DoctorLoomis

I thought the interview was fascinating and I purchased his book this morning. Without going into much detail I’ve long questioned the relationship between cholesterol and heart disease. One thing to consider: 3 years ago I had a comprehensive blood draw. Cholesterol through the roof…305. LDL through the roof. LP PLA2 thru the roof. All numbers were terrible. I had two CT coronary angiograms performed and one was looked at by the author of the textbook on CT scans, Dr. Simeon Abramson. He told me my heart was perfect, arteries perfect, and zero plaque. Go figure.

Mark Rippetoe

What did he say about your numbers?

DoctorLoomis

He was of course extremely concerned which got me extremely concerned. I was prescribed 20mg Crestor and I inject Repatha twice a month. My numbers now are sparkling but I can’t help but wonder how they got so bad. I can’t help but wonder if I’ll have a cardiovascular event someday with sparkling numbers. I’m on page 60 of Malcolm's book: maybe I’ll find some truth.

zach_the_jew

What was your HDL and HDL:Triglyceride ratio?

These are usually considered better indicators. In fact, if I understand what I've read correctly there is literally zero correlation between LDL itself and coronary issues, and if Dr Kendrick's theory of heart problems is correct there can't be.

Subby

Was this the same Dr? If the angiograms said the arteries were perfect and plaque free, what were the prescriptions for?

Mark Rippetoe

The numbers. The drugs treat the numbers. That is all. See where we are?

Barry Charles

I know this topic has come up before but I have some new experience to share and I’m anxious for more answers. I’m likely soon getting a vitrectomy to remove scar tissue (vitreous) in one eye due to lymphoma (and some minor retinal tears which have been treated). I’ll hopefully know more early in Jan.

In the meantime, of the five surgical ophthalmologists I have been treated by, four have said lifting and Valsalva are NOT a problem as it does not increase intraocular eye pressure and any blood pressure increase is transient. One said under no condition lift anything heavy, especially performing a Valsalva. Ever.

I have found one reference that claims Valsalva increases risk of glaucoma (chronic pressure increase) and several that say it decreases the risk.

My bad eye “feels” lifting a little, but doesn’t care about Valsalva or free breathing. I describe it as a tight feeling around that eye.

My question is, does anyone here know anything about this? The recovery from a vitrectomy ranges from a week or so of rest to keeping your head face down for several weeks. TBD in my case but I really want to weigh risk and reward. I’m very unhappy.

Mark Rippetoe

I know that lifting and valsalva have no effect on intraocular pressure, because of the anatomy. Look at it yourself. We'll ask about the rest.

EyeMD

Hi Barry, sorry to hear about the eye issues and your upcoming vitrectomy.

Intraocular pressure is independent of blood pressure, and unlike blood pressure, there is some evidence that intraocular pressure can be influenced by valsalva maneuver. However, the studies that I have seen that actually quantify the change generally show that it is a small change in pressure and is very transient, coming back to normal nearly instantaneously after the conclusion of Valsalva. It would be very hard to believe that such a small amplitude, short duration increase in IOP would be of any consequence UNLESS you had severe pre existing pathology (i.e., advanced glaucoma). Not an issue in your case from what I can see in your initial post.

Now, in terms of activity limitations post vitrectomy, a lot of it depends on what your vitreoretinal surgeon will actually need to do during the case, and he may or may not know until he actually gets in your eye during the surgery. You've already summarized a lot of it in your post, but if there is a retinal tear that needs treating or a small detachment develops, then they'll likely need to inject an iso expansile gas into your eye, which comes with significant limitations on your activity ranging from a few days to several weeks after surgery depending on the location of the tear, type of gas used, etc. No lifting during that period due to the need for constant head positioning (failing to do so could lead to postoperative retinal detachment or failure of the hole/tear to close correctly). If no gas is needed you would likely be good to go back to the gym within a week or so.