Replies to This Discussion

Permalink Reply by Natalie ._c- on December 13, 2012 at 8:40pm

That's because different statins ARE different, and whatever it was that was bothering him with the one he took was not present in Lovastatin. Another possibility is that the amount of drug in the red yeast rice may be lower than in the tablets, so would fall below the level at which he might react.

I definitely believe that some people are sensitive to statins, but maybe not to all of them -- there are a lot of different ones. So I wouldn't categorically say that no one should take a statin, nor would I say that everyone should take one. Some people interpret a bad reaction to one statin as a blanket counter-indication to all of them, and some doctors won't try another in a patient who has had a bad reaction to one. So it's really up to the individual and the doc to make the decision as to whether to try another one.

But for a person who has never taken a statin, and who does have indications that it might be needed, it's nonsense to rule it out a priori -- many more people take statins with no side effects than those who do experience them.

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Permalink Reply by Mayumi on December 14, 2012 at 7:58am

My particular problem is that I have tried all the statins and I have kept track of that in my file at home. BUT it has not been documented in my medical electronic chart at the doctor's office. They just recently in the last two years changed from paper records to electronic records, and my problems started back in 2003 - long before electronic records started in our area. So I am screwed because no one believes me and thinks I am some old senior citizen who is lying.

Red Rice yeast wasn't as bad for me as far as reactions go, but it was to the point where I needed a pain killer for the muscle and bone pain....that to me just is not worth the effort.

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Permalink Reply by Natalie ._c- on December 14, 2012 at 6:09pm

So you still need to discuss it with the doc and not the nurse. And you need to determine whether your cholesterol is actually high enough to put you at risk, while considering your age and life expectancy.

Then when all is said and done, the only other thing i can think of, if you truly are at risk, is to go as low-carb as you can tolerate. The reason I say that is purely personal -- when I was limiting carbs, I had a spectacular improvement in my lipid profile. I'm not limiting carbs as much now for other reasons, and I CAN tolerate statins, so it's not so crucial for me, but it might be worthwhile for you. Mind you, this is NOT medical advice, merely anecdotal for ME, but it might be worth a try for you. Totally YOUR decision. But I do hope you find a solution for your original question, and take the opportunity to talk to the doc and ignore the nurse. Good luck!

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Permalink Reply by Brian Wittman on December 13, 2012 at 3:24pm

I don't really see anything to insinuate that you have been removed from this doctor's roster. I do, however, agree with you that there is a lot of chatter out there about statins, and their side effects. I understand your fear of them, and in your mind, that is justified. I cant agree or disagree with you. Personally, I take statins because, for me, they work.

It is not unusual for a diabetic to have to do fasting lab tests. Nurse Nasty had no business insuinuateing that you are out of diabetic control. It is generally accepted that any A1-c level below 6.5-7 is in control. Your posting did not mention your blood pressure or cholesterol numbers, but I would guess that they are okay. Fact of the matter is, one sees a physician to get into control with these issues. If this practice only wants to see healthy, disease free patients, it may not be the practice for you.

I made a dietitian cry once, and I have told an endocrinologist to get real. Were this me, I would be looking for a different medical practice to patronize. They are out there, and it didn't take long to find one that I could live with very well. They were just across town.

Good luck, be well.

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Permalink Reply by DianaS on December 13, 2012 at 10:36pm

Statins are a standard of care but that doesn't mean that care shouldn't be individualized. If a medication is contraindicated because of a previous adverse reaction all a physician has to do to satisfy any regulatory enquiry is document he considered the drug and it's contraindicated because of x, y, and z and document that in the chart. Problem solved for everybody.

Patients have a right to refuse treatment too. I think the nurse way overstepped her bounds when you're just talking about a lab test. There really should not have been any of these what if's and talking about compliance issues.

That being said I would want to know what my lipids were irregardless of meds so I don't see a problem with them ordering the labs itself. Cholesterol is usually only checked once a year if you're stable.

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Permalink Reply by acidrock23 on December 14, 2012 at 4:17am

I don't think that statins and taking them or not taking them should influence one's "diabetes rating" as far as compliant or non-compliant. That's a separate category which, if anything, should really be "evaluated" by a cardiologist.

I like to keep an eye on lipids but also have ended up in adopting Gary Taubes' opinion that the key to that isn't avoiding veggies as much as avoiding carbs, exercising and, perhaps most importantly, eating lots of veggies. This has worked great for me but may not work *exactly* the same way for anyone else. I wish the doc would test it more than 1x/ year so I could work to "nudge" it like my BG but that may just be me.

I agree that insurance-oriented standards of care and doctor ratings seem fraught with peril as they seem very likely to reinforce the tendency of both the medical *and* insurance industrries to act like "know-it-alls" when, at least in terms of diabetes, there are many instances where they don't know squat. When they start judging and acting like the nurse in question in the OP scenario does, it's time to throw yellow flags, get out red and yellow cards and take your business elsewhere. It may also be interesting to explore what they will do to make you "compliant" and help you achieve everyone's goals.

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Permalink Reply by BriannaM on December 14, 2012 at 9:55am

I agree with what others have been saying,find another doctor. If his "reputation" matters more than his patients, he's seriously got his priorities messed up. If you can't tolerate a medication, he needs to realize that. A 6.1 A1C is a lot of work and a very good job. That means your BG is an average of 120.

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Permalink Reply by Leo2 on December 14, 2012 at 7:36pm

There are many of us who have refused statin drugs. Join the club. My physicians take what I say, nod, and go on. And if a nurse spoke to me that way, I'd be likely to say, "put the doctor on the phone."
There is no way a physician will "kick you out of his practice." He needs every patient he can get. Perhaps his nurse needs to be kicked out of the team. She's not adding to a team, that's for sure.
Having said that, the important thing is that you deep breathe and do not worry about any of this.
It is so important to be talking with your physician. Let him know that his nurse was insinuating you would be kicked out of his practice for refusal of statins. That is, if you want to continue with this "team" at all. Ask him if he knows his nurse said that to you. And if so, ask him to figure out another way to get your cholesterol LDL in range.
Ask him if he considers 6.1 "not very good" like she said. Tell him you think he needs a talk with her to stop badgering patients. If you like him, tell him you like him but definitely think his nurse is misinformed about A1c and quote her statement.

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Permalink Reply by Anthony Holko on December 15, 2012 at 1:33pm

Yes Calgary's best Endo.

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Permalink Reply by Stuart on December 15, 2012 at 2:17pm

Hello Mayumi:

Many have been dismissed from an endo's practice before. You are not remotely alone!

I ignored the endo's definate agenda, all her patients get a pump. I rejected her belief and politely pointed out her financial incentive seemed to provide a severe potential bias towards them.

Her office scheduled two appointments on days she had "convention-vacations". They refused to reschedule me until 5 months later, the "first available" appointment. I objected, politely-respectfully pointing out the "problem" was not my error on any level and that I should be offered any cancellations that happened long before 5 months...

I was dismissed shortly thereafter...

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Permalink Reply by Gerri on December 15, 2012 at 2:47pm

Stuart,

I had a similar experience with my first endo, whom I referred to as the pump Nazi. His opening statement, "All my patients have pumps." I don't want a pump. He repeated, "All my patients have pumps." Never even asked why I wasn't interested. Could see that relationship was headed nowhere. I moved on to another doctor before he had the chance to fire me.

Second endo wasn't much of an improvement. Told them I wouldn't be returning. Without notifying me, my insulin prescriptions were cancelled the next day. Found out several weeks later when I went to refill the Rx. Nice to leave a diabetic with no insulin. Furious I called. Response, "that's our policy." How about telling patients that's your policy!

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Permalink Reply by Clare on December 15, 2012 at 3:00pm

I am truly horrified by this and am thankful to have a primary care doctor who is perfectly happy to write me an rx for insulin or anything else I need. I'm not sure how a doctor would go about cancelling a prescription for insulin but I'm sure he left it to his nurse. In either case it is abhorent and I do hope you found a more reasonable doctor.

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