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...but soon hit the harder stuff.
OK, I apologize to Bob Dylan for tarnishing his lyrics in Tom Thumb's Blues. I do not intend to denigrate the companies that manufacture our pharmaceutical marvels. I am sure that many people have taken statin drugs upon appropriate medical advice and benefited, while others have had significant adverse reactions and outcomes. For statins, the myopathy (muscle pain and weakness) can be insidious and difficult to recognize and treat.
I started taking a statin 25 years ago and went from one drug to the next newest agent in a cycle perpetuated by the release of newer statins, allegedly more effective with fewer side effects than the one before. Initially I developed recurrent muscle cramps in my legs at night, but changing to a different brand of statin had no significant effect. (The cramping was only intermittent, and perhaps from other things. I drank a lot of pickle juice in those days to try to avoid the spasms.)
Statin drugs were pushed heavily by pharmaceutical representatives in much the same way that OxyContin and all new drugs are. Stop and read that sentence again.
Now let us move forward.
At that time physicians were informed by scientific research that it was essential to get everyone's LDL cholesterol number as low as possible, at least to 70, but absolutely lower than 100. The science was quickly settled and has not really changed. At around the same time, pharmaceutical companies were assuring doctors that this new painkiller OxyContin was non-addictive and would improve the lives of both terminally ill patients and anyone who was in significant pain. It became mandatory to ask every patient to rank their pain on a scale of 1 to 5 because reducing pain could now be achieved with a simple, long-acting, non-addictive pill.
I never had a reason to take any painkiller so I never took or prescribed OxyContin. I do not know if having an LDL cholesterol level below 100 is essential. But I have come to doubt it. I suffered from a myopathy for twenty-five years. It persistently worsened, and when I began to have actual weakness I stopped the high-dose statin. I spent six months changing the dosage and interval to try to find the lowest dose I could tolerate. When I discovered I could not tolerate 10 milligrams twice a week, I stopped statins altogether. The pain and cramping are completely gone, but the weakness persists. There may be other reasons for that. We shall see. The highest my LDL cholesterol ever reached before treatment was 120. My LDL/HDL ratio has always been considered low risk.
One anecdote is not data, and there is a reason that the word 'datum' is almost never used. But since when do we let statistics distract us from a happy anomalous outcome?
Discussion (16)
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My doctor put me on Simvastatin about, oh, fifteen years ago. I started having aches and pains, especially first thing in the morning. I put it down to "getting older." Get up, start the coffee, pop a couple of aspirin or Tylenol to take the edge off, and start the day. Getting old isn't for wimps.
After about a year on the statin, I ran out of my script and, as usual, couldn't get a refill until I went in for blood work to make sure the drug wasn't damaging my liver. For various reasons, it took a few weeks to get the blood test. By then the pains had gone away and I felt ten years younger. The lightbulb finally came on. This medication makes me feel like crap and I must be tested several times a year to make sure it isn't nuking my liver. All to control a cholesterol level that was moderately elevated, at most. I stopped taking it.
A few years later, I let a different doctor talk me into another round of a newer, better, statin said to have fewer side-effects. "Oh, yes, Simvastatin does that. This new one is much better."
I never finished the first bottle. The pains weren't as bad as before, but I was still not feeling 100%. My body was telling me something was wrong. I decided to listen to it.
Maybe I'll drop dead of a massive coronary tomorrow, but I'll take my chances.
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For years I told my primary care doc no statins. I have no family history of heart disease but last month I ended up with one stent (RCA almost completely blocked). No permanent damage and I was out of the hospital in 36 hours. My new cardiologist (I never had one before and I met this guy in the cath lab) has me on Lipitor but so far no side effects.
I’m 68, and my symptoms were about a 2/10 chest pain. If I had a higher pain threshold maybe I wouldn’t have sought help as quickly. I had an NSTEMI which is very hard to detect via an EKG. The first day bloodwork was clean and the pain resolved itself while I was in the ER. I went back the second day after the pain returned and blood testing revealed the problem. This wasn’t an ER fail; it just took that long for the bloodwork to reveal the problem.
So don’t ignore what might seem like low level symptoms; your body is trying to tell you something.
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There was a time when I believed we could find and treat coronary artery disease with blood tests and cardiac stress tests, either nuclear or ultrasonic, but it appears to me that the more we learn, the less we actually know. Every cardiac test I have ever had shows little risk of disease but preventative therapy seems to have made it very hard for me to walk more than a few blocks.
It sucks to be the datum and not the data.
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I've had a different experience. Now 69, I used simvastatin in my 50s and got temporary myopathy. So I said screw it, I'll diet. Five years ago a very understanding cardiologist put me on atorvastatin--the basic drug--and I am tolerating it just fine. My lipids are very fine.
I had a different experience with OxyContin, too. Back when Pain was the Fifth Vital Sign, I used a four day supply of OxyContin--never more--in my postop patient who had major surgery, in combination with ibuprofen (which was continued for a week) and acetaminophen (ditto). Worked like a charm, and I addicted no one. I no longer operate, but when I did, OxyContin was, because of its long half life, an exceedingly valuable drug for my practice and my patients.
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Clearly many patients tolerate and benefit from statins and Oxycontin was indeed a wonder drug within a very narrow parameter of usage. They were both pushed like every other New, New Thing and everyone knew the narrowly recommended indications would eventually be expanded into a medical Nirvana.
Nirvana never comes but new drugs get pushed over and over again.
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