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RE: [IP] reasonable?



Hi Sara,

I agree with the other sentiments that you should understand each
recommendation your physician makes.  As a physician, I always try to help my
patients understand the reasons behind my interventions, it not only helps
them feel involved, but greatly increases the rates of compliance with
therapy.

Now the emotional components put aside...what should your cholesterol goals
be, and what meds to take to get there?

The most current consensus from the American Diabetes Association and the
American College of Cardiology Foundation shows your doctor is dead to right
on his recommendations.  I will attach the PDF with some highlighted sections
for you to review, but the whole document is useful in getting the background
information needed for an intuitive understanding of why the recommendations
suggest the things that they do.  The summary of the document essentially is
as follows:

1 - All pts with DM have one "coronary" equivalent in respect to their risk
for heart disease.
2 - Any additional factors only add to your risk (i.e. BMI over 25, smoking,
male>female, family history of cardiovascular events, previous angina or MI,
hypertension, illicit drug or alcohol use)
3 - All DM patients should have a goal of LDL>70!!
4 - Increasing your HDL cholesterol levels helps offset the risks, but the
degree to which it does is not fully elucidated.

So, back to your complaint about your doctor.  Should he take you off Mevacor
(lovastatin) in favor of Zocor (simvastatin)?  Based on your LDL level,
absolutely!  I think he is trying to save you money by choosing simvastatin,
it just went generic a few months ago.  As a diabetic myself I would
preferentially have chosen the proven LDL lowering and HDL increasing statin
Crestor (rovustatin).  It isn't generic, but you get the most LDL lowering
effect and only statin with HDL increasing properties.  So if you were serious
when you said money wasn't the issue you should be asking your doctor about
all the statins and their potential benefits.  At very least you should be
asking about something like Niaspan (slow release niacin) to help increase
your HDL levels.  You do have to be careful because niacin can cause transient
rises in your blood sugar levels as it affects metabolic intermediates.

Is your doctor smart?  Yes.  Is your doctor looking out for your best
interest? Yes.  Is your doctor the best communicator?  Maybe not.  Give him
the consideration that likely most of his patients don't want the detail you
are ready for.  In fact he would probably bore most of them to death in
sharing the nitty gritty details of studies, publications, and on-going
research.  Also you have to keep in mind that with ever declining revenues for
each patient seen (thank you very much medicare/medicaid) your physician
probably has to increase the number of patients he sees every day to just keep
the status quo in terms of paying back loans, paying office staff, etc.  Don't
be surprised if physicians simply "can't" spend time with patients helping
them understand treatment guidelines if less and less if paid for their time
per patient.  The only answer would be to pay cash out of pocket to one of
these medical boutique practices, and then the doctor can "afford" to reserve
the necessary amount of time for each patient.

Kind regards,

Jared

________________________________

From: email @ redacted on behalf of S. Falconer
Sent: Fri 5/30/2008 10:45 AM
To: IP
Subject: [IP] reasonable?



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 Am I being a "bad" patient (not that I really give a dead rat's a**), if I
question my doctor on WHY he thinks he needs to change and UP my cholesterol
medicine?? Granted, we are a group, are more prone to heart attacks and
stroke
and all that, but here are the givens:

 My total cholesterol is 186, Acording to the American Heart Assoc., under
200
is desireable

 My HDL is 50 (down from its usual 65 this time, I suspect since I have
stopped
my fierce work outs due to my frozen shoulder).  The AHA says over 40 is
desireable

My Triclycerides are 98. The AHA says under 150 is normal

 My LDL is slightly over the 100 mark at 116, but given all my other numbers
shouldn't this get SOME credit??

 WHY does he want to change me from the lovostatin I have been on for years to
a
higher does of zocor?  The lovostatin is a $4 drug at Target!! The
generic
of Zocor isn't!  It is not the money -  it is WHY???? the change.

thoughts?

sara
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