I took Crestor for 3 yrs and had beautiful "numbers". Then one morning in the summer of 2003 I woke up feel as though I had the flu. When the 'flu' did not go away after several weeks of excruciating muscle aches I saw the doctor. He stopped the drug for a month and then re-started again with the same side effects.
He tried a different drug, then another, and another - until we had tried them all including things like Zetia, Questran. The last drug he tried left me almost unable to walk and I had to lean on my husband just to walk into the doctor's office. Each time doctor stopped and re-started the statin it took me longer and longer to recover. What hurts the most now is that this doctor doesn't believe me and thinks I'm lying!
I had the same issues with statins. I tried 4 different kinds and every kind just made me feel worse. MY endo put my lipitor to the 80 mg and that turned my life into a living hell. The doctors would not listen to me about the migrane headache that I had for 2 years running or the bad muscle pain and the loss of memory. Finally i stopped taking the stuff myself. The crazy thing is they keep harping on my cholesterol numbers but my A1C is at a 7 and they seem to be fine with that. I check frequently my glucose number and I am at 200 and I tell my endo and goes in one ear and out the other. Seems to be more concerned with cholesterol than A1C. But I push back on the statins.
These cholesterol medications are not without some serious potential side effects. Yes I know being diabetic can put you at an increased risk, BUT I'm not taking potentially dangerous medication,,,JUST BECAUSE. Luckily I do not have cholesterol issues, Same with an Ace-inhibitor, when I have no blood pressure problems, my diabetes is WELL managed, I have really no significant risk factors. Luckily my endo supports that as long as there is no significant risk factor, taking meds just to take them isn't really necessary, and my PCP after talking to my endo respected that decision too.
Without knowing your doctor, my guess is you have an uneducated nurse talking to you (as others have stated).
I would request a separate, longer appointment with your endo to specifically discuss YOUR goals and how to best work with the practice to achieve YOUR goals. I would state up front that if the practice is NOT interested in achieving the positive outcomes that YOU want, that perhaps the doctor will want to pursue a different career.
At this meeting, I would first ask if the doctor is aware that the nurse is beating you up for what are pretty outstanding A1C results.
I woud next ask if the doctor supports having you take statin medications that you are having a severe reaction to just so the doctor can place a check mark on your medical history. Further, is the doctor aware that the FDA is now concerned about using statins to reduce cholesterol, especially in diabetic patients? Could the doctor help you reduce your cholesterol count by using alternative methods?
etc, etc ...
The answers to your questions, beginning with the desire to meet with you to discuss YOUR objectives will tell you a lot about whether to continue with this doctor/practice.
Really sorry about the aggravation. Horrible to be threatened & blackmailed! And, that's what I'd tell the doctor.
I've had the statin argument with my doctor at most every visit. I refuse to take them as prevention & told him why. Too bad that he's not going to win a trip to London for writing enough statin scripts. A couple of times I took the Rx & tossed it because I wasn't in the mood for another discussion.
No doubt non-compliant is stamped in red on my records.
I read a few articles about lipid ranges being lowered specifically to sell more statins. Big Pharma push behind that.
I was but it was sort of that I'd withdrawn, as I hadn't seen the doc for a pretty long time, maybe 5-10 years, they'd sent letters, I'd reschedule, Walgreens would refill the RX, I'd mozy back in, etc. but the whole process moved very slowly, perhaps a gesture of support, until they cancelled my RX's. So I got a new doc. That was right about the time I decided to take things more seriously-ish, although it still took a while before they really started to click for me.
Re: having "non-compliant" on your file, the dx code should be on the itemized bill, 250.01/02/12/etc. ICD-9 coding. Here's the "trick for avoiding denials"which is sort of creepy-sounding, like many of these doctors seem to be, but is sort of an interesting article about the bizarro intersection of medical billing practices with clinical practicing. I think too that it may become more bizarre with nurses as they definitely seem to come across as nurse Ratchedy! I am not sure I could be "compliant" or "non-compliant" as my "plan" is "you know what you're doing so I can't really tell you anything except watch out for lows"
Here is where I become very confused. I do agree that an A1C of 5.1 pretty much indicates that I have too many low blood glucose levels. I am actually trying to lighten up a bit on myself, but if you saw my post about the Paramedic visit last Sunday, it is pretty obvious I am still struggling with lows.
Here is an almost exact quote of what he said (my A1C in his office that first day was 5.6): "If you having another A1C as low as 5.1, I will release you as a patient. You have a long way to go to an A1C of 7, so loosen up on yourself. Lower your carb to insulin ratio, correction, and basal rates. It is not the high glucose levels that will kill you, it is the lows, especially with your history. The lows mess with blood vessels, heart, brain and that is what will get you if you keep this up. See me again in 6 months."
And people wonder why I just use the endo for pump prescriptions.....
Folks, my guess is that we will be hearing more stories like this in the next few years as an unintended consequence of health law changes. Doctors and ACOs are going to be "scored" on their patient outcomes and a LOT of money will be riding on those scores. Better scores mean increased Medicare/Medicaid reimbursement. Combine that with a bunch of new patients in the health system without a substantial increase in doctors and you have a perfect opportunity to "game" the system. I have known my endo for twenty five years and but he is thinking about turning his practice into a "boutique." Non-compliant T2's would just be a bad memory for his staff.
I think I would feel worse than Mayumi, were I in that situation. Many, including me, expect more respect and when we don't get it from a medical professional, we are vulnerable.
another thought on this. If you have been warned about this non compliance mess I think its time to just go and get a new doctor before your insurance gets any information from them. Your new doctor does not have to know what happened with the previous doctor. When i had very bad side effects from the cholesterol medicines and the current doctor at the time decided to do nothing about it, I just went somewhere else and got a new doctor. I have one insurance company in my work but there are plenty of endos out there. Doctors are here to work for me not the other way around. My thought is no one dictates to me. I understand what they are trying to do but it does not work for everyone. So fire your doctor in my opinion and get a new one. I always tell them unless you sign a paper stating that you will pay for my emergency visits because of the statin issues then I am not taking them. I had 3 kidney stones from calcium build up from statins with bills of 3000 even with insurance paying. So statins are costing my insurance company more when I was taking them. So time to go shopping for a new endo for you in my opinion.
Blame the affordable care act! Doctors are expected to do everything to help patients get quality medicare! so If a patient comes up with a complication after the doctor sees and treats him he can get into trouble for it! If you see a doctor and he does not catch a problem and you go back again the doctor can be in trouble with the government and will NOT be Reimbursed for the second visit. They are trying to reduce repeat visits thus saving money.. The problem is that doctors DON"T have a crystal ball and they are not physic so they can not see in the future! Thats why the doctors are covering bases and pushing this type of practice!
First off lets not blame affordable care. It is going to keep a lot of us in insulin. I can deal with small repercussions. Second, there are alternatives to traditional Statins. Truly. I am neither a medical professional nor some one to offer medical advice but, my father needed statins and could not take them due to med reaction (he is not diabetic) and the doctor instead gave him Red Yeast Rice. I'd never heard of it. It actually is fairly respected in the medical community. That being said, please ask you doctor about alternatives. Tell him the statins make you sick and you want to see that that is noted in your charts for insurance purposes. If you really think he may kick you out ask to get copies of ALL your medical records from the practice to review them yourself. If he has written or noted something that is untrue about you it could affect you down the road with future doctors or insurance.
I don't really see anything to insinuate that you have been removed from this doctor's roster. I do, however, agree with you that there is a lot of chatter out there about statins, and their side effects. I understand your fear of them, and in your mind, that is justified. I cant agree or disagree with you. Personally, I take statins because, for me, they work.
It is not unusual for a diabetic to have to do fasting lab tests. Nurse Nasty had no business insuinuateing that you are out of diabetic control. It is generally accepted that any A1-c level below 6.5-7 is in control. Your posting did not mention your blood pressure or cholesterol numbers, but I would guess that they are okay. Fact of the matter is, one sees a physician to get into control with these issues. If this practice only wants to see healthy, disease free patients, it may not be the practice for you.
I made a dietitian cry once, and I have told an endocrinologist to get real. Were this me, I would be looking for a different medical practice to patronize. They are out there, and it didn't take long to find one that I could live with very well. They were just across town.
Red yeast rice works because it CONTAINS a statin. Lovastatin, to be precise. Here is an annotated paragraph from Wikipedia -- you can go to the article itself and look up the references.
"In the late 1970s, researchers in the United States and Japan were isolating lovastatin from Aspergillus and monacolins from Monascus, respectively, the latter being the same fungus used to make red yeast rice but cultured under carefully controlled conditions. Chemical analysis soon showed that lovastatin and monacolin K are identical. The article "The origin of statins" summarizes how the two isolations, documentations and patent applications were just months apart.[5] Lovastatin became the patented, prescription drug Mevacor for Merck & Co. Red yeast rice went on to become a contentious non-prescription dietary supplement in the United States and other countries.
"Lovastatin and other prescription "statin" drugs inhibit cholesterol synthesis by blocking action of the enzyme HMG-CoA reductase. As a consequence, circulating total cholesterol and LDL-cholesterol are lowered. In a meta-analysis of 91 randomized clinical trial of ≥12 weeks duration, totaling 68,485 participants, LDL-cholesterol was lowered by 24-49% depending on the statin.[6] Different strains of Monascus fungus will produce different amounts of monacolins. The 'Went' strain of Monascus purpureus (purpureus = dark red in Latin), when properly fermented and processed, will yield a dried red yeast rice powder that is approximately 0.4% monacolins, of which roughly half will be monacolin K (identical to lovastatin). Monacolin content of a red yeast rice product is described in a 2008 clinical trial report.[7]"
My take on the whole discussion is that if you react badly to one statin, you may be able to tolerate another, but if your cholesterol is good, you maybe shouldn't bother. But be aware that when a doc recommends a statin, he's just trying to protect you, because heart disease is the #1 killer of diabetics.
Huh well that explains why it worked so darn well, and for 4 bucks a bottle! I wonder why it didn’t give him all the soreness he was experiencing on the regular rx statin? Hmmmm?
That's because different statins ARE different, and whatever it was that was bothering him with the one he took was not present in Lovastatin. Another possibility is that the amount of drug in the red yeast rice may be lower than in the tablets, so would fall below the level at which he might react.
I definitely believe that some people are sensitive to statins, but maybe not to all of them -- there are a lot of different ones. So I wouldn't categorically say that no one should take a statin, nor would I say that everyone should take one. Some people interpret a bad reaction to one statin as a blanket counter-indication to all of them, and some doctors won't try another in a patient who has had a bad reaction to one. So it's really up to the individual and the doc to make the decision as to whether to try another one.
But for a person who has never taken a statin, and who does have indications that it might be needed, it's nonsense to rule it out a priori -- many more people take statins with no side effects than those who do experience them.
Statins are a standard of care but that doesn’t mean that care shouldn’t be individualized. If a medication is contraindicated because of a previous adverse reaction all a physician has to do to satisfy any regulatory enquiry is document he considered the drug and it’s contraindicated because of x, y, and z and document that in the chart. Problem solved for everybody.
Patients have a right to refuse treatment too. I think the nurse way overstepped her bounds when you’re just talking about a lab test. There really should not have been any of these what if’s and talking about compliance issues.
That being said I would want to know what my lipids were irregardless of meds so I don’t see a problem with them ordering the labs itself. Cholesterol is usually only checked once a year if you’re stable.
I don't think that statins and taking them or not taking them should influence one's "diabetes rating" as far as compliant or non-compliant. That's a separate category which, if anything, should really be "evaluated" by a cardiologist.
I like to keep an eye on lipids but also have ended up in adopting Gary Taubes' opinion that the key to that isn't avoiding veggies as much as avoiding carbs, exercising and, perhaps most importantly, eating lots of veggies. This has worked great for me but may not work *exactly* the same way for anyone else. I wish the doc would test it more than 1x/ year so I could work to "nudge" it like my BG but that may just be me.
I agree that insurance-oriented standards of care and doctor ratings seem fraught with peril as they seem very likely to reinforce the tendency of both the medical *and* insurance industrries to act like "know-it-alls" when, at least in terms of diabetes, there are many instances where they don't know squat. When they start judging and acting like the nurse in question in the OP scenario does, it's time to throw yellow flags, get out red and yellow cards and take your business elsewhere. It may also be interesting to explore what they will do to make you "compliant" and help you achieve everyone's goals.
My particular problem is that I have tried all the statins and I have kept track of that in my file at home. BUT it has not been documented in my medical electronic chart at the doctor's office. They just recently in the last two years changed from paper records to electronic records, and my problems started back in 2003 - long before electronic records started in our area. So I am screwed because no one believes me and thinks I am some old senior citizen who is lying.
Red Rice yeast wasn't as bad for me as far as reactions go, but it was to the point where I needed a pain killer for the muscle and bone pain....that to me just is not worth the effort.
I agree with what others have been saying,find another doctor. If his "reputation" matters more than his patients, he's seriously got his priorities messed up. If you can't tolerate a medication, he needs to realize that. A 6.1 A1C is a lot of work and a very good job. That means your BG is an average of 120.
So you still need to discuss it with the doc and not the nurse. And you need to determine whether your cholesterol is actually high enough to put you at risk, while considering your age and life expectancy.
Then when all is said and done, the only other thing i can think of, if you truly are at risk, is to go as low-carb as you can tolerate. The reason I say that is purely personal -- when I was limiting carbs, I had a spectacular improvement in my lipid profile. I'm not limiting carbs as much now for other reasons, and I CAN tolerate statins, so it's not so crucial for me, but it might be worthwhile for you. Mind you, this is NOT medical advice, merely anecdotal for ME, but it might be worth a try for you. Totally YOUR decision. But I do hope you find a solution for your original question, and take the opportunity to talk to the doc and ignore the nurse. Good luck!
