Q: I am worried about my husband who is in his late 60s and has diabetes. His doctor says we have to get his cholesterol down. It is now less than three. What should a normal count be?
He is otherwise healthy, goes for long walks as he is retired and eats a healthy diet. He is average height and weighs about 160 pounds.
What is the best, safest medicine for lowering cholesterol?
A: It is difficult for me to comment on your husband’s cholesterol level without knowing all the numbers. If the number three refers to the total cholesterol, that is good. If it refers to the triglyceride level, then it is not so healthy.
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There is still a lot of confusion about the correct blood levels of the different types of cholesterol, the LDLs, the HDLs, the triglycerides and the total cholesterol.
The Canadian Diabetes Association recommends that the target level for blood LDL (bad cholesterol) should be two or less in diabetics. That’s a change from the previously recommended target of 2.5 units. The association places less importance on the total cholesterol level, which should be four or less.
Diabetics are in a high risk category for getting heart attacks and strokes because the illness makes them more likely to have atherosclerosis. Lowering LDL levels is more important for these people than for the general population. Patients with high blood pressure and those who suffer from angina or who have had a heart attack or stroke should also try to reach this target.
The most common medications prescribed are Lipitor and Crestor. There is not much difference between them in terms of side-effects. A generic version of Lipitor is now available in Canada, which is cheaper.
Muscle aches and pains are the most discussed side-effects, but they can also cause memory problems. An article in the British Daily Telegraph detailed symptoms including forgetfulness, confusion, loss of names and words and problems with numbers.
Others complained of lack of libido or their limbs feeling like lead weights. Up to 10 percent of people taking these statin drugs had some type of side-effects.
Your husband will need to discuss it with his doctor to determine if he needs to use these medications. As usual, it is a choice between risks and benefits.
Physical misses condition
Q: My husband’s brother had a complete physical three months ago and was told he was in perfect health. Recently, he was rushed to hospital and had a cancerous brain tumour removed. He also has a problem with his bowels. He is in very serious condition. How could this have been missed?
A:People often assume an annual physical will find all possible illnesses and catch them in time. Unfortunately, it’s not true.
Physical examinations will catch such conditions as high blood pressure, leaky heart valves, most lung diseases, diabetes and urinary tract infections. Your doctor should also find any abnormal lumps and bumps or skin diseases and can do a rectal examination to see if there is an enlarged prostate or a vaginal exam and PAP smear in women.
Sometimes the doctor can discover the possibility of a brain tumour by using an ophthalmoscope to look at the backs of the eyes. If there is increased pressure inside the brain, the optic nerve will show a bulge.
Brain cancer and many other types of cancer may not have any obvious physical signs until they have reached an advanced stage. Bowel cancer may not be discovered until intestinal obstruction and acute pain occur.
Clare Rowson is a retired medical doctor living near Belleville, Ont. Her columns are intended for general information only. Individuals are encouraged to also seek the advice of their own doctor. She can be reached at health@producer.com.
