Monday, July 25, 2016

Vindication

For several years now, Jeff's employer has mandated that we have a yearly physical (which is free), or else they will increase our health insurance premiums by $40/month.  Much as that irks me to be told to do something, I've begrudgingly gone along with it because it would be fiscally dumb not to...and let's face it, $480 buys a lot of race entry fees, yarn, and dog treats.

That said, I had an incident this year with my former doctor that really irritated me - and yes, I said FORMER doctor, as you will soon see why.  Along with the cursory examination, routine blood work is done each year.  The health system we go to uses MyChart online, which is really great - you can make routine appointments online, send messages to your doctor, and see your test results.  So I was able to log in and see my blood work results a couple of days later, and I saw that for the fourth year in a row, my cholesterol levels were high...nothing horrible, but they were not in the normal range.  And that didn't surprise me, because both of my parents, who are thin and exercise regularly, have high cholesterol and are on medication - obviously, it's a genetic thing for me.

But, here's where the story takes a turn.  A day or so after I saw the test results, someone from his office called and told me that my doctor had prescribed Lipitor as a result of my blood tests because he did not believe my cholesterol could be controlled by diet or exercise.  Which, OK - I can see that, considering I eat pretty decently and exercise regularly.  However, none of this was discussed during the visit; it's not like my doctor looked at my previous test results and said "I see your cholesterol has been high in the past and if this year shows the same, I want to start you on medication for it" - nope, nothing.  So the phone call kind of caught me off guard, especially when I realized that I would be taking this medicine for the rest of my life.

Without having had one discussion about it with my doctor.

This might have been a routine thing for him, but it was a little jarring for me...and without getting to speak with him about it, I did the next logical step:  I Googled the medication.

I read about the side effects of Lipitor - and of immediate concern to me was muscle pain, because I didn't want to make running any harder than it already is for me.  I also read about the dosage, which varies from 10mg to 80mg per day.  Then I went back to MyChart and saw the prescription that he'd called in to my pharmacy.  It surprised me to see 40mg - why such a high dosage?  Why not start with a lower dosage and see if that works?  So I emailed my doctor:

After digesting the phone call from your nurse on Monday morning regarding putting me on Lipitor for high cholesterol, I did a little research and am concerned about the side effects of the medicine. For that reason, I'd like to start at the lowest dosage possible, which looks to be 10 mg. I can see in MyChart that you've prescribed 40 mg - can you please change the prescription? I don't want to start another set of problems while trying to solve the cholesterol issue.

This was the response I got back - I'm assuming it was dictated or something, because of the typos:

I'll change the dose if you want, but....

Not everything that she read on the Internet is based on good science. He also have to keep in mind that the incidence of complications with statins is exceedingly low.

There is a large amount of evidence that shows that the higher the dose of statin the more cardioprotection that she will get.

You have a choice: Do want to significantly reduce your risk of a common occurrence (heart attack/stroke), or do you want to decrease you risk of a already low/rare occurrence (side effects to statins.)?



All I could think after reading his response was WHAT IN THE HELL???  When did this turn into a heart attack/stroke?  Again, there had been zero discussion about cholesterol, heart attacks, or strokes during the visit - and suddenly, apparently, I'm Fred Sanford, about to croak:

Obviously I can see the humor in this, but truth be told, I was also pretty angry.  What happened to the educated patient?  Why are there brochures in the waiting rooms of medical offices, telling us to learn more about diseases and treatments, if we're not allowed to question anything?  I vented about this at different times to several of my running buddies, and each one, upon hearing about my doctor's email response, said the same thing - "you need a new doctor" - and they were right.  I emailed my original doctor one last time:

I would like to start with the 10mg dose, please.

And with that, I was done with him.  He did call in that dosage, and I started taking the Lipitor (with no side effects, thankfully).  I knew I needed to have blood work done again to see if the medicine was working, so I found another doctor, made an appointment with her, and explained what had transpired and asked her to order the next round of blood work, which I had about 10 days ago.  As you can probably guess by the title of this post, the results were excellent - the Lipitor, at the lowest dosage, had done the job and my numbers were all drastically better.


Even though I lost my trust in a doctor who I'd previously liked, I'm glad I went this direction and questioned his authority.  I have a feeling that we are an overmedicated society in general - yes, there is a time and a place for medicine, absolutely - but just because something might need addressing, it doesn't necessarily need the entire book thrown at it...sometimes just a page will do.

42 comments:

  1. Good for you for advocating for yourself!!! I always have tons of questions for my doctors. It's a good thing we don't have an online messaging system...lol.

    Glad you were able to get a second opinion. What are Statins?

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    1. Statins are lipid-lowering drugs (like Lipitor).

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  2. Make sure that you tell your doctor why you are leaving and also inform the practice manager. You might not be the only one with a problem.

    My overall cholesterol is a little high, but my triglicerides are very low and my HDL is high, so my doc doesn't worry about the LDL so much since the other 2 numbers are more important -- and doesn't recommend meds.

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    1. I should let him know why I left. I should just send him a link to this post.

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    2. This reply made me chuckle at the parallel of it. We might laugh at sending a link, but in every way he did the exact same thing to you with the phone call. SMH.

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  3. Good for you for advocating for yourself. I would let the doctors office know why you left like Lori said.

    I don't think it is good business not to discuss this with you before ordering a high dose of meds.

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    1. I got more information from Google and my pharmacist than I did from my doctor regarding this medicine!

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  4. That is the problem with online services, doctors are now just emailing what they think instead of having you come back in and have a really good sit down and discuss all options. I hate when a doctor wants to just throw medicines as a cure all. Slight diet changes can really make a difference for many borderline issues.

    Good for you for not just taking the doctor at face value and doing your own research. I feel like a cow going in for the slaughter now a days at doctor offices. There is no personal get to know you and your lifestyle anymore.

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    1. I hate that I have a mistrust of what I'm being prescribed, but you are correct in that without a sit down and frank discussion/explanation, that's when I have to do some research on my own.

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  5. Good for you! If a little does the job, then a little it should be. The side effects of any medication will blow your mind too! I've always wondered if doctors get an "incentive" from the drug companies to prescribe their medications. Makes you wonder...

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    1. I wondered that as well, about the incentive.

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  6. I loved your illustrations :)

    I have MyChart, but I don't' think they did the inservice for my doctors. I've never gotten a reply to anything I wrote. irritating… I did get an email once, about my borderline high-normal cholesterol--something to the effect, make an appointment, the doctor would like to prescribe lipitor. No thank you.

    The grammatical errors in the email are horrifying.

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    1. Thank you - I did get a laugh out of my memes in this post, if I do say so myself!

      Agree on the grammatical errors; ANYTHING that comes from a doctor's office should be written correctly...I mean, come on - a pretty extensive education came with that M.D.!

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  7. Gah. That's so frustrating. When I got put on insulin, my endocronologist never told me to stop taking all the oral medication I was taking. She also told me to take 4 units of insulin with breakfast and lunch and 5 for dinner. My blood sugar numbers were still in the 300s!

    Fast forward, she decided to go back into teaching - and I found a new doctor. You have to bring in all your medications and he took a look at the oral meds and was like "why are still taking these?" The oral meds weren't working which was why I was put on insulin. Taking the oral meds off the table saved me $125 a month!

    Then he explained that it's a ratio for taking insulin, not a set number - so now I take 1 unit of insulin for every 5 carbs I eat, and my blood sugar has been steady for the last 7 years.

    Glad you got a new doctor!

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    1. How crazy that your endo didn't educate you - sadly, she probably didn't know enough about how insulin works herself.

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  8. I have steadfastly refused to go on a statin exactly for the side effects you've described. My mother has lost good use of one of her legs and is hobbled because she has to take statins.

    My new doctor actually said he wouldn't insist - yet - but it makes me feel better to hear you've been able to take the low dose with no side effects.

    As you know I changed doctors this year too - I'm at the point in my life where enough is enough - be a good doctor, pay attention, and be on time the same way you expect me to be on time. I don't think that's too much to ask!

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    1. If you end up having to (or being forced on statins), do start at the lowest possible dosage; I was relieved to not have any side effects, but I wonder what the story would be, had I actually gone along with the higher dose.

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  9. Good for standing up for yourself and found a new doctor! And glad the low dose is working for you.

    I hardly ever go to my doctor but I have the same as my mother in law who's getting more and more health issues. I asked her once what her medications were and I couldn't believe how many different pills she took on a day. A lot of them had side effects that she had too. I advised her to go back to her doctor with all of it and ask which ones she really needed. She never did that and I gave up.

    We get a health check for free every 3 years at work that I always take and except the overweight (as if I didn't know that) so far I'm always fine.

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    1. How scary that your MIL is taking so many meds AND having side effects as a result. But some people will believe everything their doctor says, and that's not always the best thing to do.

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  10. I am so glad that you were proactive. I had a situation with my new primary care doctor. My first visit with her was a physical exam and my blood pressure was high. I can't recall the number but my numbers are generally high when I go into the office. Well not knowing my background or anything she was ready to put me on high blood pressure medication right off the bat. I explained to her that my numbers run high at the dr's office but at home they are normal. She stated to come back in a month with my blood pressure log readings and she would assessed the situation. I told her that was fine and when I returned back with my numbers she stated "Oh my goodness you have white coat syndrome"

    It pays to be your own advocate. I'm glad that the low dosage is working for you.

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    1. I'm surprised that doctor was ready to prescribe medicine after just one high reading...but then again, I'm not.

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  11. Way to go! Medicating (and not) can be a real balancing act.

    It took an incident some years ago to make me realize that my doctor is MY choice. But even with a good doctor we have to be vigilant and vocal. If possible, I prefer to have bloodwork done in advance of a doctor's appointment so results are on hand for discussion. In some places it can just be a matter of asking.

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    1. Good point about asking for the bloodwork to be done ahead of time - I'm going to remember that for next year.

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    2. With my most recent physical, I asked if I could have the lab slip so I could already have the work done for discussing at the time of the physical. The nurse practitioner said that insurance companies are starting to balk at that, and often won't pay if there hasn't been a visit first. What a racket!

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    3. Interesting...and yes, insurance sure can be infuriating.

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  12. Welcome to corporate medicine. Ugh. As a nurse practitioner, I cannot believe that your doctor prescribed a medication without talking to you personally. I cannot believe that he prescribed the highest dose without starting lower. And yes, while Dr Google is not always our friend, sounds like you made a reasonable decision based on the information you found. I mean what is the big deal about starting at a lower dose?

    Smart move finding a new doctor. But the way you were treated is sadly more the norm these days rather than exception.

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    1. Exactly - what was the big deal about starting at a lower dose? I think his ego came into play, based on that weird email, and the idea that I dared to question him did not go over very well.

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  13. I had something similar occur with my doctor. He is convinced that I need to be on some kind of diabetes medication even though I don't have diabetes. He even went as far as to call one in for me without telling me. I too, later got a call from a nurse saying there was one for me to pick up. I need to get another doctor as well, but hate starting over with someone else.

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    1. What is it with the medicine sneak play??

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  14. Good for you for looking in to it and wanting to be educated and not just following blindly! I wish their response would have been more of a conversation. I like to think it might have been had it been a phone call, but who am I kidding - it may NOT have been. I hope your new doctor is much better! (And I am happy the lower dose IS working!)

    I went to a dr for a physical and to ask about a specific issues a few years ago and he spent the whole time fat shaming me and making fun of my vegan diet. I asked him about the specific issue as he was walking out of the room. Needless to say, I need to find a new doc, too ;)

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    1. Oh dang, you need a doctor who supports your diet choice and fat shaming?? Screw him.

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  15. I'm so glad you were vindicated, Shelley! We are all well aware that the internet cannot properly diagnose, but it certainly can steer us to the right questions to ask. When those questions are answered with a sledgehammer rather than a discussion, that is the cue to look elsewhere for medical care. Kudos on your persistence and I hope your new MD works out well for you!

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    1. Sledgehammer vs. discussion - that's exactly how it felt.

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  16. Wow!!!! Good for you for finding a new doctor. WOW!!!!

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  17. I think medicines are well over prescribed. I don't take any.

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    1. You must not have any health concerns - good for you!

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  18. Just fantastic. You're a fierce, smart woman!

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  19. GOOD.FOR.YOU!!!!

    I've always been an informed patient because it's my belief that NO ONE cares about my health more than me. I've done the same as you - found a new doctor when concerns falls on deaf ears. It's a partnership, not a dictatorship.

    As you said, we are a vastly over-medicated society. More people need to be informed and question/discuss the need for medications with their doctors.

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    1. I'm going to remember this "It's a partnership, not a dictatorship" and work to have a doctor who feels the same way.

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  20. Advocating for ourselves is powerful. And while not everything on the internet is truthful there is good information out there. Someone else suggested calling him and I think you should. I left a dentist over shady business practices and I took some time to let it breath and then I called and told him exactly why I would never be back.

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