Friday, 24 April 2015

Familial hypercholesterolaemia. It's so hot right now.

It seems to be doing the rounds at all the cool kids' blogs right now. See Hyperlipid (who covered it well so many years ago) and the Fat Emperor for the smart stuff. I am so not cool, but have a plethora of FH research papers bouncing around on my hard drive. Unfortunately that doesn't always mean I get around to reading them. 

This post is simply the first of probably many where I dump some I have close to hand. If I don't put them on virtual paper soon, I'm going to lose track of them all.
Barros et al - a recent one from 2014 that describes the case of a 46 year old Brazilian man with FH, including significant xanthoma on his heels, elbows, achilles and the soles of his feet.

He didn't smoke, have diabetes or high blood pressure and his LDL-C and HDL-C were 545 and 53 mg/dL respectively. Fasting glucose and triglyceride were 85 and 158 mg/dL.

His carotid arteries were not happy, and narrowing significantly, so they put a a few stents in and all was sweet. Of course it should go without saying that "A low-cholesterol diet was immediately recommended to the patient, and clinical treatment with statins was initiated."

The interesting thing about this case was that his heart and his coronary arteries were in tip-top shape. 

"Meanwhile, the cardiac evaluation test results were normal; the aorta showed no atherosclerotic changes. In addition, the patient’s medical history showed no signs of significant obstruction in the coronary arteries."

I don't know why his body decided to dump all the hate in one area and leave his heart alone, but 46 years with LDL-C of 500+ raises some interesting questions for the heart healthy crew. 

Maybe they accidentally swapped his coronary test results with those of a vegan.

Barros mentions another similar case from Palacio et al.(reference 20), which I couldn't find online, where a 3 year old (genetically confirmed) homozygous girl who had a normal aortic valve, no calcification, and normal coronary arteries, "despite carotid intimal thickening and plaques"

I couldn't get my hands on the full text of this one, and it doesn't sound very interesting anyway, but this quote from the abstract made me laugh:

"At the time of examination, 667 of these adults with familial hypercholesterolaemia (39%) received some form of lipid-lowering treatment; 1 year later, this percentage had increased to 93%."

And the remaining 7% had a death wish??? ha ha. Good on 'em. 

I can't remember where I found this one, so I'm most likely forgetting to thank someone for the heads up, but it's written by the Steering Committee of the Simon Broome Register Group. The Register is based in the UK and they follow lots of FH people around to see if they're still alive.

I guess it was a sign of the times (1980s) that they defined FH as someone with TC of greater than 7.5 mmol/L or LDL-C of more than 4.9 plus xanthoma. Chances are, not all subjects had dodgy LDL receptors.

"A striking finding was the reduced relative risk of death from coronary heart disease with increasing age. Patients who survived through middle age seemed no longer to be at a substantially increased risk of coronary heart disease."

While that is interesting, to me the key observation was - "a family history of premature myocardial infarction was less common in the older age group."

Which reminded me of an old Hyperlipid post on heterozygous survival, where he was looking at a this paper

What Peter wrote stuck in my head, and it's why I remember it now - "In families with FH and premature heart disease there is premature heart disease. Yes, that's what it says."

But of course it must be the lipids. 

That'll do for today. Reading is nice, but I think I'd rather be fishing.

Thursday, 23 April 2015

Personalities, salad and a very special day

Today is random dribble day. Happy random dribble day!

I am an easy-going introvert with very specific motivational triggers. Part of what that means is, I sometimes get in the mood to write about anything that happens to be doing a nudie-run through my head at the time. Just like an extrovert may simply open their mouth and let the rubbish spill out, I let my keyboard do all the speaking. In both cases, I imagine it is quite a tonic for the dribbler and a bit dreary for the dribble recipient.

But, what the hell, I can do what I like here.

I don't pretend that I'm a special snow flake, and anyway, introversion can mean a lot of different things. To the typical extrovert I imagine it means “boring, eerily quiet, someone who is difficult to convince that I’m awesome”. My brand of introversion means that I usually have a constant and internal dialogue going on in my head, which makes social interaction hard work and extroverted people generally drain my energy. 

Except my wife, of course –  I miraculously found my special extroverted unicorn and did not let her go. As it happens, she/we gave birth to a brood of intro/extro hybrids, one of which looks a lot like me but has the complete opposite personality. Genetics is fun.

Don’t misunderstand me – I like a lot of extroverted people and enjoy their company. But that doesn't mean I regularly like to surround myself with people who talk for the sake of talking. Similarly, I freely admit that I’m a bit of a social retard and might be difficult to interact with. I have little interest in parties, crowds, casual chit-chat or speaking in small groups. Inviting me to a brainstorming session is the equivalent of asking me to eat okra. Or glass. I am not programmed to do these things.

As a result, people tend to think I don’t care about much. It was sort of why I chose the name for this blog, apart from being too impatient to think of a good one. Casual questions from colleagues usually receive the default response of “care factor zero” or “mate, care factor…”. That might sound arrogant and unsocial, and probably is, but I’m quite happy to chat about interesting things like their family and what they did on the weekend. But asking me about politics or giving me an uninvited history lesson on why gay marriage is a slippery slope… I figure CFZ is slightly more polite than "mate, shut the fuck up", which is what I'm thinking.

Despite appearances to the contrary, I do care about some things, but eating salad is not one of those things. How's that for a tangent? 

I don't care, I'm running with it. When I look at a big bowl of salad, all I see is hard work and very little return. It’s like giving me a wheelbarrow full of manure and offering me the opportunity to dig in and keep the 50 cents that you've hidden in there. 

I’m not saying vegetables are manure, just that it would be so much simpler and more enticing if a typical salad was one third the size and comprised ingredients with actual nutrients. I don’t care what you say, lettuce and carrots are not nutritious. Or tasty. Or satiating. Therefore, putting them in my mouth is something I rarely do.

Tomato is quite enjoyable and I like red onion quite a bit. Olives are okay and I can eat anchovies out of the jar. But avocado is second only to banana on the "vile texture scale" and don’t get me started on cucumber.

Cucumber is just fucking wrong. 

There are some things I don’t understand, but freely admit that some people may enjoy, like golf and line dancing. But why someone would enjoy a cucumber, is so beyond my comprehension of all that is sensible, that I concluded a long time ago, people eating cucumbers are clearly unstable. 

You’ll notice I said “eating”, not “inserting”, because the latter I can sort of understand, even if I don’t plan to join in on that particular type of frivolity.

If I had more time and and enjoyed pointless exercises, I’d look up the nutrients obtained from eating a typical salad and compare that with what you’d receive from eating a couple of egg yolks, some animal flesh and a bit of cheese. Regardless of the result, I bet you a million pounds that your body and brain will thank you more for the second option. Your taste buds definitely will.

What this incredibly long mass of dribble is trying to lead to is – 
  • Introverts may look like they don't care, but they're probably just focused on the conversation going on in their head. Give them a hug and tell them you understand. They like hugs;
  • Salad, as it is typically prepared, is not worth the effort. Definitely not mine, and probably not yours; 
  • There are two types of cucumber consumers and you should probably be wary of both.  
Have a fantastic day.
Photographic proof that salad leads to insanity

Friday, 17 April 2015

How to make your own ipod touch for $15 - a guide for i-bigots.

Or, more perhaps more accurately "how to avoid unnecessary nonsense and save shitlots of money at the same time"

I find it hard to exercise without my own personal soundtrack motivating me to move. Given that I have an intense hatred for all things apple (mainly because itunes, but also due to semi-illogical snobbery), I've always used Sandisk mp3 players. They play pretty much any file format you throw at them, including flac and ogg and formats you may not have heard of. The software is pretty shitty and the navigation is often annoying, but they’re fairly cheap and easy to get your music on to. As far as non-i-thing music players go, there aren’t many alternatives.
Another reason for hating apple - the marketing is emetic. 
About a month ago I was in the process of buying a new Sandisk, when I remembered I had an old android smart phone laying around, collecting dead skin cells. Not powerful enough to be a decent smart phone, but plenty sufficient to be my new training partner.

I’d rooted it years ago, so trimming the fat was a piece of piss. Deleting the very long list of rubbish apps (looking at you, Google) that were on it - nothing but the essentials remain. Then it was simply a matter of installing a decent music player, throwing in a micro SD card in with all my tunes, and that was it. 
Engineered for minimal bullshit
Where I’m from a 16GB ipod touch will set you back at least $230. 32Gb are about $300. I made my 16GB equivalent for the $15 it cost to buy a 16GB micro SD card.

Apart from saving over $200, it also:
·         doesn’t force me to use the most idiotic software program ever invented to get my music on to it.
·         plays any audio file format and any video file.
·         lets me make phone calls if I feel like throwing a SIM card in it.

Granted, not everyone has a working smart phone laying around, but surely a second hand one can be bought fairly cheaply online. Definitely less than $200.

Sure, I could use my current phone as a music player, but it's massive and doesn't fit in my gym short pocket. It also cost a fortune and I’d hate to drop a dumbbell on it.
Recycling has never sounded this cool.
If you are a fan of avoiding nonsense and saving money, you may find the details below interesting. Your kid who "needs" an ipod touch will probably tell you to pull your head in and stop being so old, but kids are so spoiled these days - tell them it's character-building. 

Phone - Huawei G300, but any android from the last few years will do.
Rooting your phone - head to xda developers and search for your phone in the forums. Rooting your phone and uninstalling apps isn't essential, but it will streamline your device and possibly make it more responsive.
App to delete the space-wasting apps - Titanium Backup or ROM toolbox lite.
Music player app - any you like. I use Shuttle or Poweramp.
Video player - video player for android.

Wednesday, 8 April 2015

An Easter miracle - the dead is reborn

I'm not ashamed to admit that the only thing Easter means to me is a four day weekend, however Easter 2015 served up a miracle of sorts in the form of a rebirth. 

It has truly changed my life.

This is our old oven that was crucified by a dodgy thermostat about 3 months ago. 

Three days...three months, it's sort of the same thing. I didn't put it in a tomb and roll a boulder in front of the door, I did the lazy thing and shoved it in the corner of our back yard and draped a tarp over it.

This is a dead chook and the belly of a dead pig, bathing in brine.
a 2 day bath, the lazy buggers
The extra long weekend gave me the time to conjure the spirit of LaGermania and perform some oven-meat-smoker-metamorphosis. With some advice from my chef-trained computer programmer friend (what an awesome combination), we set some BBQ bricks on fire and sprinkled hickory chips over the top, managed to maintain a temperature of between 60-90 degrees Celsius and shoved the chook and pork in to get a smokey baptism. 

Two hours later the chicken was done, and given the truly magical fattiness of the pork belly, it metamorphisized from a big slab of belly into a magical slab of smokey deliciousness over six and a half hours.
looks a bit wrinkly, but was surprisingly moist and tasty

a bit of maple syrup added some colour and sweetness

I was forced to attend church every Sunday until the age of 17. I hold a deep, almost serious grudge against my parents for this mild form of child abuse. Not just because Sunday school was a complete waste of time, but because they decided to stop going to church after me and my siblings moved out of home. What pricks. 

No, I'm not completely serious. I love them dearly, but we all have things from our childhood that we would rather have avoided, truly soul-scarring or not.

I hope you had a wonderful weekend with people you love. Mine was eerily quiet, given my wife and kids were interstate, but it included a fishing trip, preparing and eating my first taste of steak tartar, a chance to write a bit of bullshit here, and this Easter miracle. 

Life is good. 

All the best.

Monday, 6 April 2015

running under the influence...of statins

Papers on statins are almost always gushing in their awe of the miracle drugs, which is why I rarely bother reading them. But I got the impression fairly quickly that Toussirot and his French mates are not sold on their brilliantness. Not in athletes, at least.

The paper is a case study of a 50 year old marathon runner who appeared to develop a nasty case of Rhabdomyolysis (muscle break-down) while high on rosuvastatin.

Don't get me started on the logic behind marathon running, because I'm likely to get all judgey and arrogant. Suffice to say, I don't get it.

But ignoring that for a minute, this particular man was prescribed atorvastatin because of a family history of heart issues and his LDL level of 162 mg/dl (oh, my goodness!). Unfortunately this caused him severe muscle pain (myalgia), so he switched to rosuvastatin.

He did that silly thing where you torture your body by running 26 miles and, not surprisingly, his muscles didn't like it. But they hated it more than usual because of the rosuvastatin. Two days after the nastiness, his creatine kinase levels were still off the charts.

A year later, he had only partially learned from his mistakes, because he still had the masochistic habit, but decided to do without the drugs. Going by the CK levels, it was still a stupid thing to do, but not quite as stupid as doing it on rosuvastatin.

I guess you could argue that this is an isolated case and not indicative of anything, but it appears that if you plan on exercising and taking statins at the same time, the chances of your muscles not liking the combination are quite likely. 

From this study:

"In conclusion, our findings demonstrate that the great majority of professional athletes with severe FH do not tolerate any of the statins available."

I plan on using my muscles for quite a while yet, so I think I'll pass.
Sunrise yesterday was quite spectacular

The fish were pretty good, too.