Statins-The Gift That Keeps Giving

Boring health post but I wanted to put it out there again, Statins (cholesterol lowing drugs) suck! It's been two months since I got off Statins and I'm still dealing the muscle damage caused by using the nasty stuff for only one month. The pain in my chest muscles was easing up until I took a ride on a cold windy day yesterday. Luckily I still have some hydrocodone for pain (ibuprofen wasn't enough) left over from my hip surgery back in 2011 otherwise sleep would have been difficult last night.

The pain in my chest muscles was jacked up last night and the only thing I've done different was ride in the cold wind. The first four miles of yesterday's ride was uphill fighting the cold wind. I was working the pedals hard and sucking in cold air. I could feel the cold on my chest but in a few miles the riding would be easier and the wind would be at my back and that would be that. So I thought...

I can now easily tell the difference from Statin induced muscle pain and exercise induced pain. Unlike sore muscles from exercise which tend to be tight and stiff Statin induced muscle damage just hurts without loosing range of motion from stiffness. It seems to be small pin point areas of pain rather the generalized pain from exercise.

Some folks have taken as long as seven months to recover form muscle damage caused by Statins. In the worse case there has been death but I talked about that in an earlier post.

For the last couple of months riding hard and breathing hard has exacerbated the muscle pain, nothing a little ibuprofen couldn't handle. But the cold and the wind was a little to much for ibuprofen to handle this time. What to do? Keep riding and suck it up. In time it'll be better.

Update 5/15/13
It's been about seven months now since I've been off statins. Everything I wrote in the above post holds true today. I'm not a violent person but sometimes I sure feel like I could rip a certain doctor a new one. That not being a good idea I turned to Angie's list to warn others about that certain doctor.
It seems that if you are exercising, on a low fat diet and you take statins then you're a setup for muscle damage. 

Off the Statins

I've spent the last two weeks trying to figure out why my chest muscles are sore. I stopped exercising my upper body at the first sign of soreness  A few days ago the muscles in my shoulder and middle back started to hurt to the point where I had to take hydrocodone to be able to sleep. Then like a hammer over the head I remembered "duh, muscle soreness and pain are a common side effect of taking statins to reduce cholesterol".  I don't do we'll with drugs, my liver enzymes are way up with statins. I started a generic Lipitor (atorvastatin) 10mg about three weeks ago, the combination of muscle pain and my liver getting zapped is enough, I'm done with statins. My cholesterol was already in a good range and I know I can make some simple modifications to my diet to lower it naturally. Bottom line, after 30 days I'm now off the stuff.

If not monitored statin caused muscle pain can become a dangerous although rare condition known as Rahbdomyolysis where the muscles disintegrate sloughing off myoglobin from the muscle cells overloading the kidneys and causing them to shut down. I've collected a wealth of information via the Internet, an article by Stephanie Seneff  at MIT sums it up pretty well.

My next step is to find a general care cardiologist who is not accepting too many free lunches form drug reps and has a more integrative approach to heart health. My current cardiologist does research for drug companies (need I say more?) time to move on.

UPDATE 10/22/12
I've been off Statins now for 6 days. That is more then enough time to recover from exerciser induced muscle soreness but from what I'm finding recovering time for Statin induced muscle damage ranges from 1 month to 7 months with the average recovery time 2.3 months. A paper my a group of MD's "Outcomes in 45 Patients With Statin-Associated Myopathy" covers the topic pretty well. Once the decision is made to go off of a Statin drug it can take up to 3 weeks to clear your system. Recovery time for muscle damage is a matter of patience.

As with any drug the risks versus benefits of taking a Statin must be weighted. There is a wealth of information on the subject of Statins and muscle pain. To start off, here again are the links to two papers that will provide information on Statin induced muscle damage. Although they may get a little technical they're generally easy to follow. Use them to help guide you when asking your doctor questions.
1. Statins and Myoglobin by Stephanie Seneff
2. Outcomes in 45 Patients With Statin-Associated Myopathy

OK I'll Take the Drug

I finished up a bunch of tests with my new cardiologist and now is the time to followup to an earlier post "No Drugs Please".

Stress test - Good (I stayed on the treadmill 30% longer then is projected for a person my age (58), height (6'1") and weight (185).
Echo Cardiogram - Good
Cholesterol Levels - Good...for anyone without an history of having a heart attack.

My total cholesterol is 185 (less then 200 is desirable)
HDL 62 (greater then 60 is best)
LDL 105 (less then 129 near ideal, less then 100 if at risk of heart disease and less then 70 if at high risk of heart disease)
Triglycerides 90 (150 or less is desirable)
Total Cholesterol/HDL Ratio 2.98 (3.43 or less means 1/2 the average risk of having a heart attack)

A "healthy" person would be very happy with these numbers and their doctor would give them a well done and send them on their way...not me. I had a heart attack, not a massive one as explained in my post  No Drugs Please. I now have a history and I'm suppose to have my LDL under 70. I got my diet dialed in just right for me, a diet that I can easily live with and maintain.
To get my LDL down to under 70, side effects be damned, I'm taking my doctors advice and starting a low 10mg dose of Atorvastatin (generic Lipitor) which is suppose to reduce LDL by 34% to 38%.

Next step...get off the blood thinner prasugrel (Effient) after the one year protocol which ends December 25th. The attorneys are already lining up clients who take this stuff because of studies showing increased cancer risk.

Oooooh well, ride on!

No Drugs Please

My joints have been repaired more times then I care to count but I thought I was doing fine and then my heart attack on Christmas day of last year while cycling just pissed me off. Having a heart attack is an opportunity for the drug companies to tell you that your screwed and that you will die unless you take their drugs. 

I remember when I was a young healthy stud and sitting at lunch with my old man and his friend. The friend was telling my dad how good his proctologist is and proceeded to give details. I'm sitting there listening and thinking "man, do I have to listen to this? It's more then I want to know. It seems that all old people talk about is their ailments. I ain't ever going to spend my time talking medical stuff". WRONG! As we get older there are health issues that I feel are worth sharing. The internet"s" is a great for information gathering and I'm going to share my information and thoughts. I'm an "old people" now and being such I've earned the right to rant about health, in particular my health.

When I was lying in the hospital I took whatever drugs were in the little white cup and I did not complain. I had a heart attack and I felt that I was screwed so drug me up and save my life...please. I recovered and I've educated myself on the matter of heart disease and I now know that I'm not screwed. In fact I'm  better now then I was before the heart attack. I had one unstable buildup of plague in my LAD artery just waiting to go off like a time bomb. It did just that, it broke off while cycling hard and plugged up my artery. It has since been stabilized with a couple of stents. The cardiologist who did the surgery said the rest of my heart and other arteries are clear and healthy. He went on to say that it may have been the shape of my LAD that caused the plague to build up over many years in only one location and nowhere else. However the drug and medical community want me to think I'm still screwed and that my only salvation comes in pill like form. 

Heart disease is a frightening term and it is my opinion that many cardiologists use the term in a dire context in order to convince you that you will die without drugs..."and by the way here's a sample from the drug rep that just took me out to lunch". To understand heart disease is to understand that the term encompasses a wide range of heart conditions from minor to the serious. A drug that may be called for in one individual may be unnecessary in another. It seems that once you have a heart attack you are now a profit center of big pharma who will then do everything in there power to keep you on beta blocker (blood pressure) and statin (cholesterol) meds until the day you die. 

When I left the hospital I was downing blood thinners, beta blockers and statins. The statins for cholesterol were the first to go. The side effects were unacceptable to me. With a little help from my GP doctor I'm using good nutrition to keep my cholesterol at healthy levels. It's hard to find a cardiologist who has a good understanding of nutrition and knows how to weight the benefits of diet versus minimizing the taking of drugs...I'm still looking.  

Again with the okay from my GP the next to go were the beta blockers for blood pressure. The side effects were nasty on this stuff. I understand having to take them during the recovery phase. While in the hospital my blood pressure kept setting off the alarm on the  monitor because it kept going to low. My average at home blood pressure is 123/ 74. I monitor it at home because when taken at a doctors office it  can rocket up to 190/90, known as white coat hypertension or syndrome. That tells you how much I love going to a doctors office. Don't ever let a doctor put you on blood pressure meds based on blood pressure readings at the doctors office. Monitor yourself at home. The bottom line here is when I'm in my cardiologist's office I have to listen to the "I want you on drugs speech". No wonder my blood pressure shoots up when I'm in his office.

As for the blood thinner (Effient) I should be off it by the end of the year and then go on aspirin once a day. I'm currently gathering information on foods that act as natural mild blood thinners.

I understand that many people are willing to take whatever drugs their doctors prescribe because it's easier to take drugs then to change your lifestyle. One study said that 63% of statin users surveyed take the drug so they can continue their normal eating habits. I AM NOT ONE OF THOSE PEOPLE. I started changing my eating habits and lifestyle three years ago after back surgery to loose weight. I also started riding laid back to make my body strong. After my heart attack I've examined my diet even closer and have made some changes. 

The lack of knowledge regarding health issues fosters fear and thereby a willingness to accept prescription drugs without question. Knowledge and the desire to act upon that knowledge is a powerful tool that we can use to protect our health and happiness. It's your life...own it.

__________________________________

Mayo Clinic Cholesterol Chart

My total cholesterol is under 200, LDL (bad clolesterol) hovers around 100. HDL (good cholesterol) is over 60. Triglycerides are a little over 100. My all important HDL to Total Cholesterol ratio is 3.2, ideal is considered anything less then 3.5. Because of the nature of my heart attack I consider myself at "high risk" of heart disease, not "very high", and therefore I am confident that my cholesterol levels and ratio is good for me and I will not take statins. 

Total cholesterol
U.S. and some other countries	Canada and most of Europe
Below 200 mg/dL	Below 5.2 mmol/L	Desirable
200-239 mg/dL	5.2-6.2 mmol/L	Borderline high
240 mg/dL and above	Above 6.2 mmol/L	High

LDL cholesterol
U.S. and some other countries	Canada and most of Europe
Below 70 mg/dL	Below 1.8 mmol/L	Ideal for people at very high risk of heart disease
Below 100 mg/dL	Below 2.6 mmol/L	Ideal for people at risk of heart disease
100-129 mg/dL	2.6-3.3 mmol/L	Near ideal
130-159 mg/dL	3.4-4.1 mmol/L	Borderline high
160-189 mg/dL	4.1-4.9 mmol/L	High
190 mg/dL and above	Above 4.9 mmol/L	Very high

HDL cholesterol
U.S. and some other countries	Canada and most of Europe
Below 40 mg/dL (men) Below 50 mg/dL (women)	Below 1 mmol/L (men) Below 1.3 mmol/L (women)	Poor
50-59 mg/dL	1.3-1.5 mmol/L	Better
60 mg/dL and above	Above 1.5 mmol/L	Best

Triglycerides
U.S. and some other countries	Canada and most of Europe
Below 150 mg/dL	Below 1.7 mmol/L	Desirable
150-199 mg/dL	1.7-2.2 mmol/L	Borderline high
200-499 mg/dL	2.3-5.6 mmol/L	High
500 mg/dL and above	Above 5.6 mmol/L	Very high

Heart Attack - Final Word

1/11/12

This will be the last post devoted exclusively to my ticker. It's been a little over two weeks since I had an heart attack and I've started riding my trikes again with no limitations. 

It's time to move on and start blogging about cycling stuff. Before I do I want to share the results of what happened to me on Christmas day 2011 with the hope that others may benefit and learn from my experience. (The details of the day I had my heart attack are posted here Heart Attack and a short follow up here Bored and Drugged.)

It is only natural that we want to find a reason why someone takes a fall and to be assured that the reason does not pertain to us and that we will live a long unencumbered life. Sorry to disappoint but there was no outstanding risk factor prior to my heart attack that raised a red flag. Over the years I have avoided the risk factors associated with heart disease. I exercise regularly, my weight is under control, good diet, no family history of heart disease and blood pressure is good. Even though I have now been told that there is some history of high cholesterol in the family my cholesterol levels were good. To top it all I took two physicals (including EKG's) in 2011 in preparation for hip surgery earlier in the year. Everything checked out good. 

So how does someone who is in good shape and exercises regularly have an heart attack while exercising? Even though there is no history (until now) of heart disease in my family I still managed to build up a plague deposit in one of my coronary arteries, the LAD to be exact. While watching my cardiologist repair my LAD in less then twenty minutes with an angioplasty and two stents, he found no evidence of plague buildup in any of my other arteries. The offending artery had a good size buildup of plague. Plague buildup in the artery is characterized by a soft center surrounded by a hard shell. Under the pressure of  blood flowing through my artery, while cycling hard that Christmas day, the soft inner plague broke through the outer shell and blocked my artery and lead to an arrhythmia (irregular heart beat). Even after the blood flow was restored to my heart it took another ten hours for the arrhythmia to settle down. 

Even with a 100% blockage of my LAD I suffered no permanent damage to my heart muscle. I got help reasonably fast (I should have called 911 for a faster response). About 40 minutes passed from the time I started feeling the intense pain in my chest and the pain radiating down my left arm until Carrie got me to the fire station.  A couple of aspirin, a little nitroglycerin and an IV in my arm and the pain started to ease up. This was shortly followed by a code 3 ride over to the hospital.

Another factor that played into getting me through this mess without any heart damage was my fitness level. Even with a compromised coronary artery I have managed to build up a strong heart and vascular system with years of cycling and hiking. Even with a blocked artery and arrhythmia my heart muscle was still receiving just enough support from the healthy arteries to keep my heart "alive" until I received help.

I now know that all my arteries are in good condition. While performing the angioplasty my cardiologist took a little time to examine the rest of the arteries around my heart and gave me a thumbs up. In the future I will be taking stress tests every three years to determine the health of my heart. It seems to me that anyone over the age of fifty, has a family history of heart disease or is a competitive athlete should be taking a stress test. Doctors tell us that after you turn fifty you should have a camera stuck up your behind every few years to check for problems in the colon. How about a stress test for your heart every few years? A stress test is the most effective way to determine if you have fat filled arteries.

It'll take a little time to get used to such mundane bodily functions as the pressure of a burp working it's way up and out... it ain't a heart attack it's just that burrito I ate for lunch.

For many a heart attach would be a wake up call. Having a heart attach and getting through it was a confirmation call that I've successfully prepared for this "shit happens" moment. Being physically fit does not come easy for me but over the years I have put forth the effort to stay fit and it has paid off. I can't predict the future I can only stay strong and be prepared for whatever I'm dealt. My cardiologist says I'm good for the long run but when my time does come I will accept my fate knowing full well that I did the best I could do to be part of the lives of those I love and who love me. Until that time comes...

RIDE ON!

1/12/12

Here's an easy to follow guide about heart disease.
Visual Guide to Heart Disease

Heart Attack - Bored and Drugged

Heart Attack - Original post from 12/28/11


It's hard to walk past my trikes in the garage. I'm mentally ready to hop on and take a ride but first things first. The insertion point for the angioplasty in the artery in my right leg needs to completely heal so I don't take a chance of popping open it open. I popped it open in the hospital shortly after surgery. Got to love those nurses...they wasted no time stopping the flow of blood under my skin that was inflating by groin.  In the end I was embarrassed that I didn't listen to their instructions about taking care of the ole artery and I was left with a bloody bruise.

Everyday I get to look at my trikes just sitting there waiting for me.

Also the stink'n drugs keep me light headed. Two of the meds are to keep my blood pressure low while healing. I can't wait to get off those things. My blood pressure is normally right on target. With the meds I have to stand up slow because there's not enough pressure to quickly move the blood into my head. Result...I get light headed without having to have a couple of beers. Yes...I still get to have a beer or two. I'm not dead yet just sidelined.

I see my cardiologist on the 11th. I plan on riding on the 12th.

Heart Attack

It's Christmas day 2011 and I'm six miles away from home. I'm riding my Catrike 700 packed with a change of clothes to meet Carrie and the kids at a Christmas day party. It's a short 12 mile ride from my home in Agoura Hills to Calabasas. At the six mile mark...BAM...by chest feels like an elephant just parked it's ass on my chest. I'm having a stinking heart attack and I'm not quite ready to accept it.

The day started off simple enough. It's Christmas Day and we're invited to a party. It was a beautiful day and I didn't want to let it go by without taking a ride on my trike. What better to do then ride to the party and meet up with everyone.

I loaded up the trike and pushed off at 11 am. Right about at six miles I wasn't feeling good...my chest was hurting and feeling heavy. I pulled into an empty parking lot of an industrial building hoping to get some relieve by taking a rest. After 10 minutes I put aside my ego and called Carrie to come and bail me out. The idea of something more sinister then just "not feeling good" crept into my thoughts. At 12:45 Carrie and the kids show up and I painfully tie the trike down to the top of the car.

Once everything was loaded into the car I looked at Carrie and said "take me home I don't feel good". It was when we were driving home that the pain in my chest became overwhelming and my left arm was starting to feel an odd pain. I put aside denial and gave into reality and told Carrie to go straight to the hospital. The hospital was some miles away and I wasn't doing well so Carrie got off at the next freeway off ramp and took  me to our local Fire Station 89.

Once in Station 89 the EMT's took over and I knew that I was in good hands and actually started to relax. They hooked me up to an EKG and told me with no uncertainty that I was having a "heart incident". In the mean time one of the firemen took the kids on a tour of the station to keep there minds at ease. An IV and a few drugs later I was taking a code 3 ambulance ride over to the hospital. On the ride over my EMT no longer minced words and while spraying nitroglycerin under my tongue said "you're having a heart attack and this is what to expect when we get to the hospital..."

I never lost consciousness so when I arrived at the Los Robles Hospital I laid there in the ER and watched the well choreographed circus unfold around me. I eventually ended up in the "cath lab" and watched my doctor insert two stents into my LAD vein that supplies blood to the muscle of my heart. In less then 30 minutes I was on my to recovery and after a three night stay I made it back home.

From the time I entered the fire station to the time I existed the "cath lab" I never felt that my time was up. The folks involved in my care exercised such a high level of competence that I felt at ease the entire time. The firemen and paramedics at Station 89 are proof of why I happily pay my taxes each year.

In the end it was determined that the LAD vein supplying blood to the heart muscle was blocked. It was alone in it's attempt to bring me down. While scoping through the rest of the arteries around my heart my doctor said everything else was open and clean and there was no damage to the heart muscle. In addition to not ignoring the problem and getting help reasonably fast my fitness level was a major contributor in  preserving the integrity of the only heart I own.

Then why...genetics? Why only one vein? I'm 58, 6'1", 190 lbs, low cholesterol, low blood pressure, exercise by cycling regularly and I get regular physicals. I can only file this heart attack under "shit happens". And when it does happen be prepared for it by keeping your body healthy and strong. As an avid trike rider my heart was strong and was able to compensate for a temporary loss of blood to part of my heart muscle.

On the positive side I now know what is going on inside my heart and it looks good for the long run.

If you ask me what is the one thing that stands out from this whole ordeal it is the doctors and nurses telling me that my whole family filled up the ER waiting room. I love them all!!!