Statins and Me

What can I say. Statins are bad drugs for my body. They do have a role in people at risk for cardiovascular disease. HOWEVER, these drugs are not without side effects (beside monetary), and I have been subjected to the very common but almost disabling muscle pain that can occur with any statin medication.

First let me say that my cholesterol and LDL have climbed as my weight has dropped (more in a few sentences). About 8 years ago after a cardiac cath for chest pain and an abnormal ECG, I was diagnosed with diastolic dysfunction (left-sided heart failure probably from being too fat), but my coronary arteries were perfectly clean. My cholesterol at the time was 200 with low HDL (the good kind), borderline high LDL, and the only risk factor for heart disease was my father’s history of MI at a young age (56). I was put on a medication that rhymes with lipitor, and about 2 weeks later experienced extreme muscle weakness in my legs. That was stopped and another statin was started. I tolerated that med well but stopped it after I started losing weight.

Enter a new doc in a new town and another cholesterol check. I was now post-menopausal, adding to increased risk of coronary artery disease, my cholesterol had climbed above 200, but my HDL was surprisingly higher, and my LDL was much higher. My weight at this time was 305 – YIKES. I was started on a medicine that rhymes with crestor – a very low dose 3 times a week. As my weight plummeted, I saw a new cardiologist who declared me free of my former diastolic dysfunction and didn’t seem too upset about my cholesterol.

Next visit to my primary care doc, she suggested increasing the dose of the statin to every day. Enter the debilitating hip pain in late October, so bad that I couldn’t sleep some nights. Figuring this was a side effect of the medication, I quit the drug but continued to walk around like a little old lady, even unable to walk around the block, barely able to grocery shop. Repeating my cholesterol showed that the LDL continued to climb (despite my excellent diet!) as did the total cholesterol. Off to a rheumatologist – a wonderful woman who took time to listen to my sob story, praise my weight loss, and do extensive history taking (family history full of autoimmune disease), physical exam, and lab work-up. Thankfully everything was normal. So, statin side-effect this is. She suggested Coenzyme Q10, which is not cheap if you buy the good stuff. One week later I am feeling better! Yay, tolerating a one-mile now.

What I have learned: Statins should be reserved for those at high risk of heart disease with cholesterol problems. Not all LDL is created equal. Regular lipid profiles only calculate LDL, they do not differentiate between dangerous (small) LDL particles and the not dangerous (“fluffy”) particles. Good LDL can increase as one’s diet improves. There is much to read on this. I suggest the Heart Scan Blog linked on my page for more info and references. I’m still learning myself. I have changed to a low carb, no wheat, no grain, no sugar diet. And, I high recommend Gary Taubes, Why We Get Fat: And What to Do About It to debunk many nutritional myths about calories in/calories out paradigm.

More in later posts. This is already too long.

cholesterol cartoon

Six-month Check In

Time flies when you aren’t gaining weight. Daily self monitoring sometime becomes a “losing the forest for the trees” kind of thing, thus, time to reflect and see how I have been doing with behavior changes and remind myself and the vast (cough) number of readers what is working, what I’ve thrown out, and what my latest doctor visit revealed.

As a summary, my plans for weight loss were kick started by a laparoscopic cholecystectomy September 16, 2009. Resulting complications left me unable to eat much for over a month. My surgeon, Dr. Katie Artz, performed a superb procedure using only one incision, and she was amazingly tolerant of me. During my pathetic attempt to play patient through unexpected pain, numerous tests and ridiculous GI side effects, I resolved to make permanent lifestyle (ah, that word) changes and worked hard to outline clear behavior goals and get my partner on board to support me.

Defining goals in terms of behavior change, not just how much weight one wants to lose, is a crucial component of being successful. Ask me, I’m a behavior change expert – no really, want to see my research publications? I consider weight “goals” to be long-term outcomes of behavior. I do know it is  important to establish those long-term and intermediate weight outcomes (as I have posted on the sidebar), but without knowing how you are going to get there, it’s impossible to just go out and lose 140 pounds. Holy shit that’s a lot of weight to lose! Another reason for breaking down the goals into behavior change components is that individual behaviors are much more doable than just dropping an entire person off your body.

Knowing what has worked for people who have successfully lost weight and maintained that loss, knowing from scientific data what people do to change health habits (on their own or with help), knowing my own stumbling blocks from prior losses and regains, here is how I started: I chose a ultimate weight outcome, intermediate weight outcomes, a physical activity outcome and then listed what behaviors I needed to do to get there. January 8th I posted these. Now time to revisit.

I have done stellar at self-monitoring my weight and food intake. I’m still eating a higher percentage of carbs than I would like, but they are complex carbs, so I will live with the current balance between carbs/protein/fat. I still do not eat any protein from animals with eye lashes (go figure – it’s some aversion that occurred postop). No sweeteners – check.  All food within my reach is something on my plan because I still have such low impulse control. The only refined products are Lean Cuisine© and Eating Right© frozen dinners plus the occasional protein shake + skim milk to supplement protein and calcium intake. Fruits and veggies easy now with huge salads, fresh fruit with lunch or breakfast, and low sodium V8 as a treat. And, I have not even looked at ice cream. Breakfast, ummm, sometimes after my morning coffee it’s already time for lunch, so that needs improvement. Although I do not indulge in late night eating any more, I do eat dinner after 7 pm frequently. I need to rethink my time limit or buckle down and cut off eating by 7 pm.

I have continued to keep my family and partner in the loop of what I am doing. Sue and I have effectively blocked her mother subverting my eating plan this winter (perhaps another post about family sabotage later). I stay connected to online support groups because that is the only place where I have been comfortable getting and receiving support in this effort. When I feel a bit edgy, usually in the evenings, I appease my other senses by lighting candles, having an abundance of herbal teas, luxuriating in my therapeutic tub with exotic mineral salts, playing non-violent video games (a change in my gaming pattern), holding the pets, listening to music more, and trying to write more.

My physical activity long-term outcome of walking a 5k is on hold because of a knee injury. An appointment with orthopedic surgeon scheduled since walking around the block is almost impossible at this point.

Having lost 61 pounds and eating so healthy, I proudly presented myself to my PCP for a routine visit, a recheck of cholesterol, and follow-up on liver enzymes that were out of whack for months after surgery. I had gone off my cholesterol lowering med because of its effect on the liver and the fact that I was eating so damn healthy. Good news, my blood glucose is low, low, low; liver enzymes are back to normal. Bad news, my total cholesterol is higher than it has ever been; HDL cholesterol (the good kind) is high; but LDL (the bad kind) is very high. So back on medication. Rats! Also, my blood pressure was elevated even though I am on a beta-blocker for another condition. WHAT THE HECK?

So now… Nothing to change on the diet front. I satisfied that my salt and fat intake are not contributing to my cholesterol and BP problems. In fact, I’m giving myself a huge pat on the back for keeping my behavior changes going although I have so much more to accomplish and a lifetime ahead of me. There are other ways that I can be physically active that do not involve my knee – looking for a pool (we must be the only people in our Tucson neighborhood without one) where I don’t feel too self-conscious showing so much flab. Checking blood pressure 3 times a week for now. Starting on new cholesterol med.

I do allow for special occasion eating. Life goes on, and it’s OK to have a romantic 5-course dinner that includes a few bites of desert – as long as I plan for it.

Oh yes, I am enjoying buying new clothes but still disgusted with my body. Fodder for another post.