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LipidsJuly 13, 2005

My doc called me in this week because she found something in my recent labwork. It's not a very big deal, but I found out I have high triglycerides.

Now, my doctor is not Miss Bedside Manner, although she totally thinks she is. She's got a rockin' office, and her girls at the desk are all rockabilly and cute, and she wears Doc Martens and great glasses, and I would bet she's got a wife at home. It's the only doctor's office in the whole world that I've ever been asked on a form whether I was sexually active, and if so, was it with the same sex, opposite sex, or both. I LOVED that. I do everything in my power to like her. I totally should like her. She says nice things about my knitting. (And then she winces and says, "I'd never have time." No one does, lady. We just do it.)

But she's not helpful, and that's irritating. When I had pneumonia last year, I had to pull the info out of her. She literally said, "I'm not going to tell you what you'd have, because you'd just worry. Just take this medication and you'll feel better soon." We had to have a heart-to-heart in which I explained my buried-but-latent Type A-ness, and I HAD to know or I'd break into her office that very night to read my chart. And then there's the mess to clean up, all the glass on the floor, and then there's going to court in three months.... Messy. Better just to tell me my DIAGNOSIS.

When I went in for my migraines last month (I get a migraine once a month, three days into my period. Think it might be hormonal?), she didn't do anything but write me a referral for a neurologist. She said the neurologist would know better than she would.

Two days ago, when she saw me, she explained that I have really high triglycerides (almost 400, should be less than 150) although I have reasonable cholesterol levels. So she's putting me on meds and sending me to a cardiologist.

"But you said this isn't a big deal, why do I have to see a cardiologist?"

"Mostly it's for CYA. My own protection against malpractice. Besides, he talks about the heart all day long, and he likes it. I would be SO bored. But he'll be able to tell you more."

"Side effects?"

"Like none."

THAT made me a little suspicious. So I checked, and as long as gallstones aren't considered side effects (and why would they be? Such fun!), I'm all right.

Eh. But I'm going to go on the meds (low-dose gemfibozil) for now. I'll go back on the fish oil, which I had forgotten about (women! Take your fish oil for the love of god!) and cut back on the beer, maybe just a couple of bottles with Lala once a week, and cut down on the sugar (but not on the ice cream, are they fucking nuts?) and make more of my own food and get tested again in three months. We'll go from there.

Irritates the hell out of me that I could run a marathon and still be all hyper-lipid-y. For that matter, it irritates the hell out of me that I could run a marathon and still get winded walking up two flights of stairs. There is no justice.


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Your doc seems cool but odd. Why not just be upfront. I would worry more if I didn't know what was going on moreso than if I got the whole story!

I always get a migraine either right before I start or right along with the first few days. I thought it was just me. I have been getting migraines as long as I can remember. Not just during the period week either. Since practically nothing helps anymore (cause I have tried just about everything, maybe too much of everything) I just try to deal with it.
Hope everything comes out fine for you!

Bodies are so fricking weird. And it's totally unfair that we lose fitness twice as fast as we gain it--I really hate that. I actually imagine crap like cholesterol and bad stress hormones blowing out of my arteries when I run -- not so much as a "make it so" visualization, more like a reminder of why it's good for me.

I get migraines right after my period ends. My gyn explained that it is hormonal and he put me on the a small dose of estrogen that I take during my period only. It totally works!! I love it when my brain doesn't feel like it is going to explode out of my forhead once a month.

Hey Rach--

I feel ya on crazy docs. I stopped going to the doctors for my Cerebral Palsy for, like, 10 years. Now I'm seriously making up for lost time. I have, usually, 4 appts. a month. Enough to drive a girl nuts, especially when they play "pass the buck." Hang in there, and keep running. That'll keep your ticker in good shape regardless of triglycerides. But take those meds, too :-)

OMG, you are so demanding. You want a diagnosis when you go to the doctor? Isn't there an additional charge for that?

me thinks you need a new doctor. . .

Hip just doesn't really cut it for a doctor. She sounds pretty suspect to me. Please demand that she take care of you, or *I'm* going to break into her office.

Dear Rachael - I used to get migraines quite frequently (it started when I was appr. 7-8 yrs. old), for a few years, I've been taking Magnesium supplements (200-300 mgs daily), so far, it seems to help.
All the best!

Doctors are like hairdressers, you've got to find one you can communicate with, even if they have brown carpet and a wood veneer reception desk.

Cute glasses and Doc Martens or not, your Dr. sounds like she may need to be replaced . . . not telling you what's wrong in unacceptable -- after all, it's YOUR body. And something like migraines, especially cyclical ones, should be within her realm of practice (I'm assuming she's either an internist or a general medicine person?). Grrrrr.

p.s. Relpax really helps me with migraines.

Doctors seem to have a disturbing habit of trying to make you guess what's wrong. For instance, I have yet to hear dialysis out of a doctor's mouth about my husband's kidneys, yet what's the next step? Yep, you got it, dialysis. Instead they look at me and say, "you know what the next step is, right?" and then they make me say it. It is, however, better than my newly-former GP who, when told about my level of stress and anxiety, asked if the situation would resolve itself anytime soon. Yeah, sure, Dr. McCoy is gonna beam up and give the DH a pill and he'll grow a new kidney. Yeah, that's the ticket.

I smell trouble. A doctor is refusing to tell you what she thinks is wrong?!? WTF? Switch doctors - when your health is the issue, you need someone you TRUST. Sorry to get preachy, but this is important. Messages like "I'm too bored to discuss this" or "I won't tell you what it is" are ways that doctors cover up for their NOT KNOWING what is wrong. I knew an MD/PhD who told me his training included how to BS his way around what he didn't know, "Can't let a patient know you don't know, then they lose confidence in you." Gah!

i worked in a teaching hospital for a long time and am pretty opinionated about doctors -- she sounds patronizing and someone else said it, sometimes ya gotta shop around (friend's referrals are sometimes helpful)-- tough if ya live someplace like i do where they either don't take your insurance or aren't accepting new patients -- bah!

I hope you acheive peace in the medical realm. I ran a half marathon THEN I found out that I had high cholesterol. So I lost 25 pounds. Guess what? It's still high. Sometimes you just have to chalk these things up to genetics. Blech. My least favorite answer EVER!

...but you ran the marathon!!

Too bad about your Dr. She sounds like she could be a cool person, but not a great doctor. Bummer.

"like none?"

"It's mostly CYA?"

Nope. This is NOT standard of practice. Not wanting to give a diagnosis because you'd just worry? (insert pat on head)

That's called "paternalism"

Doc Martens do not a doctor make. You are WAY to smart for her, Rach.

Find a doctor who will let you participate in your health care! (Do I sound the tiniest bit whacked?, Sorry)

Off. Soap. Box.

You may like her now but (it will take some work) but there can be a better doc out there! And sometimes a good doc may not be for you all the time - they change too. Hope you get a good one, someone who will answer you or can at least, steer you right. For now, nag, nag, nag till you get your answers.

Maybe she'd be better if she had one more chance and you said something like, "This is not working for me, and I need you to be up-front and detailed and honest. I can take the news and am very much interested in what you know about my health, but if I don't feel I'm getting straight answers, I'm going to find a new doctor."

Not that you should have to say it at all, but sometimes people will step up if you tell them exactly what you need. I was very upset by something inappropriate one of my docs said, so the next time I went in I told her it had upset me, and she won't do THAT again.

(This is not an apology for bad doctoring. But my best friend has just started his residency and has learned along the way that the "how to deal with patients" part is harder to get than he expected.)

And finding a new doctor is a huge pain in the ass.

Rachael..she sounds like our doctor who, when my husband had some issues a few years ago, said "whats the matter NOW"..we switched and have not looked back..please consider shopping around..she may be cute and chic but I question her integrity..sorry, just my 2 cents..
btw, how is Miss Idaho feeling?? Is her dare-ee-air better??? I worry about my "left coast" buddies!!

Holy crap, Rachael...

She's too BORED to help you? CYA?


That's not a doctor, that's a woman who spends a lot of YOUR money on looking cool and gives you nothing real in return, except for perhaps something nice to look at when you're in her office. Jay-sus, girl, the diagnosis and the upfrontness about what's serious and what's not is not just a fringe benefit, it's the whole point...

Sorry to sound ranty about that, but I'm kinda practised in the art of yanking info out of doctors lately, and if your own GP can't manage to be up front with you, well...that makes being your own advocate a LOT harder.

Hang in there with the beer and sugar reduction. Not easy :-)

I agree with what they said, the doctor may be hip but she's totally condescending.
You have a right to that information, and a right to be told the truth without being treated like you're too dumb to get it or like it isn't worth her while to waste the time telling you, and if you're seriously tempted to do what the carpet cleaner guy did to you, you should find a better doctor.

I also get migraines connected with my period; it's actually fairly common. Mine are the cluster ones, not as severe as some people suffer but they come back twelve hours or so after I take the drugs, sometimes for up to almost a week. Toni's doctor's solution scares me a little; I'd be afraid to up my estrogen dosage, especially while on the pill. The amount of estrogen I already take just so as not to get pregnant is too much, I think.

I have to say being up-front about your health is way more important than having good glasses and not assuming the sex of your partner(s). If it were me, I'd find a new doctor. Please take care of yourself. You're the only Rach we've got.

Good for you finding out about stuff even if you can't get it from your doctor. You are the owner of your body and you have to ask all the right questions. Like I've been telling my mother, push for the info, research, ask others. Don't be afraid to visit another doctor for another opinon. Really, don't be!

PS It ticks me off too that I get winded walking up stairs yet somehow ran an entire marathon, have done triathlons -- geesh! Stairs, they wipe me out! :P

Don't bother asking your doc about the meds and side effects and such. Even the best docs might not know the most recent findings on meds. If a doc is putting you on something that is going to be an everyday med--actually any med for that matter--find a pharmacist that you trust and only use that pharmacist. Have a consultation with that pharmacist everytime you get a script filled and disclose everything you are taking, including occasional OTC meds to them. They are the ones who know about side-effects, interactions w/ OTC meds and such. I think a good pharmacist is so important!

I don't think you're being "Type A" to expect reasonable communication from a doctor. I can't believe she said that telling you the diagnosis would just worry you. Beyond. That would be a deal-breaker for me! Definitely would outweigh whatever eyewear and footwear she had on.

I don't like the sounds of the doc.. altho I understand the reasons why you are still seeing her (sometimes history is alot) but perhaps when you see this cardiologist you could ask him for a recommendation of a good internist with verbal/people skills?

thank goodness about the winded thing. I was thinking that even with all my exercise there was something wrong for my winded-ness when I walk up stairs.

Sorry Rach...I'm with the other here... Hip or not, I wouldn't stand to be treated in such a manner from a doctor that obviously doesn't take my health seriously.

Wow. It sounds like your doctor is trying too hard to be hip and cool and not hard enough to be...a doctor. I agree with the other folks-- you need to find someone who will welcome your participation in your healthcare.

I have to agree with some of the comments about your doctor's communication skills -- your doc wouldn't suit me, as that is key to me. But your mileage may differ. ;o)

I was interested in the comment that your cholesterol should be lower than 150; I've seen online somewhere that you're at greater risk of strokes & other bleeding risks if it's lower than 170-180. See an article here (take with a grain of salt, of course; they're selling a supplement). But I'd definitely ask a doc or pharmacist about it: http://dan.xtend-life.com/products.asp?product=ch&page=facts#2

Good luck! Sounds like you're being a good advocate for yourself!

So sorry to hear your doc is being so elusive and weird. Stating that something is CYA seems SO N-CYA! You deserve some proper answers, and don't let that "what sex is your partner" thing sway you... that's standard practice at my clinic, and I'm in MN!!

BTW, I just have to point this out... Type A-ness... think about it...

Hi Rach, I think I saw a commercial for period related migraines. If I see it again I'll tell you what it was for.
I wish I could help you more! Try taking the meds and test them for side effects - they might help and work fine for you. But don't look up side effect on internet or you WILL get them all! :)

Yeah, I agree with the other commenters--that doctor doesn't sound too hot. I hates it when doctors don't answer questions and act like their patients are too stupid to understand stuff. I'm ignorant, but is that med a cholesterol reducer? Those things scare me--I've read articles about nasty things they do. If it's not, then just disregard.

I also get hormonal migraines and I have had countless doctors that have been absolutely no help on the topic. (Although I did have one suggest that I go off the pill. Any of Rachael's readers with hormonal migraines that have tried this? I'd like to know if it actually works before I try it, 'cause, you know, while a pregnancy might temporarily help the hormonal migraines I'm guessing that the resulting headaches from raising the kid would be worse.).

Anyhoo... what's the fish oil do?

Wow. That's patronising. And it sounds like she likes to make a lot of referrals to expensive specialists. I wonder if they are her friends. Just curious: did she check you out for diabetes and high blood pressure? I've just spent four Tuesdays in a row at my mother's diabetes education sessions. Triglyceride issues often go with diabetes. (Diabetes, heart disease, and hypertension often form an unholy triumverate.) If she's that into CYA, must assume she did. Hope so.

Can I change my answer?

Everybody else makes a lot of sense. You do deserve better. (We all do.) Though I still think that if you wanted to give her one last shot, she might step up if she were told _exactly_ what's expected of her.

By the way, it took me ALL DAY to figure out what CYA means.

I won't tell you to find a new doctor because everyone else has said it.

I will tell you that many healthy people have high cholesterol/lipids and that the science isn't all in yet about the links between heart disease and cholesterol levels.

But the big pharma certainly created a fat stake in promoting that fact.

I read about a recent study that found that younger and younger types are being prescribed these drugs and that 100 000 need to take them to prevent 1 heart attack. They question the new prescribing rules.

Problem is, finding a doctor who is willing to be pragmatic and critical of this trend toward these drugs.

And, the big question, do they have side effects over the long term? Are you on these for life? What are the risks of not taking it?

But I bet your doctor won't engage you in that sort of conversation (most won't).

ok, i'm a bit late, and several others have already said some of this. I had the same problem with migraines (which, btw, I was too stupid to notice, but my *Dr* asked if it was monthly, thank you) and I was put on the continuous pill so that I have them less frequently. I thought this was great, until someone mentioned low dose of estrogen during period ... interesting.

So anyway, I understand where you're coming from and wish you all the best, whatever you decide to do about all of this.

I'm a family doctor (unfortunately not in your area or I would send you my card). I also knit through my residency- often while working 90 hour weeks and you are absolutely right, you just do these things (on the bus, in bed, in meetings, etc).

I think you should switch doctors- it was unethical for her to withold that pneumonia diagnosis from you. I also think that a doctor who is uncomfortable working on migraines and triglycerides (two very very common things that people deal with and YES migraines are absolutely hormonal for many many women) and needs to send you to specialists for those concerns may not know what she's doing. Sure, sending you to a specialist if these things end up being more challenging to address than you both anticipated may be COMPLETELY appropriate. I agree with your dietary modification plans and the fish oil (flax oil also works well). GOOD LUCK!

sorry to post again, just found a great link: http://www.aafp.org/afp/20020901/tips/14.html

so things to try for your period-related migraines:
- take a pain reliever (Aleve twice a day may be most convenient) for a couple of days before you anticipate getting your migraine, it may lessen the severity or prevent your migraines from occurring
- talk to your doctor about peri-menstrual hormones to try (a few days of the patch, a few days of the pill, etc)to see if that helps. That way you don't have to be on hormones all month unless you want to be.

What Marie said is accurate, but unfortunately not a part of standard American medical practice.

High triglycerides *should* have been an early indicator that I was insulin-resistant and borderline diabetic, but it went undetected since I fell within normal weight.

Frequent migraines *should* have been a sign that I had blood sugar issues, but they were written off as PMS/stress related.

It wasn't until the hypertension kicked in that I learned what was wrong.

Fortunately, the solution for me was an easy one - eliminate processed carbs and all forms of sugar. No drugs necessary.

Two and a half years after this discovery, my triglycerides are down to 150, from 400 or so, my migraines are GONE completely, and my blood sugar is under control.

Hope you find a solution too, and that it's not an indication of something worse - thinking positive thoughts for you :)

Sigh. Doctor woes. I hear you. Mines answer to everything under the sun is "Have you started jogging yet?" Now I KNOW she is an addict and that is all fine and good. But I seriously swear I could go in there with a broken leg, fractured pelvis, and my head falling off and she would say "Have you started jogging yet?"

Hope you are just fine and dandy Rachael :)

Are you sure your doctor's not French? Because I swear I've had similar conversations with at least 80% of the doctors I've gone to here. They definitely have a need-to-know policy around here, and they don't think a patient needs to know.

And, this might sound weird, but I had some migraines related to my period at one point and went to a homeopathic doctor. They were gone in no time. It's hormonal, most likely. You can have that trouble with pregnancy, as well (as I did). You may actually want to check with an OB/GYN about that issue.

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