just a factor just to pause there just to make sure that everybody's following along so when you were holding up you know the tennis ball right what you're talking about essentially is that let's say that there are these lipoproteins that are floating around the blood and you know they may have you know cholesterol inside of them so damage which can come in all sorts of different forms we're gonna go through a whole list of like one of the top things that damage those those that endothelial lining and then you end up having like sort of like a little bit of a a pothole and then these cholesterol you know these lipoproteins get stuck there right and so that's what you're talking about in terms of like you know you have had some damage and now these lipoproteins that are floating around have gotten stuck in this little this little divot

exactly right and it starts with the endothelial dysfunction so maybe we'll backtrack there before you go fully into the calcium score because that's kind of like a late-stage finding so sometimes I'll use an algae of like subway stations you know the first stop is endothelial dysfunction so to define it your endothelium is the inner lining of your arteries it's one cell thick that coats the entirety of the 60,000 miles of blood vessels that you have so that one cell has multiple functions but one of them is to release something called nitric oxide nitric oxide is signaling molecule when it's produced on the artery wall it will cause that artery wall to relax the muscle under the endothelium so this is gonna keep flow normal this is gonna keep your blood pressure optimized but when nitric oxide becomes low things tend to start sticking to the artery so for younger people they may not remember what Teflon actually is but when you have high levels of nitric oxide the lipoproteins the white blood cells the platelets they just zoom on through the lumen kind of like a maglev train and just slide right through but once you have endothelial damage the gel coat above it the glycocholics damage then these lipoproteins start sticking there the white blood cells start sticking there like velcro and they may get retained into the artery wall the body is basically in his senses and attack you know bacteria is attacking it so the white blood cells come out they start gobbling the stuff up and that starts causing inflammation in the wall so their arteries start swelling you can monitor that with a particular type of carotid skin called a carotid intermimidial fitness test but if that process is allowed to go on then these kind of like baby soft black start rolling and then eventually the body will start trying to scar it down but again may take many years and once it scars it down it may calcify it as a stabilizing factor and that will get picked up on one of the CT coordinate calcium scans but again that's a kind of a later stage finding so often you'll see on you know social media where other people will say well cholesterol doesn't matter because my calcium score is zero that just means you're not late to the game you don't have calcified plaques in your artery but you'd have a bunch of soft plaques still building up and you wouldn't know that unless you want to go looking for it with some of the non-vision tests I know you've had or doing some other advanced testing that looks at the endothelial health yeah

and actually you were the one and dr.