New Doctor, New Rules?

[badatmath]

Anyone in Boston might be interested in BOSTON HEART
CHOLESTEROL BALANCE test. https://bostonheartdiagnostics.com/...6/02031115-CBT-Treatment-Algorithm_160108.pdf

"Studies show patients with the highest cholesterol production get the greatest benefit from statin therapy in terms of LDL-C lowering and heart disease risk reduction, while those with elevated cholesterol absorption get the least"

My rudimentary understanding is that it is supposed to show more about why your cholesterol might be high: hyper responder to it in food, overproduced in your own body, impaired ability to clear it from your body and that finding these sterols in your blood provides clues.

It looks kind of cool honestly though whether it is of use I cannot say. I thought some of you might like to look at it.

 

[sengsational]

I've warmed up slightly on actively treating the causes of ASCVD. There are more and better choices, and a higher awareness of what to watch out for. There's PSK9 inhibitors, that have a different mechanism of action. But it depends on risk. The sad fact is that a huge fraction of us are going down because of ASCVD, and you can actually take steps to prevent the progression of that.

 

[athena53]

My rudimentary understanding is that it is supposed to show more about why your cholesterol might be high: hyper responder to it in food, overproduced in your own body, impaired ability to clear it from your body and that finding these sterols in your blood provides clues.

It looks kind of cool honestly though whether it is of use I cannot say. I thought some of you might like to look at it.

I'd sure like to try that. In one podcast I listened to a doctor stated that "high cholesterol is an abnormal lab result", implying that statins may not solve any underlying issue, just bring the numbers down. It would be good to know WHY the result is abnormal to the treatment could be better-focused.

 

[braumeister]

It looks kind of cool honestly though whether it is of use I cannot say. I thought some of you might like to look at it.

A proprietary test you can only get from them?
Pass.

 

[badatmath]

I don't really know if you can only get it from them. I ran across the information by pure chance when I was looking for something else and thought I'd share.

If available I might do it in a gee whiz way that people do 23&me or whatever but I don't have time to look at it further right now.

I agree with you athena though, making the numbers better that may not really solve the underlying issue. . .

 

[braumeister]

I don't really know if you can only get it from them.

Seems pretty clear on their website:

Boston Heart is the only company that offers a complete understanding of cholesterol production and absorption pathways through the proprietary Boston Heart Cholesterol Balance test.

 

[Koolau]

A thing I have learned from the internet recently is that some patients are refusing to be weighed as they find it offensive if the doctor even suggests that losing weight would help their condition.

But I can see some overworked and disinterested doctors just not bringing up any topics that might upset the patient in order to get them out the door quicker.

Interesting take.



My PCP (that didn't notice my weight loss) is VERY good about going over my blood tests. He'll spend 30 minutes with me for a (wait for it) 30 minute appointment. I never feel rushed nor short changed - except he seems to have different emphases than other doctors. SO, is it neglect? Indifference? "Rushing?" Disinterest? I don't think so. I think it's just that each doc has his/her own "things" they look at or emphasize. I'd like to think there is more science than art in medicine, but everything I've seen in the past 10 years suggests to me that it IS more art than science. YMMV

 

[brett]

The physician at my recent check up very much focused on weight, diet, alcohol consumption, exercise, blood pressure, blood sugars, and cholesterol levels. The last few blood results took up half the time. Plus the usual...past issues, family history.

The last check up I had was 12 years prior. Similar process except that I was on the edge and should reduce my weight, change my diet, and get more exercise to maintain acceptable cholesterol levels I had just retired from a position that entailed longer hours, lots of travel and entertainment.

I followed that advice from 12 years ago. We both still do. Travel made a huge positive impact on our respective diets. I started to see a significant difference in 6-12 months. Dropped weight, changed diet, and took more exercise. Seemed straightforward and logical at the time so we both followed it. That regime no doubt contributed to my current results and level of health.

 

[Koolau]

After seeing this post I googled how much money is made from statins. In 2019 Pfizer made 2 billion dollars from Lipitor in the US. I also have some friends that work in the medical field that have read the Pubmed studies on statins and except for a small group of patients that meet certain criteria statins can do more harm than good. It’s actually scary when some types of drugs are overprescribed.

I'm a "consumer" of drugs so I understand folks upset with the "evil drug companies" for "gauging" and advertising and all the other stuff that makes drug companies so "popular" these days. Having said that, I think we're way better off having these evil companies trying to make a profit off of our need for their products. Do we need to be our own advocates with our docs? You bethca. But do we throw the baby out with the bath water when it comes to consuming drugs? I think not. We all have to decide for ourselves (hopefully with the help of our physicians) in making the risk-benefit decision.

My statin costs less than $5/3-months and has lowered my numbers to "amazing" in the eyes of my doc. IF I have significant side-effects from it, I'm not aware of them.

As far as drug companies making a lot of money: I always ask "Do you own their stock?"

 

[Teacher Terry]

I'm a "consumer" of drugs so I understand folks upset with the "evil drug companies" for "gauging" and advertising and all the other stuff that makes drug companies so "popular" these days. Having said that, I think we're way better off having these evil companies trying to make a profit off of our need for their products. Do we need to be our own advocates with our docs? You bethca. But do we throw the baby out with the bath water when it comes to consuming drugs? I think not. We all have to decide for ourselves (hopefully with the help of our physicians) in making the risk-benefit decision.

My statin costs less than $5/3-months and has lowered my numbers to "amazing" in the eyes of my doc. IF I have significant side-effects from it, I'm not aware of them.

As far as drug companies making a lot of money: I always ask "Do you own their stock?"

I realize that drug companies need to make money in order to develop new drugs. If I remember your situation correctly you are male with a serious heart condition so you are the type of person that was studied and taking a statin is in your best interest.

What I object to is making a blanket recommendation that most people should take statins which is what’s happening. I take a beta blocker for my HBP and tachycardia because it’s genetic and I would have been dead at 50 without the medication.

They keep lowering the criteria for HBP which would mean medication will get prescribed to more people and some will not need it. Studies also show that as people age their BP increases and doctors used to recognize that but current recommendations are ignoring that.

I am against this one size fits all for healthcare. While I trust my doctors I also do my own research and make my own decisions because in the end only I will suffer the consequences of those decisions.

 

[FindingForward]

NONE, not even one of my 5 doctors, from PCP to heart specialist has suggested I lose weight - ever. When I did, not one of them noticed. I asked PCP why they take the weight if they don't pay attention to it. No answer.

You can blame today's PC world for that. An extended family member of mine is a physical therapist. For every 1 lb of excess weight on the human body, the stress and impact is MULTIPLIED many times over in terms of additional stress on the knees and hips.

While many of her patients complaining of knee and hip pain are extremely overweight with poor BP and other vitals and very little interest in exercise or diet, she is prohibited from suggesting weight loss or mentioning it at all as a potential cause or mitigating factor, as it "insults" the patient and they get upset. This is a serious medical issue, yet she has gotten in trouble with her supervisors and written up for mentioning weight.

Docs won't mention weight or counsel their patients - they just keep writing scripts for therapy and expecting PTs to fix the problem, but there's zero chance of any significant progress without addressing the root issue.

Extra weight on the joints leads to injury eventually. People just don't want to hear it and like to blame the messenger.

 

[bmcgonig]

To no one in particular..Take statins or don’t take statins but for heaven’s sake stop with the idea that a doctor making 300k a year cares diddly about how much money he or she’s going to make from your $2 generic statin prescription.

Many doctors now are just sick of the whole discussion. They ask you if they want them. If you don’t, that’s on you.

 

[brett]

You can blame today's PC world for that. An extended family member of mine is a physical therapist. For every 1 lb of excess weight on the human body, the stress and impact is MULTIPLIED many times over in terms of additional stress on the knees and hips.

While many of her patients complaining of knee and hip pain are extremely overweight with poor BP and other vitals and very little interest in exercise or diet, she is prohibited from suggesting weight loss or mentioning it at all as a potential cause or mitigating factor, as it "insults" the patient and they get upset. This is a serious medical issue, yet she has gotten in trouble with her supervisors and written up for mentioning weight.

Docs won't mention weight or counsel their patients - they just keep writing scripts for therapy and expecting PTs to fix the problem, but there's zero chance of any significant progress without addressing the root issue.

Extra weight on the joints leads to injury eventually. People just don't want to hear it and like to blame the messenger.

My spouse was a health professional for years. She saw this day in and day out.

The staff at the clinic where she worked sometimes wondered why people bothered coming to the clinic. They never followed the advice. Good health is a two way street.

The physcians got tired of seeing grossly obese people asking for a weight loss pill so that they could continue stuffing their faces with food that had no food value. And complaining, as above, about aches and pains when their only exercise was to from the sofa to the fridge/pantry or from the front door to the car. There is no secret that a piece of fresh fruit, etc. is better than a big bag of Cheetos and a bottle of pop or beer. Or some fat and chemical laden fast food...supersized of course that has zero nutritional value.

My belief is that there are a lot of very lazy people out there who have incredibly poor eating and lifestyle habits. Is is any wonder why North Americans are the most over medicated in world while at the same time having unenviable mortality rates?

My guess is that a good third of physician visits could be eliminated if patients took a little responsibility for their own health outcomes instead of engaging in lifestyles and diets that reduce their lifespans, quality of life, etc.

When I go to the MD I do not want to be pampered. I want straight goods. If I am too fat then tell me that I am obese or that I am well on my way to becoming obese. Ditto for cholesterol, blood sugars, etc. Then it is up to me to do my bit.

I would rather my physician say drop 40lbs you fat so and so rather than 'it might be good if you lost a little weight'. Unless you want to drop dead from a heart attack or become one of the many who are now diabetic because of years of excessive and poor eating habits. Or all the other related ailments, aches, and pains. No room for any misunderstanding then. And as your physician this is how I recommend you do it. Gradually, without risk to your health and with long lasting results/success.

And two years later if I am back in the same office, another 10lbs heavier, with the same issues I wonder why the physician would even want me as a patient. What would be the point?

 

[athena53]

My spouse was a health professional for years. She saw this day in and day out.
<snip>
My belief is that there are a lot of very lazy people out there who have incredibly poor eating and lifestyle habits. Is is any wonder why North Americans are the most over medicated in world while at the same time having unenviable mortality rates?

Total agreement here. When I post elsewhere about how we could greatly reduce healthcare costs by "preventing what's preventable" I am immediately flamed for fat-shaming. Umm, I never brought up the F-word. They did.

Health insurance is priced on a "cost-plus" basis. If they pay less than the minimum % (80 or 85% IIRC) of premiums out as claim payments they have to give the difference back to policyholders as dividends. Reduce the cost of care, the premium MUST come down.

I know Stuff Happens no matter how healthy our lifestyle and all of us know many examples of that including ourselves- but it can make a huge difference.

As for weigh-ins: About 15 years ago my doc told me I was edging towards an Obese BMI at 147 lbs. and 5'7". I could blame menopause but I'd also remarried and DH's comfort food cooking was very good and I wasn't exercising portion control. I slowly dropped 20 lbs. and have kept them off. In my case, the weigh-in was a wakeup call.

 

[badatmath]

Well now they would tell you 147 is down right thin because the other patients your height have gotten so much bigger. . .

 

[athena53]

Well now they would tell you 147 is down right thin because the other patients your height have gotten so much bigger. . .

I know! But I feel good at this weight and one of the things I can do to keep my mitral valve prolapse from getting worse (yeah, I'm a Stuff Happens example) is keep my weight down.

Every time I get bloodwork I shudder at the double-wide chairs they have in the phlebotomy room. They would honestly fit two of me.

 

[badatmath]

I know! But I feel good at this weight and one of the things I can do to keep my mitral valve prolapse from getting worse (yeah, I'm a Stuff Happens example) is keep my weight down.

Every time I get bloodwork I shudder at the double-wide chairs they have in the phlebotomy room. They would honestly fit two of me.

I noticed that a couple weeks ago myself. They took me to a different room with a huge chair and I was like OMG . . .

 

[Cayman]

"Evidence based medicine" ... a phrase I excitedly embraced 20+ years ago as an enthusiastic 30+ year old. Alas we're not there. Today, many practices have evidence based guidelines (and many don't) but that's just the beginning. Things get in the way. For example your provider may or may not be aware of current scientific evidence. Your provider may place too much weight on his/her opinion or personal preference and may ignore the best science/clinical guidelines.

Fun "fact" per Harvard Business Review: It takes hospitals and clinics about 17 years to adopt a practice or treatment after the first systematic evidence shows it helps patients. https://hbr.org/2019/08/4-ways-to-make-evidence-based-practice-the-norm-in-health-care

Why physicians don't follow clinical practice guidelines: https://www.acc.org/~/media/Non-Cli...cian knowledge,or behavior (external barriers.

 

[badatmath]

Seems pretty clear on their website:

Mayos appears to have a test for it though IDK under what circumstances they give it or if insurance covers it: https://www.mayocliniclabs.com/test-catalog/overview/82079

This is one of those topics people really take a deep dive in or not. I kind of . . . not . . . but if it was readily available at my local lab for a small fee I might do it KWIM?

 

[brett]

Some people do not want to hear the truth. They want it surrounded by soft words so they can justify to themselves doing absolutely nothing and making no effort or sacrifice to improve their own health.

In my spouse's experience these are the ones who constantly moan and groan about their aches and pains. It would seemingly never occur to them to accurately follow medical advice or basic common sense.

And they are the same ones who ring up or come in asking about the latest Rx drug advert that will give them the lifestyle displayed in the advert. They do not really want to put any effort into their own well being. Somehow they think taking a pill that they saw on TV or heard about from their neighbor's cousin will solve everything.

I have a sister who does exactly this. We see it first hand. It is poor me, poor me. When it comes to doing what she needs to do for her health and well being, what her specialists advise her...well she knows better. She follows it for three days, then she is off the wagon so to speak. No surprise about that.

 

[catii]

I have "heard" that doctors that work for large corporations are "graded" on how well they follow "rules" like prescribe x or order y.

No way to know if this is accurate but I could believe it.

You'd better believe that it's accurate! A 100% bullseye!

I had a PCP appointment yesterday, a few months after he bought into the iggest medical corporation in the country. He's been our PCP since we moved here in 1991, & I had been keeping his network up & running for the past 25, so I had a pretty good idea on how he was doing.

We spent the entire hour (!!) talking about how sorry he is that he made the changeover. First, he was shocked that all but one of his long-time staff were terminated. Second, he no longer has the ability to schedule time with patients. Instead, he has to see four per hour, no matter what their medical problems may be. He skipped lunch to talk with me. Third, they changed his office to a much-larger one, & put 3 other doctors in with him. But the real shock came when none of his old paper medical records were available, & when he complained, he found that they had been burned!

The company did contact us, & gave us two weeks to pick up our old records, which DW & I did. But our son didn't get there in time, so his only records are those that were captured electronically by the hospital, other doctors, etc. His lawyer shrugged, & said that was perfectly legal, as he had been given time to retrieve them. My records were more than two inches thick!

Anyway, our PCP said that he had been tired of "running a business," including personnel, billing, etc. That's now all taken care of, but he now spends even more time trying to work with the company's "modern software." He had me time how long it took him to decrease the dosage on one of my prescriptions: it took him 16 minutes! He claimed that that had only taken him a few seconds, with his old software.

Now, he's thinking about retiring, which would have panicked us, except his new contract states that he owes the company 5 years of his services! DW & I are already planning on what to do when he does depart! He's a few years younger than I am, & he knows our problems far better than these youngsters!

 

[RetiredHappy]

To no one in particular..Take statins or don’t take statins but for heaven’s sake stop with the idea that a doctor making 300k a year cares diddly about how much money he or she’s going to make from your $2 generic statin prescription.

Many doctors now are just sick of the whole discussion. They ask you if they want them. If you don’t, that’s on you.

+1

I will start by saying that my last comprehensive blood work in Sept 2023 was described by my PCP as "Perfect lab work and I have not seen one like this amongst all my patients for many years."

I had always had borderline high cholesterol (200-240 range), with LDL at 130+. I have been with my PCP since 2017 and it took him 2 years to talk me into agreeing to start with low dose statin when my LDL finally hit 150. 10mg Atorvastatin and my LDL came down to 50 to 60 with every half yearly bood work, and has remained there since.

In April of this year my PCP asked if I had a cardiac artery calcium scan done before and if I were interested, and I said absolutely. My score came in as 0 and risk of heart attack over the next 10 years is 0. One remark on the report said "Statin not recommended." The person preparing the report did not know my cholesterol level and whether I was on statin or not. I much prefer to be on statin because I am in a good LDL range now and statin has given me ZERO side effects. About half the people whom I come across started statin and stopped within a month because it gave them aches. They would be reporting the same aches if they were taking placebos. There are so many anti-statin movements out there that it has caused personal biases in taking statins.

My husband has been taking statins for at least 2 decades and has no side effects.

Statins is not the enemy but the negativity promoted against statins is not doing any favors to people who need them but refuse to get on.

 

[athena53]

About half the people whom I come across started statin and stopped within a month because it gave them aches. They would be reporting the same aches if they were taking placebos. There are so many anti-statin movements out there that it has caused personal biases in taking statins.

I'm glad they're working for you but some of us have/had real side effects. I started on Prevastatin in 2014 (supposedly one with the lowest risk of side effects). Yes, it brought the numbers down but over a period of months I was having episodes of pain in my elbow joints so severe it hurt to raise a spoon to my mouth. I was starting to feel pain in my knees. I hadn't done any research on side effects since my parents had been taking them for years and I tolerate meds pretty well. And pain is extremely rare for me unless there's some logical explanation (e.g., just rode 20 miles the day before).
Yes, this WAS a possible side effect. I threw them out. Over a period of months the pains went away.

So, no, it wasn't in my mind. If my cardiologist ever thinks they're needed in my specific case I'm willing to try again- maybe a different type, lower dose, careful monitoring- but those pains were NOT psychosomatic.

 

[RetiredHappy]

I'm glad they're working for you but some of us have/had real side effects. I started on Prevastatin in 2014 (supposedly one with the lowest risk of side effects). Yes, it brought the numbers down but over a period of months I was having episodes of pain in my elbow joints so severe it hurt to raise a spoon to my mouth. I was starting to feel pain in my knees. I hadn't done any research on side effects since my parents had been taking them for years and I tolerate meds pretty well. And pain is extremely rare for me unless there's some logical explanation (e.g., just rode 20 miles the day before).
Yes, this WAS a possible side effect. I threw them out. Over a period of months the pains went away.

So, no, it wasn't in my mind. If my cardiologist ever thinks they're needed in my specific case I'm willing to try again- maybe a different type, lower dose, careful monitoring- but those pains were NOT psychosomatic.

What was the dosage? Maybe higher dosages cause more problems?

A close friend of ours has always had very high cholesterol, in the 300s and was prescribed high dose of statin. He encountered muscle pains on the first 3 statins and he is now on one that he has no side effects.

What I am saying is that I know of way too many people where they have pains all the time or that they think they have new pains because they are now on statins. This really good golfer friend is always having painful joints and she is currently not on statin. She was prescribed statin but she stopped within a week because it gave her joint pains. Heck, she had joint pains way before she started on statins. She had a TIA and hence she was put on a statin. Now no statin and she may get another TIA or worse.

 

[Koolau]

What was the dosage? Maybe higher dosages cause more problems?

A close friend of ours has always had very high cholesterol, in the 300s and was prescribed high dose of statin. He encountered muscle pains on the first 3 statins and he is now on one that he has no side effects.

What I am saying is that I know of way too many people where they have pains all the time or that they think they have new pains because they are now on statins. This really good golfer friend is always having painful joints and she is currently not on statin. She was prescribed statin but she stopped within a week because it gave her joint pains. Heck, she had joint pains way before she started on statins. She had a TIA and hence she was put on a statin. Now no statin and she may get another TIA or worse.

It's unfortunate but there is a "truism" of drugs: Drugs without side effects are drugs without therapeutic effect.

Doctors and patients have to play the game of finding the best effect with fewest side effects. The more powerful the drug, the more powerful the side effects in many cases. That is why I have no problem with drug companies who produce "me too" drugs. The side-effect profiles may well be different (better?) for a slightly different drug which accomplishes similar therapeutic effects. There are many examples where a "me too" is effective and tolerable where the original causes too many side effects. Just one more in a long list of "issues" with drugs (and drug companies and the gummints that regulate them.) YMMV