The Curious Case of Cholesterol Meds

What to do about your cholesterol?  That’s a rather complicated answer now-a-days! First, if you have diabetes or have known coronary artery disease, the answer is pretty clear: get on a statin med (statins are a class of cholesterol meds that include Lipitor, Zocor, Pravachol, Crestor and their generics) and make sure your bad cholesterol (LDL) is under 80.  If you don’t, well, let’s have a conversation.

For those with high cholesterol that can’t be controlled with exercise and diet, medicines have been the answer and have been prescribed now for years.   If one medicine didn’t work, time to increase the dose, change to another med, or add a second medicine from a different class.   The common thought in medicine was that anything that could get the cholesterol lower was a good thing and was good for patients.  However, in the past couple of years, we’ve found that some meds that lower cholesterol don’t lower risk for heart disease (niacin) or may even increase the risk (Zetia).  We’ve also found that for those with very little risk for heart disease, the benefits of any medicine at all may be very small.  

First, if you’re older than a teenager you really should know your cholesterol and have had a discussion with a medical professional about what it means.   If you’re already on cholesterol meds and you are not diabetic or have no known heart disease, please visit with your doctor and discuss with him your overall risk for heart disease and the relative benefit you would get from medicine.  There are calculators that can be used to determine that risk. It may be that you are getting a big benefit from the meds, or it may be that you are not.

Let me give you an example of a middle aged man with whom I’m very familiar (Ok, it’s me, and I’m sharing some pretty personal information – hopefully that won’t be used to steal my identity!)  My most recent total cholesterol was 209 with a good cholesterol (HLD) of 39 and a bad (LDL) of 156.  I’m not very proud of these numbers and in the past would have been inclined to discuss cholesterol meds with someone with similar findings.  However, where I have very few risk factors other than a sub-optimal cholesterol panel, my 10 year risk for some type of heart event is only 8%.  If I were to go on cholesterol meds and get my levels to more optimal ranges, I could decrease my 10 year risk to 5%.

So, let’s see.  With meds I have a 92% chance of not having an event in the next 10 years, and with the meds I would have a 95% chance of not having an event.  Are the costs (prescriptions, office visits, labs) and potential side effects (muscle aches, memory effects, liver inflammation)  worth that extra 3%?  I thought not and have been involved in an aggressive exercise regimen and improved diet (still struggling with chocolate). 

Don’t get me wrong.  I am a strong believer in medication for cholesterol and for many it is truly a life or death issue - please don’t change any of your meds without first discussing them with your doctor!  But in addition to your cholesterol number, you need to know your risk in order to determine if meds are right for you.  And remember, exercise and a healthy diet are always helpful in preventing heart disease!  The side effects (more energy, increased stamina, better self-esteem, lower risk for other diseases) aren’t bad either!  Until next time, keep on moving and stay out of the pantry!

Eat More Fish!

Some misconceptions about the flu shot

Flu Shot Time Again!

The cool in the air combined with falling leaves in the mountains reminds us all flu season is fast approaching. While we encourage all to receive the shot, if you’re under 5 and over 50, or you’ve a chronic illness such as asthma or diabetes, you’re at high risk for complications of influenza and should receive a shot.  These complications include pneumonia, dehydration and hospitalization.   The only true contraindication for the shot is a history of severe egg allergy or having had a serious reaction to a previous flu shot.

In an effort to encourage more of our community members to receive the flu shot, I’d like to address some of the misconceptions regarding the shot. 

1. “The flu shot gives me the flu”.  While older forms of the vaccine may have caused occasional fever and body aches, the current, more purified form causes very few side effects.  The flu shot only protects against true influenza (a severe respiratory infection associated with high fevers, body aches and cough) not against the many other respiratory viruses that can cause colds and, at times, more serious respiratory illnesses similar to influenza.  “Stomach Flu” (nausea, vomiting and diarrhea) is causes by intestinal viruses unrelated to true influenza.  Having the flu shot will not protect you against all viruses, but it will protect you against the most serious virus, influenza, that we see each winter.
2. “The flu shot is not safe in young children”.  The safety and efficacy of influenza vaccination in children has been well studied.  While we do not recommend the flu shot for children under 6 months of age, we highly recommend it for those 6 months to 5 years.  They are at particular risk of suffering complications from influenza.  The side effects of the shot are minimal and there has been nothing to suggest that adding the flu shot to their regular vaccinations is harmful. The shot can be given even when the child is suffering from a cold. 
3. “Pregnant women should not be vaccinated”.  Pregnant women are actually included in those considered high risk of influenza complications.  Not only is it safe, it is highly recommended for all women who will be pregnant during the flu season.

We encourage all those at high risk and any others who wish to receive the vaccine to call your local clinic today to arrange for a shot.  We also recommend any who have close contact with high risk individuals to have the flu shot. There's no shortage of vaccine this year, so do yourself and those at risk around you a favor. Go get that shot!

Sun Rise at Deep Creek.  Thousand Lake Mountain

Dr. C's Keys to a happy life

A hardy hello! from the land of red rock desert, flat topped mountains, spectacular vistas and the nicest people on earth!  There's a saying in medicine, "If all the world's a stage, doctors get a front row seat."  Well, for nearly 20 years now I've been sitting in that seat doing my best to help peoples lives be better - trying to help them be "happy" if you will.  While each individuals circumstances are unique, here's some things that I think can help us all:

 Dr. C’s Keys to a Happy Life

1. Smile.  While we can’t always change situations, we can change our attitude. Besides, it’s contagious!
2. Develop healthy habits.  What you can do for yourself is much more than your doctor can do for you.
3. Be active in your church.  Spiritual health improves emotional and physical health.
4. Exercise, exercise, exercise!  It’s the fountain of youth.
5. Have regular medical checkups; know your blood pressure and cholesterol and have recommended cancer screening.
6. Enjoy life.  Each day is a wonderful gift with its special moments.  Find them.  Relax, enjoy, love, live.
7. Food is wonderful, but not in excess.  Emphasize small portions with a lot of raw fruits and vegetables.  Go easy on the junk food and fat.  Remember, obesity is second only to tobacco as a preventable cause of disease.
8. Sleep an average of 8 hours daily.  Benefit from its healing and rejuvenation.
9. Seat belts, helmets and life jackets.  Accidents are the leading cause of death between the ages of 5 and 40.
10. Make time for family and friends.  After all, when all is said and done, happiness is found in our relationships with others.

Have a great day!  

San Rafael with my children.