This week the American Heart Association and the American College of Cardiology have changed that with a set of new guidelines to measure the risk of heart disease and the need for cholesterol lowering medication.
The prediction is that these new guidelines may result in twice as many Americans being prescribed statins for life. Another major change: Some patients who would have been prescribed statins under the old guidelines may now be told to lower their cholesterol the old-fashioned way a€” via better diet, more exercise and life style changes like quitting smoking and monitoring alcohol intake. A LDL cholesterol numbers are no longer the solitary focus for doctors prescribing statin drugs to lower the risk of heart disease and stroke. So – I first gave the patient a phone call and spent 20 minutes on the phone with her. She was scheduled for an appointment with me 2 days later and I made a promise that we would discuss more in depth and map out a personal plan for her to get her diabetes under control and start walking again.
She was thankful for my phone conversation and later, when we met, I would find out that she said she could tell from just that one conversation that I was going to work with her and help her get her life back on track. That first appointment with her I spent an entire hour to hear her story, get the details and find out how she had been doing overall. Life-stressors with finances, her children, and her failing health were actually to a point where the patient DID NOT FEEL WORTHY OF CONTINUING HER MEDICAL TREATMENT since she did not feel that she could EVER get her diabetes or weight or any of her other problems under control.  She was also SAD about the fact that she was becoming more of a burden than a help to her family as she could no longer drive due to her eyesight and chronic leg ulcers and neuropathy (decreased feeling in her legs).
After spending a lot of time talking about her life-stressors and ways to cope, aside from patient’s Depression, as had been revealed in our phone conversation, the patient was overwhelmed with the sheer number of medications so she had quit taking ALL of them!

Well, I spent time to REVIEW all of her medications and  TYPED THEM OUT IN SPANISH for her (since she did not know what medication was for what and when to take them).  After explaining what each medication was for and WHY it was important to be on them, she understood and I gave her a print out to take home with her. Now, for those of you who do not know, you can only bring a patient’s HgA1C down about 2-3% at maximum on the Highest Doses of all Oral medications, PLUS being on Injectable INSULIN. So, we went over simple chair exercises she could perform for mobility, strength and stretching. Okay, so, our hour long conversation ended on a positive note and the patient was more Educated and more Empowered.  I stressed the importance of her to RE-START her Medications first and foremost, and THEN  to start making small changes with regard to diet and exercise. She was sent out with all new re-fills for her medications and with goals to follow up with me in one month. Weight, blood pressure and LDL cholesterol levels have for years have been the most important markers heart disease.
No longer is the LDL level (low density lipoprotien cholesterol a€“ the bad kind) the deciding factor of whether you are prescribed statin drugs. The new guidelines however take in a broader scope of health aspects to predict a percentage of risk.
Some physicians worry that using these guidelines to prescribe statins to currently heart healthy people who score as a potential risk under the new calculator will result in patients ignoring their recommendations. That’s still a terrific way to prevent high cholesterol and heart disease later in life.

I let her know I was her new doctor and that I had reviewed her chart and we really needed to get some new labwork on her to see how her diabetes was doing and to talk about getting a hold on it and getting everything under control. Patient stated that she actually self-discontinued all of her medication because she was feeling overwhelmed with the number of medications she was taking.
Well, in that one hour, I did address every one of her medical problems, and reviewed ALL of her medications, But do you know what was the biggest issue in her Healthcare?
Simply put, medications are a band-aid – a temporary solution to a problem without addressing the CAUSE of the problem.
The formula for calculating that risk takes into account patients’ age, sex, race, blood pressure, cholesterol levels and whether they smoke or have diabetes. We spoke, in depth, about the use of the medication to control her blood sugars and the extreme need for better NUTRITION and EXERCISE in her lifestyle changes.
Patient said, however, that she had a diabetic ulcer on her foot and her podiatrist told her to stay off of her foot.

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