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Re: Cholesterol drugs in the elderly
Old 02-19-2007, 01:43 PM   #21
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Re: Cholesterol drugs in the elderly

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Originally Posted by Rich_in_Tampa
The older and more experienced I get, the fewer prescriptions I recommend.

At my local hospital, the nurses have been overheard saying, "Here comes Dr. Rich_in_Tampa. Watch him slash and burn." While a bit of an exaggeration, the policy has stood me (and my patients) well over the years.
I wish more physicians had that mind set. But many have too little time and operate in a society that wants a simple solution.

As I understand some of your Dr role - it is to ensure that providers and very ill patients have the "perfect communication". When well coordinated and thought through, treatments can take critical factors as well as risks and returns into account and a "less is more" approach will generally emerge.

But, with so many variables to consider and so many unknowns, it is not any easy task to achieve that balance on your own - whether dealing with a single issue from the primary care office or more complex multi-problem situtation in a hospital.

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Re: Cholesterol drugs in the elderly
Old 02-19-2007, 01:55 PM   #22
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Re: Cholesterol drugs in the elderly

Quote:
Originally Posted by Sandy
As I understand some of your Dr role - it is to ensure that providers and very ill patients have the "perfect communication". When well coordinated and thought through, treatments can take critical factors as well as risks and returns into account and a "less is more" approach will generally emerge.

But, with so many variables to consider and so many unknowns, it is not any easy task to achieve that balance on your own - whether dealing with a single issue from the primary care office or more complex multi-problem situtation in a hospital.
Well, I oversimplified to make a point, but it can sometimes be "counter-cultural" to practice in that way. Also, there are some boundaries that need to be drawn - patients (assuming unimpaired) who are so far out there in terms of what they insist upon that I am not comfortable being their advocate; if coaching proves unsuccessful in those extreme cases, I have (rarely) bowed out.

It's alot like financial planning, really: dealing with probabilities not certainties; everyone needs to accept some risk for the best outcomes in general; complicated information to process; more than one right way to do things; highly personalized decision making; people doing foolish things despite all efforts to the contrary by others, etc.
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Re: Cholesterol drugs in the elderly
Old 02-20-2007, 08:32 PM   #23
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Re: Cholesterol drugs in the elderly

Hi
I hate when I forget to put in the link. This is a conclusion of the study.
I agree that in many cases doctors tend to overprescribe.On the other hand people living longer tend to have a lot more issues.
Osteoporosis
Arthritis
Diabetes
Blood pressure
cholesterol
So you can expect more medications. Although now a days many of the drug companies are slick . You have pills that have more than one medication. The idea is to improve compliance, but its also good for there bottom line. Since they have a new patent and no generic competion .



Quote:
http://www.medscape.com/viewarticle/444971
Conclusions
The results of PROSPER clearly show that the benefits of statin therapy observed among middle-aged adults are extended to include older patients (> 70 years). Pravastatin, at a dose of 40 mg, was well tolerated and achieved a 15% relative risk reduction in the primary endpoint at 3.2 years follow-up. Treated patients had coronary events significantly reduced by 19% and coronary mortality by 24%; however, the drug did not seem to have an effect on stroke or cognitive function. These results emphasize the need to expand statin therapy to include this elder patient population in order to reduce the incidence of vascular-related events.
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Re: Cholesterol drugs in the elderly
Old 03-16-2007, 04:38 PM   #24
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Re: Cholesterol drugs in the elderly

Here is a related study that questions the overprescription of statins:

http://www.overdosedamerica.com/imag...COMMENTARY.pdf
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Re: Cholesterol drugs in the elderly
Old 03-17-2007, 11:02 AM   #25
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Re: Cholesterol drugs in the elderly

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Originally Posted by Buckeye
We just discovered that my 92.5 year old MIL was prescribed Lipitor by her doctor at her last routine visit. She has no health issues other than high cholesterol. Her health is excellent and always has been. What is he thinking?

Something here makes no sense. The women is alive and healthy at 92+

Why lipitor? Drug companies.
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Re: Cholesterol drugs in the elderly
Old 03-17-2007, 11:44 AM   #26
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Re: Cholesterol drugs in the elderly

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Originally Posted by newguy888
Something here makes no sense. The women is alive and healthy at 92+

Why lipitor? Drug companies.
Maybe.

Or the research suggesting (but not proving in this age group) that statins reduce strokes by 20%. I'll be watching that one carefully.
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Re: Cholesterol drugs in the elderly
Old 03-17-2007, 02:37 PM   #27
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Re: Cholesterol drugs in the elderly

This is odd. My mother has a terminal problem. Multiple atrophy (parkinson like symptoms). Several years ago when she was first exhibiting the problems she was visiting doctor after doctor. Then one doctor saw something in a catscan and thought she had liver cancer. Long story short. He puts her on a statin for high cholesterol. Her cholesterol level was only slightly elevated. Anyway. She eventually move in with us (in a different city). I took her to a new doctor. He quickly took her off the drug. She takes several other drugs. He said that cholesterol was the least of her problems. She takes a baby aspirin as a blood thinner.


She had borderline cholesterol levels. I think doctors now day just prescribe it. I have a marginal level and my doctor is suggesting that I go on a statin. I am going to try to get it in line with diet and exercise.

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Re: Cholesterol drugs in the elderly
Old 03-17-2007, 05:26 PM   #28
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Re: Cholesterol drugs in the elderly

Rich

are you familiar with the discussion about Triglycerides and hdl? Ratios?

The lower the percentage the fatter you LDL would be?

Examples Triglycerides 40 Hdl 60 for a number of <1 60 divided by 40 meaning the LDL is big and fluffy and not a problem with deposits on the artery walls.

Example Triglycerides 500 HDL 35 > 12 means small and dense LDL would be a problem.
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Old 06-02-2007, 10:17 PM   #29
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Hi Ferco!

You may not be aware of the latest on Cholesterol drugs.

A closer look at why Cholesterol versus High blood pressure.
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Old 06-02-2007, 10:27 PM   #30
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It is the goal of the Pharmaceutical industry for every man, woman, child and PET! on the planet to be on some type of drug from birth to cremation.
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Old 06-05-2007, 04:20 PM   #31
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Spot on Alex!
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Old 06-05-2007, 04:25 PM   #32
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It is the goal of the Pharmaceutical industry for every man, woman, child and PET! on the planet to be on some type of drug from birth to cremation.
What?! And miss out on the opportunity to sell some embalming fluid? No way...
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Old 06-05-2007, 08:14 PM   #33
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What?! And miss out on the opportunity to sell some embalming fluid? No way...
oops, I forgot about that one. If Big Pharma has anything to do with embalming fluid, we'll soon be seeing TV ad's that show how "bad" cremation is (unless of course you get embalmed first!) and why embalming and burial is the only way to be responsible.
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Old 06-06-2007, 11:16 AM   #34
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Old 06-07-2007, 09:41 AM   #35
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Just a generic question that arises from the language of some of the quotes above, as well as things I have heard in general conversation:

Why do people say "My doctor put me on ________" or "My doctor took me off ______". To my ear, this sounds strange, as if one has no control over the matter. I would think the doctor makes a recommendation and writes a prescription, but in the end it is the patient who chooses to take a drug or to stop taking a drug. Does it make people feel better to hand control over health outcomes to their doctor so they don't have to think about it? Or are some people intimidated by doctors and will do anything they say? Or maybe its just a figure of speech with no meaning. I don't know.

I honestly intend no criticism of any particular person. It just sounds weird to me and I wonder why people say it. I'm sure I never would.
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Old 06-07-2007, 09:56 AM   #36
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Just a generic question that arises from the language of some of the quotes above, as well as things I have heard in general conversation:
The way it works is this:

If the drug does nothing or causes side-effects, your doctor "put you on" it.

If it works great and has no side-effects, you doctor advised that you research and consider it and make a decision as whether or not you take it. A variation of this situation is that you "asked your doctor to put you on it."

More seriously, your point is well taken. I try hard to present facts, describe uncertainties and do shared decision-making. That's worked pretty well for me so far. Nothing wrong with accepting risk but plenty wrong with being blind-sided by it when it was a know possibility.
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Old 06-07-2007, 10:56 AM   #37
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Quote:
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Why do people say "My doctor put me on ________" or "My doctor took me off ______". To my ear, this sounds strange, as if one has no control over the matter.
My ex-doctor put me on stuff. The one thing that was not allowed was for me to ask a question. She'd angrily say-"How do you know about that?"

Finally I knew I had to move docs, so the last time she asked "How do you know?" I said- you know Doc, likely many of your patients are not the dumb hicks that you seem to think we are.

The only other time I was really annoyed at a doctor was years ago my wife had to see a neurosurgeon. He said, "I think your spine is OK and also you have fantastic tits."

I complained to the department head. About 2 weeks later I got a callback- the offending Doc had died of a brain tumor.

Truth really is stranger than fiction.

Ha
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