I had a calcium score scan on a 64-slice machine at the Morristown Hospital in New Jersey. No contrast was injected. The technician did three separate scans that included the lung, even thought I didn't for a lung scan. I wonder why three scans were taken. Does it mean that I had three times the radiation?

Hi,
Of course I can't comment specifically on what was done, but it is common practice to perform 1) a "scout" film for the technologist to identify the location of important "landmarks" like the sternum and the top and bottom of the heart to minimize the window of exposure, and 2) lung imaging as a routine part of  heart imaging, not necessarily an additional scan.

If an additional and unrequested lung scan was performed, you may want to call and ask why this policy is in operation.

What do you feel about yearly nuclear stress tests for people with CAD?  The radiation exposure seems high and the ability of a stress test to pick subtle changes in flow is low.  In the absence of symptoms it would appear that the common practice of nuclear stress tests for people with CAD is a questionable practice.

I agree. The radiation is excessive. I tend to follow that route only when nothing else is possible. An alternative for stress testing is stress echocardiogram in its various forms, none of which involve radiation. They still suffer the other pitfalls of stress testing, of course, but do not involve radiation.

I just launched a webiste that may answer some of your questions.  www.xrayrisk.com. It allows you to calculate your cancer risk based on studies you have had and answers some faq on radiation exposure and cancer.

There are several ways to estimate your cancer risk - the best site for background information is probably the Image Gently campaign.

The American College of Radiology has similar information pages for patients and the general public.

To track your exposure, as Mike said there's the xrayrisk website.
There's also a program for the iphone called Radiation Passport that tracks all of your radiation exposure and gives you the associated risk of developing cancer from your radiation exposure.

CT coronary angiography presents a different story. This is where radiation really escalates and puts the radiation exposure issue in the spotlight. As Dr. Cynthia McCullough's chart shows above, the radiation exposure with CT coronary angiograms is 5-12 mSv, the equivalent of 100 chest x-rays or 20 mammograms. Now that's a problem.

The CT scanner was originally designed to take pictures of the brain. Now it is much more advanced and is used for taking pictures of virtually any part of the body.

The scanner is particularly good at testing for bleeding in the brain, for aneurysms (when the wall of an artery swells up), brain tumours and brain damage. It can also find tumours and abscesses throughout the body and is used to assess types of lung disease.

I often soak raw almonds (and other nuts) about 24 hours in filtered water with sea salt, then dry them a day or two at about 150°F in the oven.  I doubt the studies take this kind of "processing" into account, but any idea how that might change the absorption scenario?

I'm glad you posted this.  A few women I know have been wary of eating many nuts for fear that fatty nuts would cause them to gain weight.  

Really like the little bit on healthy gut flora caused by almonds too.  A healthy gut is important to me.

I would certainly agree that it is possible to eat enormous quantities of nuts without absorbing all of their calories. I noticed I could remain weight stable while sedentary and eating 3,500 calories back when I used to eat large quantities of nuts. Even when well chewed a proportion of them end up you-know-where! Just flush...

Peter

Dr. Davis, this is a great example. Thanks for posting it. I have a question on the 88 calories. I tried to work through the calculations to demonstrate this to one of my clients. I couldn't come up with 88 calories per ounce.

I kept coming up with 80 and here's how. 50% calories from fat is 63. I used 50% for protein and digestible carbs - based on the info provided. For protein, that leaves 3 gms or 12 calories. For carbs, half of 2.5 gms is 1.25 gms, which equals 5 cals. These add up to 80 (63 + 12 + 5).

I’m probably making a silly mistake but I’d like to come up with the same numbers when demonstrating this to clients – makes me feel kind of silly.

Thanks again for the blog, I greatly appreciate the information you post.

Brian

Does pasteurization affect the positive effect almonds have on gut bacteria? Last year it became manditory that all California almonds must be pastuerized by one of these methods: fumigation with propylene oxide, blanching and oil roasting. This is to prevent salmonella. http://www.almondboard.com/Programs/content.cfm?ItemNumber=890&snItemNumber=450

I eat a handful of almonds just about every day. I have wondered if there benefits have been compromised.

The study was sponsored by The Californian Almond Association

In the era of the 64-oz. soda, the 1,200-calorie burger, food companies now produce enough each day for every American to consume 3,800 calories per day as compared to the 2,350 needed for survival. Not only adults but kids are also consuming far more calories than they can possibly use. http://www.phentermine-effects.com

For a long time I've suspected that some foods are very inefficiently absorbed. I've particularly suspected that raw nuts are relatively poorly absorbed and thus yield only a fraction of the calories ingested.

Great post, and painfully true for me; my father had to undergo his 2nd coronary bypass operation this past April 2007, and despite the strangely 'status-quo' or 'business as usual' attitude of both the surgeons and assisting doctors and nurses involved in my dad's procedure (yes, the whole thing seemed like such a regular day at the beach to them because Holy Cross in Fort Lauderdale performs so many of these operations on a daily basis, with success, of course) did nothing really to quell my family's fears of the severity of this operation; this is still a monstrous operation that not only takes a heavy toll on the patient, but on the family sitting in that waiting room as well.
I still cry at the memory of having to tell my dad, "hey Pop, you need another CABG" after an invasive angiogram revealed disaster after disaster in his arteries.
And this is why your message is so important, and why it needs to get out every day, and loudly.

I'm rooting for you. And I'm thankful you're here.

A few thoughts about this post:
The first is a question. What do you think about ultrasound screenings for carotid artery plaque, abdominal aortic aneurysm, and peripheral arterial disease? A company called Life Line offers these, saying that they show evidence of plaque build-up in the arteries. Are they useful in conjunction with a heart scan, or can they indicate risk similar to a heart scan? It sounds like they are intended to be early detectors of stroke risk. Are they worth the investment?

The second comment is an observation. Those of us not in the medical field tend to assume that anyone who is knows what he or she is talking about on the subject of the human body and illness. However it is apparent that those with M.D.'s can come to very different conclusions about what causes us to get sick and what we should do to prevent illness. Dr. Dean Ornish is an M.D. You are an M.D. Dr. Atkins was an M.D. Yet the dietary advice differs noticeably, so how do we know who is right and who to listen to? I've learned not to believe something just because a doctor says so, because when I followed the low-fat high-carb advice I got fat and felt horrible, but now that I am following a low-carb plan with plenty of protein and fat, I've lost 25 lbs. and feel great. My bloodwork also supports your claims: low triglycerides, high HDL, and low fasting blood sugar. It's kind of sad in a way that I actually get better medical advice from doctors whose blogs I read on the internet (I'm also a Dr. Eades fan) than from my personal physician. And finally, a thank-you: since reading your advice about Vitamin D, my flower garden is in the best shape it's been in in years, since I have a new knowledge about why it's so important spend some time in the sun and a new motivation, therefore, to be outside pulling the weeds.

And concerning your recent post  about breakfast cereals,congratulations are in order: I've broken my husband's cereal for breakfast habit. (I broke my own years ago.)

I have had good results with the Lifeline service, but only when used in conjunction with a heart scan. It cannot replace a heart scan. This is because, while atherosclerosis is a body-wide process, this disease does not perfectly track in parallel in all arteries of the body. You can, for instance, have lots of plaque in the carotid arteries while having only a modest amount of plaque in the coronary arteries, and vice versa.

I agree with your second comment. In fact, I have posted on this Blog about this.

We are all swimming in a sea of information and mis-information, and blind alleys along the way to the truth. We can only educate ourselves as best as possible and then come to our own judgements about the value of this or that argument.

I have a comment too: I think one reason there is so much confusion is because dietery connection with heart disease hasn't been sufficiently studied. We only saw some partial studies by Drs Ornish, Agatston, Atkins, Hayes but not much independent verification, AFAIK. For example there are some studies done by now on the effects of a high fat low carb nutrition in diabetes and epilepsy but virtually nothing that I know of for cardiac patients.  The only one such study I heard of was halted half way through (after showing very promising results) when the funding was cancelled, 27 years ago.
Stan (Heretic)

A somewhat updated comparison of old care versus new care: I was on American Airlines this week, and looked through their magazine. There was a full page ad from the Cooper Clinic in Texas; a 46 year old woman pictured said "I had no idea I had heart disease, but had a family history...an EBT scan and four stents later, with some lifestyle changes, I'm a new woman".

I understand you can't generalize from one case, and while this seems to represent cutting edge treatment, it also gives me the creeps thinking about the obvious drive for revenue here. Couldn't they have tried your approach for awhile before invading? Thanks.

I think that they tell the stories that have a "WOW!" factor. The Cooper Clinic does indeed engage in a low-level grade of preventive care (AKA Lipitor, etc.)

But I really hate those stories, too.

Saw a lady at shul today, she is convinced of Dr. Esselstein's more carbs- is- better method. Ornish, Esselstein.....hard to refute the drumbeat of eat carbs, cut meat and fat.