It certainly has been awhile. It is good to be back.

A lot has been happening and I know some of you are interested in my current status. As far as my latest testosterone measurements, taken 1 month after stopping the oral medications Clomid and Nolvadex, was 550 ng/dL. Not trusting this number and knowing that increases in my testosterone levels have been accompanied by increased liver enzymes in the past, I asked to be re-tested. However, a severe cold held off the latest blood test until yesterday. This time I am checking my testosterone, liver enzymes, kidney function, C-Reactive Protein, lipid profile, thyroid, vitamin-D, and a few other tests. I should have the results back in two weeks.

Meanwhile, next week on Friday I have a cardiac nuclear stress test. If I pass it, it will be 8 months since the placement of my last set of stents. My cardiologist is taking an 18 month sabattical and assisting a poor area in El Paso, TX to build a cardiology community.

For me, that meant going on a search for a new cardiologist. My previous cardiologist suggested one of his partners. This is my first option. My own research lead me to two well respected cardiologists in the Austin area. No surprisingly, they were unhappy with my number of stents, saying that most of them were probably not medically necessary. However, they both agreed that some cardiologists are more agressive than others with the use of stents.

This brings me to an interesting story. During my testosterone replacement cessation I reported a drop in my maximum heart rate (it has since returned to normal). So I thought I would ask a question on the Cleveland Clinic “ask the expert” forum. As the Cleveland Clinic is considered the best Cardiology clinic in the country, I thought asking them the question would fall under the category of a good idea. I told them of my heart rate issue and mentioned my 25 stents. Now imagine this – I go back and check for an answer a few days later and find that someone has addressed my concern. So I decide to read the response and ended up with a lump in my throat. The heart rate issue – no problem said the expert – before adding that he hoped all 25 stents were not in my coronary artery. Gulp! If an expert from the best clinic in the country is concerned, how should I feel about my predictament? In the end, my own research has lead to others who have even more stents. One of the new cardiologists I met with recently stated that one of his patients from my previous cardiologists had so many stents that had failed that additional stenting was deemed inappropriate therapy. A bypass could not be performed due to the presence of the stents, so the patient underwent a heart transplant. This caught my attention.

My attitude towards using stents as a first line of defence is changing. Aggressive drug therapy should always be tried first, especially if your angina is stable. It is now well known that statins like Crestor can stabilize plaque, and that agressive drug therapy, combined with diet and exercise can reverse or halt the progression of plaque buildup. Should I fail my stress test next week, I will probably undergo an angiogram. But this does not necessarily mean I have to get a stent. As a patient, always remember that. A good cardiologist should use the angiogram as a tool to determine the course of therapy. Having an angiogram does not equate to getting a stent. Make sure your cardiologist is aware you understand this. Depending on the blockage (is it re-stenosis or new plaque, or a cominatin of both) and its severity I will be instructing my cardiologist prior to the procedure exactly under what conditions a stent should be used. I have learned a great deal in the past three years and I am taking control of my care. More stents is not the answer anymore – at least not for me – unless absolutely necessary.

I did have angina during exercise up until about two weeks ago. The angina has since passed and my exercise tolerance has vastly improved – both cardio and weight lifting. It could be collaterals. I may know soon enough.

Best case scenario? My testosterone is still in the mid-normal range and I pass the stress test. I think I will allow myself some champagne should these two results come to pass.

I am very excited about my first Mended Hearts meeting next Tuesday. We will be discussing the left ventricular assist device – a device designed with heart failure patients in mind. I will be reporting on the meeting soon after.

Best Regards,

Gerald Merits