2021-07-22, Thursday
Sleep: 9h21, plus up 7x (1h57) (0' doze) ↔️ Feeling ?90% well, pain ?1 of 7 ✅
!exact times
0mg Tryptophan & 1xFCS, 2x2 Mg & 2x Passiflora & Gastritol & psyllium & Ω3 & perenterol at meal 19:30, !1200mg GABA & !600mg Glutamine & 1x Passiflora 21:55, exercises?
Then 350mg capsule GABA OR 10mg sublingually every time I wake up (GI!), plus 23:00 FCS#1 (or try before sleep again?), 1:00 FCS#2, ?Perenterol, 4:00 6 if nec.
22:20- Not dozing, due to FCS. 
23:24 3’ p2 due to no Trypotophan. Left ring finger hurting all evening: Arnica cream
0:01 3’ p1. Finger still hurting.
0:39 3’ p1: tryptophan(?) Finger still. Wasn’t acupressure that had helped sleep. drink. Gastritol. 200 glutamine = 800mg, & 350 GABA = 1550mg.
1:52 3’ p3, finger, neck → arnica, left knee… drink, no GI altho forgotten psyllium. Gastricumeelm, nose clotted,
2:53 3’ p2, finger, left lower jaw #5, right knee
4:11 3’ p2, finger, nose clotted, cold? → trousers on hungry → Gastritol
5:23 3’ p0, finger, nose: cold → woolen socks over the other 3 pairs 
, left shoulder, right elbow.
Is this literally a COLD turkry of the tryptophan or has it just got cold outside?
fw1’ Next time I have to pee frequently remember to put more socks on!
Finding it a bit hard to remember to write in English.
-6:00 Itchy. Pretty awake. How ironic, it’s Thursday and I’m up before the Thursday’s alarm altho I don’t have to go to work that early anymore. 
Pressure on forehead. fw. 6. Hungry → ate.
7:39-9:38: +2h (thumb & fw & deep sleep every p-time)
-9:38
Sum: 1h40+9h38-(3+3+3+3+3+3=18+1h39=)1h57’= 11h18(10h78)-1h57=9h21, plus up 7x (1h57), minus =0’ doze
Strange, never had a night like that before.
Activities: Cycling fast 30', TT easy :↔️:90%/1 ✅
Acupressure: A bit exhausted from the treatment, but everything better. ✅
Acupressure 2h Tues & 2h Thurs: Lots of short stabs in elbows, knees, improved by today’s acupressure, shoulders and loins too. Treatment was ear - as always-, neck, shoulders and right elbow. Tender jaw remained. Left ring finger pain reduced, but still there.
Supps:↗1550 GABA,↗800 glutamine,↘0mg Tryptophan ✅ better. GI: bit of D, forgot psyllium ❌.
0x200mg Tryptophan, 2x400mg Mg malate, 2x500mg Mg glycinate, 3x290mg passiflora, 1550mg GABA, 800mg L-glutamine:
Physio-type self-treatments: 44'... ✅, fibro-work 2h
* Timing, AuTr 5’, hunchback-pillow 15’, cold shower (10’), back 7’, gums 2x30’’, thumbnails 8x30’’, RR 4x2’ = 44’…
palpate 1’, belly 3’, workout 7’, twist-stretch 2’, neck 1+ ‘, neck 2 1’, V ‘, yoga ‘, loins 1 1’, loins 2 1’, marionette-hang 1’, breath-hold 11’, shaking dance 1’, *
Fibro-work: Night: = 2h
Symptoms: Bladder pain down to 0(-1) since starting then stopping Tryptophan ✅ 🧐. RR 17:45 OK.
RR 17:41 120/72 62, 130/76 67 irr, 120/73 63, 130/73 65.
Lying good, standing OK, sitting OK on a garden chair 60’, Talking: 60’ chat with neighbours OK, altho tired dunno GI: Bladder: Better at last! Therapy: Docs/Diagnoses: Development:
Do I still need to take ezetimibe+atorvastatin despite Mediterranean diet, lots of Ω3 and very low LDL now? According to all recent studies they can't reduce lipoprotein (a), which EVERYONE now says is important, but even INCREASES it a bit, and several new drugs are in the pipeline. So I'll get the bloods done with and then without and if nec. regularly and ask my GP.
Tsimikas 2020: “Statin therapy increases lipoprotein(a) levels - PubMed” - but probably not clinically significant, statins are still good for cholesterol: https://academic.oup.com/eurheartj/article/41/24/2285/5536315
Tsimikas 2020: APO(a)-LRx reduced lp(a) Lipoprotein(a) Reduction in Persons with Cardiovascular Disease - PubMed (There are no approved pharmacologic therapies to lower lipoprotein(a) levels.)
Jang 2020: Lipoprotein(a) and Cardiovascular Diseases - Revisited - PubMed New therapeutic strategies using proprotein convertase subtilisin-kexin type 9 inhibitors or antisesnse oligonucleotide technology have shown promising results in effectively lowering Lp(a), as statins, niacin and others don’t really.
Tada 2019: Lipoprotein(a) as an Old and New Causal Risk Factor of Atherosclerotic Cardiovascular Disease - PubMed Lp(a) is currently considered a mere biomarker but may emerge as a novel therapeutic target in future clinical settings.
Wang 2021: Effect of different types and dosages of statins on plasma lipoprotein(a) levels: A network meta-analysis - PubMed Statins have no clinically significant effect on Lp(a) levels.
Hoogeveen 2021: Residual Cardiovascular Risk at Low LDL: Remnants, Lipoprotein(a), and Inflammation - PubMed Clinical trials demonstrate persistent residual ASCVD risk despite aggressive LDL-C lowering. Growing evidence supports a causal role for TGRLs, lipoprotein(a).
Anastasiou 2021 Lipoprotein(a): A Concealed Precursor of Increased Cardiovascular Risk? A Real-World Regional Lipid Clinic Experience - PubMed elevated Lp(a) levels in CVD. Lp(a) levels slightly increased during follow-up (eze+statins).
Jang 2021: New Trends in Dyslipidemia Treatment - PubMed ASOs targeting TG/TRL, such as angiopoietin-like 3 or 4 (ANGPTL3 or ANGPTL4), apolipoprotein C-III (APOC3), or Lp(a) have effectively lowered the corresponding lipid profiles without requiring high or frequent doses. Clinical outcomes from these novel therapeutics are yet to be proven.
Sahebkar 2021(Altern Ther Health Med): Flaxseed Supplementation Reduces Plasma Lipoprotein(a) Levels: A Meta-Analysis - PubMed Results suggested a significant decrease in plasma Lp(a). Potential clinical significance of flaxseed supplementation for patients who are at risk of a high residual CVD despite intensive statin therapy, patients with hyperliporoteinemia(a), and patients who prefer natural remedies for CVD prevention in the context of a healthy lifestyle. Further RCTs are needed to establish the role of flaxseed-containing products on lowering Lp(a).
Rhainds 2021: Lipoprotein (a): When to Measure and How to Treat? - PubMed association between Lp(a) level and CV risk. Lp(a) is a current target for drug development to reduce CV risk in patients with elevated levels, and lowering Lp(a) with ASO represents a promising avenue.
Reiner 2019: Can Lp(a) Lowering Against Background Statin Therapy Really Reduce Cardiovascular Risk? - PubMed Conclusive evidence is still lacking as to whether the treatment with PCSK9 inhibitors against background statin therapy actually additionally reduces ASCVD risk due to the lowering of Lp(a) or simply due to lowering LDL-C to levels much lower than high-intensity statin treatment as monotherapy.
Brandt 2021: Association of vitamins, minerals, and lead with Lipoprotein(a) in a cross-sectional cohort of US adults - PubMed Lp(a) associated similarly to LDL-C when vitamins, minerals, and lead were tested as continuous variables, while only Lp(a) correlated with vitamin B12 and folate when tested as categorical variables.
Sinning 2021: [New Lipid-lowering Agents] - PubMed They’re looking…
Karapostolakis 2021: Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a) - PubMed atorvastatin had a beneficial effect on the lipid profile and cIMT progression in children with severe dyslipidemia (Carotid intima-media thickness)
Wong 2021: Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a) - PubMed
Mortensen 2021: Examine low-density lipoprotein, remnants, and lipoprotein(a) in parallel in high risk patients - PubMed = https://academic.oup.com/eurheartj/article/42/18/1809/6044433 pro statins, Koh ‘anti’.
Eraikhuemen 2021: Emerging Pharmacotherapy to Reduce Elevated Lipoprotein(a) Plasma Levels - PubMed “The newer and emerging lipid-lowering agents, such as the second-generation antisense oligonucleotides, cholesteryl ester transfer protein inhibitors, and proprotein convertase subtilisin/kexin type 9 inhibitors” are better than statins, fibrates, or bile acid sequestrants: these are ineffective.
Wong 2021: Relation of First and Total Recurrent Atherosclerotic Cardiovascular Disease Events to Increased Lipoprotein(a) Levels Among Statin Treated Adults With Cardiovascular Disease - PubMed The risk of first and total ASCVD events is increased with Lp(a) levels of ≥70 mg/dL and ≥50 mg/dL, respectively, among adults with known CVD on statin therapy.
Wilson 2021: Expert position statements: comparison of recommendations for the care of adults and youth with elevated lipoprotein(a) - PubMed Lp(a) is emerging as important, incl. due to COVID-19.
Obońska 2021: Low dose of ROSuvastatin in combination with EZEtimibe effectively and permanently reduce low density lipoprotein cholesterol concentration independently of timing of administration (ROSEZE): A randomized, crossover study - preliminary results - PubMed Fixed-dose combination of rosuvastatin and ezetimibe significantly and permanently decreases LDL-C regardless of the timing of drug administration.
Hussain 2021: New Approaches for the Prevention and Treatment of Cardiovascular Disease: Focus on Lipoproteins and Inflammation - PubMed
Mayo 2021: Lipoprotein(a) as a unique primary risk factor for early atherosclerotic peripheral arterial disease - PubMed Early lp(a) is vital.
Hermans 2021: Lipid and cardiometabolic features of T2DM patients achieving stricter LDL-C and non-HDL-C targets in accordance with ESC/EAS 2019 guidelines - PubMed T2DM = Diabetes.
Ruscica 2021: Lipid Lowering Drugs: Present Status and Future Developments - PubMed Despite the demonstrated benefits of statins, a large number of patients still remain at significant risk because of inadequate LDL-C reduction or elevated blood triglyceride-rich lipoproteins or lipoprotein(a). The area of lipid modulating agents is still ripe with ideas and major novelties are to be awaited in the next few years.
Pecin 2021: Novel Experimental Agents for the Treatment of Hypercholesterolemia - PubMed Some of them are almost ready to use in everyday clinical practice.
Vogt 2021: [Management of dyslipidaemias: The New 2019 ESC/EAS-Guideline] - PubMed For patients at very high risk the new LDL-C goal is < 1.4 mmol/l (55 mg/dl) and reduction of ≥ 50 % from baseline. The overall aim is to reduce “cholesterol life years”.
Nurmohamed 2021: Working towards full eradication of lipid-driven cardiovascular risk? - PubMed Although the use of triglyceride-lowering therapies remains a matter of debate, post hoc analyses consistently show a benefit in subsets of patients with high triglyceride or low high-density lipoprotein cholesterol levels. … Lp(a)-lowering therapies such as pelacarsen are under clinical investigation, offering a potent Lp(a)-lowering effect. If proven effective in reducing cardiovascular endpoints, Lp(a) lowering holds promise to be the third axis of effective lipid-lowering therapies. Using these three components of lipid-lowering treatment, the contribution of apoB-containing lipid particles to the CVD risk may be fully eradicated in the next decade.
Pearson 2021: 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults - PubMed For any patient with triglycerides ˃ 1.5 mmol/L, either non-high-density lipoprotein cholesterol or apolipoprotein B are the preferred lipid parameter for screening, rather than low-density lipoprotein cholesterol. Health behaviour modification, including regular exercise and a heart-healthy diet, remain the cornerstone of cardiovascular disease prevention.
Rosenson 2021: Existing and emerging therapies for the treatment of familial hypercholesterolemia - PubMed specific.
Afshar 2021: Drugs for Prevention and Treatment of Aortic Stenosis: How Close Are We? - PubMed overview (CDN)
Abbreviations & explanations
Entries start with night meds & sleep, before activities & treatments, because the “night before” is vital. So Fri-day starts with Thursday night, the night before Friday.
Pain "7" = crying (/out) point; my 1 is others 2-3, and due to pacing/treatments
My wife says my 7 is other people’s 12. 1 is probably 2-3. Due to pacing, keeping work down to 25% (12h/wk) and all my treatments (acupressure, GABA) and physio self-treatments I manage to keep getting my pains & Ache down quickly. 3 usually means the Ache, not pains; these I address individually, often automatically and on the fly now, e.g. twist-stretching everything or something specific after getting up.
TIME DATA, e.g. ' = mins, h = hours, 18:10:40', date YYYY-MM-DD
’ = mins = minutes, ‘’ = secs = seconds, h is hours as time length, 3h is 3 hours long, 3:00 is 3am, 15:00 is 3pm. 18:10:40’ means 40 minutes, starting at 18:10, = 10 minutes past 6pm up to 10 to 7pm. The date is the logical digital standard: YYYY-MM-DD.
SLEEP: slp, w, lbu/LBU, RLS, p, i
slp = sleep; reasons for getting up: w = (a)wake, lbu/LBU: lower back unrest (‘RLS’?), p: pee, p2: pain 2 of 7 before peeing, i: ideas.
ACTIVITIES: TT, e.g. "5:1"
TT = table tennis, 5:1 = score, usually showing how well I’m feeling: energy, relaxedness & alertness if the first number is much higher than the second.
SELF-TREATMENTS (about everything else...)
The self-treatments listed are only things that I’m spotlighting & rewarding myself for at the mo by counting them; much of what I do at night is self-treatment to get back to sleep or alleviate (1-2h/d), certain regular movements at daytime, like twist-stretching (30’), writing this blog is self-treatment (30’-60’/d), and the further fibro-work is an indirect form.
Self treatments are usually preventative or always have the same positive effect (e.g. cold showering improves Ache and sleep) - at least I do them for that - and I use “
” to show what I’m doing to alleviate something and mark it off in the details “/” whether it works well enough for a time or doesn’t’, e.g. Ache cold fast shower “”
fw = fibro-work, meaning reading and writing this blog, the reference base, on 4 fibro-forums and researching fibro-stuff on the web.
AuTr = Autogenic Training (usually to actively get - back - to sleep, so counting it as sleep and AuTr…),
cold/FCS = Flash Cold Shower (20’’-60’’) , I count it as 10’ tho. At night with ear plugs & all lights off.
breath-hold/WHM-B-H = Wim Hof Method Breath-Holding,
Neck 1 is stretching top right to bottom left, vice versa & sky/ground, neck “1+” is stretching far further diagonally downwards, neck 2 is pressing my head against my hand “without moving”, left right and front.
loins = loins/groin = stretching the ligaments there.
ex = exercises
HWB = Hot water bottle,
RR = bp = blood pressure (Riva Rocci), plus pulse. Used to be normal, plus sometimes white coat syndrome, went up since fibro, seems to have gone down again, but I’m still sort of on meds, candesartan 16mg, instead of 8mg plus lercanidipine, cos I saw that c. has less side effects.
“V” for loins = lie on back, legs up and let legs fall to sides;
twist-stretching more for the loins