I need cholesterol advice.....

  1. Hi Nurses!!!

    I need some advice.... I know the safe level of cholesterol is under 200 and I know that you can run borderline a little above.

    I know that you have your HDL's and LDL's etc....

    I belive if you don't have a too high cholesterol level you can modify it by changing your diet and some good exercise....

    But I need help on this one... My great aunt is 81. She just had a check up today because she is now on high BP med's and her cholesterol level is 345!!!!!! She asked the doctor is she could be put on some kind of med. and he said "NO the damage is already done, and it would hurt your liver, plus you would need to keep coming in for liver tests after you are put on the medication.
    I was not happy with this advice. I do think that if your cholesterol level is that high, and you have risk factors such as elderly, high BP.... she needs some med's to help regulate it.

    What should I tell her. I think a second opinion and I also belive she needs to be put on some kind of med.

    We eat good I know that, all the garlic we use, guess she is Italin

    thank you for your help.........
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  2. 11 Comments

  3. by   duckie
    During a recent checkup my MD told me my Triglycerides were too high. He told me to take 8 fish oil capsules a day. (1000 mg each) I also take Lecithin, both of which can be purchased at Walmart. The fish oil capsules are huge but I'm certain it could be bought in a liquid form if this is a problem. I prefer a natural remedy rather than medication and my MD says he has had great results with the fish oil caps. Hope this helps and I must say that this MD is a bit of a jerk. It's never to late, unless you're dead. And since she is not, tell her to do everything she can to get them down, who knows she may out live this shallow minded dim wit! Hope this helps.
  4. by   Cafe
    I would get a second opinion!!!!!!! Did they check her liver enzymes already and what were the results? I am really surprised there wasn't more advise from the doctor on this.
    Definitely, they should be talking to her about ways to reduce her total cholesterol level and checking her ratios of HDL to LDL and explaining this and what can be done to lower these to reduce risks. No way would I accept this as the answer without thoroughly investigating what she could do further. There are a variety of cholesterol lowering drugs out there. If nothing else, following her BP and how to reduce it and instructions and teaching on lowering cholesterol without meds, with follow up blood checks. Man, you even see that on the commercials now.
    Good luck.
  5. by   Mariah
    You need a second opinion, may be even a cardiologist. Liver damage is a potential problem, but I know quite a few people on it and no reports of liver damage. She is much more likely to die from cardiovascular disease now than from a possible potential liver problem later. No problem and the cholosterols are doing great. The latest guidelines from the AHA is even more aggressive on getting people on these meds, even with moderate elevations.
  6. by   P_RN
    Well I'm not 81 and I am a College educated RN. AND I have high cholesterol. About 5 years ago my doc put me on Zocor. After about 3 mos he checked liver enzymes, and about3 monts after that.

    Within the year I started having terrible muscle pains, then I started losing strength.....bottom line I had a CPK of nearly 750!!! The Zocor was messing up my liver and my muscles to waste away........!!!

    Maybe her doc is thinking of her financial or other age related problems. The statins are VERY expensive.

    PS I stopped the Zocor and my enzymes dropped to normal within a month....I recently was started on Pravachol...and believe me I will be much more aware of any new symptoms.
  7. by   MollyJ
    Linda, honey, she's 81.

    She's already exceeded the average life span of an American woman and the way you write about her, she's got a pretty good life (people care about her if something would happen).

    I agree with the other poster, that it would help me to know if she's got a good LDL:HDL ratio and some other data but the first line of cholesterol control is exercise and diet NOT necessarily meds. Now, she has got a pretty high cholesterol and some folks would treat that with meds immediately--all things being equal--but what does SHE have to say about this?

    Does she want a second opinion? Does she want to be on meds? Does she want to change her diet and lifestyle? At 81, these things are a _choice_. You may think her doc is a little cold (and he certainly wins no awards for finesse) by saying, "The damage is already done," but her coronary and carotid and cerebral arteries likely do look like an 81 year old American woman's and starting cholesterol lowering meds tomorrow (like one poster said, expensive and not without risk) won't change that quickly.

    Read a little further on this BB and you will see that the one thing that wears nurses out the fastest is the number of interventional deaths* in which they get to participate in the ICU. Your dear, lovely, and loved great aunt is going to die some time. That's a fact. Starting cholesterol meds at this point won't change that immutable fact. It's not going to magically undo 9 decades of diet and exercise behavior. And it may change how much money she has in her pocket to go to bingo, how good she feels daily and it signals the doctor that "this family wants a lot done to preserve the life and not necessarily the quality of life of this person." (bingo money counts as quality of life in my book).

    Now, all things done, you and your family might well decide to go ahead and take great auntie to the internist that will aggressively treat her high cholesterol. and that will be fine with me. I am not against the medical treatment of 81 year olds. My parents are that age. _But do her the dignity of asking her what she wants and listen closely to the answers._

    Entertain that she just wanted to ventilate her worries. "The doctor said my cholesterol is high and he said that he's not sure there's a beneift to treating it." She knows daily she's going to die; she's lost a lot of her family, friends and peers at this age. But the doctor just underlined that fact with her. Listen to her and hold her hand and help her look at her options but realize that _sometimes_ the RIGHT thing to do is this: "Don't DO something, Just sit there."

    I am hoping some other experienced nurses might post some thoughts here. Do what your auntie wants to do and don't rush her into acting.




    *In America, the highest medicare expenditure for elderly statistically occurs in the last 1 to 3 months of their lives as American medicine heroically pours resources into the lives of elderly people who are mostly tormented by their efforts. For many seniors, this is is a *horrible* interventional death that includes IV lines, feeding tubes and ventilation. Don't get me wrong. I am a former ICU nurse and I "worship" at the altar of technology, but there is a time and a place when those interventions are not called for and they are cruel. The efforts prolongs lives that have NO expectation of survival OR more importantly, returning to their mostly satisfying, pre-illness level of functioning.
  8. by   lyndalous
    Well thanks for the thoughts and concens.....

    Just to let everyone know... my family is very knowledgeable of "when to let someone die" and "when to help someone".
    My aunt is the one who was just seeking my advice on whether to do the med's or what else she could do..... She has a lot of money and can afford them... and would never play bingo, hehe...
    My family is not trying to medicate her and keep her alive.

    Her and her husband are both 81 and 82 have their own big house, and he still works. Her family consits of 12 bro and sis. and the avg. age expentency of them is in high 90's.

    Her and her husband are very knowledgable and are the only ones who make the decisions form themselves medically. They never even tell us when they have checkups!!!

    I just felt like in the last post I was being babied and I am a very smart College graduate BSN and I just felt like I was being talked down to...

    Just to let everyone know... My aunt had the high colesterol a couple months ago... and it is down to 140... her liver enzymes are great.... and she does her exercise reg.......

    Thank you everyone.....
  9. by   lyndalous
    P.S.

    I also wanted to add that I think after five years of nursing, etc., and a mother who is a nurse, and a very educated family we would of course do what my Aunt wants, whether it is to sit back or to help answer questions.......

    Thank you everyone once again...

    I really don't need "any more experienced nurses" to voice their concerns because she is fine and the first couple of posts were very helpful..
  10. by   lpnandloveit1
    lyndalous good for you the thought that your Aunt doen't desereve treatment because she is 81 is frightning!!!! I hope she gets the help she needs and feels much better.
  11. by   lyndalous
    Thank you lpnandloveit!!!

    I really need to hear that!!

    Have a nice day!!!
  12. by   MollyJ
    Twasn't my intent to hurt your feelings and, as I said, I have no problem with her doing what she wants to do, whatever that may be.
  13. by   lalaxton
    lyndalous,
    Just my two cents worth. As may have been mentioned earlier make sure Auntie has a total FASTING lipid profile done, you get a much better picture. I know some docs who wont even consider a total cholesterol unless it is fasting and in relation to other lipids. Secondly, although statins and other chol lowering drugs do affect liver enzymes in some patients, it is not all of them and as was suggested earlier, keeping close watch on them will give you answers. Even a slight elevation in liver enzymes is not particularly harmful. Either way you may want to suggest to Auntie to have a visit with a dietitian who is familiar with cardiac diets to help look at how her diet can be modified, I know several patients that have reversed their CAD and significantly lowered their cholesterol and lipid levels on diet alone, this does however take self-control as we all know. Adding things like soy, vitE, omega3 fatty acids, and oatmeal (to name a few) can help.

    Finally, I also agree that getting a second opinion, maybe with a gerontologist who greatly appreciates the changes of older seniors would be beneficial.

    Hope this helps....

    Lesley FNP

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