TromboneAl
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
- Joined
- Jun 30, 2006
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- 12,880
How many of you spent more time choosing a doctor than choosing a car?
So how do we explain my MIL who had high cholesterol (around 300) and lived to nearly 95 with no indication of heart disease? There is much more going on that we understand when it comes to heart disease and cholesterol.
This article pretty much sums up my and my doc's opinion on cholesterol numbers and there relevance to heart attack risk.
What your cholesterol number really says - CNN.com
Buckeye said:So how do we explain my MIL who had high cholesterol (around 300) and lived to nearly 95 with no indication of heart disease? There is much more going on that we understand when it comes to heart disease and cholesterol.
This article pretty much sums up my and my doc's opinion on cholesterol numbers and there relevance to heart attack risk.
What your cholesterol number really says - CNN.com
How many of you spent more time choosing a doctor than choosing a car?
It seems to me that we all need to eat healthy and get some exercise. And it also seems that doctors are quick to prescrbe drugs for every little thing that could be a problem, partially because the drug companies have a very good sales force who persuade them to push their products. And statins are the best example of this that I can think of.
In contrast: The Cholesterol Myths
Which ones are those, and how do we know that the 'right protocols and recommendations' are really what is best?
These are documents hammered out by committees, which may have members who just like congressmen have their constituencies. The protocols are not the original journal papers, and they may not very faithfully reflect all the evidence, including the unpopular evidence.Hi ERD50
Clinical guidelines, protocols, and recommendations can be found at AAFP, Epocrates, or at the National Guideline Clearinghouse. For example try National Guideline Clearinghouse | Home and search "diabetes" to find Screening and Management details. You can also find guidelines and protocols at associations' websites, i.e.
https://www.aace.com/publications/guidelines
I also use sometimes emedicine or 5 minute consult to find additional information re: latest treatment protocols. I am sorry that the situation looks like a mess to you.
Hi ERD50
Clinical guidelines, protocols, and recommendations can be found at ...
OTOH, statins are very good at treating numbers, and doctors are very good at focusing on numbers. So it's kind of a marriage made in heaven, from that point of view. But to me, this is an example of confusing a variably useful metric with the outcome the patient is interested in-a meaningfully longer, more pleasant life.
Ha
ERD50 said:Thanks for the reply, but it leaves me hungry. Haha's post echoes my sentiments.
And specifically:
Yes, exactly! And I have a lot of empathy for the Doctors on this. Let's be real - they have a job to do,and are pressed for time, and with all these variables and the inability to really control the environment of the patient, it's tough to really know what is best. But if a number is considered 'bad', and prescribing a drug makes that number 'better', it makes the Doctor look good (and he/she may well be doing good). Who wouldn't want to do something that makes them appear to be doing good? So I suspect there is some built in bias on the Doctor's part to prescribe these statins. The numbers come down (they almost always do), so it all looks good, everyone (Doctor & patient) appears to be happy. As haha says 'a marriage made in heaven'.
But, did fixing the 'number' really improve the patients (on average) quality of life? That's not so clear to me. My doctor has me on statins, but he did give me 6 months to try exercise/diet, so I'll give him some credit there, it wasn't a totally automatic reaction. But I also know it means coming back every six months for Lab work, and that means regular $ in his pocket. That's fine if it is needed, but does it cloud his judgement? A little? A lot? Not at all? Who knows?
My son is in his third year of Pharmacy school, I guess I should challenge him on this, see what he's got.
-ERD50
These are documents hammered out by committees, which may have members who just like congressmen have their constituencies. The protocols are not the original journal papers, and they may not very faithfully reflect all the evidence, including the unpopular evidence.
The studies are usually easy enough to find, although it takes an excellent medical library to carry paper copies of even all the main journals, and sometimes various journals restrict electronic access to subscribers.
At any rate, the large, randomized clinical studies mostly show some improvement in both all cause mortality, and specifically cardiovascular mortality. But it is small, and given the various side effects and occasional disasters it seems like a rational decision to at least consider sitting out this game.
OTOH, statins are very good at treating LDL numbers, and doctors are very good at focusing on LDL numbers. So it's kind of a marriage made in heaven from that point of view. But to me, this is an example of confusing a variably useful metric with the outcome the patient is interested in-a meaningfully longer, more pleasant life.
Ha
Haha's post echoes my sentiments.
I guess I need to heed the doctor's advice to limit the high cholesterol food I take.
The more I read, the more confuse I become. What do my numbers really mean? In any case, I don't want my bad cholesterol to go higher and I know I won't want to go on medication for high cholesterol. Someone in the thread asked me to check my triglycerides which is ok standing at 0.9 mmol/L. I guess I need to heed the doctor's advice to limit the high cholesterol food I take. So, here's my action plan:-
Food Intake - (a) take oatmeal with almond flakes/bananas (great suggestion from some of the contributors in this thread). Unfortunately, DH bought 2 large bags of instant oatmeal - so will finish those before I buy the non-instant ones. (b) Include fenugreek in my diet - I have friends who swear that this will work. (c) Cut down (but not eliminate) on red meat (which I love), animal skin, liver, egg yolks, sausages, cheese and similar high cholesterol products. (d) Eat more fish, vegetables, fruits and nuts. (e) Hopefully, very hopefully, eat less carbohydrate.
Exercise - increase my exercise level to ensure my heart gets a good cardiovascular exercise. I already exercise 6 days a week. Now, I will push myself at each exercise session - just bought a new pair of running shoes - it's time to start serious jogging again to replace the usual brisk walk.
My medical report suggests I take my blood test again in 4 months time - wonder whether this is really necessary. Will check with the doctor in due course. Hope all this will work!
More and more, I'm becoming convinced that this is a religious dispute.
these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.
Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
There is one side that understands, interprets, accepts and applies medical science. The other side does not.
these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.
Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
I completely understand what you are saying. It has much to do with the point I was trying to make. There are constraints on a doctor's freely derived opinions of evidence. You can't get picked off if you are in the middle of the herd. That is one reason why it may be naive to believe that doctor always knows best, at least as judged by what he says which as you point out might be different from his unfettered judgment.Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.
Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
obgyn65 said:Ha - these are documents that may be hammered out by committees, but these documents also protect me and my license in a court of law and in front of my peers. I do not practice medicine to include popular or unpopular evidence in it, just what protects my patients and my license. I know this sounds strange, but that the state of today's medicine we are in.
Like all clinicians, I have a license to protect. Therefore I must practice defensible medicine first.
braumeister said:More and more, I'm becoming convinced that this is a religious dispute. Those that subscribe to the cholesterol hypothesis and those of the low carb persuasion are just practicing different religions. Neither is likely to convince the other to cross over to the dark side (although it happens).
This is probably my final post on the topic, because I really don't see the value in further discussion of it.