Bear Down Wildcats

I ask because staying off prescription drugs is important to me. Doctors who push meds without considering side effects and other options bug me. So when Doc had the cholesterol talk with us (we're both moderately high but have very good ratios) we reluctantly tried them for a month. We both felt like shit: brain fog and muscle pain. I also had a liver reaction which shitcanned the whole thing. We bailed and I did some research (always dangerous) and insisted on a CT scan.

https://www.msn.com/en-us/health/medica ... li=BBnb7Kz" target="_blank

The result was 0.00 and Doc agreed the statins were unnecessary. Does anyone who has gone the statin route, or has opted not to go with statins, have a pertinent experience? Statins deliver blockbuster revenues but I think they are over prescribed and have many potentially debilitative side effects.

Dunno if it's helpful but my wife is a nurse in the cardiac unit and is getting her master's soon. She shoulda been a doctor! I could ask her opinion, especially since she's not a doctor she tells shit like it is and isn't selling anything.

scumdevils86 wrote:Dunno if it's helpful but my wife is a nurse in the cardiac unit and is getting her master's soon. She shoulda been a doctor! I could ask her opinion, especially since she's not a doctor she tells shit like it is and isn't selling anything.

I'd really appreciate that Scum. Statins work, there's no dispute, as long as "work" is defined as lowering cholesterol. But, as always, the totality of the gig is what one lives with. At my age (61) I know lots of older friends and family on statins who have cognitive decline and a general muscular disability both of which could easily be attributed to age but are also statistically likely side effects of statins. If cardiological standards are all that is applied to statins then they are nirvana. Life, on the other hand, is more complicated.

Good discussion and I do tell it like it is.

Yes they are over prescribed, the hdl/ldl ratio and Framingham risk score carries higher predictive ability of 10yr risk for MI and stroke then a number. After you’ve had your first mi or stroke the number becomes much more important. Of course lower ldl the better but you have to take everything into account and the statin side effects are very real and underreported in the literature.

As a doc here’s my advice...many of us in our profession work on autopilot. It’s sad and it pisses me off because that mentality is bad for patient care and bad for outcomes. That being said the days of kick backs from prescribing practices are generally long gone or at least on their way out; most of us are affiliated with a health system the prohibits that, less so for those with their own clinics.

Question your doctors. Make sure they explain things in a way that you understand. My personal test is if my patient can go home and answer the question to their family and friends “what did you talk to the doctor about today” and answer it to their ability about the managment and plan then I’ve done my job. That is as important if not more than most things we can do in a treatment plan.

Also find a doc that works off data but isn’t beholden to it and can individualize the treatment. Too many practice algorithmic cook book medicine with out considering the literature behind it. There are too many lazy docs out there and I feel for the patients that have to suffer for it.

I’m not immune to my own blindpsots either, but I make a concert effort to keep learning, be chanlleged by peers, to see each patient and the issue they deal with as new to me, even if it’s my 10th case for the day, it’s new and unique to that person. Practice with a beginners mind as the Buddhist would say. This approach has served me well and it make sound cocky, arrogant, confident, whatever; damn good at what I do.

CalStateTempe wrote:Good discussion and I do tell it like it is.

Yes they are over prescribed, the hdl/ldl ratio and Framingham risk score carries higher predictive ability of 10yr risk for MI and stroke then a number. After you’ve had your first mi or stroke the number becomes much more important. Of course lower ldl the better but you have to take everything into account and the statin side effects are very real and underreported in the literature.

As a doc here’s my advice...many of us in our profession work on autopilot. It’s sad and it pisses me off because that mentality is bad for patient care and bad for outcomes. That being said the days of kick backs from prescribing practices are generally long gone or at least on their way out; most of us are affiliated with a health system the prohibits that, less so for those with their own clinics.

Question your doctors. Make sure they explain things in a way that you understand. My personal test is if my patient can go home and answer the question to their family and friends “what did you talk to the doctor about today” and answer it to their ability about the managment and plan then I’ve done my job. That is as important if not more than most things we can do in a treatment plan.

Also find a doc that works off data but isn’t beholden to it and can individualize the treatment. Too many practice algorithmic cook book medicine with out considering the literature behind it. There are too many lazy docs out there and I feel for the patients that have to suffer for it.

I’m not immune to my own blindpsots either, but I make a concert effort to keep learning, be chanlleged by peers, to see each patient and the issue they deal with as new to me, even if it’s my 10th case for the day, it’s new and unique to that person. Practice with a beginners mind as the Buddhist would say. This approach has served me well and it make sound cocky, arrogant, confident, whatever; damn good at what I do.

Great post man. I don't claim to know much about the medical world but I've learned a lot from my wife about stuff and I'm always glad to see this. I'll have to convince her the stranger from the sports board said so

My doctor wanted to prescribe them, so I bargained with her: Give me few months to bring my numbers into the safe range through diet and exercise. It worked, the numbers have stayed where they are for years, and the doctor never brought it up again.

CalStateTempe wrote:Good discussion and I do tell it like it is.

Yes they are over prescribed, the hdl/ldl ratio and Framingham risk score carries higher predictive ability of 10yr risk for MI and stroke then a number. After you’ve had your first mi or stroke the number becomes much more important. Of course lower ldl the better but you have to take everything into account and the statin side effects are very real and underreported in the literature.

As a doc here’s my advice...many of us in our profession work on autopilot. It’s sad and it pisses me off because that mentality is bad for patient care and bad for outcomes. That being said the days of kick backs from prescribing practices are generally long gone or at least on their way out; most of us are affiliated with a health system the prohibits that, less so for those with their own clinics.

Question your doctors. Make sure they explain things in a way that you understand. My personal test is if my patient can go home and answer the question to their family and friends “what did you talk to the doctor about today” and answer it to their ability about the managment and plan then I’ve done my job. That is as important if not more than most things we can do in a treatment plan.

Also find a doc that works off data but isn’t beholden to it and can individualize the treatment. Too many practice algorithmic cook book medicine with out considering the literature behind it. There are too many lazy docs out there and I feel for the patients that have to suffer for it.

I’m not immune to my own blindpsots either, but I make a concert effort to keep learning, be chanlleged by peers, to see each patient and the issue they deal with as new to me, even if it’s my 10th case for the day, it’s new and unique to that person. Practice with a beginners mind as the Buddhist would say. This approach has served me well and it make sound cocky, arrogant, confident, whatever; damn good at what I do.

I wish you were my PCP. When I can have a 15 minute discussion with my Doc, given the amount of research and proactive lifestyle/diet/exercise investment on my part, there is almost always a non-pharma option to any emerging health condition. But if your Doc is averse to the standard of discourse you lay out above, it's a tough slog that leads to over-prescription and myriad interactions and side effects. Thanks for your input.

Longhorned wrote:My doctor wanted to prescribe them, so I bargained with her: Give me few months to bring my numbers into the safe range through diet and exercise. It worked, the numbers have stayed where they are for years, and the doctor never brought it up again.

Yup...for most people, not everyone, 6 mo of concerted effort of diet and exercise, is a good approach for trying to turn things around. Of course age and stage of life plays a role as well.

Longhorned wrote:My doctor wanted to prescribe them, so I bargained with her: Give me few months to bring my numbers into the safe range through diet and exercise. It worked, the numbers have stayed where they are for years, and the doctor never brought it up again.

This is what I did for a number of years, but things change, not only one's numbers, but the medical thresholds as well. Props to you for doing what was needed to manage your blood born fats. Most people can't pull it off, not even close.

dovecanyoncat wrote:
I wish you were my PCP. When I can have a 15 minute discussion with my Doc, given the amount of research and proactive lifestyle/diet/exercise investment on my part, there is almost always a non-pharma option to any emerging health condition. But if your Doc is averse to the standard of discourse you lay out above, it's a tough slog that leads to over-prescription and myriad interactions and side effects. Thanks for your input.

Thank you dove and you’re welcome.

So that is so wrong....I LOVE proactive patients, makes my job easier! I wish I could bottle up half of what you and many of my folks bring to clinic and give it out the rest, people would be so much healthier and better off.

I am of a different generation...my era was all about shared decision making and being a guide. The profession was too paternalistic in previous eras and got burned for it. I was also fortunate to go to training programs that reinforced the mantra as “physician as teacher”. Also, couched as this is my opinion, very few medications truly lifelong medications. Coumadin for afib, sure; antidepressants and various cocktails of antihypertensives and other classes of pharma....they need to be readdressed every 6-12 months. If there is a good medical need then obviously one can be on these medications for life, but only with continuous re-evaluation and not because of chart lore.

CalStateTempe wrote:

dovecanyoncat wrote:
I wish you were my PCP. When I can have a 15 minute discussion with my Doc, given the amount of research and proactive lifestyle/diet/exercise investment on my part, there is almost always a non-pharma option to any emerging health condition. But if your Doc is averse to the standard of discourse you lay out above, it's a tough slog that leads to over-prescription and myriad interactions and side effects. Thanks for your input.

Thank you dove and you’re welcome.

So that is so wrong....I LOVE proactive patients, makes my job easier! I wish I could bottle up half of what you and many of my folks bring to clinic and give it out the rest, people would be so much healthier and better off.

I am of a different generation...my era was all about shared decision making and being a guide. The profession was too paternalistic in previous eras and got burned for it. I was also fortunate to go to training programs that reinforced the mantra as “physician as teacher”. Also, couched as this is my opinion, very few medications truly lifelong medications. Coumadin for afib, sure; antidepressants and various cocktails of antihypertensives and other classes of pharma....they need to be readdressed every 6-12 months. If there is a good medical need then obviously one can be on these medications for life, but only with continuous re-evaluation and not because of chart lore.

You bring up a point that is almost as important as the potentially detrimental health effects
of over prescription: the "need to be readdressed every 6-12 months." I get that it's vitally important to establish a patient's baseline numbers before prescription and to verify efficacy, interaction and tolerance in follow-up. Hell, that only makes sense. But these protocols eventually take over a person's life if they enter the cascade of dependency that a regimen of just 3 or 4 prescription drugs can entail. Even the good Docs have office protocol/software that tells me it's been 6 months, time to come in. Sigh.

True and I’m glad you bring it up. We do work off protocol, but you are right...what if everything is going swimmingly....do you really need that lab draw, that time away from your life, just for what amounts to a social visit, probably not.

I personally am encouraged by the potential of telemedicine and email to address these type of visits for patient convenience.

CalStateTempe wrote:True and I’m glad you bring it up. We do work off protocol, but you are right...what if everything is going swimmingly....do you really need that lab draw, that time away from your life, just for what amounts to a social visit, probably not.

I personally am encouraged by the potential of telemedicine and email to address these type of visits for patient convenience.

In innumerable respects your "work of protocol" is our salvation. My Aunt developed glaucoma within her annual eye exam time period. There probably are countless other examples of how this saves people from detrimental disability. I learned 20 years ago I had to be my own first advocate and to partner with the "autopilot" of protocol. For a lot of people that won't work, and the work you do will ultimately have more effect on them than they will ever appreciate. Sometimes I wonder if my PCP hates me or cherishes me. Ha! that reminds me .... time to schedule my annual cystoscopy. Groan. On the bright side: you just aren't a real man if you haven't been repeatedly catheterized!