Medication for the rest of your life

These comments are fascinating to read as a doctor, keep them coming please.

My only comment is that I think we (doctors) could do better at explaining the difference between primary (computer says you’re at risk of X) and secondary prevention (you’ve experienced X, now what?).

The risk of X in those two scenarios is usually vastly different and perhaps we don’t communicate that well enough.

The concern is that some people can feel like they are being overmedicalised when they are well, while others underestimate the risk of actual disease.

And have you?

It was last week! Give me chance Cougar. No crisps or crisps like snacks have passed my lips since I spoke to the GP. Not back to the gym yet due to work. Should be back on a more regular basis from Monday.

Dude… Change your job?!

Working on it, but it is difficult when you’re the main bread winner, two young kids and not well qualified.

Had my complementary NHS health check the other week. Overall not too bad – a bit overweight (well, a fair bit more than I’d like – which I know) but cholesterol a bit high (5.7). A few days later a call from the nurse saying they’d like me to start taking statins. For now, I have rejected that as an idea as I want to see if I can manage it better by upping the exercise a bit and sorting my diet out. I guess I resented a little the idea that the solution was straight to statins with no discussion of alternatives at all.

You’re very very likely going to have another stroke without meds, you’re possibly going to have on with them. Being on thinners will massively reduce the risk of any serious damage if you do, for the sake of taken a couple of pills a day. Contrary to popular belief Dr’s don’t just put you on medication for shits and giggles.

As I would explain to any person I prescribe medication to – all medication has side effects – it’s just evaluating those with side effects of not taking them.

Blood thinners & statins are the more common meds and benefits certainly outweigh the risks by a long way.

An old saying I used to hear was; as we grow up our bunch of keys get bigger. As we get older our medication box gets bigger.

2 daily meds at 53 isn’t so bad.

I guess I resented a little the idea that the solution was straight to statins with no discussion of alternatives at all.

Statins are an interesting case in that the benefits are huge and side effects not generally serious.  Other strategies are not effective across populations ie diet and exercise.  Hence statins are first line treatment

I think it’s worth taking four questions into any consultation about tests or treatments:*

What are the benefits?

What are the risks?

What are the alternatives?

What if I do nothing?

*not my list but part of a well known campaign I’ve promoted.

Statins ……… side effects not generally serious

I’ve been trying to find one that doesn’t have side effects, they seem to have weird effects with me. Over the past two years I’ve had over 50 different types of blood test (some repeated a dozen times or so), typically I take a statin which improves some things and makes others worse, try another, have another round of blood tests, different things improved, diferent things made worse, try another, more blood tests, repeat…………………

The concern is that some people can feel like they are being overmedicalized when they are well, while others underestimate the risk of actual disease. – I remember a girlfriends Mum who did both. She refused any medication from Drs because it was pumped out by giant pharma companies who forced you to take it whether you wanted to or not. You opened a kitchen cupboard and there were 50-60 jars of pills and leave of natural ‘snake oil’ remedies that she took to prevent all the modern illnesses that she was bound to get. She had an A4 sheet with her natural medicine regine inside the door and it was 10-15 tablets a day.

Statins – I was prescribed these and within a week of taking them I felt tired. Nothing specific, just tired and a bit stiff. I went back to the Dr after 2 months to discuss and he told be that it was because I had read about side effect in the Daily Mail. this was the first time the side effects had even been mentioned. I looked at my Strava history and the miles ridden each week dropped about 40% when I started the statins. I stopped taking them and I felt better. I had a similar, but more noticeable, reaction to the 2nd type they tried. They are now asking me to try something else.

If feels a bit like trial and error on their part while I have to put op with the various side effects for 2 months at a time. I don’t think it helped that the first Dr, now retired, basically told me to ‘give up and get over it, you are old’. The new Dr is the one who is suggesting the start the random statin sweetie testing on me again. Anyone got any recommendations for which ones to try?

Statins are an interesting case in that the benefits are huge and side effects not generally serious.  Other strategies are not effective across populations ie diet and exercise.  Hence statins are first line treatment

Regardless of anything else – your basic issue is a mix of not wanting to use meds on the grounds of principle v the actual downsides of using those meds v the risks of another episode if you don’t, I think – I’d be having a very honest look at your diet, lifestyle, exercise regime etc. I suspect a lot of us eat more ultra-processed foods, cake, biscuits etc, drink too much alcohol etc and don’t get enough fibre, variety of veg etc. It’s our societal norm.

It may be that improving your lifestyle may reduce the chances of you having further issues regardless of medication. If you have some sort of genetic pre-disposition to issues things may be slightly different to something that could have a lifestyle root.

I’m assuming that your main priority here, is not to have another (suspected) stroke. I’d also be having a proper talk with the medical professionals familiar with your individual case about the likelihood of further episodes with or without medication. I wouldn’t be basing any big medical/health decisions on advice from people on a mountain biking forum. Irony much. Anyway, good luck whichever way you decide to go.

prontomonto
Question about the blood thinners: do they limit MTB due to risk of cuts? My dad’s on blood thinners and gets bad bruising from bangs and small cuts don’t stop bleeding etc. I always thought I’d strongly push back to avoid having to take them for that reason, if it ever arose

They are usually anti-coagulants these days and so yes, bleeding can be a pain -I’m more likely to cut myself chopping tomatoes than mtbing, but I bleed a lot when I do. You get a medical card in the pill box which tells how you should be treated medically. I certainly wouldn’t let them dictate how you live your life! Mountain bike like you always have. Just don’t become a sword swallower 🙂 (Ibuprofen is bad too, stomach bleeds can be quite dangerous, but I still take it in v small doses cos its the only pain killer that works on me)

Pushing back on them isn’t wise if they’re needed, as mentioned by many above.

As far as side-effects go, I had really bad stomach issues from the original anti-coags I was prescribed. Plus extreme lack of energy from the bisoprolol (beta-blocker ) – when I had the review they were changed to meds that agree with me a lot more. Won’t be racing Tom Pidcock any time soon, but at least I can run, swim, ride for a decent amount of time. So get reviewed if you have issues.

I’ve got high cholesterol too.

Me and my partner both eat the same stuff, similar age, but I exercise more, barely drink any acholol and don’t east crips or anything (unlike her!!)
My cholosterol is off the scale, hers is absolutely fine! (both recently tested by GP). She’s even o got better blood pressure results.

It’s very frustrating.

I’m getting side effects from statins (bad joint pain, especially in the knees) so trying to go quite extreme on diet and seeing a physio to build up my knee strength, but theres’ very little effect at the moment.

Sometimes I think if you’ve got the wrong genes, its a choice of taking medicine or accepting the extra risk of cardiovascular disease.

Statins are an interesting case in that the benefits are huge and side effects not generally serious.

To put that in context, it’s crystal clear that there are significant benefits post-stroke in people who have elevated HDL cholesterol or other factors pointing to artery disease.

OP’s comments suggest to me blood cholesterol markers were/are normal, so it’s slightly less clear whether he would personally see those benefits, which is why he is posing the question. Fair enough, something to be discussed with the specialist.

Personally, if I were in the position of looking to prevent a second stroke/TIA, I would view the statins as potentially beneficial, even if I couldn’t directly see where I fitted into the research/ target population. The consequences of further strokes mean I would accept a degree of overkill in medication, particularly in the first few years post-stroke.

I went back to the Dr after 2 months to discuss and he told be that it was because I had read about side effect in the Daily Mail.

Well known phenomenon.  this really does happen.  As you are anti meds then your chances of getting “side effects ” is increased – sort of placebo effect in reverse.

this was the first time the side effects had even been mentioned.

Poor – should have been discussed

If feels a bit like trial and error on their part while I have to put op with the various side effects for 2 months at a time. I don’t think it helped that the first Dr, now retired, basically told me to ‘give up and get over it, you are old’. The new Dr is the one who is suggesting the start the random statin sweetie testing on me again. Anyone got any recommendations for which ones to try?

Standard practice – there is no real way of predicting who will have which or any side effects.  As for which ones to try – your GP is the right person to ask

However, I’ve always been against too much medication – won’t have antibiotics unless they are totally necessary and believe in the body being able to mostly look after itself. I’ve always had a pretty decent immune system

This is pretty common view amongst men. Taking medication or seeking medical care goes against an image of stoic masculine self-sufficiency, and it’s something that I hear from men pretty often in the practice. When we ask why men are reluctant to come to the GP, or canx/DNA their appts – I’m too busy, It’s embarrassing, it’ll probably get better on its own, are themes we hear all the time.

Because men are reluctant to come to the GP, there is often a l lack of knowledge of how to navigate primary/secondary healthcare which only makes guys more reluctant and its easier just to ignore it all, and hope it’ll go away/get better by itself, and is  compounded when men get told that the solution is a long term, or life time treatment.

The answer is probably better health literacy aimed at men, something I think the NHS is realising it doesn’t do very well.

Yeah I having trouble with statins too.  Been on blood pressure meds for genetically high BP for years with zero side effects, started statins early this year.  Started to get pain in the arch of my foot, which eventually spread to the other foot.  Doc said it was “classic plantar fasciitis”, which seemed odd in both feet. Stopped the statin and the pain went..started again after 2 weeks and pain returned within 2 days.  Anyway, got a different statin, but after 4 weeks the arch pain is back (altho in a slightly different place).

Hey ho….back to the doc for a 3rd try I guess.

I should add, I didn’t particularly want to start on statins, for no logical reason, but given my family history, and relatively healthy lifestyle, it seemed the right choice.  Not sure what I do if I can’t find one I can tolerate.

barely drink any acholol

Are you sure 😉

That’s my second breakfast every day since Long Covid did a number on me. I too am (was) anti-pills for life, but dropping 1.5 stone, getting fitter so my resting heart rate dropped 10 bpm and heavily adjusting my diet made no difference to any of the symptoms or risks. GP and Consultant were both very patient with me.

Statins are an interesting case in that the benefits are huge and side effects not generally serious.

There’s a reluctance sometimes I see in GPs that means that becasue they often ignore/play down patients (mens’) concerns that something they think is trivial – pain in the foot, for example can be a total embuggerance for the patient, and there’s a cycle of “don’t want to take this as it cuases X pain/discomfort, I feel fine, so I go off my  meds, flare up of issue – back to the GP”

For our patient with long term conditions, we’re starting to offer them an appt where instead of fixating on say; why their blood glucose levels are not good, we ask what’s preventing them form taking the steps to maintaining it themselves. Often times the answers; My work is shit, my home life is rubbish, I have a pain in my back that I numb through drinking, are often more usefully resolved first by giving them pointers to where they can find help about those issues, than battering them around the head with dietary advice.

If i’d had a mini stroke id be terrified of it happing again. And if chomping on a couple of smarties in the morning reduced that risk i wouldn’t be considering anything else.

53yo – 2xbp tablets and 1xstatin. Never seen this as an issue.

Been on Allopurinol for gout for last 30 years.  More recently on 2x bp and a statin too.

As Blackflag says:

Never seen this as an issue.

OP. Almost exactly the same situation as you except I’m 62. My feeling is that I’ve dodged a bullet here. Got diagnosed on the back of having what felt like a trapped nerve leaving me with pins and needles all down the right side of my body. Whilst being in I mentioned that I’d had the slightest split second of blackout a couple of days before. They did all the tests and saw I’d had a blood clot on my brain. I’m on meds for life which could well stop me getting a full blown stroke and ruining my (and affecting my family’s) life. I’d say that was a pretty good deal really.

I have been very lucky, I was diagnosed Type 2 diabetic following COVID with an hba1c of 60, doctors only response was “pick up your metformin” on the way out, there was no education, no alternative given etc.

I asked if I could try to beat it without medication and give it three months, and got a genuinely shocked look from doctor and diabetes nurse.

But I also have a type 1 diabetic daughter, she has been since 4 years of age, and is now 14, and the advances just in medication and control (also on Medtronic closed loop system) have been amazing.

So i will never knock medication, i feel lucky that i had read many books on diabetes and come from a sports science background so had the knowledge to seek to control my disease without meds, plus I truly believe that it is something you need to fight straight away, or you can only fight up to a certain level, as the longer blood glucose levels are elevated, the more damage is caused, and the harder remission is.

I don’t blame doctors for the “heres the medication” approach, they are seriously overworked (any my wife is a consultant therapy radiographer on a cancer ward with a daft work load), and they want people back on an even keel as soon as possible. Ideally though, I wish there was more of an educational side to these things, that they had the time and resources to be able to say, “lets try this” before just medication, and then have the time to be able to see you reguarly to be able to see if changes you’re making are working and not just meds. But i know that they do not have the luxury of that often these days.

tarted to get pain in the arch of my foot, which eventually spread to the other foot.  Doc said it was “classic plantar fasciitis”, which seemed odd in both feet. Stopped the statin and the pain went..started again after 2 weeks and pain returned within 2 days.  Anyway, got a different statin, but after 4 weeks the arch pain is back (altho in a slightly different place).

Hey ho….back to the doc for a 3rd try I guess.

This is very similar to my experience. I iniitally didn’t correlate the knee pain with the statin, but I’ve stopped and started statins 4 times now and each time the pain comes back to the point I can’t even cycle along flat ground. Doc just keeps saying “it’s very unlikely its the statin” and told me to go to physio. Tried atorvastatin, rousavastatin, and finally nustendi and it’s the same with all of them. After the most recent blood test the doc just wrote a note saying “As expected raised cholesterol as patient refuses statins” and thats that! WTF

tarted to get pain in the arch of my foot, which eventually spread to the other foot. Doc said it was “classic plantar fasciitis”, which seemed odd in both feet. Stopped the statin and the pain went..started again after 2 weeks and pain returned within 2 days. Anyway, got a different statin, but after 4 weeks the arch pain is back (altho in a slightly different place).

Hey ho….back to the doc for a 3rd try I guess.

This is very similar to my experience. I iniitally didn’t correlate the knee pain with the statin, but I’ve stopped and started statins 4 times now and each time the pain comes back to the point I can’t even cycle along flat ground. Doc just keeps saying “it’s very unlikely its the statin” and told me to go to physio. Tried atorvastatin, rousavastatin, and finally nustendi and it’s the same with all of them. After the most recent blood test the doc just wrote a note saying “As expected raised cholesterol as patient refuses statins” and thats that! WTF

These both reflect my experience. Nothing too specific, just a weary ache and some new pain. Easy to dismiss, as my Dr did. It was only when I correlated the Strava results showing the big drop in my cycling to the dates I started taking the statins I had any evidence. Basically they made me feel just bad enough to not bother riding much.

If I hadn’t made the connection I could have spent the rest of my life feeling run down and achy every day but with a reduyced chance of a stroke. Without statins I enjoy my days much more but have an increased risk of stroke.

I’m 4 years ahead of you, happily taking the meds. Having seen my mum’s life debilitate after having strokes there’s no way I am risking that if I can avoid it, tho I’m not aware of any downsides.

Godspeed.

just anecdotal but when I started nursing 40 years ago major strokes were relatively common and made up a chunk of the workload.  Now since statins they are very much more rarely seen and stroke services have been reorganised to reflect this as we sim-ply do not need the same number of rehab beds.  Thrombolysis has also had an impact as have other therapies but the impact of statins on stroke is just incredible

I have had the bad luck (or maybe just the genetics?) to have suffered two serious conditions that hit me in my early 40s – just under 20 years ago. One condition was highly correlated with men over the age of 65 (which I clearly wasn’t), and the other highly correlated with smoking (and I have never smoked in my life). So, I have been on various meds ever since – with ongoing discussions with GP about the risks/benefits of each whenever they are reviewed. But the bottom line is that there is a pretty high risk that I would not be riding my bike at all without them and they have allowed me to enjoy the best riding of my life over these past 20 years.

So – of course – we are all different and lots of factors coming into play (age, fitness, exposure to risk factors, luck !) and you can’t hold too much store in individual experiences. But, the big trends are worth paying attention to (as mentioned  above) where the prevalence of some once-common conditions has been massively reduced by the introduction of some medications.

ps I am now compensating for the side-effects of one tablet by way of prescribing myself an ebike purchase last year ….and what an amazing thing the ebike is when you really need it 🙂

I had an exactly similar experience to the OP two weeks ago. Hospital docs told me I had high cholesterol, blood pressure and blood sugar. All testing failed to show any indication of a TIA but it was diagnosed as most likely. As well as pills for life for blood platelets and cholesterol, I was told not to drive for 3 months (which is causing huge problems). Finally got to see a consultant neurologist on Tuesday who said that a TIA was only possible, not probable, but kept the pills for life. Reduce driving ban to 1 month which is good. Then on Wednesday saw my GP who reviewed my notes and said my blood pressure, cholesterol and blood sugar were within a normal range.

I would like to try to control this by diet and exercise if possible. So I need to get out on the bike. And i have signed up to the Zoe diet app which monitors your blood sugar and gut biome to suggest dietary changes. My wife already does this and is feeling better for it.

So let’s see what happens. If I have to continue the pills it’s not a hardship, i already take Omeprazol for acid reflux and Tamsulosin for prostate every day.

I was recently diagnosed with arthritis (this year has not been a good one for riding my bike), and to try and avoid having to take Naproxen indefinitely I’ve got an appointment where they’re going to set me up with DMARDs (methotrexate if memory serves) which I imagine I will be taking for several years if not for the rest of my life.

I turned 40 yesterday and have always been a reasonably healthy guy, and this diagnosis has somewhat taken the wind out of my sails. I’ve got two very nice bikes sitting around doing sod all at the moment and unsurprisingly exercise has taken a nosedive, even though long term it’s important I keep it up to keep the weight off and reduce stress on my joints.

If one pill a week (which from other experiences here makes me realise is good going) can wind the clock back a year, then I’m all for it.

Disgustingly healthy here in my 50s, sorry. But don’t worry, I’ll get struck down by something at some point. Luck and genetics (and a reasonably sensible lifestyle, nothing obsessive though) won’t last for ever.

Now I’m worried, had a TIA 7 years ago due to a neck injury, got some new plumbing in the neck artery and only popping asprin daily until I drop. Do I need more pills?

In terms of thinners and mountain biking – I can attest that it’s not a great idea. I spent 6 months looking like the recipient of a proper kicking until I got my carotid fixed. I probably should have taken some time off the bike tbh.

I wouldn’t be worried.  I assume the surgeon that did the surgery decided what was appropriate treatment for you.  You had a arterial graft by the sound of it to fix a mechanical issue.  the asprin is to slightly reduce clotting.  From the little I know seems reasonable – its a very different scenario from atherosclerosis or small vessel disease etc

I’m on beta blockers and flecainide. I developed atrial fibrilation after a particularly heavy weekend at a MTB festival a few years ago. I’ve since had three cardioversions and an ablation. My latest attack was on New years day this year after a heavy night on the Jack Daniels. Since that day, I’ve given up alcohol. I’m coming upto my 59th birthday and am still able to ride along with, even ride ahead of people who are quite a few years my junior. Whether it’s the beta blockers or the sobriety that’s helping me I’m not sure but I feel quite fit at the moment. I intend to keep it that way by staying off the drink which I know is the trigger.

@natrix  “I’ve been trying to find one that doesn’t have side effects”

After trials of various statins and dosage (over 18 months) I’ve ended up with 10mg of Ezetemebe along with 180mg of Nilemdo (Bempedoic Acid) which has pretty much stopped my side effects for over a year now, but keeps my cholesterol levels acceptable for someone with cardiac disease. The downside, I believe, is the cost of these compared to standard statins.

I’d be having a very honest look at your diet, lifestyle, exercise regime etc

Ironically when it happened, I was the slimmest and fittest I’ve been for a good 10-15 years when it happened, hadn’t had an alcoholic beverage for 7 months, was riding three times a week, going to the gym four times a week

To pick up on some other comments

I’ve had no side effects from the thinners or the statins yet, that I know of – nearly 4 months in

I do worry about crashing the bike more now – one for the fact that I’m on the thinners and two, I had a bit of a slip and a bang 20 minutes before the TIA happened

I’m not taking advice from an MTB forum per se. Both my GP and stroke specialist have said I’m on them for life. End of story. I doubt there’ll be a review, as my condition can’t really improve as they have found nothing wrong with me from any tests

Some good replies all round though, so thanks

I’m very much opposed to people ignoring medical advice. When i was a youth one of my sisters wonderful friend died of an asthma attack. She had been told be a quack to stop taking her asthma meds as they were chemicals that were poisoning her.

But i think threads on here discussing medical advice are brilliant. I’ve learnt so much about symptoms, treatment and life style choices.

I think I’m correct in saying that it’s established that men’s health suffers from a lack of discussion between men, compared to women?

mens health suffers from being macho IMO

against an image of stoic masculine self-sufficiency

I guess I’m lucky I’ve been on asthma medication since the age of 6 (45 years now), so taking meds doesn’t bother me one bit. (The fact I had to pay for the asthma meds until 2 years ago still boils my wee) I think this was a huge saving grace when I needed antidepressants. It wasn’t that much of a big deal. (Taking the pills that is, not the anxiety/depression.) Last 2 years I’ve also been on thyroxine, hence my asthma meds now being free.

mens health suffers from being macho IMO

Indeed it does

In my case, I have no problem talking about medical conditions – nor visiting a GP.

Whether my aversion to over medication is machismo or not, I’m not sure