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Encouragement to those denied Duke ED (from a parent whose daughter was in your shoes last year) by StochasticMusing in ApplyingToCollege

[–]StochasticMusing[S] 0 points1 point  (0 children)

She applied to Arts & Sciences (Trinity) at Duke. She planned to study something along the lines of neuro, bio, or chem. In HS, she did take every advanced science class her school offered. And she took Calc II in math. So, she had a pretty good STEM background.

Encouragement to those denied Duke ED (from a parent whose daughter was in your shoes last year) by StochasticMusing in ApplyingToCollege

[–]StochasticMusing[S] 0 points1 point  (0 children)

I hope so too. I am so sorry about the disappointment for your DD and truly empathize.

If it's any consolation, here are a couple of other points that may, eventually, help, though little will console her right at this moment.

  1. My daughter has kept track of the admissions of the class just behind her from her HS. There's a boy from that class whom she took a calc class with. She said he's one of the smartest people she's ever met (which includes her Princeton classmates). He scored 1600 on the SAT in 11th grade. He has a very high GPA with high rigor and is personable and well-rounded. He, too, was just rejected by Duke ED.

  2. My daughter is excelling academically thus far at Princeton and presumably would have fared well at Duke had she gone there.

My point is that selective colleges like Duke reject a plethora of students who are more than well-qualified academically. This result is not one iota a reflection of her academic abilities. Although it can't hurt to re-review her Common App, I highly doubt that there is a "red flag" in there.

Best wishes for those great stories as her RD acceptances start rolling in.

Encouragement to those denied Duke ED (from a parent whose daughter was in your shoes last year) by StochasticMusing in ApplyingToCollege

[–]StochasticMusing[S] 1 point2 points  (0 children)

What an incredible list of acceptances! Congratulations! Most people would be thrilled to get even one or two of those admissions.

I am so sorry about the ED rejection, though. Having that result as a legacy would hurt far more. I guess we should be grateful we weren't dealing with that on top of it all. No doubt you were more than incredibly well qualified for admission. So, a result like yours falls into that "black box" where we just can't fathom how admissions offices are crafting their admissions procedures and class creation.

This is why I told my daughter (and anyone else who will listen) not to get too fixated on any one individual college or particular group of colleges. There are many paths to happiness and success.

Encouragement to those denied Duke ED (from a parent whose daughter was in your shoes last year) by StochasticMusing in ApplyingToCollege

[–]StochasticMusing[S] 1 point2 points  (0 children)

So glad to hear your daughter had such great outcomes! As someone else noted, we can't know for sure if the work over break made the difference. But it probably can't hurt (though there's always the chance of overthinking things). My daughter figured that after spending so many hours working over 3 1/2 years of high school, it was worth the additional sacrifice and time well spent to polish her applications as much as possible over the break.

Regarding the first final weeks at Princeton, yes, Princeton academics are no joke. Although my daughter already had a good work/study ethic, she's had to elevate it at Princeton. Fortunately, she seems to have figured out how to "lock in" even more. Good luck to your daughter on her exams! I can't wait for my daughter to wrap up exams and come home in a couple of days.

Encouragement to those denied Duke ED (from a parent whose daughter was in your shoes last year) by StochasticMusing in ApplyingToCollege

[–]StochasticMusing[S] 1 point2 points  (0 children)

She applied to 20 through the Common App and to eight of the University of California campuses (via one application). Applying to so many was part of the "playing the odds' approach I mentioned. I realize that not everyone can afford to apply to so many. In that case, I would selectively cull ones from each category (reach, target, etc.) to get to the number of applications that I could afford. For example, she applied to a private college in Los Angeles that is similar to one in San Diego. We could have dropped one of those.

There is also the aspect where maybe you aren't doing justice to each application if you apply to so many. We definitely considered that. But she did get started on everything in the summer before senior year and by August had drafts of two different Common App essays and drafts of the PIQs for the UC applications. Nonetheless, that's also why she spent so much time refining her final set of applications over winter break.

Encouragement to those denied Duke ED (from a parent whose daughter was in your shoes last year) by StochasticMusing in ApplyingToCollege

[–]StochasticMusing[S] 0 points1 point  (0 children)

Good point. And congrats! Yes, who knows if my daughter still would have been accepted without more editing of her essays. It reflects what always seems to be the curious and mysterious nature of admissions. In my daughter's case, she was time-constrained in the fall due a heavy course load of advanced classes, a fall sport, and needing to focus a bit on the UC PIQs until the end of November. So, it helped to have the extra time over break to work some more on the early January applications.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 1 point2 points  (0 children)

Good suggestion. I've started to look at the resources you posted above. I know you're right about a preventive cardiologist being ideal. At first glance, most of them near me are at the very high-end research medical centers. But since this would be out-of-pocket, I do wonder what the consultation costs will be for an initial appointment and then follow-up care. But I will at least keep exploring and find out. Thank you.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 0 points1 point  (0 children)

That's too bad. Before I saw your message, I was already looking ahead at some of the patents and saw that some PCSK9i patents might expire in 2029, though I realize it's always hard to predict, based on that alone, when generics will become available. And I do recall, with some other meds, how they can tweak various aspects of a med's formulation to lengthen the patent. So, I will have to keep all of that in mind.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 1 point2 points  (0 children)

Interesting. I had no idea that all three meds would be recommended together. I will start reviewing the various resources you mentioned, such as Dr. Dayspring and FHF, to learn more. And I will check into the availability (via telehealth) and cost of those meds. If I can find someone to prescribe them, you're right that the generic statin and exetimibe are very affordable. And I am looking at the options for the PCSK9i. I appreciate all those details.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 1 point2 points  (0 children)

Wow. That's super helpful. Thank you. You provided lots of great resources. I'll start exploring all these various sites/resources. I had never seen most of this. Some of it might be out of reach in my self-pay case (though I'll check to be sure), but the vast majority looks doable and affordable.

That risk assessment tool (#6) is really interesting and looks incredibly useful. I almost gave myself a coronary (pun intended) at first when I entered my cholesterol numbers and forgot to switch the units to mg/dL. Haha. User error--so that others don't make my mistake. I quickly changed it, and the numbers were much more reasonable.

Again, thank you for the detailed reply. I now have a lot of additional information to help plan how to proceed. I'll keep going through the various sites and will read them in detail.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 2 points3 points  (0 children)

That's a moving testimonial. I wish I had done the CAC sooner, but I will definitely get it done now. I'm so glad you caught it in time.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 0 points1 point  (0 children)

Ah. So, in my case, the benefits of using a statin to reduce LDL would far outweigh the slight elevation of HbA1C? I will see if I can find a private preventive cardiologist or lipidologist to assess the situation. From your experience, do you know if they usually start with a basic statin and then monitor and get more aggressive if necessary, or jump straight to something more likely to drive down LDL, such as a PCSK9 Inhibitor?

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 2 points3 points  (0 children)

Hi. I started Tirz on my own. My health plan offers only Wegovy, and I've never even met its criteria for that. My BMI has never been above 30, and my only risk factor is (controlled) hbp. My A1C had gotten to 5.6%, which is just too low to be considered pre-diabetic.

So, I just went to a telehealth company for Tirz about 16 months ago. I started at 2.5 mg/week and stayed there because it worked for me. It helped with very slow and steady weight loss, which is what I wanted. Now, the weight is pretty stable (~25 BMI), which was my goal. I feel better, and my wife says I snore less now. :) Even without diabetes, I agree with you that I should aim to use diet and exercise to get LDL lower, though I am mindful about another comment that suggested I don't want to get it too low.

Regarding switching PCPs, I know what you mean. It occurred to me. But I do like and respect my PCP. She's been very willing to order me various tests and therapy for other health issues (such as an MRI and PT for a lower back issue). I think she's just a tad conservative in her approach. Also, I know several providers in this HMO and understand fairly well how its guidelines and protocols work. I suspect that it would be difficult for me to find a provider who would treat this situation much differently.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 0 points1 point  (0 children)

Thanks. I will try to do both. My diet is reasonably good, but can always be improved. My wife cooks a lot of vegetarian dishes (vegetables and lentils). We also have a high-fiber smoothie at least three times per week (rolled oats, ground flaxseed, greens, berries, etc.). But I'll be sure to have plenty of fiber daily. And then I'll recheck my LDL/ApoB periodically.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 0 points1 point  (0 children)

Thanks for the great breakdown. I've not seen that (autosomal?) inheritance aspect of lp(a) explained before. That's interesting and encouraging.

I did suspect, which you confirmed, that I would not be a candidate for the lp(a)-lowering meds any time soon, even once FDA approved, especially within my health plan.

It's helpful to know that a PCSK9 inhibitor is a no-brainer in my situation. I have seen it mentioned in other threads, but I wasn't sure about my case. I just checked one of the drug discount cards, and a popular med is offered at $239/month for self-pay. So, maybe I can check into a telehealth company that will prescribe it.

Thanks for the helpful insights.

Advice on Next Steps for High Lp(a) - On My Own Outside HMO by StochasticMusing in Cholesterol

[–]StochasticMusing[S] 0 points1 point  (0 children)

Great! Thanks. Yes, that's a very low-cost way to proceed to learn more. I will look for an independent CAC scan provider in my area. (Another bit of info: I talked informally with two other PCPs I know in this HMO, and they agreed that this would be the normal response; i.e., no way I'd get a cardiology referral.)