4 ms·

I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse t

by AaronAPU 11mo ago

I was planning to start getting scans ordered for specific risks like aneurysm or heart attack but what holds me back is the idea the scans will harm me worse than those things. It is very difficult to have any level of confidence with the medical industry so my current approach has been to eat as healthy as possible while staying as fit as I can without undue extreme stress.

rogerrogerr 11mo ago
As someone who would like to do this but has generally been choosing the easy paths - curious what your diet and exercise regime looks like.
- AaronAPU 11mo ago
  Well “fortunately” I’m forced to have a strict diet due to some sort of IBS issues. For that, I use the MacroFactor app and talk through my daily recipes with ChatGPT, making sure to hit the macros and calories targets while also optimizing for heart health and IBS. Fat, protein, carbs, fiber. Taking AG1 to fill gaps. For fitness I’m obsessed with biking so I do like 90 minutes of endurance/tempo pace 5 days a week and usually a race once a week. Zwift is great with a Tacx when weather is bad (often). That isn’t a time option for everyone but it is also likely well beyond what is necessary for most people. I also don’t drink or smoke or vape which I think is important. Not going to say I’m an expert or an exemplar of health but I am really trying everything I know to do at this stage.
- sn9 11mo ago
  There are specific recommended minimums in the physical activity guidelines about strength training and endurance training where meeting them is likely to significantly reduce your disease risk and improve your health: https://www.barbellmedicine.com/blog/where-should-my-priorities-be-to-improve-my-health/ https://www.barbellmedicine.com/blog/where-should-my-priorit...
captainkrtek 11mo ago
A relevant anecdote. I’m very athletic and skinny, eat well, have a resting heart rate in the 40s, but was recently prescribed a statin at 30, due to my very high LDL cholesterol and lipoprotein A. My family has a history of cardiovascular disease despite us doing what we can w.r.t eating and exercise. I’d encourage you to get some tests at least. My mother similarly was put on statins and is getting a cardiovascular work up (calcium scan) because she now has early atherosclerosis. She eats super healthy and is a former olympic sprinter.. Bonus anecdote: In my free time I do shifts as an EMT with my fire dept (911), that is a big wake up call to wanting to be as healthy as can be. The number of patients I see who are 50+, nearly all are on 5-10+ meds, few are just one 0, 1, or 2. At that age I see type 2 diabetes, hypertension, high cholesterol, and more.
- AaronAPU 11mo ago
  They have me on blood pressure meds and do the usual blood tests, the tests I considered have been elective and I requested them explicitly. Just haven’t followed through due to aforementioned hesitations. I’m very much aware heart issues run in the family and that I have symptoms. But I would be very happy to do any elective non invasive tests. On the fence about going beyond that until/unless the Dr. flags it as needed.
  - captainkrtek 11mo ago
    That makes sense! Its easy I think to also go overboard and analyze too much, causing stress as you suggest.
- guerby 11mo ago
  You're probably a "lean mass hyper-responders", a phenotype which is actively investigated, initial paper: Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research https://pubmed.ncbi.nlm.nih.gov/36351849/ https://pubmed.ncbi.nlm.nih.gov/36351849/ A few other more recent papers: https://pubmed.ncbi.nlm.nih.gov/35498420/ https://pubmed.ncbi.nlm.nih.gov/35498420/ https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109 https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109 Note: I'm not a doctor.
JoshTriplett 11mo ago
> scans will harm me worse than those things There are two known harms from scans: - Radiation. This is why people shouldn't get these scans several times a year, but 1-2 are very unlikely to move the needle. The average radiation from a full chest CT is just under the average dose for ~2 years of normal background radiation. (I don't know if a CTA uses less than average.) - Acting on something you would otherwise have ignored, where ignoring it might have been the right answer. The main problem here is that it's hard to get a medical opinion saying "you should ignore this" because of perverse incentives: there's an aversion to recommending doing nothing because that could lead to a lawsuit, whereas "overtreatment" will not get a doctor sued. However, you can make a deliberate decision to do this anyway even after getting the scan; seek second and third opinions, consider alternatives, weigh risk versus reward, make a considered decision.
sn9 11mo ago
Health guidelines take into account when screening/testing is a net harm or benefit for patients in general, and when they move from being a net harm to a net benefit conditional on specific factors like existing diseases, obesity, etc. Any decent doctor should be at least following those, and you can pretty easily find them from the major disease-focused organizations. Importantly, there are also recommendations for how often you see a doctor based on things like age and known disease risk. You might discover you have risk factors that are genetically resistant to lifestyle factors, and the earlier you find out, the more leverage you have to decrease your lifetime risk with appropriate medication. I'd check out the Barbell Medicine podcast episode on the health priorities they recommend patients focus on: https://www.barbellmedicine.com/blog/where-should-my-priorities-be-to-improve-my-health/ https://www.barbellmedicine.com/blog/where-should-my-priorit...

rogerrogerr 11mo ago

As someone who would like to do this but has generally been choosing the easy paths - curious what your diet and exercise regime looks like.

AaronAPU 11mo ago
Well “fortunately” I’m forced to have a strict diet due to some sort of IBS issues. For that, I use the MacroFactor app and talk through my daily recipes with ChatGPT, making sure to hit the macros and calories targets while also optimizing for heart health and IBS. Fat, protein, carbs, fiber. Taking AG1 to fill gaps. For fitness I’m obsessed with biking so I do like 90 minutes of endurance/tempo pace 5 days a week and usually a race once a week. Zwift is great with a Tacx when weather is bad (often). That isn’t a time option for everyone but it is also likely well beyond what is necessary for most people. I also don’t drink or smoke or vape which I think is important. Not going to say I’m an expert or an exemplar of health but I am really trying everything I know to do at this stage.
sn9 11mo ago
There are specific recommended minimums in the physical activity guidelines about strength training and endurance training where meeting them is likely to significantly reduce your disease risk and improve your health: https://www.barbellmedicine.com/blog/where-should-my-priorities-be-to-improve-my-health/ https://www.barbellmedicine.com/blog/where-should-my-priorit...

captainkrtek 11mo ago

A relevant anecdote. I’m very athletic and skinny, eat well, have a resting heart rate in the 40s, but was recently prescribed a statin at 30, due to my very high LDL cholesterol and lipoprotein A. My family has a history of cardiovascular disease despite us doing what we can w.r.t eating and exercise. I’d encourage you to get some tests at least. My mother similarly was put on statins and is getting a cardiovascular work up (calcium scan) because she now has early atherosclerosis. She eats super healthy and is a former olympic sprinter.. Bonus anecdote: In my free time I do shifts as an EMT with my fire dept (911), that is a big wake up call to wanting to be as healthy as can be. The number of patients I see who are 50+, nearly all are on 5-10+ meds, few are just one 0, 1, or 2. At that age I see type 2 diabetes, hypertension, high cholesterol, and more.

AaronAPU 11mo ago
They have me on blood pressure meds and do the usual blood tests, the tests I considered have been elective and I requested them explicitly. Just haven’t followed through due to aforementioned hesitations. I’m very much aware heart issues run in the family and that I have symptoms. But I would be very happy to do any elective non invasive tests. On the fence about going beyond that until/unless the Dr. flags it as needed.
- captainkrtek 11mo ago
  That makes sense! Its easy I think to also go overboard and analyze too much, causing stress as you suggest.
guerby 11mo ago
You're probably a "lean mass hyper-responders", a phenotype which is actively investigated, initial paper: Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research https://pubmed.ncbi.nlm.nih.gov/36351849/ https://pubmed.ncbi.nlm.nih.gov/36351849/ A few other more recent papers: https://pubmed.ncbi.nlm.nih.gov/35498420/ https://pubmed.ncbi.nlm.nih.gov/35498420/ https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109 https://www.jacc.org/doi/10.1016/j.jacadv.2024.101109 Note: I'm not a doctor.

JoshTriplett 11mo ago

> scans will harm me worse than those things There are two known harms from scans: - Radiation. This is why people shouldn't get these scans several times a year, but 1-2 are very unlikely to move the needle. The average radiation from a full chest CT is just under the average dose for ~2 years of normal background radiation. (I don't know if a CTA uses less than average.) - Acting on something you would otherwise have ignored, where ignoring it might have been the right answer. The main problem here is that it's hard to get a medical opinion saying "you should ignore this" because of perverse incentives: there's an aversion to recommending doing nothing because that could lead to a lawsuit, whereas "overtreatment" will not get a doctor sued. However, you can make a deliberate decision to do this anyway even after getting the scan; seek second and third opinions, consider alternatives, weigh risk versus reward, make a considered decision.

sn9 11mo ago

Health guidelines take into account when screening/testing is a net harm or benefit for patients in general, and when they move from being a net harm to a net benefit conditional on specific factors like existing diseases, obesity, etc. Any decent doctor should be at least following those, and you can pretty easily find them from the major disease-focused organizations. Importantly, there are also recommendations for how often you see a doctor based on things like age and known disease risk. You might discover you have risk factors that are genetically resistant to lifestyle factors, and the earlier you find out, the more leverage you have to decrease your lifetime risk with appropriate medication. I'd check out the Barbell Medicine podcast episode on the health priorities they recommend patients focus on: https://www.barbellmedicine.com/blog/where-should-my-priorities-be-to-improve-my-health/ https://www.barbellmedicine.com/blog/where-should-my-priorit...