My Cardiologist Is Applying to my Insurance Company to See if I Can Have a $6,500 Injection.

[NNadir]

I apparently have a problematic aortic valve that murmurs sweetly (aortic stenosis), which if I read the literature correctly, means I can drop dead at anytime. For severe aortic stenosis - mine is described as moderate but worsening - life expectancy for someone my age is about three years. That of course is average, some people die more quickly, some last longer.

It's related to my elevated LDL levels, which my cardiologist believes is not related to my diet - I haven't eaten a mammal or bird in close to 50 years - but to my genetics, he says. (I'm not sure about this; I have to look it up.)

He told me he'll contact my insurance company to see if I can have an injection of inclisiran, which is a swell RNA drug with which I have some familiarity in a scientific sense.

Statins don't touch it, and in any case, I have developed after 30 years on statins, great muscular sensitivity to them.

This is amusing: The doctor has to ask the insurance company it's OK.

If it happens I'm not around here anymore, having disappeared suddenly, this is a potential reason for the outcome.

I'm not all that upset about any of it; I've had a long and wonderful life and a sense of mortality makes it more precious, but I will confess to doing some Kubler Ross type bargaining.

I mean, I got to fall in love and to be parent to two wonderful young men.

By the way, I don't have a problem with the cost of the drug. I understand intimately the costs that went into developing it. The economic implications of "one and done" shots is highly problematic, and I confess that I do like to get paid for what I do, and, if doses are rare, the cost has to be covered high per dose prices.

We'll see what happens; there are multiple treatment options, including valve replacement but the ethics of the expense strike me as worthy of consideration. Money spent on an old man is not quite as valuable as that spent on a younger person.

[murielm99]

1. I want you to stick around.

We need you.

[Swede]

2. I wish you the best of luck Nnadir.

I don't know if how you chose your DU name, but this is what comes up for "nadir".

Nadir is part of the galaxy of scientific words that have come to us from Arabic, a language that has made important contributions to the English lexicon especially in the fields of mathematics, astronomy, medicine, and chemistry. The source of nadir is naḍhīr, meaning "opposite"—the opposite, that is, of the zenith, the highest point of the celestial sphere which is positioned vertically above the observer. (The word zenith itself is a modification of another Arabic word that means "the way over one's head.&quot According to our sources, usage of nadir reached an apex in the 1980s. But worry not for the word’s future: it’s still flying high.

Synonyms of nadir
Relevance
depth
zero
abyss
Examples of nadir in a Sentence
Nantucket reached its nadir in the post-Civil War period. The whaling industry had become moribund, many New Englanders had been lured to California by the discovery of gold, and the island population dropped from ten thousand in 1830 to scarcely more than three thousand in 1880.
—David H. Wood, Antiques, August 1995
But then, at the very nadir of that dark abandoned moment, that moment of despair and sickness unto death, …
—T. Coraghessan Boyle, The Road to Wellville, 1993
My nadir was the time I presented an oral book report on "Les Misérables," having read only the Classic Comics version …
—Stephen Jay Gould, New York Times Book Review, 12 Oct. 1986
The relationship between the two countries reached a nadir in the 1920s.
the discussion really reached its nadir when people resorted to name-calling
Recent Examples on the Web
Examples are automatically compiled from online sources to show current usage. Read More
Tudor bears ultimate responsibility for Spurs’ latest nadir in Madrid for starting Kinsky, and his treatment of the 22-year-old Czech was brutal.
—Oliver Kay, New York Times, 10 Mar. 2026
Born in the nadir of the Great Depression, SAG began as an act of self-preservation in response to demands by the major Hollywood studios that the talent pool eat a 50 percent salary cut.
—Thomas Doherty, HollywoodReporter, 28 Feb. 2026
Four years ago, the women’s figure skating event was the absolute nadir of the Beijing Winter Games, after a trio of teenagers from Russia finished the competition in tears under the cloud of a positive doping test by Kamila Valieva.
—Sara Germano, Sportico.com, 23 Feb. 2026
Tang’s last three seasons have not matched his first, a series of diminishing returns that are reaching their nadir this year.
—Dana O’Neil, CNN Money, 17 Feb. 2026

Word History
Etymology
Middle English, from Middle French, from Arabic naḍhīr opposite

First Known Use
15th century, in the meaning defined at sense 1

Time Traveler
The first known use of nadir was in the 15th century
See more words from the same century
Rhymes for nadir
aider
fader
grader
kadir
prader
raider
schrader
seder
shader
trader
crusader
invader
Browse Nearby Words
NADH
nadir
nadiral
Articles Related to nadir
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Cite this Entry
Style

MLA
“Nadir.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/nadir. Accessed 15 Mar. 2026.

[NNadir]

5. The etymology of my screen name is rather simple.

Last edited Sun Mar 15, 2026, 05:48 PM - Edit history (1)

After the travesty of the 2000 Presidential election there was a lot of carrying on about the effect of Ralph Nader on the election in Florida.

The first blog on which I wrote was one called "Smirking Chimp" which was populated by pro-Nader and anti-Nader types.

I have never had any use his holiness Ralph Nader, and so signed up as "NaderNadir," meaning his anti-Gore campaign was a "nadir" for that asshole.

When I migrated to DU - the best American leftist political blog on the internet - I didn't want to bring along that asshole's name, since people sometimes abbreviated it to "Nader" so I dropped the "-ader."

We have, since 2000, certainly reached a new "nadir" as a country, I think, interrupted by the glorious Obama and Biden years.

[niyad]

34. Do you know that Jeff Tiedrich (smirking chimp) has a substack

column, "Everyone's Entitled To My Opinion"? I read it with my coffee in hand every morning.

[surfered]

3. I know 2 people who just had surgery to replace that valve. Both doing fine

[NNadir]

6. Yes, I've looked into it. I find it amazing that it can now be done without open heart surgery, via catheter.

I'd love to know how that works. If it comes to it, I'll definitely look into how it does so. I just might do so anyway.

[ratchiweenie]

4. I hope it is approved and that it works. Even a few years more, once we are quite elderly, is a true gift. Let us know

what happens.

[LuckyCharms]

7. This is purely anecdotal...

I used to take my mom to all of her doctor's visits.

During a visit when she was around 80 years old, we were told that she had aortic stenosis that was pretty severe, and her options at that time were very limited. The cardiologist balked at surgery, which he said in her case, there was about a 20% chance of failure.

I remember walking my mom back to my vehicle, and then going back in to speak to the cardiologist one-on-one. He told me that she likely had less than a year to live. I broke down in the office and had to compose myself before going back to the car to bring my mom home.

As it happened, she lasted about another 14 years, and died at age of 94 due to something unrelated to her heart.

This was years ago, and I'm sure that there have been improvements in treatment, including the Inclisiran, which appears to have been placed on the market in 2021.

Try to keep positive thoughts, and push the dark thoughts away. You're a smart guy, and you will naturally pursue the options that are right for you in your case.

Tell yourself that you will likely be around for awhile...I'm sure that you will be.

[NNadir]

9. Keep up with this optimistic anecdotal stuff and...

...I'll punch you in the eye! (A joke between my friend Lucky for any potential alerters around here.)

[LuckyCharms]

10. .

Seriously...no dark thoughts. I'm the only one here who is allowed to have dark thoughts!

You're going to do what you need to do.

Your knowledge and intuition will inform your decision on how to proceed.

You're not going to drop dead. You're going to be alright.

[niyad]

32. Hey, who said you could have my dark thoughts???

[niyad]

31. Oh, geez, do I have to separate you two AGAIN?

[Polly Hennessey]

8. You are not allowed to leave, just yet.

I would say you are worth far more than $6,500. Worth is immeasurable, or so I have heard. 🤗🍀👍

[OLDMDDEM]

11. Keep us informed. I hope this works for you.

[Cheezoholic]

12. Need ya to stick around and keep irritating folks with the facts and edumacating the rest of us ;). Good luck !! n/t

[EndlessMaze]

13. I got my aortic valve replaced 5 years ago.

I was ambivalent about getting the surgery, but it worked out great, and the recovery time was tolerable. Now I'm retired, and in my late 60s. Totally worth it. Even if I have to endure the orange nemesis.

[gay texan]

14. Please stick around as i enjoy your science writings n/t

[LoisB]

15. Positive thoughts for approval. Whatever treatment you ultimately choose, I pray that it

resolves the problem. Many an old person has more "worth" than many a young person (in my humble opinion). We don't cease to be valuable because we are old.

[jfz9580m]

16. I am sorry to hear that NNadir

Let’s hope for the best. 🤞
These things aren’t that mathematical wrt human health. Hopefully you beat the odds whatever you choose..

[AltairIV]

17. Hoping for the best for you!

[Gore1FL]

18. Mine was rejected. I ended up with Repatha. My LDL's are negligible at this point.

It's twice-a-month self-injection vs twice a year injection by a medical professional.

[area51]

19. I wish you the best.

And F the insurance companies.

[AverageOldGuy]

20. So . . .

Let's see -- we have two options:

1. Spend $6,500 to save a life.
2. Spend the $6,500 on another bespoke suit from a London tailor for the pharma CEO.

[Norrrm]

21. So we can figure a three year review for possible approval?

We can just wait him out.

[hamsterjill]

22. Nothing to add to all of the already heartwarming posts, but

Just wanted to wish you all the very best. Please keep us posted on the status. Take the best care of yourself possible, and as I'm sure you already know (I can tell from your attitude!!!) don't stop living.

[dalton99a]

23. Ask to see an interventional cardiologist about TAVR

https://www.mayoclinic.org/tests-procedures/transcatheter-aortic-valve-replacement/about/pac-20384698
Transcatheter aortic valve replacement (TAVR)

[NNadir]

36. I've already looked into this case. It's intriguingly cool.

If it comes to that I'll certainly look into the details.

[LetMyPeopleVote]

24. I wish you the best

[erronis]

25. I know you're a spring cluck, but aren't you on Medicare? And if so, is it covered?

I just started a new immunotherapy drug for CLL (leukemia) that is listed at $18,000 per month (60 tablets) - taken the rest of my life. My copay per month would be around $2,000 which wouldn't be possible.

Someone mentioned a grant that would cover the copay and I am extremely grateful to the generosity of the grantor. The other benefit is that the first month's copay covered my "donut hole" so I have no more "covered" drug payments this year.

The US healthcare system, especially pharmaceuticals, is extremely messed up.

Anyway, I wish you the best - especially since I need your frequent excursions into science and other strong opinions.

[h2ebits]

26. Thank you. I needed this today.

I just saw a cardiologist for the first time. I had an echo cardiogram on Thursday and am awaiting the arrival of the heart monitor that I will be wearing for a month.

A one sentence "Results" for the echo has been posted to my account . I'm assuming that more information will be added but last night I did my armchair analysis via Internet--revealing next to nothing.

Obviously, there is a problem with my heart but I can't share it with my kids and family until I get an actual diagnosis and directions for moving forward so this is a scary time for me.

Please listen and take heart.

It is great to have the DU community here offering support. And, while it is support for you, it is also support for the rest of the community, as well.

Thank you for sharing. And thank you to all who have commented.

I am a grateful member of the DU community.

[jfz9580m]

27. All the best to you

Yes it is a great (dammit ..great, like ..so many words ruined by Trump, Facebook etc) community.

I wish you all the best. Let’s hope it turns out to be nothing.

[h2ebits]

30. Thanks for your thoughts.

[littlemissmartypants]

28. NN, I'm befuddled by this and frustrated with my lack of a response for this news.

It's awful and unfair but time marching is going to find all of us. It will be a great loss if you go. I will miss you, enormously. Thank you for being a great teacher and friend.

We love you. Stay encouraged. ❤️

[blm]

29. Rooting for you, NNadir.

🫶🏽

[niyad]

33. Vibes for the very best possible outcome, my friend.

[multigraincracker]

35. Best of luck. I have 4 cardiologist and I proved them all wrong.

A a very strong heart, but like me. Can’t count. Have a pace maker do it can keep up with me.
I figure longevity is like diarrhea, runs in your genes. Have to subtract a couple for life style. But both were miserable after 85 and lived another 6.
Figure I’m past my “best if used by” date.
I’ve been the luckiest man in the world. Half of it good luck and half of it bad luck

[harumph]

37. Do not short change yourself - valve replacements are done every day.

[retread]

38. I'm sure you've looked into it. What are the outcomes of the replacement vs the injection for a man of your age and

health?

[femmedem]

39. It sounds to me as if you might have high lipoprotein (a), which is genetic.

Last edited Mon Mar 16, 2026, 01:31 PM - Edit history (1)

Inclisiran injections reduce it somewhat, but for the first time, there are more effective treatments doing well in phase 3 clinical trials. I believe one of the drugs' clinical trials will be ending this year, and others within the next several years.

I understand your concern about spending money on someone nearing the end of their lifespan, and I don't know how old you are. But I think the argument about how many resources to spend on saving your life as opposed to a younger person's would be more applicable to something like an organ transplant, where there are only so many organs to go around. There's lots of money in this world, and most of it is being spent on worse things than extending your life.

And if you can get a valve replacement or other effective treatment for the aortic stenosis, if I'm right and the root problem is high lipoprotein (a), if you can make it through these next couple of years, incredibly effective treatment is on its way.

And for folks who don't know about lipoprotein(a), doctors usually don't test for it unless you ask. But because of the new treatments on the horizon, it might make sense to get tested, especially if you have a family history of early cardiovascular problems. I do, so I got tested. Mine is stratospherically high--in the worst 1%, almost 4x the point at which people see problems. So I'm reducing any other risk factors as much as possible, hoping to increase my odds of being here when those drugs become available.

[NNadir]

43. Thanks. To be perfectly honest I only see four trials for PCSK9 inhibitors in aortic stenosis, three in China, one...

...in Korea.

Many of the other arteriosclerosis lipoprotein A related studies actually include inclisiran either as a co-administration agent or as a standalone; some with statins, for which I have developed either a tolerance or, as I suspect, a degree of hypersensitivity. I am experiencing the muscular issues..

In my career in drug development, I've come to understand that getting to a phase 3 trial is not an indication that a drug is safe and effective; if it were, there would be no reason to do a phase 3 trial. I have been around phase 3 trials that completed without the drug being approved, a famous case in which I was peripherally involved being omapatrilat, a dual ACE/NEP inhibitor, which failed in phase 3 owing to an incidence of angioedema in a subset of patients. (I tend to think that with modern molecular biology screening, it would have been possible for the drug to have been approved; it addressed a refractory population, generally African American who do not respond well to traditional blood pressure medicines.)

In any case, I don't think my case requires waiting for an additional treatment option in clinical trials. In the worst case, I will need a TAVR, which I've already begun investigating on an admittedly superficial level at this point. I only recommend the use of experimental treatments to friends and colleagues who ask for my comments in situations in which no viable approved treatment options exist, such as certain cancers.

There is an online calculator for TAVR risk which I've used. The risk of a fatal failure is reported for my age, GFR (which is required for some reason) is about 1.5%. It's not preferable to zero risk, but isn't all that bad either.

In a sense, PCSK9 inhibitors are a case of shutting the barn door after the horses escape to use the well worn cliche. It is possible that inclisiran will slow progression of the disease somewhat, but will not reverse it, at least from my preliminary understanding as I look into the matter in the literature.

It is interesting that of my six maternal aunts, three of them, as well as my mother, were reported to have rheumatic fever related valve disease. One of my aunts was the tenth person ever to have an artificial heart valve replacement - obviously open heart, not TAVR. She lived for about 15 years after the procedure if memory serves me well. Whether the etiology of their syndromes was in fact related to rheumatic fever or represented a genetic case is interesting to consider. During their lives diagnostic tools of the type we have today simply did not exist. None of my three maternal uncles had valve disease. Only three of my affected aunts died from heart disease, the one who was the tenth case, and two of her sisters, although one was in her mid 80's, a long well lived life, and the other who passed suddenly in her 60s despite life long heart issues. My mother did not live long enough to develop full blown heart disease; she died of a brain tumor at 51.

No one in my paternal family exhibited heart disease, although it appears that my paternal uncle and father had a genetic anomality known as Barrett's esophagus, which I have apparently inherited. I've outlived both of them. This syndrome triggers cancer upon exposure to nitrosamines, to which both my father and uncle were exposed owing to their really bad cigarette addictions. I may have been exposed to nitrosamines from an unexpected complication related to making the synthesis of valsartan "greener," recycling DMF. I get routinely checked: So far, so good.

The molecular biology of lipoprotein A strikes me as interesting, and may involve an allosteric interaction if I'm reading my preliminary papers from the literature correctly, and I'm looking into it both out of curiosity and personal interest. Thank you for stimulating that interest.

Thanks as well for your comments and suggestions. Right now I'm happy with my medical care which strikes me as sufficiently reasonable. It's a bit unnerving to recognize this syndrome, to be sure, but I've been increasingly aware of my mortality as time goes on, and frankly, regard mortality in a positive light, as it makes life precious in a sense. Facing a risk gives me an excuse to say some things I have wanted to say to my sons and to my wife without being overly morbid.

I have lived a life better than I deserved I think. I can't argue with it.

[femmedem]

44. I understand what you mean about the positives of mortality.

My husband and I have become more conscious of the preciousness of life, too. We're more appreciative of each other, of family, of birdsong and sunrises--really, of any calm moment.

Your scientific knowledge far exceeds mine, and I thank you for taking the time to share so much information. And it sounds like despite your comfort with your own mortality, you're pursuing treatment and have good medical care. I'm glad. I've always appreciated your posts, and hope for both our sakes that I'll be reading them for years.

You probably already found this, but in case you didn't and are still enjoying digging around, pelacarsen is the drug in phase 3 trials that has me most hopeful. https://www.managedhealthcareexecutive.com/view/new-therapies-on-the-way-to-lower-lp-a-a-cardiovascular-risk-factor

[NNadir]

45. Thanks. The drugs listed in the link are all "me too" PCSK9 inhibitors in the siRNA class except Muvalaplin, which...

looks novel. It has a certain beautiful 3 fold symmetry, as I looked at the structure.

I don't know much about it though. Again, I don't think I'm a candidate.

Thanks again for your kind words. I'll try to keep on living as long as I can. (I would very much like to outlive the orange pedophile in the White House and toast Niyad and Orrex.)

[Ms. Toad]

40. Make sure they are measuring your apolipoprotein B (apo(b))

A friend of mine had a heart attack that was likely preventable had they been monitoring apo(B), rather than the standard cholesterol. He was dead for a few minutes - fortunately, he happened to be with a cardiac surgeon at the time who knew the best steps to take to keep him alive.

There is a lot of hype about diet and serum cholesterol (often correlated, but not always, and causation v. correlation is not always clear), and about serum cholesterol and heart attacks (again - often correlated, but not always, and causation v. correlation is not always clear).

Statins are miracle drugs for lowering serum cholesterol - but if that isn't the cause of of the condition, it won't help (as in your case) - and the cost of the magic is that the same mechanism that blocks cholesterol production (forcing your body to pull cholesterol from the blood) also blocks production of other things your body needs. (CoQ10, for one.)

I've got high serum cholesterol - but zero cardiac calcification. There's a lot we don't know yet.

[yardwork]

41. Wishing you good health for years to come!

I would miss you very much.

[Skittles]

42. not sure which is worse

the doc having to plead with insurance, or the fact that one shot costs $6500

it's all just disgusting......wishing the best for you my sweet

[hatrack]

46. Fingers crossed for approval . . . .

We don't agree on everything in E&E, but you serve a valuable function there - keeping people honest!