAP.  Some people with obstructive sleep apnea develop central sleep apnea while using continuous positive airway pressure (CPAP) for treatment. This condition is known as treatment-emergent central sleep apnea. It is a combination of obstructive and central sleep apneas. Medical condition-induced central sleep apnea.

I have my three week equipment check coming up on Nov 28.  Hopefully they can explain this.  And the next appt after that is at 8-weeks.  They say I should know at that point if CPAP is for me or not.  

My events per hour is less than two on the CPAP so it's working.  But now I have central sleep apnea as well.  Having difficulty finding why this happened.  ChatGPT says:  "CPAP therapy my reveal underlying central apneas that were not initially apparent.  This can happen when the continuous positive airway pressure from the CPAP influences the respiratory control system, leading to changes in breathing patterns."  Central apnea is when the brain stops telling the body to breathe.  Central sleep apnea occurs because the brain doesn't send proper signals to the muscles that control breathing.

One reason CPAP was first line of treatment was they say insurance will only pay for one.  CPAP I can return, night guard I can't (since its custom made.)   So better to try the one I can return first.  

Finding more information.  1) There are mouth exercises that may help strengthen the throat and reverse sleep apnea.  2) May have been caused by my stroke.  3) Cervical spine not being straight may contribute to OSA.  Neck brace may help.  4) Singing or playing wind instrument may help.  5) Upping my antioxidants (Vit C, E, D) might help.  6) Taking care of blocked nasal airway may help.  7) Exercise may help as the hard breathing may strengthen throat muscles  8) Less alcohol before bedtime will relax muscles less.

Since the CPAP... 1) I sleep alot more.  At least 9 hours if allowed.  Even 10.  I feel I can just sleep forever.  Going to bed earlier.  By 11pm, but sometimes around 10p.  2) I fall asleep within 15 min of wearing mask unless I'm staying up and reading.  3) Less daytime tiredness, noticebly when sitting.  4) BP has gone UP.  150/100.  Back to taking amlodipine when I remember.  5) Pulse seems lower.  Upper 60s.  6)  Lungs hurt the first week.  I feel like I take deeper breaths when hooked up.  7) "Natural" breathing seemed to resume when on machine.  Don't feel like I have to give an effort to breath like I used to have to.  Mainly at night in bed.  Often in sitting up/recline position.  Tho sometimes when lying down too.