Many Doctors Hesitant about Statins – Part 1

This is not an easy discussion, and I have some serious doubts about the accuracy and validity of this study.

You're going over the results of some blood tests with your doctor. She/he tells you that your “bad” cholesterol (LDL) level is high. Will you need to take a statin drug to bring it down? The official answer used to be an easy one, but lately it's gotten more complicated. This I can agree is true.

For years, there were clear cut-offs -- numbers your doctor looked for. If your levels were above them, then your doctor was supposed to prescribe a statin plus lifestyle changes (healthy eating, limiting unhealthy fats, and being more active).

A healthier lifestyle is still definitely part of the plan. But the statin question changed a bit when the American Heart Association (AHA) and American College of Cardiology (ACC) updated their guidelines.

Now the only people who automatically get a statin based only on their LDL are those whose number is very high (190 mg/dl or higher). Otherwise, your doctor is also supposed to look at other things, such as whether you have diabetes and whether the AHA/ACC's risk calculator predicts that you have at least a 7.5% chance of having a heart attack or stroke within the next decade.

It's worth noting that many doctors are not following these guidelines to the letter, and that they've generated some controversy.

"I'm not [using them], and nobody else is, either," says Steven Nissen, MD, chairman of the department of cardiovascular medicine at the Cleveland Clinic. He prefers to use a combination of older guidelines and another risk calculator, called the Reynolds Risk Score.

Regardless of whether your doctor is on board with the newer guidelines, he or she should also consider other heart disease risk factors before making a recommendation.

Ultimately, the decision about statins is yours. You’ll want answers to these questions to help you decide.

What Can Statins Do for Me? If you take one, you can expect your LDL cholesterol to drop by anywhere from 35% to 50% or more, depending on the type of statin you take and your dose, Nissen says. And that could cut your chance of a heart attack or stroke.

Statins work in your liver. They block an enzyme that helps your body make cholesterol. They also lower inflammation in the arteries and stabilize plaque (cholesterol, other fatty substances, and clotting agents) that may have built up inside your arteries, says cardiologist Suzanne Steinbaum, DO, director of women and heart disease at Lenox Hill Hospital in New York. "That's more important than anything, because if plaque bursts it can cause a heart attack or stroke," she says.

Cardiologists generally agree that statins are a no-brainer for people who've already had a heart attack or stroke, because there’s strong evidence that they can help prevent a second one.

There's been some debate as to whether statins are as helpful in preventing a first heart attack or stroke. But most experts say there's plenty of proof that they're safe and effective for this purpose.

If you're at high enough risk for your doctor to recommend a statin, "I think you can safely say that a moderate dose will reduce the risk of either a heart attack or stroke by 30%," says Jennifer G. Robinson, MD, MPH, director of the Prevention Intervention Center at the University of Iowa.

She notes that several major studies -- including a review of 18 trials based on data on nearly 57,000 people -- have shown that statins lower the chances of developing both fatal and non-fatal heart disease, as well as cut the risk of dying from any cause during those trials. Robinson was vice chair of the team that developed the AHA/ACC guidelines in 2013.

Protein in Wheat Linked to Inflammation

Scientists have discovered that a protein in wheat triggers the inflammation of chronic health conditions, such as multiple sclerosis, asthma and rheumatoid arthritis, and also contributes towards the development of non-celiac gluten sensitivity.

With past studies commonly focusing on gluten and its impact on digestive health, this new research, presented at UEG Week 2016, turns the spotlight onto a different family of proteins found in wheat called amylase-trypsin inhibitors (ATIs). The study shows that the consumption of ATIs can lead to the development of inflammation in tissues beyond the gut, including the lymph nodes, kidneys, spleen and brain. Evidence suggests that ATIs can worsen the symptoms of rheumatoid arthritis, multiple sclerosis, asthma, lupus and non-alcoholic fatty liver disease, as well as inflammatory bowel disease.

ATIs make up no more than 4% of wheat proteins, but can trigger powerful immune reactions in the gut that can spread to other tissues in the body. Lead researcher, Professor Detlef Schuppan from the Johannes Gutenberg University, Germany, explains, "As well as contributing to the development of bowel-related inflammatory conditions, we believe that ATIs can promote inflammation of other immune-related chronic conditions outside of the bowel.

The type of gut inflammation seen in non-celiac gluten sensitivity differs from that caused by celiac disease, and we do not believe that this is triggered by gluten proteins. Instead, we demonstrated that ATIs from wheat, that are also contaminating commercial gluten, activate specific types of immune cells in the gut and other tissues, thereby potentially worsening the symptoms of pre-existing inflammatory illnesses".

Clinical studies are now due to commence to explore the role that ATIs play on chronic health conditions in more detail. "We are hoping that this research can lead us towards being able to recommend an ATI-free diet to help treat a variety of potentially serious immunological disorders" adds Professor Schuppan.

Further to inflaming chronic health conditions outside of the bowel, ATIs may contribute to the development on non-celiac gluten sensitivity. This condition is now an accepted medical diagnosis for people who do not have celiac disease but benefit from a gluten free diet. Intestinal symptoms, such as abdominal pain and irregular bowel movements, are frequently reported, which can make it difficult to distinguish from IBS. However, extraintestinal symptoms can assist with diagnosis, which include headaches, joint pain and eczema. These symptoms typically appear after the consumption of gluten-containing food and improve rapidly on a gluten-free diet. Yet, gluten does not appear to cause the condition.

Professor Schuppan hopes that the research will also help to redefine non-celiac gluten sensitivity to a more appropriate term. He explains, "Rather than non-celiac gluten sensitivity, which implies that gluten solitarily causes the inflammation, a more precise name for the disease should be considered."

'Experts' Disagree on Type 2 Screening

You will have to excuse me for slamming the supposedly diabetes 'experts.' I am seriously wondering who made them the 'experts.' First, it was against screening for prediabetes, and now it is another expert speaking out against screening for type 2 diabetes.

Two experts from the Beth Israel Deaconess Medical Center in Boston debated the benefits and harms of screening patients for type 2 diabetes at the institution’s Department of Medicine Grand Rounds conference.

“The prevalence of diabetes in the United States has increased over recent decades and has paralleled the increase in obesity rates. At present, 12% of U.S. adults have diabetes mellitus and another 37% have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT),” Gerald W. Smetana, MD, also from the Beth Israel Deaconess Medical Center and Harvard Medical School, wrote in a “Beyond the Guidelines” paper based on the discussion.

The U.S. Preventive Services Task Force (USPSTF) recommends that overweight or obese patients aged 40 to 70 years without symptoms of diabetes undergo blood glucose screening every 3 years, according to Smetana.

Martin J. Abrahamson, MB, ChB, in favor of screening, and David M. Rind, MD, against screening, debated their viewpoints at the conference.

According to Abrahamson, 25% of patients with diabetes have never been diagnosed. Diabetes often goes undetected due to a prolonged asymptomatic stage, he said.

“People with diabetes have a high prevalence of depression, absenteeism from work and decreased productivity, all of which add to the morbidity of the disease,” he said. “We cannot wait for symptoms of diabetes to develop before diagnosing this condition—we need to intervene beforehand.” Abrahamson noted that the screening tests are easy to administer, provide reliable results and do not have any adverse consequences.

In opposition, Rind pointed out that the USPSTF’s recommendation is to screen for abnormal blood glucose “as a part of cardiovascular (CV) risk assessment” which does not suggest that the purpose of the screening is to identify and prevent diabetes. Rather, he claims that improving the CV risk estimate is the focal point of the guideline. Rind defined “diabetes” as a surrogate outcome for patients who meet laboratory criteria for type 2 diabetes but are asymptomatic.

“Screening for ‘diabetes’ is unlikely to be helpful in patients at low risk for diabetes or who are at either low or high CV risk, since finding ‘diabetes’ is unlikely to change management or improve outcomes,” Rind argued.

However, Abrahamson argued that diabetes is not a surrogate outcome because interventions during this phase reduce the risk for complications over time. According to Abrahamson, progression to diabetes can be reduced by identifying prediabetes in asymptomatic overweight or obese patients and enrolling those patients in a lifestyle modification program to increase exercise and weight loss. Lifestyle interventions can improve outcomes and reduce the risk for progression to type 2 diabetes.

“There is evidence that lifestyle intervention reduces the risk for type 2 diabetes in individuals with IFG and IGT (prediabetes) by 58%,” he said. However, he noted that a lifestyle intervention may not influence the risk of mortality or CV disease during a brief period though possible benefits may be seen after many years. Abrahamson added that patients with prediabetes may also be treated with metformin, which reduces the risk for type 2 diabetes by 31%.

Rind argues that these lifestyle interventions are general recommendations for any patient who is overweight or obese. He said, metformin can be administered to patients with prediabetes to prevent progression to diabetes; however, lifestyle changes are more effective and “metformin has not been shown to reduce the risk that patients with prediabetes will develop micro- or macro-vascular complications.”

Rind cited the results from a meta-analysis of 10 randomized trials, which discovered that “while interventions reduce progression to ‘diabetes,’ they had no effect on all-cause mortality or CV mortality.” He added, “Interventions that reduce ‘diabetes’ do not actually appear to improve patient-important outcomes.”

Abrahamson stressed the importance of screening for type 2 diabetes because of its underlying morbidity as well as the preventive measures such as lifestyle interventions that can be enforced to reduce and prevent the risk of progression of the disease. Rind argued that screening all patients would be ineffective and suggested a more individualized approach — to screen patients who would be more inclined to make lifestyle changes given the results of testing.

Supporting a Loved One with Diabetes

Diabetes is a self-managed disease. Whether you have a supportive family or even supportive friends, you still have to manage diabetes to the best of your ability. They cannot and should not manage your diabetes, unless you are incapacitated or have a form of dementia. Even many adults with type 2 diabetes expect their doctor to manage their diabetes.

When you have diabetes, you have it 24/7 with no vacations. It is not an easy task and it takes a real task manager to stay on top of diabetes. Supporting someone you love is natural, but it can be difficult if he/she shuts you out or won't take charge of his/her diabetes. Finding the right ways to help is a key. You must work with them, but at the same time help them to accept their diabetes and manage it.

Because the chances are you are not knowledgeable about the disease, you will need to learn starting with the basics and carefully manage the terminology. Unless it is your child that has diabetes, you will still want to go to the doctor appointments, if the spouse will allow this. You should be able to ask questions during the doctor visit and because diabetes is different for everyone, knowing about their diabetes will make helping them easier.

Still, if you're a family member, friend or partner of someone with diabetes, it's important to remember whose diabetes it is and respect boundaries. Crossing these boundaries can often create additional problems. Nagging, being a watchdog, extracting promises, and manipulating someone to do what you want them to do doesn't work in most cases.

“So what should you do? Dr. William Polonsky offers the following advice:

• Don't assume you know what your loved one with diabetes is thinking.
• Do try and understand how your loved one's actions make sense from their perspective.
• Don't offer advice unless you're asked.
• Do offer to help if the individual is receptive.
• Remind your loved one that he or she is loved on a regular basis.
• Take care of yourself and seek education about diabetes.”
  

“In addition, it may be useful to:

• Ask your partner, friend or family member to join you for a walk, bike ride or other activity (but accept "no" if that's the response).
• Offer healthy food options, but don't make demands. Ultimately, it's the other person's choice.
• Try not to nag.
• Don't let another person's diabetes take control of your life.
• Seek counseling if you feel overwhelmed.
• Try motivating yourself to make lifestyle changes if needed.
• Learn to set boundaries.”
  

Help Manage Medications

People with diabetes need to take their medicines as prescribed. Sometimes, they may need a little help with that.

Make sure the person is able to give himself or herself the medication. Can he open the cap on the pill bottle or give himself insulin? Does she keep all her diabetes supplies in a convenient place?

If your loved one takes pills, capsules, or tablets, use a pill calendar. This plastic container has days of the week listed and is divided into parts of the day. You can get one at most larger pharmacies. Fill the pill calendar once a week or once a month, as needed. Check it regularly to see if they missed any doses.

It could be that your friend or relative doesn’t see well, and can’t read the prescription bottle. Make an appointment with an eye doctor (an ophthalmologist) for a vision checkup.

Get Support

Take care of yourself, too. If caregiving starts to become stressful, it helps to talk with someone you trust, whether it’s a friend, relative, or counselor. You may also want to join a support group.

To find one, ask your loved one’s doctor, or check with a local hospital.

Most Diabetes Patients Skip Eye Exams

This is something I do not understand. Why about 60 percent of people with diabetes do not have annual eye exams is a real puzzle. I was told to have an eye exam shortly after being diagnosed with type 2 diabetes. I had my exam within 4 months and would not have changed doctors if it had not been for a change in prescriptions that the office would not make right after giving me glasses that were creating vision problems.

I was fortunate when I changed eye doctors and the eye doctor could see what was causing the problem and ordered me a new set of glasses that really helped me. I have stayed with this office and have received the care I needed.

People with diabetes are at increased risk of developing serious eye diseases, yet most do not have sight-saving annual eye exams, according to a large study presented this week at AAO 2016, the 120th annual meeting of the American Academy of Ophthalmology. This is especially timely as the Academy is reiterating the importance of eye exams during the month of November, which is observed as Diabetic Eye Disease Awareness Month.

Researchers at Wills Eye Hospital in Philadelphia have found that more than half of patients with the disease skip these exams. They also discovered that patients who smoke as well as those with less severe diabetes and no eye problems were most likely to neglect having these eye exams.

The researchers collaborated with the Centers for Disease Control and Prevention to review the charts of close to 2,000 patients age 40 or older with type 1 and type 2 diabetes to see how many had regular eye exams. Their findings over a four-year period revealed that:

• Fifty-eight percent of patients did not have regular follow-up eye exams

• Smokers were 20 percent less likely to have exams

• Those with less-severe disease and no eye problems were least likely to follow recommendations

• Those who had diabetic retinopathy were 30 percent more likely to have follow-up exams

One in 10 Americans has diabetes, putting them at heightened risk for visual impairment due to the eye disease diabetic retinopathy. The disease also can lead to other blinding ocular complications if not treated in time – think cataracts, glaucoma, and a few others. Fortunately, having a dilated eye exam yearly or more often can prevent 95 percent of diabetes-related vision loss.

Eye exams are critical as they can reveal hidden signs of disease, enabling timely treatment. This is why the Academy recommends people with diabetes have them annually or more often as recommended by their ophthalmologist, a physician who specializes in medical and surgical eye care.

"Vision loss is tragic, especially when it is preventable," said Ann P. Murchison, M.D., MPH, lead author of the study and director of the eye emergency department at Wills Eye Hospital. "That's why we want to raise awareness and ensure people with diabetes understand the importance of regular eye exams."

The Academy has released a new animated public service announcement to help educate people about the importance of regular exams and common eye diseases including diabetic retinopathy. It encourages the public to watch and share it with their friends and family.

"People with diabetes need to know that they shouldn't wait until they experience problems to get these exams," Rahul N. Khurana, M.D, clinical spokesperson for the Academy. "Getting your eyes checked by an ophthalmologist can reveal the signs of disease that patients aren't aware of."

American seniors 65 and older may be eligible to get a medical eye exam at no cost through Eye Care America, a public service program of the Academy.

With Diabetes – Stay Positive

Diabetes can bring out the best and the worst in people. We should always look for the best and stay positive in our actions and thoughts. People newly diagnosed can have shock or even wonder how this happened, but should never develop anger or a negative attitude. Doing either may cause significant problems later in the management of their diabetes.

Yes, it takes a big commitment to keep your diabetes in check. Even so, you’ll be more motivated on some days than others, or you wonder how it’s going. Time for a fresh perspective! You can counter these negative thoughts whenever they strike.

The negative - ‘I Don’t Have Time to Exercise.’ Rethink It: Take it 10 minutes at a time. Tell yourself, “I don’t have to do it all at once.”

Exercising doesn't have to take a lot of time. Even a little will give you a burst of optimism and energy. Try 10-minute spurts of activity. You won’t need to change your clothes.

For example, instead of playing solitaire on your phone when you’re in a waiting room, ask the attendant if you have time to take a 10-minute walk around the

parking lot before your appointment.

The negative - ‘What's the Point?’ This is a classic "it’s too late for me" thought. Your goal weight feels always out of reach. Maybe you’ve tried to get there before and have been disappointed.

Rethink It: Bring your thoughts back to the here and now. Mental health experts say most anxiety comes from worrying about the future. The more you focus on what you can do today, the better.

Little steps, over time, will move your health in a positive direction. Ask your doctor to help you set mini-goals along the way to your ultimate goal. You want reachable goals that you can build on. For instance, if you lose a little bit of weight at a time, it can lower your blood sugar levels and blood pressure sooner than you may think.

Start slowly. First, learn to eat more fruits, vegetables, and protein.

The negative - ‘I've Blown It!’ This is the "all is lost" attitude. You didn’t follow your meal plan when you ate a giant plate of macaroni and cheese, and now you think you’ve wrecked all your progress.

Rethink It: Give yourself credit for your good food choices. It could be that you used to overeat all the time, and now you’ve had balanced meals most days this week.

Aim for progress, not perfection. You don't have to give up your favorite foods completely. Just account for the carbs.

Set the setbacks aside. Tell yourself, “I can get back on track,” and the possibilities open back up.

3 More Ways to Shift Negative Thinking

It takes practice to turn your inner voice into your friend instead of your critic. Make it a habit with these tips:

#1. Keep a journal. Write down your thoughts. After about a week, read it to look for patterns.

#2. Write positive messages for yourself, like “I am healthy." "I am strong." "I am managing my health well.” Put them in places you'll see every day -- your wallet, bedside table, near your toothpaste.

#3. Make a point of saying something positive to yourself every time you look in the mirror. “Nice smile!” “My hair looks really good today!” “This is a great color on me!”

You would be surprised what a positive attitude can do for you. Granted, it will not prevent mistakes, but a positive attitude will help you minimize them and return to good habits.

Health Is Everything

A few months ago, I would not have given this a second thought, even with type 2 diabetes. Now it is part of my everyday thoughts and wondering how to improve my health.

What happened? On September 7, I was taking a trash bag out to the curb to have it ready for pickup the next day. As I set the bag down, I apparently caught my left foot in the crab grass growing near the sidewalk and over I went, full out onto the street.

When I came aware in a few minutes, I attempt to get up. However, the pain in my left shoulder would not allow any weight on it. The only thing I could determine was that I had injured my shoulder in trying to break my fall. About 15 minutes later, two individuals coming to visit someone in the apartment building next door stopped and asked if I needed help. My answer was yes.

They were able to get me into a sitting position and then my neighbor arrived and with him pulling on my right arm and the two of them grabbing my pants and lifting, I was standing. My neighbor was able to walk me to my entrance and I was able to get into my apartment.

After cleaning myself off, I knew I was in trouble and drove myself to the local hospital emergency room. After about 30 or more minutes of them prodding and poking me, I was sent for x-rays of my shoulder. My shoulder socket was separated from the ball of my left arm and the ball was broken, a crack extended almost to my elbow and the elbow was cracked. I was fitted with a motion immobilizer and a sling. I was given a class 2 narcotic pain killer and sent home with instructions to see a bone doctor as soon as possible.

Because my wife would not let me drive, the appointment was delayed for two days and I needed more pain medication. Because of all the fuss and restriction placed on class 2 pain meds, they can no longer call them to your pharmacy and the pharmacy can no longer receive a call or fax for these meds. A patient can carry a prescription once he/she has seen a doctor. As a result, I could only receive a prescription for tramadol.

The following week went okay, as I was able to avoid any pain meds. The following Monday and Tuesday, I required some pain meds and I took some of the tramadol. Unfortunately, not having taken tramadol, I had forgotten my blog here about tramadol, and did I receive a shock when I finally was awakened on Wednesday morning. I had received a shot containing glucose because my blood glucose level was 24 mg/dl. I was asked to have something more as the 15 minutes had passed. I asked for the gel as it had 25 grams of glucose. No, I don't remember my reading before the gel, but 15 minutes later, it was 60 mg/dl. At that point, I was able to get up and be dressed. They, my wife included, still wanted me to go to the hospital emergency room.

Once there, I was given more carbs – too many as far as I was concerned and after I was given a new chart for my insulin dosage, I was sent home. It is only a short walk, but my glucose reading at home was 164 mg/dl. I am very unhappy with the new insulin chart now that I am more than a month away and have adapted the chart to my needs. My insulin needs have decreased as my weight has dropped and I am using less insulin.

Next, I have had a prostate biopsy and that result showed that I now have prostate cancer. I will not know more until the last of this month when I will see the Urologist again.

If you are wondering about how important your health is, and if reading this hasn't caused some concern, just realize how quickly the situation can change. I will update this as I learn more and my arm continues to heal.