Cholesterol Lowering and Drugs

I do not claim to be perfect but I DO claim to be a good doctor.  Not just a good psychiatrist.  Being a good doctor comes first.

One reason is that despite a lot of medical practice since graduation (I will admit to wincing a bit when I quote the figure in years–34) in multiple specialties, I still believe that taking care of other human beings and trying to help them through life is a sacred trust.  I actually believe that doing what I do the best I can is more important to whatever religious future my soul can scrape up than showing up at public worship.  Honest.

Another reason that I am a good doctor is that I am old enough that an amazing amount of bad medical things have happened to me.  Often before I knew better, they were the side effects of prescription drugs.  I now accept them only as temporary solutions.  I would rather dive into the world of alternative natural substances — which do work — if the practitioner is someone who knows what they are doing which I do.

I have lived long enough to have survived drug-induced hepatitis from a statin drug.

Any of them can do it.

I was in a mental health clinic.  My husband and I were in Northern California, finishing up a temporary assignment in a clinic where the chief wanted nothing more than to finish his career and open a small winery.  We were living in (and my agency was paying for) a picturesque and overpriced vacation cottage.  As we walked outside to the car in the morning I would pass a bush that gave out a crackling noise.  I loved watching the snails destroying the foliage, and fought the impulse to capture them in a jar with a couple of leaves, because I thought they would make excellent pets.

I even dreamed of becoming a professional “snail wrangler” — an excellent career if I ever retired from medicine.

At least I knew I could deal with any stampedes.

Now, I have no plans to retire from medicine mainly because I don’t expect anyone but me to even try to fight our broken system with enough force to try to make medicine work.

I started throwing up between patients, and nausea slowly became a constant companion.  It became an extra effort to remain my cheery loveable self.

My husband and I had decided I could hold it together until I finished the assignment, when we drove to a VA, where I was well known.

They told me to stop two drugs.  One, metformin, and old standby commonly used blood sugar lowering drug, was NOT the culprit. (Drug developed in France — hooray for our side.)  I have been on it since with absolutely no ill effect, as have millions of folks.  Still, it has side effects for plenty, too.

The culprit was a statin drug.  My liver enzymes were elevated, which means a few of those noble cells (I will never forget the  hepatologist who once kept me immobilized for several hours at a cocktail party trying to convince me that the liver is more important than the brain) died dead as door nails and released some of their constituent enzymes into my blood stream.  Of course, a couple of these cells have got to die — everything in our bodies including bone degenerates and regenerates — but it took a lot of months for my blood tests measuring my liver function in this way to get back to normal.

I remember finding out that these drugs, statins, were recommended to more and more patients.  I remember learning that cholesterol levels in the population were higher and more frequent, and becoming a problem in adolescents, who were being recommended these drugs more and more frequently.

I have found things on routine blood tests of patients that made me want to get them off statins, which, since they are not psychiatric drugs, I would never have prescribed.  I shall spare you a discussion of my rabid multiple attempts to get patients off these drugs in favor of a list of potential side effects.

Oy!

Let’s start with the basics.  How does someone determine that a cholesterol level is too high?

What I remember memorizing in medical school is exactly the same number quoted in a Wikipedia article on how normal lab levels are determined; 95% of the population has to have them. People allegedly test humongous amounts of people’s blood to figure out what they are.

We have a problem already.

According to this article, half of all adults between ages 40 and 75 are eligible for statins, the class of drugs that screwed up my liver.

The “normal” cholesterol determination may be dead wrong here, if half of the folks are eligible and 95% of the folks have to be normal to say normal is normal.

But wait, there’s more.

Anybody besides me notice this article is from yahoo FINANCE?  Somebody has got to be thinking that if people have high cholesterol, we can sell them drugs.

Numbers and statistics and prediction are fairly easy; quality of life is tough.

The highest cholesterol numbers I have ever seen in my life, I saw when treating eating disorders.  Your body needs a little cholesterol, or else it will go crazy trying to make some.

Oy.

But wait, there’s more.

I was induced to write this article now because this is in the news.  For once, I was overjoyed to see the response of the medical community, who raised the question — does this new kind of drug actually help prevent heart disease, which is why we are all worried about cholesterol in the first place?  We need to wait to really know about both safety and efficacy. We also need to separate marketing from medical efficacy.

The Atkins Diet seems to have helped many people lower their cholesterol, and there are several articles that reflect this.  There are also some that do not, and the literature is a mess.  I have read a lot of his stuff.

No single diet is good for everyone and you really do need a personal health professional to lead you through this mess.

To be more exact, no diet works for anyone, mostly because you have to go off it sometime, unless you have some form of obsessive-compulsive disorder and need instructions in detail for everything — in which case you have other problems.

Dr. Atkins did say that any doctor should be able to think of at least three ways to lower cholesterol without drugs.

There are so many ways to attack this problem that even the hyper-mainstream Medical News has a page on how to do this.

Although supplements seem to help, it is not just a matter of stop-the-prescription and take the red yeast, even though the Mayo clinic has a useful — if a tad cynical — page on supplements.

Cholesterol takes months to change, and supplements take months to work, as do all serious attempts to treat this sort of thing.

There are the ubiquitous lifestyle factors.  You’ve got to exercise in this sedentary world.  This seems to be especially difficult for postmenopausal women. Me, I have a private ballet instructor and intend to locate and hire one wherever I move.  I will perform at some point, silly comic dances of my own invention, whether or not anybody has the insight to pay me.

This is fun, whereas normal exercise is boring.

I have studied and loved the dance for a long time.  This is a lifestyle factor.  In general, if people want to do something regularly they have to like it, even love it.

If your happiness is throwing around a basketball with the girls then do it. Me, the idea of any kind of competitive sport makes me want to barf–and I have not taken any statins for many years. You know — there is something you actually enjoy that involves leaving your seat on the couch.  Even walking, presumably in a place you actually like, is good.

This shows that everyone, even an over educated excessively cerebral older woman, can find a way to exercise.

With computer medical records, hard copy charts, although everywhere, seem pretty useless.  Me, I “pump” them between patients instead of iron.  My muscle tone is not good enough to reduce my unsightly “matronly upper arms” but it is getting better.

Diets? We know they don’t work.  Just avoid over-processed foods, designed to line the pockets of their manufacturers by getting you addicted to them, and keep it simple, like your ancestors of about two generations ago when obesity was not a problem. We need more common sense, less obsession with numbers.

We need to think — not have knee-jerk responses like needing pills because we have bad numbers on blood tests.