我是Donna， 一位身心治療師、催眠治療師，夢境和敘事治療師。
這裏，我分享自我療愈，身心修復、身心整合的理念和方法，個案和啓示。
分享夢境啓迪、生命故事、探索人性和健康知識、如何運用潛意識的力量，活得自在輕鬆、潛能得到有效的發揮。
這裏，記載了我工作和日常生活的啟迪。
讀懂一個人，與人產生深刻的連結，陪伴人們活出健康和夢想的天空，是我的夢想。
Being a dream therapist, hypnotherapist, and health therapist, my philosophy is to improve abilities in self management, self healing, self coaching and body-mind in alignment.
A panic attack is a sudden episode of intense fear that triggers severe physical reactions when there is no real danger or apparent cause. Panic attacks can be very frightening. When panic attacks occur, you might think you're losing control, having a heart attack or even dying.
Many people have just one or two panic attacks in their lifetimes, and the problem goes away, perhaps when a stressful situation ends. But if you've had recurrent, unexpected panic attacks and spent long periods in constant fear of another attack, you may have a condition called panic disorder.
Although panic attacks themselves aren't life-threatening, they can be frightening and significantly affect your quality of life. But treatment can be very effective.
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Symptoms
Panic attacks typically begin suddenly, without warning. They can strike at any time — when you're driving a car, at the mall, sound asleep or in the middle of a business meeting. You may have occasional panic attacks, or they may occur frequently.
Panic attacks have many variations, but symptoms usually peak within minutes. You may feel fatigued and worn out after a panic attack subsides.
Panic attacks typically include some of these signs or symptoms:
Sense of impending doom or danger
Fear of loss of control or death
Rapid, pounding heart rate
Sweating
Trembling or shaking
Shortness of breath or tightness in your throat
Chills
Hot flashes
Nausea
Abdominal cramping
Chest pain
Headache
Dizziness, lightheadedness or faintness
Numbness or tingling sensation
Feeling of unreality or detachment
One of the worst things about panic attacks is the intense fear that you'll have another one. You may fear having panic attacks so much that you avoid certain situations where they may occur.
When to see a doctor
If you have panic attack symptoms, seek medical help as soon as possible. Panic attacks, while intensely uncomfortable, are not dangerous. But panic attacks are hard to manage on your own, and they may get worse without treatment.
Panic attack symptoms can also resemble symptoms of other serious health problems, such as a heart attack, so it's important to get evaluated by your primary care provider if you aren't sure what's causing your symptoms.
It is about Cholesterol LDL with high oxidized bricks and other bricks or taxis , particles. With a normal LDL or high LDL does not mean you have heart disease or disease risk.
This is an excellent and important question.
For decades, the standard test has been **LDL-C (LDL Cholesterol)**, which measures the *amount of cholesterol* inside LDL particles. However, research over the past 20+ years has shown that the **number of particles** is a more accurate predictor of cardiovascular risk.
What is the dangerous particles:
Here’s the key insight: **You can have a "normal" LDL-C levelbut a high number of small, dense LDL particles.** These particlesare especially dangerous because they can easily slip into the artery wall and contribute to inflamation and plaque formation.
Here is a comprehensive overview of Apolipoprotein B (ApoB), explaining what it is, why it's crucial, and how it differs from other cholesterol tests.
In simple terms, ApoB is the main structural protein found on the surface of the most atherogenic (artery-clogging) lipoproteins.
Think of it this way: Lipoproteins are like taxis that carry cholesterol and triglycerides through your bloodstream. ApoB is the driver of the taxis that are most likely to cause plaque buildup.
Every single one of the following harmful particles has one ApoB molecule on its surface:
Chylomicrons: Carry dietary fat from the intestine.
VLDL (Very-Low-Density Lipoprotein): Carries triglycerides made by the liver.
IDL (Intermediate-Density Lipoprotein): A transition particle between VLDL and LDL.
LDL (Low-Density Lipoprotein): The infamous "bad cholesterol." This is the primary carrier of cholesterol.
Lp(a): A particularly dangerous, genetically influenced type of LDL.
Therefore, measuring ApoB gives you a direct count of the total number of these atherogenic particles in your blood.
Why is ApoB So Important? The "Particle Number" Theory
For decades, the standard test has been LDL-C (LDL Cholesterol), which measures the amount of cholesterol inside LDL particles. However, research over the past 20+ years has shown that the number of particles is a more accurate predictor of cardiovascular risk.
Here’s the key insight: You can have a "normal" LDL-C level but a high number of small, dense LDL particles. These particles are especially dangerous because they can easily slip into the artery wall and contribute to plaque.
LDL-C (Cholesterol Content) is like measuring the total weight of passengers in a fleet of taxis.
ApoB (Particle Number) is like counting the exact number of taxis on the road.
A high ApoB count means you have a lot of "taxis" (particles) roaming your arteries, increasing the chance of one crashing into and damaging the arterial wall, starting the process of atherosclerosis.
ApoB vs. Other Lipid Markers
Marker
What It Measures
Why It's Used
Limitation
LDL-C
The cholesterol mass inside LDL particles.
The traditional, widely available standard for "bad cholesterol."
Doesn't account for the number or size of particles. Can miss high risk.
Non-HDL-C
Total cholesterol minus HDL cholesterol. (Includes VLDL, IDL, LDL).
A better marker than LDL-C; includes all atherogenic cholesterol.
Still a measure of cholesterol content, not particle count.
ApoB
The number of all atherogenic particles (VLDL, IDL, LDL, Lp(a)).
Considered the best single marker for cardiovascular risk related to lipids.
Not as widely available or ordered as traditional panels (though this is changing).
In summary: ApoB is a more direct and accurate measure of your risk from atherogenic lipoproteins than LDL-C.
When is an ApoB Test Recommended?
An ApoB test is particularly useful in these scenarios:
Personal or Family History of Heart Disease: Especially if it occurred at a young age.
High Triglycerides / Metabolic Syndrome: People with these conditions often have a high number of small, dense LDL particles, which a standard LDL-C test can underestimate.
Diabetes: Diabetes significantly increases cardiovascular risk, and ApoB helps refine that risk assessment.
To Refine Risk Assessment: When traditional lipid panel results are borderline or conflicting.
Monitoring Treatment: To see if cholesterol-lowering drugs (like statins) are effectively reducing the number of harmful particles.
What Do the Results Mean? (ApoB Levels)
Target levels can vary slightly by lab and guidelines, but a general framework is:
Low Risk:< 80 mg/dL (or < 0.80 g/L)
Moderate/High Risk (or on treatment):< 65 mg/dL (or < 0.65 g/L) is a common aggressive target.
Very High Risk (e.g., existing heart disease):< 55 mg/dL (or < 0.55 g/L) may be the goal.
A high ApoB level indicates an increased risk for heart attack, stroke, and peripheral artery disease.
How to Lower ApoB
The strategies are the same as for lowering LDL-C, as they target the same particles:
Medications: Statins are the first-line therapy. Other options include Ezetimibe, PCSK9 inhibitors, and bile acid sequestrants.
Key Takeaway
Apolipoprotein B (ApoB) is considered by many experts to be the single best blood test for assessing the risk of atherosclerosis caused by lipids. It provides a direct count of all the dangerous cholesterol-carrying particles, offering a more precise risk picture than the traditional "LDL Cholesterol" test. If you are concerned about your heart disease risk, discussing an ApoB test with your doctor is a very proactive step.
2) LIPOPROTEI a <lp(a)>
It increase the speed of inflammation and clog formation. It is sticky , highly inflammation particles.
Lp(a) is a type of lipoprotein, a particle made of protein and fat that carries cholesterol through the bloodstream. Think of it as a subtype of LDL ("bad") cholesterol, but with a unique and potentially more dangerous structure.
The key to understanding Lp(a) is its unique structure:
LDL-like particle: At its core, it looks very similar to an LDL particle, containing a cholesterol-rich center.
Apo(a) protein: This is the critical difference. Attached to the LDL-like particle is a unique protein called Apolipoprotein(a), or Apo(a). This protein has a structure that is very similar to plasminogen, a key protein in the body's blood-clotting (thrombolytic) system.
This dual nature—mixing cholesterol transport with interference in clotting—is what makes Lp(a) particularly harmful.
Why is Lp(a) Important? The Risks
High levels of Lp(a) are now recognized as a major independent, genetic, and causal risk factor for:
Atherosclerotic Cardiovascular Disease (ASCVD): The buildup of plaque in arteries, leading to:
Heart attacks (Myocardial Infarction)
Strokes (Ischemic)
Peripheral arterial disease
Aortic Stenosis: A narrowing and calcification of the aortic valve in the heart. This is a particularly strong association.
Why is it so dangerous?
Pro-Atherogenic: Like LDL, the Lp(a) particle can enter the artery wall, become oxidized, and drive plaque formation.
Pro-Thrombotic: Because its Apo(a) protein resembles plasminogen, it interferes with the body's ability to break down blood clots. This increases the risk of dangerous clot formation.
Key Characteristics of Lp(a)
Genetically Determined: Your Lp(a) level is almost entirely (over 90%) determined by your genes. It is not significantly influenced by diet, exercise, or most lifestyle changes. If you have high Lp(a), you were likely born with it.
Not Routinely Screened: It is not part of a standard lipid panel (which measures Total Cholesterol, LDL, HDL, and Triglycerides). You must request it as a separate test.
"Silent" Risk: You can have high Lp(a) and feel perfectly healthy, with no symptoms, until a cardiovascular event occurs.
Who Should Get Tested for Lp(a)?
Medical guidelines recommend testing in the following situations:
Personal history of premature cardiovascular disease (e.g., heart attack or stroke at a young age: <55 for men, <65 for women).
Family history of premature heart disease or high Lp(a).
A strong family history of cardiovascular disease without other clear risk factors (like high LDL, diabetes, or smoking).
Personal or family history of aortic stenosis.
Having high LDL cholesterol despite treatment (to assess overall risk).
To refine risk assessment: Even without a strong family history, knowing your Lp(a) level can help you and your doctor understand your true cardiovascular risk.
Interpretation of Results
Lp(a) is measured in mg/dL (milligrams per deciliter) or nmol/L (nanomoles per liter). nmol/L is considered more accurate.
Desirable / Low Risk: < 30 mg/dL or < 75 nmol/L
High Risk: > 50 mg/dL or > 125 nmol/L
Very High Risk: > 100 mg/dL or > 250 nmol/L
If your level is high, it means you have a genetically inherited, lifelong elevated risk for heart disease and stroke.
Treatment: The Current and Future Landscape
This is the most critical part. There are currently no approved medications specifically for lowering Lp(a) that have been proven to reduce cardiovascular events.
Statins (e.g., Atorvastatin, Rosuvastatin): These are very effective at lowering LDL cholesterol but do not lower Lp(a). In fact, they may slightly increase it. However, if you have high Lp(a) and high LDL, treating the high LDL is still absolutely essential.
Niacin: Can lower Lp(a) by 20-30%, but its side effects are common (flushing, itching), and clinical trials have not shown a clear benefit for reducing heart attacks.
PCSK9 Inhibitors (e.g., Evolocumab, Alirocumab): These powerful LDL-lowering injectable drugs can also lower Lp(a) by about 20-30%.
Estrogen and Aspirin: May have modest lowering effects but are not used as primary treatments for high Lp(a).
The Future is Bright: Lp(a)-Specific Therapies There are several drugs in advanced clinical trials that directly and dramatically lower Lp(a) by targeting its production. The most promising are:
Pelacarsen (TQJ230): An "antisense oligonucleotide" given by subcutaneous injection.
Olpasiran (AMG 890): A "small interfering RNA" (siRNA) given by injection. These drugs have shown an 80-95% reduction in Lp(a) levels in trials. The critical outcome trials to see if this reduction translates to fewer heart attacks and strokes are ongoing.
What to Do If Your Lp(a) is High
Don't Panic. Knowledge is power. You have identified a key risk factor that you can now manage proactively.
See a Specialist. Consult with a cardiologist or lipidologist (a cholesterol specialist).
Aggressively Manage ALL Other Risk Factors. This is the current standard of care. Since you can't directly lower Lp(a) yet, you must be meticulous with other factors:
LDL Cholesterol: Get it as low as possible.
Blood Pressure: Keep it under control.
Blood Sugar: Prevent or manage diabetes.
Lifestyle: Do not smoke, eat a heart-healthy diet, exercise regularly, and maintain a healthy weight.
Consider Aspirin: Discuss with your doctor if low-dose aspirin is appropriate for you to help reduce clotting risk.
Family Screening: Inform your blood relatives (parents, siblings, children) so they can also get tested.
Summary
Feature
Description
What it is
A unique, LDL-like particle in the blood with an added "sticky" protein (Apo(a)).
Primary Risk
Independent, genetic risk factor for heart attack, stroke, and aortic stenosis.
Key Fact
Levels are genetically determined and not affected by lifestyle.
Testing
Not routine; recommended for those with personal/family history of early heart disease.
Current Treatment
No approved drugs to lower it. Focus is on aggressively managing all other risk factors.
Future Treatment
Highly promising drugs in clinical trials that can lower Lp(a) by over 80%.
3) High sensitivity C - Reactive Protein ( Hs- CRP) - elevated CRP
To measure inflammation, the silent amplifier of clogging due to chronic stress, poor sleep, metabolic dysfunction, depression, chronic diseases that cause chronic inflammation.
C-Reactive Protein (CRP) is a protein produced by your liver. It's a key player in your body's inflammatory response. When there is inflammation anywhere in your body, your liver releases CRP into the bloodstream. Think of it as a general alarm system.
Standard CRP Test: This measures much higher levels of CRP and is used to detect major inflammation, like that caused by a serious bacterial infection, a major injury, or a chronic inflammatory disease (e.g., rheumatoid arthritis).
High-Sensitivity CRP (hs-CRP) Test: This is the same protein, but the test is far more sensitive. It can detect very low levels of CRP in the bloodstream, which are often linked to low-grade, chronic inflammation.
What Does an Elevated Hs-CRP Mean?
An elevated hs-CRP indicates a state of low-grade, systemic inflammation. This is not the acute inflammation from a cut or an infection, but a smoldering, body-wide inflammation that can damage blood vessels over time.
The most significant and well-researched implication of an elevated hs-CRP is its link to cardiovascular disease.
1. Primary Use: Cardiovascular Risk Assessment
Your doctor likely ordered the hs-CRP test as part of a cardiovascular risk assessment. It provides information that cholesterol tests alone cannot.
The Theory: Chronic inflammation inside the walls of your arteries can make fatty plaques (atherosclerosis) more likely to form and, crucially, more likely to rupture. A ruptured plaque can cause a heart attack or stroke.
hs-CRP as a Predictor: Elevated hs-CRP indicates this inflammatory process is active, independently predicting your risk for future heart attacks, strokes, and peripheral arterial disease, even if your cholesterol levels are normal.
Standard hs-CRP Risk Categories for Heart Disease:
Low Risk: hs-CRP less than 1.0 mg/L
Average Risk: hs-CRP between 1.0 and 3.0 mg/L
High Risk: hs-CRP greater than 3.0 mg/L
Important Note: An hs-CRP level above 10.0 mg/L suggests a major source of inflammation (like an active infection or illness) and is not considered useful for cardiovascular risk assessment. The test should be repeated after the illness has resolved.
2. Other Potential Causes of Elevation
While cardiovascular inflammation is a primary concern, an elevated hs-CRP can be due to many other conditions that cause chronic inflammation:
Metabolic Syndrome: A cluster of conditions including insulin resistance, high blood pressure, and abdominal obesity.
Infections: Chronic low-grade infections.
Obesity: Fat tissue, especially visceral belly fat, produces inflammatory chemicals.
Smoking: A major cause of systemic inflammation.
Sedentary Lifestyle: Lack of physical activity is linked to higher inflammatory markers.
Poor Diet: Diets high in sugar, refined carbs, and saturated/trans fats can promote inflammation.
Sleep Apnea: Intermittent low oxygen levels during sleep can trigger inflammation.
Periodontal (Gum) Disease: Chronic infection in the gums can lead to systemic inflammation.
Cancer: Some cancers can cause elevated inflammatory markers.
What to Do If Your Hs-CRP is Elevated
An elevated hs-CRP is a warning sign, not a diagnosis. It's a call to action to identify and address the underlying cause.
1. Work With Your Doctor
Your doctor will interpret the result in the context of your overall health. They will:
Rule out an obvious recent illness or infection.
Consider other tests (e.g., for autoimmune conditions).
Assess your overall cardiovascular risk (cholesterol, blood pressure, diabetes screening, family history).
2. Lifestyle Modifications are Key
The most effective way to lower hs-CRP is by addressing the root causes through lifestyle changes.
Adopt an Anti-Inflammatory Diet:
Increase: Fruits, vegetables, whole grains, nuts, seeds, and fatty fish (like salmon and mackerel rich in Omega-3s).
Decrease: Sugar, sugary drinks, refined carbohydrates (white bread, pasta), processed foods, and red meat.
Consider: The Mediterranean diet is an excellent anti-inflammatory eating pattern.
Exercise Regularly:
Aim for at least 150 minutes of moderate-intensity aerobic exercise (like brisk walking, cycling) or 75 minutes of vigorous exercise per week.
Regular exercise is a powerful anti-inflammatory.
Achieve and Maintain a Healthy Weight:
Losing even 5-10% of your body weight can significantly reduce inflammation.
If You Smoke, Quit: This is one of the most impactful actions you can take.
Manage Stress: Chronic stress elevates cortisol and other inflammatory chemicals. Practice techniques like meditation, deep breathing, or yoga.
Prioritize Sleep: Aim for 7-9 hours of quality sleep per night. Address sleep disorders like sleep apnea.
Practice Good Oral Hygiene: Floss and brush regularly to control gum disease.
3. Medical Interventions
Depending on your overall risk, your doctor might recommend:
Statins: These cholesterol-lowering drugs also have a powerful anti-inflammatory effect and are proven to reduce hs-CRP levels and cardiovascular events.
Low-Dose Aspirin: For some high-risk individuals, this may be recommended (always under a doctor's supervision).
Summary
Elevated hs-CRP = Low-grade, chronic inflammation in the body.
Its most critical implication is an increased risk for heart attack and stroke.
It is a modifiable risk factor. Through significant lifestyle changes and, if necessary, medication, you can lower your hs-CRP and, more importantly, your overall health risk.
Disclaimer: This information is for educational purposes only. Always consult with your healthcare provider for a proper diagnosis and personalized treatment plan based on your specific health situation.
Core Components of Metabolic Dysfunction
The dysfunction typically involves problems in several key areas:
Insulin Resistance: This is the cornerstone. Your body's cells stop responding effectively to the hormone insulin. As a result, the pancreas pumps out more and more insulin to try to get glucose into the cells, leading to high insulin levels (hyperinsulinemia).
Dyslipidemia: An unhealthy pattern of blood lipids (fats), often characterized by:
High triglycerides
Low levels of HDL ("good") cholesterol
High levels of small, dense LDL ("bad") cholesterol particles
Central (Abdominal) Obesity: Excess fat stored around the organs in the abdomen (visceral fat) is highly metabolically active and releases inflammatory substances that drive insulin resistance.
Hypertension (High Blood Pressure): Often linked to insulin resistance and the associated changes in blood vessel function and kidney fluid handling.
Dysregulated Blood Sugar: This can range from mildly elevated fasting blood glucose to full-blown Type 2 Diabetes.
Chronic, Low-Grade Inflammation: The body is in a constant state of mild inflammation, driven by signals from excess visceral fat and other tissues.
Hepatic Steatosis (Non-Alcoholic Fatty Liver Disease - NAFLD): The buildup of fat in the liver, which is a direct consequence of the metabolic overload.
The Clinical Diagnosis: Metabolic Syndrome
When these dysfunctions cluster together in a specific way, it's often diagnosed as Metabolic Syndrome. While definitions vary slightly, a common one (from the International Diabetes Federation) requires central obesity plus two of the following:
Elevated triglycerides: ≥150 mg/dL (or on treatment)
Reduced HDL cholesterol: <40 mg/dL in men, <50 mg/dL in women (or on treatment)
Elevated blood pressure: Systolic ≥130 or Diastolic ≥85 mmHg (or on treatment)
Metabolic dysfunction is a classic example of a condition arising from the interaction between genetics and lifestyle.
Primary Drivers (Lifestyle):
Diet: High intake of ultra-processed foods, sugary beverages, refined carbohydrates, and unhealthy fats.
Physical Inactivity: A sedentary lifestyle reduces the muscles' demand for glucose, worsening insulin resistance.
Chronic Stress: Leads to elevated cortisol, which promotes fat storage in the abdomen and increases blood sugar.
Inadequate Sleep: Disrupts hormones that regulate appetite (ghrelin and leptin) and increases insulin resistance.
Underlying Factors:
Genetics: A family history of Type 2 Diabetes or heart disease increases susceptibility.
Age: Risk increases with age.
Hormonal Changes: Conditions like PCOS (Polycystic Ovary Syndrome) are strongly linked to insulin resistance.
Consequences and Long-Term Risks
If left unaddressed, metabolic dysfunction significantly increases the risk for:
Cardiovascular Disease: Heart attack and stroke. This is the most significant risk.
Type 2 Diabetes: The progressive failure of the pancreas to overcome insulin resistance.
Non-Alcoholic Steatohepatitis (NASH) and Cirrhosis: The progression of fatty liver to inflammation and scarring.
Chronic Kidney Disease.
Certain Cancers: Such as breast, colon, and pancreatic cancer.
Neurodegenerative Diseases: Like Alzheimer's disease, sometimes referred to as "Type 3 Diabetes" due to its link to insulin resistance in the brain.
Management and Treatment
The good news is that metabolic dysfunction is largely preventable and reversible through comprehensive lifestyle changes. Medication may be used, but lifestyle is the foundation.
Dietary Changes:
Focus on Whole Foods: Prioritize vegetables, fruits, lean proteins, and healthy fats (like those in avocados, nuts, and olive oil).
Reduce Refined Carbs and Sugar: Cut out sugary drinks, white bread, pastries, and processed snacks.
Increase Fiber: From vegetables, legumes, and whole grains.
Physical Activity:
Aerobic Exercise: Aim for at least 150 minutes of moderate-intensity exercise (like brisk walking) per week.
Resistance Training: Building muscle mass (2-3 times per week) improves the body's ability to use glucose and improves insulin sensitivity.
Weight Management: Even a 5-10% reduction in body weight can dramatically improve insulin resistance, blood pressure, and lipid levels.
Stress Management and Sleep:
Practices like mindfulness, meditation, and ensuring 7-9 hours of quality sleep per night are crucial for regulating metabolic hormones.
Medications:
If lifestyle changes aren't enough, doctors may prescribe medications for specific issues:
Metformin: For improving insulin sensitivity.
Statins: For high cholesterol.
Blood Pressure medications.
In summary, metabolic dysfunction is a systemic problem rooted in modern lifestyle patterns. Addressing it requires a holistic approach that focuses on the underlying causes rather than just treating individual symptoms like high blood pressure or cholesterol in isolation.
