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I told my doctor I did not want to take any more pills for high cholesterol. She didn't try to talk me out of it; she knew the history of not tolerating them at all.
She asked me about a DNR. I told her what I had read somewhere here..... that I wanted one but wondered about medics in ambulances, etc. who worked at saving people because that was their "rule."
She gave me a form that essentially told any rescuer that I had a DNR and to honor it.
She appeared to be OK with what I said and the decisions I have made.
I go back in 3 months for re-check.
When the ambulance came to my father’s house, the EMT told me that they couldn’t go by the written DNR, but do honor the DNR bracelet (a red, plastic band-type bracelet) that my father wore. The bracelet came from my father’s doctor and was put on by a nurse.
Fortunately the god-like attitude of some physicians is becoming way less frequent. Regardless half the docs are below average and sometimes even average is not good enough. You have helped to describe when it can be important to change docs. The next step is to find out how to get a good doc you can work with.
That's the challenge. Finding a good doc who works as a team with patients. Even more challenging as we get older and move to Medicare. Reimbursements are low, but that's not the patient's fault, but some docs in some locations aren't taking new Medi patients, diminishing the pool of available physicians.
As someone on another thread said, "You have to kiss a lot of frogs to find a prince." I think that applies to finding a good PCP in any location, and I have to add, it doesn't matter if it's a top healthcare system or not. There are good, mediocre and bad docs in all of them, IMO. Ferreting out the "good" ones is a challenge, and many of the good ones are retiring. I've had 3 of my doctors retire in just the last year. Mid-career physicians have "closed their panel" to new Medi patients, leaving only newbies right out of med school, not always the best choice for older adults due to a lack of experience and a style that relies on algorithms.
They use the prescription bone meds, but they can have bad side effects. I know a few residents where i work who have jaw necrosis from them. The dentist can't do much work without fear of the consequences. I personally wouldn't trade some bone protection for a possibility of jaw necrosis...but that's me. I have a nurse co worker who won't go near them either.
Bone vitamins and minerals, lots to research there of what to take and exercise that stresses the bone, walking, hiking, weights, etc. to help.
Vit. D, but it has to be enough (the doses most people get aren't enough, I've looked at the Vit D council's info and other sites), Calcium (but supplements have heart risks, I eat my calcium) K (possibly, mixed research) and things like zinc, boron and other trace elements. I've read research that magnesium can help, too. Has to be a medley of stuff for the bones.
The standard bone density meds are bisphosphonates (Fosamax, for example). Long list of serious side effects, which you mentioned in your post. These drugs are only effective for about 5 years. I took Fosamax for 5 years and regret it. It did little to increase bone density and I'm still living with some of the damaging side effects 20 years later.
Everything you mentioned is good: calcium, Vit D, exercise, etc. None of that will "stop" the decrease in bone density over time, but may slow it down.
Other new drugs on the market are Forteo and Prolia. Both have very serious side effects and are indicated for patients with a history of fracture due to osteo. Both are also very expensive. The retail price of Forteo is about $4500 per injection (2 injections per year) and it's a top tier name brand drug so Part D only pays a small portion, depending on the policy.
With Forteo, for example, they stopped the trials after 2 years due to the high incidence of bone cancer. Patients on Forteo can only take it for 2 years, due to the possibility of bone cancer, and after 2 years, any density gained is lost since the drug has to be stopped.
Prolia is indicated for patients with breast cancer who have undergone chemo, which can greatly reduce bone density, and serious infections are one side effect due to compromising the immune system. There is a long list of other side effects. Prolia retails for about $1500/injection, 2x per year, administered by a professional, as is the case with Forteo.
If any physician recommends these drugs, I would suggest doing thorough research before starting either of them, and having a detailed conversation with the doctor. There is good info online about both of these drugs.
Last edited by olderandwiser456; 06-19-2019 at 09:10 PM..
There is nothing 'unsafe' about blood pressure medications, with proper dosage.
Actually, there are at least 4 BP meds that have recently been recalled due to carcinogens in the tablets. The article below describes some of the recent BP meds recalls. Valsartan, Losartan, Irbesartan, and others.
Completely agree with this. I've been able to get my BP down quite a bit via daily exercise, plus shedding a few pounds and improving diet, and drinking hibiscus tea every day. If I am able to drop another 10 pounds I might not need the tea anymore and may be in the normal range by next checkup. If not, I'll only have to go on a small dose of BP meds which (according to my NP) is safer and has less side effects than a larger dose. So even if exercise and lifestyle changes don't work 100%, it's still worth it to be able to take lower med doses with less potential problems.
I lowered my BP quite dramatically by nearly eliminating salt, or greatly reducing salt, in my diet. Processed foods are high in salt, so eating fresh whole foods is the better approach, IMO.
The standard bone density meds are bisphosphonates (Fosamax, for example). Long list of serious side effects, which you mentioned in your post. These drugs are only effective for about 5 years. I took Fosamax for 5 years and regret it. It did little to increase bone density and I'm still living with some of the damaging side effects 20 years later.
<snip>
Other new drugs on the market are Forteo and Prolia. <snip>
With Forteo, for example, they stopped the trials after 2 years due to the high incidence of bone cancer. Patients on Forteo can only take it for 2 years, due to the possibility of bone cancer, and after 2 years, any density gained is lost since the drug has to be stopped.
<snip>If any physician recommends these drugs, I would suggest doing thorough research before starting either of them, and having a detailed conversation with the doctor. There is good info online about both of these drugs.
Scary stuff- thanks for all the above. I'd read about the osteonecrosis risk, as well as unexplained fractures from "normal" activities such as walking down a step, with Boniva and Fosamax. When I had one of my dental implants I asked my oral surgeon about the implications of either of those meds. He said, "If you were on Boniva or Fosamax I'd have you sign a whole new set of waivers." He'd already supplied a very thorough list of anything that could go wrong with an implant and I'd had to sign it indicating that I understood the risks. He's very good- I now have 5 implants and no problems whatsoever. I want to keep it that way. I think I'll just keep up with the calcium, the magnesium and my cardio workouts.
My 86 almost 87 year old mother has high triglycerides, she has tried medication and the side effects caused her to end up at the ER thinking she was having a heart attack!
Her most recent MD tried to get her to start meds again and she said no way. She exercises most days and feels fine.
A great many of you seem to be trying to be your own doctors. That seems to me to be extremely foolish. We don't have the years of training and experience. Even if we had the skills and the knowledge needed, we cannot perform procedures, run tests or prescribe meds.
Others of you have described the side effects of drugs and the value of exercise, diet and other steps to improve health. Physicians are not stupid. They know the details of these factors especially if you deal with doctors who are specialists in the areas of importance to your health.
If you want to continue to be your own doctors, that is your choice but I think it is an extremely poor choice. Note becoming educated on your health issues is important but that does not mean you ignore medical advice.
It can be difficult to find a good doctor that you trust and can work with. I have a few suggestions that might help.
First, consider your choices in insurance. I am not locked in and limited to using HMO doctors. I do have to pay quite a bit for good supplemental insurance, but I have never had an issue with gatekeepers, with limited choices or with doctors that do not provide services due to poor reimbursement.
When it comes time to pick a new doctor, look at the doctor's medical education and experience. Most doctors now work in groups. Look at the education and experience and board certifications for other members of the group. It is often difficult for a doc to be accepted into a group of excellent doctors or specialists. Exclusive practice groups will select only those physicians who are first rate. Next look for direct referrals from other physicians. If you have a good PCP they should be able to help with finding specialists and visa versa. I avoid referrals from patients who are not knowledge of the medical field. I want first rate docs not people who win popularity contests. There is a lot more I could add but the first step is to realize the importance of finding good docs and the importance of moving on when you are not satisfied.
Scary stuff- thanks for all the above. I'd read about the osteonecrosis risk, as well as unexplained fractures from "normal" activities such as walking down a step, with Boniva and Fosamax. When I had one of my dental implants I asked my oral surgeon about the implications of either of those meds. He said, "If you were on Boniva or Fosamax I'd have you sign a whole new set of waivers." He'd already supplied a very thorough list of anything that could go wrong with an implant and I'd had to sign it indicating that I understood the risks. He's very good- I now have 5 implants and no problems whatsoever. I want to keep it that way. I think I'll just keep up with the calcium, the magnesium and my cardio workouts.
Thank you for mentioning dental implants. I had a dentist that kept pushing implants, and I kept telling him that with osteo and a history of taking Fosamax, not to mention that I would also need a sinus lift and bone graft, it just wasn't in my future. I would consider a bridge, however. Turns out this dentist did his "advanced training" in implants, and they are very pricey. In my case, I was looking at $6-7,000 total with all the other surgeries involved, for one back tooth, all out of pocket. Not going to happen. There are other solutions for an older adult. Keep in mind with a very pricey dental procedure, if it fails at any point in the process, you don't get your money back.
jrkliny: You are, of course, entitled to your opinion.
I will make every effort to not judge you.
Please afford me the same courtesy.
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