I was on Zocor for high cholesterol and constantly complained to my doctor of sore muscles. He switched me from Zocor to Crestor a year and a half ago. After a year on Crestor I was really miserable with sore muscles and fatigue. For the prior six months, I had not been able to raise my right arm due to a sore shoulder that still keeps me awake at night. I stopped taking the Crestor for 30 days at the end of 2007 and felt much better, except for my sore shoulder. When I notified my doctor, he then put me back on the Zocor.

From what I have read previously in your column that if a person is over 60 and has a cholesterol level under 200, he or she shouldn’t need drugs. Do I have to take medication that makes me miserable?

DEAR READER:
The purpose of these drugs is to reduce the risk of heart disease because of high cholesterol. As I have reported in the past, some medications for this purpose do cause muscle pain, leg cramps, fatigue, and a number of other symptoms. What’s more, they can affect the liver once taken, even in appropriate doses. For this reason, simple periodic lab testing should be done to assure levels remain within normal limits.

Unfortunately, you did not indicate in your letter if you have other medical conditions, particularly cardiac in nature, that would suggest your physician might want you to have total cholesterol levels below the 180 reported. If this is not the case, I personally feel you do not need any drugs. I should also add that there are considerations such as niacin and flax seed oil that could be taken without prescription that have been reported to reduce levels. Still, lab testing should be done periodically.

In any event, I strongly urge you to return to your physician for an explanation and guidance. If he or she has a strong basis for wanting you to have lower readings, find out what they are. Ask for a trial without medication while on a restricted diet. Make sure you get your questions answered to your satisfaction.

I would also like to comment on your doctor’s prescription decision. You claim to have had side effects from Zocor. At that time your doctor appropriately switched you to another medication. However, you also had adverse reactions. Now comes the problem. Your physician put you back on the medication that caused symptoms and the reason for the switch in the first place. In my opinion, this is down-right dumb. You have a prior history of side effects and should not have been put back on that medication. There are several choices available to lower cholesterol and there is no need to put a patient back on a medication that has caused problems. If you truly need statin medications, you need to try a new non-statin, not one that will invariably cause you ill effects.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

His stomach protrudes slightly but also has a smaller “bump” beyond that. It’s noticeable through t-shirts or when he lies flat and is located exactly where the internet information says an aortic aneurysm would be. I cannot find anything that says if one can be visually detected, though. This spot looks like a grapefruit is hidden in his stomach.

He is “medically dense” and doesn’t even know that it’s there. Looking straight at it in a mirror, it can’t be seen. I don’t want to raise a red flag if there is nothing to worry about.

DEAR READER:
To the best of my knowledge, an abdominal aortic aneurysm (AAA) is not visible through the skin because the vessel is located deep within the abdominal cavity.

Your male partner most likely has a hernia. This can be easily diagnosed by his personal physician and an ultrasound examination. Depending on the location and severity of the hernia, he may need surgery to repair it to ensure the loop of bowel that has become displaced doesn’t become necrotic (dead) and cause serious problems. Testing is especially important if he is having bowel problems or abdominal pain.

The technician should be able to do an AAA screening at the same time as the hernia screening if that is something that is still a concern. As I have said before, men over the age of 50 should be checked for abdominal aneurysms. At age 71, your partner is, in my opinion, overdue for the test.

If you are truly concerned about him, I urge you to speak to him. I am sure he would be more than willing to see his doctor to put you at ease. Don’t push and nag. Simply voice your concerns and wishes. Show him my answer to your question.

I have a friend who is a medical doctor who says not to start the medication. She claims that my high good cholesterol offsets the bad because a normal HDL is only around 40. She also says that if my HDL were 40 with the other numbers I have, my total cholesterol would only be 168.

I know that 200 is the magic number, under is best, and over is bad. But my HDL is twice the normal level and everyone says that the higher the good cholesterol the better. Should I take the medication?

DEAR READER:
Your friend the doctor is, in my opinion, brilliant; we agree completely!

In my practice, anyone over 60 years of age was permitted to avoid drug therapy for mildly or moderately elevated cholesterol levels. A total cholesterol of 212 certainly does not warrant medication, especially with an HDL level of 84. Statin drugs are recommended for those who have preexisting heart problems, are at high risk or have a strong family history of heart attack or stroke, or have high cholesterol that does not respond to diet and exercise. You have none of these.

Respectfully decline your physician’s suggestion to take the medication and continue your healthful lifestyle. Remember to have your cholesterol checked each year to ensure it remains as low as it currently is.

To give you related information, I am sending you a copy of my Health Report “Understanding Cholesterol”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Now my question. It is a bit complex but I will try to be concise. In 2005 I started developing symptoms of peripheral neuropathy. After a consult with my family practitioner and a few preliminary tests that were negative, I was referred to a neurologist. While waiting for the appointment, I discontinued my Zocor and a mild antidepressant to see if symptoms declined. (One of Zocor’s side effects is neuropathy.) Within a few weeks to a month the symptoms declined somewhat. The neurologist continued with more tests. Most of them were normal. The milder neuropathy symptoms were and still are present but intermittent.

When the results of my protein studies came back, including the paraneoplastic panel, my striated muscle levels were elevated. Because of this, my neurologist ordered a lung scan which was negative. At that point I was told to just wait and see if I had any symptoms that might suggest lung cancer.

Since I am proactive in my health care, I did my own research online and found that small cell lung cancer can be preceded by peripheral neuropathy before the onset of disease. Several existing studies suggested that regular follow up testing was advised because waiting for symptoms can result in poor prognosis if covert cancer is present. I reviewed this information with my family physician who agreed with the wait and see approach of the neurologist.

I had a repeat paraneoplastic panel one year later (2006) and the striated muscle portion was still elevated but lower than the first test.

Is there anything you would recommend? Should I ask for a referral to a different specialty? I am not looking for trouble but on the other hand, I do not want to ignore a problem if there is something I should or could be doing.

DEAR READER:
Your physicians have addressed your problem using excellent medical care. If agree with the wait and see approach, especially given the fact that your blood test improved during 2006. I do not know the cause of your neuropathy (nerve malfunction). If your symptoms are stable or improving, I would not worry too much. If you truly feel uncomfortable, speak with your neurologist or ask for a referral to another doctor for a second opinion. If your symptoms start to worsen, see your neurologist who should order more tests and address possible issues, including treatment options.

Continue with your yearly monitoring and follow your physician’s advice. Good luck and let me know how this turns out.