Thursday, April 7, 2011

Calcium In Heart and Arteries

Recently I posted about remarks in two different PET scans. A PET scan uses two different imagining technologies, combining the results to show where cancer cells might be congregating. One of those is a CT scan, which shows clear images of bones and any other calcium in the body. Three years ago, in 2008, the radiologist who read the CT images said "There are scattered mild vascular calcifications in the aorta and coronary arteries." Calcification is an indicator of heart disease, but this didn't sound too bad. This year, though, the radiologist wrote "Coronary and vascular calcification. Bilateral renal calculi." Sounds worse, more definite, right? For sure, the kidney stones (renal calculi) were not mentioned three years ago, and no qualifiers like "scattered mild" appeared this year.

The scans were viewed by different radiologists, so was there really a difference, or was the apparent difference simply due to different personalities or reporting styles? I actually called the radiologist who did the recent report, and didn't get much help. He sounded very busy and, without looking up my actual report, said (1) he sees calcifications on many (most?) scans, (2) for sure all of the scanned images that he uses to make his report would be there for me to see on the DVD, and (3) I should trust the opinion of my oncologist rather than his, as he was "just" a radiologist.

PET Images:

I asked Mayo Clinic to send me a DVD containing both scans, so that I could provide them to local doctors but also so that I could peek at them myself. The DVD contains thousands of images and also the software necessary to view them. I believe I have identified several calcified spots in the heart, and I see no difference between last year's scans and those of 2008. Same spots in the same places. Similarly, I see very evident kidney stones, but not much difference since 2008. I've already reduced my calcium supplements to deal with those.

Doctor NB:

My new primary care provider (PCP) is just out of residency, but seems pretty sharp. He assured me that "almost all" of the CT scans he sees show vascular calcification. That is scant comfort, of course, when we know that heart disease is the leading cause of death among mature adults. But he also said that I am already doing everything that he would recommend. We eat a very heart-healthy diet, I run 20-30 miles per week, and get enough sleep. My blood pressure is fine, cholesterol is good except for HDL, which is chronically too low, always has been. We talked about ways to improve HDL, but I've tried niacin without success and he was reluctant to prescribe statins because the potential side effects might outweigh the benefit.

We've read that HDL can be related (inversely) to belly fat, and I have an extra 10 or 15 pounds of that. When I told Dr NB that I intended to take some of that off, to help increase HDL, he seemed a bit skeptical but certainly didn't discourage it.

Bottom Line: I'm done worrying about "calcification" for now. I'll do the Weight Watchers' thing, take the weight off, and then we'll see.

This is a CT "fusion" Image, from the PET/CT scan, looking at a slice of my body from the viewpoint of the feet. I'm laying on my back, so the spine is at the bottom of the image, the sternum at the top, upper arms outside right and left. The two large, dark areas are the lungs, with the heart appearing as a gray area between the lungs, slightly off-center to the left (our right). There is one bright spot in the heart - a calcification. There are a few others in other parts of the heart. Anyway, that's my very amateurish interpretation:


  1. Don, I also found out a couple of days ago that I have low HDL. (Other cholesterol levels are great) Have you ever heard that this is related to myeloma or the treatments, or are we just unlucky? :)

  2. I've had low HDL ever since we started checking it (in early years they just measured total cholesterol). So I'm definitely unlucky in that respect (very lucky in others).

    But it is an interesting question. My total cholesterol dropped from 237 to 154 when I started running and eating well, without much improvement in HDL. That's something I'll ask my onc next time I see him/her.

  3. Don, at least as far as kidney stones (renal calculi) are concerned, I have a very simple (maybe even stupid) advice:
    drink a good amount of water.
    In almost all mm patients seminars I have attended, dehydration has been mentioned as a common effect of mm. Hope it could help avoid calcification in general.
    Best wishes.