You won't see anything terribly new here but if I don't get it out I'm going to stew all night, and I don't have a blog.

It finally happened: after years of watching other people make this kind of post, now it's my turn. A year ago I made the mistake of letting them test my cholesterol, and I had the typical low-trigs/high-LDL pattern and my doctor flipped out. I've been dreading having to follow up for my prescriptions ever since. And let's talk about those. I take:

--ambien, for lifelong insomnia
--tramadol (50mg), for arthritis in my hands. this is a very mild painkiller that the DEA doesn't even bother to schedule.

She's been just fine with giving me these for several years and I have not requested dosage increases or anything like that. Do you know where this is going yet?

I couldn't put off the follow-up any longer, so I saw her today. You already know what I'm going to say. More flipping out. Demanding a retest (which I have not scheduled). Also:

No, she is not encouraged by my low triglycerides. They don't matter.

Everything I read on the internet is completely wrong. (This was when I said, "If it's any reassurance, I have read about this extensively and no one in my family has CHD anyway". I didn't say anything about the internet.)

She also knows I've seen Dr. Westman ("My Big Fat Diet") and has made it really clear with her tone and body language what she thinks of him. Total dismissal.

I finally told her point blank I would not be taking statins. (I'm a 38 year old female, with no family background of CHD or stroke, for christ's sake.)

She smiled and nodded and then announced that she felt we should start weaning me off the tramadol because it is addictive.

Nevermind actual pain management, I might develop an addiction to these stupid little quasi-painkillers that just happen to be perfect for relieving my chronic hand pain that I've been getting since my 20s. And then...what? I have no idea. Maybe in ANOTHER five years it'll be a gateway drug to...tylenol #3s? FFS. I don't smoke or drink. I think the ship has sailed on me becoming a junkie.

Sigh.

Anyone have any info on a lowcarb-friendly doctor in the Durham area? I suppose I'll try to get back in to see Dr. Westman, but I really need a gen'l practitioner. I assume she'll try to withhold my ambien next and then I'll really be screwed.

That's awful!

You are not alone. Same thing happened to my bil. He has pain from a major accident that he was in about 5 years ago. He was lucky to live through the accident. Bil told his doctor that he was not taking statins and the doctor said that he would address his pain after he got his cholesterol under control.

Bil won't file a complaint with the medical board despite my sister's urging. He's looking for a new doctor now - actually, she's looking for him.

Wow! That sounds so unethical. Time to change doctors, for sure.

Too bad you cannot force your doctor to listen to Confessions of a RX drug rep, what we all must know. Of course, if she is totally brainwashed then you might as well talk to the wall.

You might also want to get Confessions of an Rx Drug Pusher by Gwen Olsen, the person giving the talk on youtube. The doctor won't read it but having it in hand with pages flagged to relevant passages might work.

Can you get your health insurance provider (if you have one) to give you a list of doctors in your area that they work with. I am with BCBS and can get a list of their preferred providers. You would then need to "interview" each one to check for statin bias. Good luck.

Thanks, folks.

I also forgot to mention that she avoids acknowledging my 50# weight loss, other than to ask somewhat snidely "so the weight loss was intentional?". I couldn't make this crap up, honest I couldn't. The saddest part is that my patient-doctor relationship with her has been fine for years, up until I dug my heels in on this one issue.

Anyway, once I cooled off I called and was able to get an appointment with Dr. Westman for next week--I figure I'll take the opportunity to talk with him about setting a goal weight and getting to it; about how to manage the whole cholesterol issue while still being able to access other medical care (how ridiculous is it that I even have to type this), and whether he can write me the two scrips I do need to have available. If not then I'm hoping he can refer me to a primary who isn't married to the statin playbook.

Edited to add: newruth, I reread your post, and wow--sounds like that doctor was even more overt about the blackmail than mine was.

Just curious..did she fractionate the LDL? If not, it's all useless anyway.

I guess she hasn't read the research the statins show NO health benefit to women except for a minor sub-population who are young who have had a major cardiovascular event. If you're over 50 no benefit whatsoever.

Personally, as a healthcare provider, I see and hear this over and over again--holding someone hostage until they fall in line with <insert here>. The answer is so simple....all she needs to do (but she won't because she's so wedded to conventional belief--but I do it all the time). It goes something like this in their chart:

Discussed risks and bnenfits of <insert here>. Information was given. All questions were answered and patient refuses <insert here>. Simple. Easy peasy. If she were really that paranoid, she could have you sign a disclaimer also that you were counseled on the <insert here>, and declined treatment.

Dr. Westman??!! THE Dr. Westman??!!! I'm so jealous.

From your point of view as a health professional, is it ethical?

Of course it's not ethical.

There are in fact guidelines about adequate pain relief. However, these are aimed at keeping fears of drug addiction and prescription abuse from preventing adequate pain control.

The whole idea of withholding an unrelated drug (such as for pain control or insomnia or anxiety) to coerce a patient into cooperating with, say, cholesterol medication, is different, and completely unethical. It would never stand up in court - but the difficulties of proving it are obvious. A physician would have to be stupid indeed to document that he/she had done exactly that.

Although it is not an opiate, Tramadol works on the opiate receptors, therefore has been known to cause opiate cravings for those who are trying to ditch the addiction.

Ambien will cause dependency, as well. Lot of people are known to have bizarre behavior during sleep. Of course, they are unaware of it, unless someone sees and tells them.

Wow, Gwynne, I hope you do file some sort of complaint with the appropriate regulating body. Glad you're not caving. 38 year old female w/no CHD, for crying out loud.

On a related note, I have a nagging feeling my GP will try to force me to get a certain test I don't want when I go later to get my birth control system renewed. Ain't gonna work, bud, even if I have to go somewhere else.

Cnmlisa: it is that Dr Westman; by the time I was able to get in to see him the first time (about an 8 mo delay for new patients) I had discovered IF and lost a big chunk of my needed weight, and I only followed up a few times; then I switched insurance, and then my mom got cancer, with the end result being I haven't seen him in about 18 mos. I was thinking about this earlier and I realized that this should serve as a wakeup call to me to take advantage of the fact that I do have access to this doctor, especially while I try to lose the last 20-30 lbs and deal with the cholesterol issues (on paper).

Regarding the ambien and tramadol: rather than get into a debate, I'll just say that my doctor herself had been satisfied that I had educated myself thoroughly on both of these meds and knew I took them very responsibly. For five years. Until I refused to come along with her on the cholesterol panic.

My other thought on this....

Go to a sleep doctor, let HIM (or her) do an evaluation, get your sleep meds thru him.

Go to a pain specialist, let HIM (or her) do an evaluation, get on a pain med contract and get your meds thru them.

I have chronic insomnia and have since I started doing shift work as a RN and then taking call as a midwife. I went to the sleep specialist--got some good tips and get my sleep meds (Ambien) thru him. NEVER an issue.

Like I mentioned before...unless the LDLs were fractionated, it's useless drivel.

Lisa: this doctor starts rolling her eyes if I even say the word "triglycerides" and she is just a shopping-plaza family practioner. So while I'm not sure what fractionating is (does that have to do with large fluffy particles and whatnot?) I can guarantee she's not interested.

Good suggestions on the sleep/pain issues. I have bad, bad, bad insomnia and a specialist had never occurred to me. (I follow good "sleep hygiene" by the way, I'm not doing anything like drinking coffee in the evenings and then being surprised I cant sleep. Been like this since puberty.)

I also forgot to mention, both parents have had to have thorough heart exams for diffeerent reasons in the last year (dad is obese and mom is getting chemotherapy). Mom's cholesterol numbers look like mine and they found no signs of arteriosclerosis.

Maybe time to find a new health provider.

Yep. Finding out specifically if you have the dense dangerous LDL or the nice fluffy, poofy LDL. Or...if you really wanted to shut her up for good, have heart scan done and track your plaque--that should stop her in her statin covered tracks

It doesn't matter even if youfollow good sleep hygiene. A sleep specialist will talk to you about the specific type of disorder you may have, if you're getting adequate REM sleep, when you dream most vividly, do you dream in color/black white, etc. Since I saw the sleep doc, I still have insomnia (I was told I always will until I stop taking call), but thru his tips on taking my Ambien, I find that I take way less and don't need to take it as often.