Dr that doesn't believe me

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MattCo
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Dr that doesn't believe me

Post by MattCo »

How do I talk to a doctor that doesn't appear to believe me? I started another thread about what to do about my prescription for a statin (avostatin). This is what I told my doctor:
Is there a chance we can talk about this? Two things: First, my lipid panel last year was much better and I'd like to try and get back to that. I'm more than willing to have a lipid panel taken every 2 months to help understand what does and doesn't work.

Second, and part of the reason I'd like to see if there's another way to solve this problem, is that I have one ApoE4 gene. Furthermore, atorvastatin is lipophilic, can cross the blood brain barrier and is known to increase the risk of Alzheimer's. It's likely worse for those with an ApoE4 gene. Given that I already have an ApoE4 gene and my father has Alzheimer's, I'd much rather try a hydrophillic statin if I have to try one.
and this was his response:
We can change his Atorvastatin to Rosuvastatin 10 mg daily.

His comment that Atorvastatin is known to increase the risk of Alzheimer's is not correct. A small study showed a small subgroup that may have negative effects on cognition which reversed when taken off the statin but there is no controlled trial that showed these cause Alzheimer's.

Overall, statins likely help cognitive function due to the decrease in vascular disease and stroke prevention.

Changing from the Atorvastatin to the Rosuvastatin will change his from a lipophilic to hydrophilic statin.
Am I right? From what I've read on this website I am. At the same time, I have some other genes that imply I'm in trouble including: MTHFR C677T, or snp rs1801133 (hi homocysteine) , rs5082 (bad results with sat fat), rs662799 (hi triglycerides and early heart attack), rs10757278 (heart attacks).

I would just like to talk to someone about this. I don't want to be stupid but at the same time I feel like I'm being managed by a one size fits all algorithm.

Thank you for your understanding.
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SusanJ
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Re: Dr that doesn't believe me

Post by SusanJ »

MattCo wrote:I would just like to talk to someone about this. I don't want to be stupid but at the same time I feel like I'm being managed by a one size fits all algorithm.
Have you had a heart scan? It would help you know if you have existing plaque, because that might help you settle the question to take a statin or not. Statins can be lifesaving for people with a established plaque.
circular
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Re: Dr that doesn't believe me

Post by circular »

MattCo wrote:How do I talk to a doctor that doesn't appear to believe me?



Am I right? From what I've read on this website I am. At the same time, I have some other genes that imply I'm in trouble including: MTHFR C677T, or snp rs1801133 (hi homocysteine) , rs5082 (bad results with sat fat), rs662799 (hi triglycerides and early heart attack), rs10757278 (heart attacks).

I would just like to talk to someone about this. I don't want to be stupid but at the same time I feel like I'm being managed by a one size fits all algorithm.

Thank you for your understanding.
Hi MattCo. Many of us here can agree with your desire to have a real and respectful conversation with our doctors about medical matters, rather than to be talked down to or to be just another number coming through the door among patients who are all treated the same. I think I went through three primary care doctors before finding someone I can work with, where we show mutual respect and a coming together in the middle given our different positions. I feel it is worth taking the time to keep moving on until you find the doctor who is the best possible fit for you. This can be more challenging within the conventional medical system. Many turn to functional medicine, but some of its expensive approaches and treatments aren't covered by insurance. A good alternative can be an 'integrative' practioner who was trained and practices in the classical/conventional medical system but thinks from and practices using a more systems/holistic/functional approach. That's my preferred sweet spot. Sometimes integrative specialists can be located as well as integrative primary care doctors. This kind of doctor can still be a bit hard to find though, and I imagine particularly so outside of larger cities (?).

I don't think you're being stupid at all to be turning over lots of rocks and trying to make the best decisions for yourself. As you do so, I'll just caution you against using Promethease to look up your genetic results, if that's what you're using. I did a comparison of a large handful of SNPs between my Promethease files and my 23andMe raw data as displayed at the 23andMe site. Promethease displayed them wrong too often for my comfort. The other problem I've seen over and over occurs when one's own phenotype doesn't correspond with the genotype description as to how their SNP variant should manifest. I think the best thing when possible is to test, test, test. So for example try not to stress about the implication that your homocysteine could be high. Just test and know and forget the genes for which you can't determine how your SNP variant is actually playing out. I don't at all mean not to take some of our genetic results seriously, because they can sometimes lead us down really important paths, but I think that out of context of lab or imaging results our SNPs not as helpful as we would like to think. They can even cause chronic fear which itself contributes to chronic stress which in turn contributes to all kinds of badness including cognitive issues at present or later. Often there will be compensating pathways that are working in us just fine, or other genetics that are offsetting a bad player. That said, often we will be the poster child for a particular SNP result we carry. I guess it's a balancing act: How do we focus on the ones we can test and do something about while ignoring the ones we can't.

This comes to play even when considering specific effects of ApoE4. There's a tendency for people to say, 'ApoE4 does this or does that', as if the effect mentioned is the same in all people. I don't find this as helpful as, say, 'ApoE4 has been shown to do X in some/most/majority/? of carriers of [1 or 2] copies in [eg, mice or humans].' Then, if it always does something in carriers, it would be more helpful to read something like, 'ApoE4 always does X in carriers with [1 or 2] copies as studies in [mice or humans] have shown.'

I also encourage you to keep in mind that while there are many people here who are really knowledgable about a lot of topics, the science is so often not settled. Personal conviction here doesn't necessarily equate with settled science. Nor does hearing something said many times over. (This is much like the web in general.) Sometimes perspectives will be backed with very strong science in animal models or even humans, but not always. And with over 4,000 members in this forum, it's probably impossible to even say what 'most' of us do or think.

You may already know all this, but I think the big picture is important to reiterate once in a while. (PS, I'm not official here, a moderator, or anything other than a contributor.)

I loved your using the word 'chaos' to describe the diet conundrums :lol: . It seems that over at PubMed we mostly have these two scenarios when researchig topics: 1) not enough of an evidence base to make an unequivocal claim, or 2) so many papers on a topic that there really is no possible way for one human brain to synthesize it all. But this (along with all of the above) might say more about my mood and (lack of) capacity as a worn down caregiver than the state of science at PubMed :D
ApoE 3/4 > Thanks in advance for any responses made to my posts.
MattCo
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Re: Dr that doesn't believe me

Post by MattCo »

SusanJ wrote: Have you had a heart scan?
I always thought those were really expensive. Apparently they're not so bad. Thanks for the tip.

Anyway, nobody has answered by question, was I wrong about what I told my doctor? It may be true that statins are good for the heart, but is there a tradeoff with AD, especially for statins that cross the blood brain barrier?
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floramaria
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Re: Dr that doesn't believe me

Post by floramaria »

MattCo wrote:
SusanJ wrote: Have you had a heart scan?
I always thought those were really expensive. Apparently they're not so bad. Thanks for the tip.

Anyway, nobody has answered by question, was I wrong about what I told my doctor? It may be true that statins are good for the heart, but is there a tradeoff with AD, especially for statins that cross the blood brain barrier?
Hi MattCo, personally I don’t think you were wrong in what you said to your doctor. But I am not a doctor. And as Circular pointed out, personal conviction does not equate with settled science. I think SusanJ’s suggestion is a positive step towards clarifying where you stand.
I am one of the people on this site who follows Dr. Bredesen’s approach. There are undoubtedly others, like your doctor, who disagree. In Dr. Bredesen’s book, The End of Alzheimer’s Program he discusses elevated lipids and statins. (pgs 124-127) What he presents supports what you said to your doctor. He states that statins can increase the likelihood of cognitive decline and provides a footnote . And, as you told your doctor, Dr Bredesen says it is important to protect cholesterol synthesis in the brain by using a low dose hydrophilic rather than lipophilic stain if a statin is necessary. You might benefit from looking at these pages and the footnoted supporting materials. (He also recommends the CAC scan to see if you have active coronary artery disease and suggests finding a cardiologist or lipidologist who uses a low carb approach.)
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MattCo
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Re: Dr that doesn't believe me

Post by MattCo »

Thank you.
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Re: Dr that doesn't believe me

Post by ApropoE4 »

Statins are so widely (and successfully) prescribed that any large effect on AD (even if only in 4/4 or 3/4 carriers) would have manifested itself by now and therefore this should not be a consideration.
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Re: Dr that doesn't believe me

Post by floramaria »

MattCo wrote:Thank you.
You might find the comprehensive WiKi on Cholesterol, Lipids, and treatment options, including statins helpful :
https://wiki.apoe4.info/wiki/Cholestero ... ng_statins
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MattCo
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Re: Dr that doesn't believe me

Post by MattCo »

floramaria wrote:
MattCo wrote:Thank you.
You might find the comprehensive WiKi on Cholesterol, Lipids, and treatment options, including statins helpful :
https://wiki.apoe4.info/wiki/Cholestero ... ng_statins
That's the page that got me into trouble. :)
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floramaria
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Re: Dr that doesn't believe me

Post by floramaria »

MattCo wrote: That's the page that got me into trouble. :)
:lol:
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