Anything else? - Update

[AndBreathe]

On Thursday I have a telephone consultation with the GP who reviewed my recent bloods. I have never met her, so I have an open mind, but I guess neither of us knows what to expect from the meeting.


In preparation, I have consolidated all my bloods since diagnosis, but I am conscious the only notes appended to the latest set are connected to the Cholesterol section. Frankly, that's a mixed bunch, with the Total and LDL being high, but the HDL, Trigs and ratios being categorised as optimal, good or ideal, by the following website: http://www.hughcalc.org/chol-si.php . Along with some acronyms I'm not familiar with, there is a ?hypothyroidism note. That really surprised, and unsettled me, me as this was the first time I am conscious my TSH levels have been tested. The TSH is recorded as being slap bang in the middle of the published normal range, at 3.0.


I'm not sure what the outcome of the consultation will be, but if I am to have another visit to the vampires, I'd like some added value for me. I am totally asymptomatic, so I'm certainly not looking for any form of diagnosis, but if there's more blood to be drawn, what would you like tested? I'm thinking of my diabetes, not just this cholesterol/hypothyroidism potential highlighted by the last bloods.


Thanks as ever for your feedback.

 

[Pipp]

B12 and potassium.

 

[AndBreathe]

So, this morning I had my scheduled call with the GP to discuss my recent bloods. I hadn't been looking forward to it, but like any meeting I consider important, I had done my prep a couple of objectives I wanted to achieve.

On balance, it went really well, if you were me. The points of discussion and outcomes were:

I had queried unfamiliar acronyms, and a “?hypothyroidism” note on my blood results. Apparently these notes are added by the lab these days. The acronyms were explained and she stated they have no concerns for my thyroid, with the TSH bang on mid range.

Doc's conclusion about my cholesterol is that the current levels are probably my body's endogenous levels, and that any further reductions, due to any dietary modifications would be very modest.

I challenged the focus on total cholesterol, so we moved onto the underlying components and the Qrisk profiling. The GP's initial profile was based on my weight in February, and the last recorded BP reading taken at the surgery, despite the nurse accepting my home readings when she reviewed my machine at my review. There was no way she could know I had lost weight since then. With the new numbers the qrisk score was more better.

She was then at pains to explain the amended scores still sat above the population average. Smarty-pants that I am I then challenged the binary application of the T2 flag, bearing in mind my HbA1c scores, which have all been non-diabetic, aside from the diagnostic test. I asked at which point they (i.e. the medics) would begin discounting the T2 weighting. In this context I meant discounting on a potentially sliding scale, rather than disregarding it. She agreed this to be a fair challenge, and suggested that to all intents and purposes my diabetes has gone/resolved/in remission, but stated that knocking it off the record is trickier. (I wasn't asking her to do that.) I suggested if we even halved the weighting, I would feel the assessment to be fairer (but I already knew what that meant in terms of score). So, we settled on that qrisk score. )

So, having established I had done some reading, she confirmed I realised NICE guidelines for diabetics is for a routine recommendation for statins. I asked if she is aware of any empirical research or evidence focusing on women of my age without current CVD, or even on women per se.

She admitted she didn't know of anything compelling. I asked her to help me to understand the true benefits, to me, of filling a prescription for a long term drug, for which there is no empirical evidence of efficacy for my sort of person, and which could give me unwanted side-effects, including raising the HbA1c I have worked so hard to reduce. She admitted it, based on our discussion, it wasn't a a recommendation she was willing to push.

We agreed to look at the numbers again in a few months. The period of 3 months was set by me.

I get the impression she was going to head for the kettle after our little chat. I know I did, and at least one of us had a smile on their face.

 

[Brunneria]

Well done.
Am very chuffed for you.
Do you think you will have to have the same conversation, over and over, with every checkup?

I have nowhere near your negotiation skills. So when statins are offered to me I am going to fall back on a series of 'no thank you' s. Plus requesting that test (no idea what it is called!) that measures LDL particle size.

 

[Pipp]

So, this morning I had my scheduled call with the GP to discuss my recent bloods. I hadn't been looking forward to it, but like any meeting I consider important, I had done my prep a couple of objectives I wanted to achieve.

On balance, it went really well, if you were me. The points of discussion and outcomes were:

I had queried unfamiliar acronyms, and a “?hypothyroidism” note on my blood results. Apparently these notes are added by the lab these days. The acronyms were explained and she stated they have no concerns for my thyroid, with the TSH bang on mid range.

Doc's conclusion about my cholesterol is that the current levels are probably my body's endogenous levels, and that any further reductions, due to any dietary modifications would be very modest.

I challenged the focus on total cholesterol, so we moved onto the underlying components and the Qrisk profiling. The GP's initial profile was based on my weight in February, and the last recorded BP reading taken at the surgery, despite the nurse accepting my home readings when she reviewed my machine at my review. There was no way she could know I had lost weight since then. With the new numbers the qrisk score was more better.

She was then at pains to explain the amended scores still sat above the population average. Smarty-pants that I am I then challenged the binary application of the T2 flag, bearing in mind my HbA1c scores, which have all been non-diabetic, aside from the diagnostic test. I asked at which point they (i.e. the medics) would begin discounting the T2 weighting. In this context I meant discounting on a potentially sliding scale, rather than disregarding it. She agreed this to be a fair challenge, and suggested that to all intents and purposes my diabetes has gone/resolved/in remission, but stated that knocking it off the record is trickier. (I wasn't asking her to do that.) I suggested if we even halved the weighting, I would feel the assessment to be fairer (but I already knew what that meant in terms of score). So, we settled on that qrisk score. )

So, having established I had done some reading, she confirmed I realised NICE guidelines for diabetics is for a routine recommendation for statins. I asked if she is aware of any empirical research or evidence focusing on women of my age without current CVD, or even on women per se.

She admitted she didn't know of anything compelling. I asked her to help me to understand the true benefits, to me, of filling a prescription for a long term drug, for which there is no empirical evidence of efficacy for my sort of person, and which could give me unwanted side-effects, including raising the HbA1c I have worked so hard to reduce. She admitted it, based on our discussion, it wasn't a a recommendation she was willing to push.

We agreed to look at the numbers again in a few months. The period of 3 months was set by me.

I get the impression she was going to head for the kettle after our little chat. I know I did, and at least one of us had a smile on their face.

Thank you for sharing this.
I will be using your script at my next review. With non-diabetic HbA1c results for 3years, I too could be deemed to have reversed T2. So do I still need the statins? Ok so I am fat, and have had medication for BP, but BP has needed less medication since I have had the non-diabetic BG.

Sorry, don't mean to highjack your thread.

Well done on your achievement, and for being assertive with doc.

 

[Bluetit1802]

Well done AndBreathe. You did much better than I did in a very similar conversation with my GP last week. (QRisk calculation, statins, one size does not fit all diabetics) Her attitude was I am diabetic, therefore my CVD risk is doubled. We came to a similar compromise to yourself. No statins for now, but a serious review in December when my next diabetic review and blood tests are due.

 

[AndBreathe]

Thank you for sharing this.
I will be using your script at my next review. With non-diabetic HbA1c results for 3years, I too could be deemed to have reversed T2. So do I still need the statins? Ok so I am fat, and have had medication for BP, but BP has needed less medication since I have had the non-diabetic BG.

Sorry, don't mean to highjack your thread.

Well done on your achievement, and for being assertive with doc.

The reason I shared was because I know I'm not the only woman of a certain age who is unconvinced by the flimsy statin arguments, and it's good to share.

The only blot on my copy book was when I almost lost it when she summarised confirming no strong recommendation for statins was being made and that she completely understood my standpoint and rational arguments. However, where I almost lost my cool was when she said (probably to save a bit of face) that she wanted to be sure I didn't think I was missing out on any medication available to me to manage my health......

My response started something like, "Well, as you've brought it up. The only thing I really feel I have been denied are the tools to self manage my diabetes; meaning meter and strips."

I could almost hear her thoughts screaming "Oh no. What have I said!?!?!"

We had a bit of a chat about that, and clearly she suggested with my current levels there would be absolutely no way they could support testing for someone with serial non-diabetic blood results, Of course, I knew that, and I had no intention of bringing it up, but her statement begged me. It goaded me into it.

We had a decent chat around that, and the recommended low fat diet for diabetes management, and how that would work out. I thanked her for the first honest and adult conversation I'd had on the subject.

I liked her. She'll never last. But, I would like it of she did.

 

[Pipp]

The reason I shared was because I know I'm not the only woman of a certain age who is unconvinced by the flimsy statin arguments, and it's good to share.

The only blot on my copy book was when I almost lost it when she summarised confirming no strong recommendation for statins was being made and that she completely understood my standpoint and rational arguments. However, where I almost lost my cool was when she said (probably to save a bit of face) that she wanted to be sure I didn't think I was missing out on any medication available to me to manage my health......

My response started something like, "Well, as you've brought it up. The only thing I really feel I have been denied are the tools to self manage my diabetes; meaning meter and strips."

I could almost hear her thoughts screaming "Oh no. What have I said!?!?!"

We had a bit of a chat about that, and clearly she suggested with my current levels there would be absolutely no way they could support testing for someone with serial non-diabetic blood results, Of course, I knew that, and I had no intention of bringing it up, but her statement begged me. It goaded me into it.

We had a decent chat around that, and the recommended low fat diet for diabetes management, and how that would work out. I thanked her for the first honest and adult conversation I'd had on the subject.

I liked her. She'll never last. But, I would like it of she did.

A very successful outcome then. Well done. Keep up the good work.

 

[AndBreathe]

So, today was another follow up on my pesky lipid profile.

It's safe to say, it was all a bit weird. I don’t think DrK has ever known my gob be so well and truly smacked! My appointment wasn’t at all what I expected, and fair play to her, I reckon she just grabbed back the upper hand,......... for today!

Having had the long and detailed discussions the last twice we've spoken, with the desire to refer me to the Lipid Specialist, this time she was “utterly delighted" with my bloods, and I quote/paraphrase,

“………. With those ratios I’d be delighted. What fantastic trigs and HDL. With those ratios, I’m not concerned in the least the total is 7.4. It would be nice if it was less, but with the ratios, it’s an irrelevance…………..”.

And she stated, she would not recommend statins with my numbers, because there was a danger of denting the great ratios. I just hadn’t considered that volte face for one second! Allegedly the reason she doesn’t want to make the referral now is my total has dropped below 8.

I queried the rise in my serum albumin from 20 at diagnosis, through 16, 23 to 28, with a view to gallbladder function. She has asked me to have the LFTs repeated in 3 or 4 weeks and provided it hasn’t risen again, or gone well into the 30s, she’ll be content to look again at the end of the year.

To be honest, I’m now working out what I’ll be teaching her next. Professor Sikaris and Dr Peter Attia have a lot to answer for.

My summary lipids are as follows:

The RAG flags are my own assessments, reflecting against NICE guidelines..

As a matter on interest @donnellysdogs , how do my lipids now compare with your own? I've lost track of where you are, apologies.

 

[donnellysdogs]

Hi @AndBreathe

Wish I (and hubby) had your doc..!!

Mine are:
5.4 total now (dropped from over 6.)
Trigs now back to 0.6
HDL up to 2.1 (way over the target of 1.6)
LDL 2.9. Disappointedwith this a little..

Yes, stupid GP mentioned statins and I've now got a form being processed as to look at my medical records because they have not marked on them that I do not tolerate statins.

Hubby went on 40mg atoravastatin (no heavy dairy but lots of mediteranean food.

His have these results from 17 Feb to 17 May

Total was 6.5. Now 3.6
Trigs was 1.4 now 0.8
HDL was 1.2 still 1.2!!
LDL was 4.7 now 2.0

Despite all the extra med fat my HDL shot up, his stayed the same. I'm sure the statins have killed off the HDL as well...

He sent a note up asking for 20mg to be prescribed in future but suspect that the GP will fight this as they just remarked "good" in report and filed it. It's got them their targets.....he is going to cut them in 1/2 if they don't drop them to 20mg.


How do you work out the ratio?? What should it be? I'm glad that myHDL shot up and my trigs went back down.

Good to read that you have a doc that can see past the "total". I couldn't believe when mine suggested statins on just a "total" figure snd thats why I am so bothered and wound up that despite me having a copy of a letter my consultant sent them last year saying "intolerance to statins" - they have nothing marked on my records...

Do you think for you though regarding LFT's that a request for a stomach scan would be beneficial as this does then check out all your spleen, kidneys, liver and gallbladder without having worry over rising levels in the serum albumin?

 

[AndBreathe]

Hi @AndBreathe

Wish I (and hubby) had your doc..!!

Mine are:
5.4 total now (dropped from over 6.)
Trigs now back to 0.6
HDL up to 2.1 (way over the target of 1.6)
LDL 2.9. Disappointedwith this a little..

Yes, stupid GP mentioned statins and I've now got a form being processed as to look at my medical records because they have not marked on them that I do not tolerate statins.

Hubby went on 40mg atoravastatin (no heavy dairy but lots of mediteranean food.

His have these results from 17 Feb to 17 May

Total was 6.5. Now 3.6
Trigs was 1.4 now 0.8
HDL was 1.2 still 1.2!!
LDL was 4.7 now 2.0

Despite all the extra med fat my HDL shot up, his stayed the same. I'm sure the statins have killed off the HDL as well...

He sent a note up asking for 20mg to be prescribed in future but suspect that the GP will fight this as they just remarked "good" in report and filed it. It's got them their targets.....he is going to cut them in 1/2 if they don't drop them to 20mg.


How do you work out the ratio?? What should it be? I'm glad that myHDL shot up and my trigs went back down.

Good to read that you have a doc that can see past the "total". I couldn't believe when mine suggested statins on just a "total" figure snd thats why I am so bothered and wound up that despite me having a copy of a letter my consultant sent them last year saying "intolerance to statins" - they have nothing marked on my records...

Do you think for you though regarding LFT's that a request for a stomach scan would be beneficial as this does then check out all your spleen, kidneys, liver and gallbladder without having worry over rising levels in the serum albumin?

It's easy to manually calculate your rations, but sites, like this one, does it for you and assesses the good, bad and the ugly in it all.

http://www.hughcalc.org/chol-si.php

To be honest, I was so aghast today with her new found stance on the whole issue that I could hardly think. I'm happy to have the next bloods, then take it from there.

 

[donnellysdogs]

I can imagine how gob smacked you were!!! I have chuckled to myself!!

 

[donnellysdogs]

Thank you for the link... My hubbys hdl is high risk although ratios are ideal.
Mine are all optimal or ideal except the total.. Which as a female at 5.4 doesn't bother me....

The link is brilliant. Thank you!!