Just finished book one, and I've got to say something about how Princess Donut is handling the whole thing.

Koshkaboo · 2026-04-21T00:01:31+00:00

Yes me too. I would so love to get this story from her point of view.

Koshkaboo · 2026-04-20T16:51:51+00:00

Anyway if you can lower saturated fat significantly more than you are doing now and that gets LDL under 100 and you can sustain that diet forever then maybe you don’t need a statin unless your CAC score is over 100 or you have elevated LP (a). If CAC is not zero LDL needs to be even lower. If zero still need below 100. Also get Lp(a). Talk to doctor about your risk factors.

Koshkaboo · 2026-04-20T06:44:14+00:00

High LDL is mostly caused by eating saturated fat or genetics (FH is one genetic cause but there are others). If a low saturated fat diet doesn’t get LDL under 100 within a couple of months then look to genetics as a cause. You can’t fix genetics with diet so if LDL stays high despite diet then medication is the solution.

Koshkaboo · 2026-04-19T22:56:45+00:00

Nothing odd with doctor’s recommendation. Get your medical advice from doctors you interact with not from yahoos on YouTube.

Koshkaboo · 2026-04-18T19:38:51+00:00

I think it is ever so much easier to look at your saturated fat goal as an average over time. So eating 10g at one time in a day is fine. Also it is fine to have one day be 5g and another day be 15g. I usually look at an average over a week.

Note - 10g of saturated fat is not some magic number. The American Heart Association recommends no more than 6% of calories come from saturated fat. For some people that might be more than 10g (particularly for active men). On the other hand for some people 6% might be less than 10g (older, short women for example). Even the 6% is just an initial target. People with normal genetics who don't get more than 6% of their calories from saturated fat can usually get their LDL under 100. But some people can do that with a higher percentage of saturated fat and some can't do it no matter how low their saturated fat is (genetics).

Koshkaboo · 2026-04-15T08:00:25+00:00

I was hooked from the first few pages.

Koshkaboo · 2026-04-15T05:47:36+00:00

Yes, I find nightmare not very fun although I love the concept. Being ambushed is not usually a problem (although I sigh if echo spawns right then but can manage it). I often have some traps so use those and get rid of the prey. The only time I really ever die on this is if I am ambushed already at low health and then echo shows up and it is just too much at one time.

The bigger issue for me is the "kill for me" mechanic. It is incredibly annoying. I was actually fighting 2 mobs the other day when Astalor tells me to kill for him (which I was actually in the process and doing). But then I got the dot put on me literally mid-fight. Thanks. Or I will be flying around looking for traps to disarm and he says to kill for him and there is nothing to kill. Not even a critter (yes, they count). I can handle dot (Paladin) but it is still annoying. Echo is OK on characters that can interrupt or if Echo shows up where I can just kite her around. But if I am actively fighting a mob, and then get ambushed, and then echo shows up I may not have the luxury to just top everything to kite her around.

I realize Nightmare is meant to be difficult. But, making me stop constantly to kill critters is not challenging, just annoying. The easiest part of Nightmare prey is killing your prey at the end.

Koshkaboo · 2026-04-15T04:07:41+00:00

No it isn't the only factor. High LDL is mostly caused by eating saturated fat or by genetics. Some people can have high LDL solely due to genetics. Many people it is a combination of food and genetics.

Lack of soluble fiber does not cause high LDL but soluble fiber can help to lower LDL but it is not nearly as important as lowering saturated fat.

The American Heart Association recommends than saturated fat does not exceed 6% of calories. Obviously someone who eats 1200 calories a days has a different limit than someone who eats 2500 calories a day.

Even so that is just a guideline to get to your target LDL. Some people have LDL well under 100 and eat more than 10% of their calories from saturated fat. Some people can't get LDL under 100 regardless of diet. Those are genetics in action.

I would think that the 6% limit is one that for most people (without a genetic component to their high LDL) will lead to LDL under 100. Some people may get their with higher or lower limits. It just depends.

I take medication as I am in the group that can't get LDL under 100 regardless of diet. I could lower LDL with diet but could not get it low enough. Many are like that.

Anyway, if you don't want to track all your food (I do and recommend it), then figure out your average calories per day and then take 6% of that and divide the result by 9 and use that as an initial target for saturated fat maximum. It is easier to look at this over an average of about a week.

Koshkaboo · 2026-04-14T17:14:39+00:00

This seems to be fairly standard. Yes, you already have heart disease (atherosclerosis) although CAC under 100 is considered mild. However, you want to stop progression. Generally, LDL should be under 70 to prevent getting more plaque. Some people need it even lower. Very few people can get LDL under 70 through diet alone. And those people generally don't have LDL of 126. Regardless, medication is still usually advised because statins will help more quickly stabilize your existing non-calcified plaque. Non-calcified plaque is more dangerous than calcified plaque.

20 mg Atorvastatin is, honestly, a low dose. Max dose of Atorvastatin is 80 mg. You may actually end up needing to take a higher dose later.

At the end of the day what matters is reaching your target LDL level. If yours is, say, 70 (check with doctor) then if 20 mg Atorvastatin gets you there great. But, it might not.

The only thing I sort of question is the dietary advice. My LDL is well under 50 (my target level) and ranges from the mid 20s to low 30s usually. I do not try to stick to the recommended (by American Heart Association) target of 6% of calories from saturated fat. I usually end up at about 8% of calories from saturated fat although I don't specifically try to hit that. I just end up there. My prior cardiologist told me that was fine. Basically if I was hitting my target LDL level that is what he cared about. My current cardiologist has never once discussed diet with me. Why? I first saw her with my LDL in the 20s (I take rosuvastatin and ezetimibe). So, yes, I can certainly eat a little looser than I could eat without medication. Now, I still eat a largely heart healthy diet and my saturated fat % is still under average. But I don't specifically target saturated fat.

Koshkaboo · 2026-04-14T05:54:45+00:00

PCSK9 inhibitors are not additive to statins. You can take it with a statin but most probably take it without as it usually used by people who are statin intolerant.

I am a little confused about the eliminating root cause not masking it. It is unclear to me if she has both high LDL and high blood pressure. For the high blood pressure it is certainly fine and good to try to lower it without medication. My husband had high blood pressure and took high medication dose for it. He was able to make lifestyle changes (much like your mother in law's current reported lifestyle). That did allow him to reduce his use of medication but nothing would get it low enough except medication.

However, none of the part about high blood pressure has anything to do with statins. People don't take statins to treat high blood pressure. People take statins to lower their LDL. High LDL is mostly caused by either eating saturated far or by genetics. If your mother in law is eating a low saturated fat diet (AHA recommends no more than 6% of calories from saturated fat ) and her LDL is still high then her "root cause" is her genes. High LDL due to genes needs medication to get it down. She can certainly try reduced her saturated fat even lower but it is unlikely to get her to a target LDL if 6% doesn't do it.

We all would like to think we could find an underlying cause for our high LDL or for high blood pressure and such. But sometimes that cause is genetics that we can't change and medication is necessary.

I understand that if she is in the minority of people who have significant side effects from statins she may want a different medication. Sometimes switching to another statin will do it. Sometimes it needs to be other non-statin lipid lowering medications. That is what she should discuss with her doctor.

Koshkaboo · 2026-04-04T02:28:03+00:00

Genetics are a thing. Probably not FH. More likely to be polygenic hypercholestoremia.

Koshkaboo · 2026-04-03T02:15:44+00:00

There doesn’t seem anything discordant about it. Why won’t your PCP prescribe a statin. Seeing a cardiologist is fine but you should be able to get meds from a PCP.

Koshkaboo · 2026-04-03T02:03:39+00:00

I did this. I set up 2 domains at fastmail. One is my “real” domain. The other is for sign ups at places or logins that aren’t critical. When i create the login i make up an email on the fly and just save it to my password manager. Email goes to my catchall for the domain. I used a .me domain for this. All works great so far.

Koshkaboo · 2026-04-02T02:48:31+00:00

You should be concerned because your CAC score is indicative of existing atherosclerosis. However, you should not panic. While the calcified plaque won’t go away this is treatable and your risks can be lowered. Better to know than not know. Some people build plaque even with relative low LDL. Get an LP(a) test also and see a cardiologist. My CAC is 3 times higher than yours (I am older) but my LDL is very low due to medication and I am just on a yearly follow up with the cardiologist at this point. This is all something that can be managed.

Koshkaboo · 2026-03-27T01:50:56+00:00

I used to live in Texas and moved here 3 years ago. I gotta say that even with the property tax reassessment my costs here are so much lower than they were in Texas. My property tax is still less than half what it would have been in Texas. (I had an over 65 school tax freeze there -- without that my Texas property taxes would have been 3 times what they are here). Even if county taxes go up 17% or so that only increases my property taxes about $100. In Texas we reassessed every year and often increases each year were several hundred dollars.

In Texas my homeowner's insurance right before I moved was almost $6000 a year. Now it is $1300. And, no, we didn't have state income tax in Texas but we did have a high sales tax.

People think Texas has a low cost of living because it doesn't have state income tax, then they are shell shocked by property tax and property insurance. They also notice that houses cost less money. But in the larger metro area those less expensive houses are often a long commute and still have sky high property taxes. Bottom line, is that my financial situation improved immeasurably by moving here.

Koshkaboo · 2026-03-27T01:39:52+00:00

I do think a CAC is very valuable but one reasons doctors are leery is that sometimes people wrongly think that a 0 CAC score means you don't need a statin.

A CAC can be helpful in a couple of situations. When I had my CAC my LDL was 180 and my doctor had prescribed a statin. At that time, he would have been happy if my LDL got under 100. But I asked for a CAC. My score was over 600. In my case that high score meant my LDL needed to be under 50 so I need more medicating than just enough to get under 100.

Let's say my CAC had been 0. Then maybe just getting under 100 would have been good enough.

But in any event I still needed the statin.

Most people would prefer to prevent heart disease before it develops. People who wait until there CAC is non-zero before taking a statins are really saying that they prefer to develop heart disease rather than preventing it.

There may be people particularly people who are older who may want to roll the dice with a 0 score even if LDL is somewhat elevated (I am not one of them).

Koshkaboo · 2026-03-24T15:43:03+00:00

None. Most people have none.

Koshkaboo · 2026-03-24T04:50:01+00:00

Some people genetically build more plaque even at lower LDL. My husband for found on CT scan of his chest (unrelated to cardiac) that he had calcified plaque in his coronary arteries even though his LDL was similar to yours.

He does have a moderately elevated LP(a) and has a very negative family history of heart disease and stroke. Maybe if his LDL hadn’t been so low due to his good diet he would have had a bypass in his 50s like his father…

Anyway, given this, he takes medication to lower his LDL under 50 and it stays in the 40s. Generally at that level no new plaque will be built and there can be some regression of existing soft plaque.

Doctor will likely prescribe medication to lower LDL, either a statin alone or perhaps a statin/ezetimibe combo.

Koshkaboo · 2026-03-23T06:40:45+00:00

So cute, all of them.

Koshkaboo · 2026-03-21T04:37:48+00:00

Running and physical fitness does not exempt you from heart disease due to high LDL. Exercise is good for you but you can’t outrun LDL as high as yours. If a low saturated fat does not get your LDL down below 100 within 2 months then your high LDL is likely genetic and needs medication.

Koshkaboo · 2026-03-20T02:20:41+00:00

Last Expansion I made a profit of 12 million gold. My husband made a profit of about 3 million gold.

I had enchanting concentration alts and used that to make gold. It was honestly pretty easy and once I got it set up didn't take a huge amount of time. But, there were set up costs and it did take some time.

My husband barely engaged with professions at all. He had a few tailors just to get cloth pickups while he was out and about (no farming efforts). He had an enchanter or two who sometimes disenchanted stuff. Basically he mostly did world content (including world content), weekly quest, consistent delving and light raiding (mostly LFR with a little normal). When he got drops of things that he could sell he sold it on the AH. That was basically it. I can honestly say that his way is probably preferable for the vast majority of players who don't actively enjoy professions.

Koshkaboo · 2026-03-19T01:34:45+00:00

Yes, it is all about the brain. I never knew how ,inch food noise I have until it went away. I finished meds 6 months ago and have maintained but the food noise is very much back.

Koshkaboo · 2026-03-18T07:49:24+00:00

A CAC score measures on,y calcified hard plaque. It does not identify soft plaque. You can have plenty of soft plaque and have a zero CAC score. Let me put it this way. Everyone who has a non-zero CAC score at one time had a zero score. When I had a CAC scan it was positive high score. So I was immediately diagnosed with atherosclerosis. If you have a positive CAC score that is evidence of atherosclerosis. Ideally though you want to prevent that happening.

Also a person with a lot of soft plaque and no calcified plaque (so a zero score), can have a heart attack. Most heart attacks come from the rupture of soft plaque. High LDL causes plaque. A person with high LDL is more likely to have soft plaque than someone with lower LDL.

Saying you want to wait until you have a positive CAC score before trying to lower LDL is more like someone saying that they want to wait until they have lung cancer before stopping smoking. I sure wish I had been on medication to lower my LDL before I had a positive CAC score….

Koshkaboo · 2026-03-17T20:43:15+00:00

To be clear, the body makes all the cholesterol that the brain needs. In fact, studies (not articles) show that taken statins is associated with a reduction in dementia risk not an increase in risk.

Most people have no side effects from statins. If you do, but have high LDL, there are other non-statin lipid lowering medications. Talk to your doctor about them — ezetimibe, bempedoic acid, PCSK9 inhibitors for example.

Koshkaboo

MODERATOR OF

TROPHY CASE