Curious.....

[Cordelia]

Are any of you on cholesterol-lowering medications because you are on dialysis even though your cholesterol levels are fine?

[thegrammalady]

i'm on medication, but my levels are a touch high. it was prescribed by my gp, not my neph.

[Cordelia]

My levels are perfect, so a neph in my unit says, (not my primary neph) he wants to put me on choloesterol meds even though my blood labs for cholesterol are just fine and dandy.

He wants to put me on zocor, just because supposed studies have been done and said that it's safter for a dialysis patient to be on this drug because of dialysis patients developing coronary disease. I understand it could be for "preventative" reasons, but really, since my labs are perfect, I don't see where a nephrologist can justtify that, "Just because there were studies done"

I'm very angry about this. I have had nasty reactions to changing so much as a blood pressure pill and suffered badly from the side effects. I don't eat a huge amount of fatty foods, either.

Everytime I see this !@#$ doctor about every 6 months, he's trying to change something, I've nicknamed him a pillpusher to people in my family and my friends. No other neph is doing this to me, just him.   

I could totally understand if my levels were slightly elevated. This is really bothering me. This doctor doesn't know me well at all, he's not my primary nephrolgist, by any means. He does his "rounds" about twice a year in my unit.   

Thanks for letting me vent.   

[thegrammalady]

vent away! and tell the doctor "no way" he can't force you to take anything!

[Joe]

While I typically defer to my neph, his doctorate is in medicine, mine's in computer science, every once in a while I've told him no. If my logic is sound for telling him no, he usually defers to me. If he can convince me otherwise, I go with him. As I see it, it's a partnership we're working on here.

[Cordelia]

Thanks thegrammalady       

Joe, I didn't say 'no' and I didn't say 'yes' ....

I explained my concerns to him...........

He said to me, "Think about it" and walked out of the room.       

[MooseMom]

Who IS this guy?

You are not his patient; you are A patient.

He is not your neph; he is A neph.

I think it's a bit unprofessional and irresponsible for him to just mindlessly start messing with your meds in this way.  You are not stupid.  You ask valid questions, but he doesn't supply you with reasonable replies.

You have to ask why dialysis patients so often develop cardiac disease.  One main reason is high serum phosphorus levels; this leads to the calcification of blood vessels.  If you keep your phosphorus within normal range, along with your calcium and PTH, then you lower your risk.  And if your cholesterol is normal, I really don't see the point of Zocor.  These statins are effective but they have their own side effects, so they need to be used with caution.

Don't say yes unless and until you are very sure and have done your research.

(BTW, I'm on Zocor, but I really need it!  So I am not against the use of statins, per se; they are very important drugs for the renal community, but first the real NEED must be established.)

[Cordelia]

I thought the exact, very same things as you, MM! I totally think it's unprofessional for him to do that. Everytime I see the man, he's trying to change something. I'm tired of it. I reallly am.

Yup, I asked perfectly valid questions and he didn't supply reasonable explanations.

My phospher levels are within the 'safe range' as long as I take my binders religiously and watch what I eat, they don't get too high.

I've looked at this cholesterol medication from every angle, and I clearly just do not see the point.

I have suffered from severe leg cramps from just changing my bp meds and that made me absolutely miserable.        That was a only a few weeks ago.   

I clearly understand where you're coming from when you say the real NEED must be established!      He has failed to do that.   

[sullidog]

time to find a new neph!
Never heard such crap in my dialysis life.
If I told my neph this he'd say that neph is full of sh*t!

[monrein]

I was only put on statins once my cholesterol and lipids became elevated.   

[Cordelia]

Unfortunately, because I'm at what's called a 'satellite' unit, a team of about 6 nephrologists, rotate and take turns. Each covers for one month at a time, over the phone but only visit once a month. I'm stuck with this guy when he does his twice yearly rounds at my hospital. I agree with you, Sulli, I sure wish I could have a different one! I do much prefer my own neph when mine comes in for his twice yearly rounds too.

Me too, I thought the same thing, never heard such ridiculous crap in all my 14 months of dialysis life, either!          

Monrein, thanks for letting me know your situation too. I'm getting the sensing feeling here so far is that one should really only go on statins if deemed absolutely necessary.

[Sax-O-Trix]

I am not on dialysis, but was on 80 mgs of Zocor for 12 years... Yeah, I know, they just said 80 mgs long-term is not a good idea, lol.  Perhaps it contributed to my CKD.   I just switched to 40 mgs. of Crestor.  Statins are not candy and can have very serious side-effects.  I would NOT take them if I did not have genetically high cholesterol, which is now even higher (over 300 at times) because of post-transplant drugs. 

You thought about the 2x a year nephs suggestion .  You won't see this guy for another 6 months.  Will he follow through and try to give you the script?  If not, I'd ignore the suggestion and wait to speak with your real neph about it the next time you see him. 

[Cordelia]

Hi Sax-O-Trix,

I agree. They can have very serious side effects. I agree, why go there, if its not necessary? I'm thinking the same thing......

Hmmmm I've been thinking about the scenario with the script. I'm sure he'll raise the question again once I see him. I am planning to say no and explain my reasons why.

[monrein]

Also say that you agree that it's an important and serious issue and you'll have your cholesterol checked as often as they like and then do something.  You might also suggest that you would take fish oil supplements (excellent for cardiac health) in the meantime.  Good quality fish oil can be expensive but it really is an excellent thing for us all to take and it controlled my cholesterol levels for a good two years post trx, after they already showed signs of rising.  My neph agreed that we would delay the statins if the oil worked.  I'm now on Prevastatin but still take high potency fish oil every day, twice a day.

[mcclane]

i'm on 2 kinds of cholesterol meds, both max doses too.

I've been taking those meds for gods knows how long now, I think ever since I was on pd years ago.  They never lowered my cholesterol meds even with my first transplant.  I figure by now my body is soooo royally screwed up that it doesn't matter anymore.

[Cordelia]

Never thought of fishoil, thanks for the idea, I'll definitely keep it in mind, Monrein!    

I'm so sorry to hear that, Mcclane.        So, if your levels are elevated pre transplant and then once going on the anti-rejection meds, the choloesterol rises?       

[mcclane]

Never thought of fishoil, thanks for the idea, I'll definitely keep it in mind, Monrein!    

I'm so sorry to hear that, Mcclane.        So, if your levels are elevated pre transplant and then once going on the anti-rejection meds, the choloesterol rises?       

I honestly can't remember, I think so, the immunosuppressants cause cholesterol levels to rise, hence the cholesterol meds.

[malaka]

I'm predialysis, so I don't know if this information is valid for you or not.  I tried Lipitor, but couldn't take it as it showing bad muscle/heart enzyme levels with mel.  So, is fish oil per the nephro and his rx of Welchol which lowers cholesterol in a different way than statins do. Damn horse pills, but no bad side effects so far.

[Cordelia]

Thanks, Mcclane   

Malaka, I've never heard of Welchol, either.

My husband's step dad is taking Lipitor, I'm familiar with that one.