Saturday, November 13, 2010

It's a gamble

I like doctors; I really do. I just think they spend a lot of time guessing.

My journey to simplicity encompasses all facets of my life, and that includes my health. I enjoy keeping things simple. I've gotten my eating down to an art form, for instance. I eat the same delicious low-carb breakfast every day of the week that I go to work, and those days I enjoy the same big delicious salad for lunch. Yummy.... I've been repeating this routine since February this year, and I'm still not bored with it, and I still look forward to my breakfasts and lunches. I try to make healthy decisions and I'm at my ideal body weight.

But part of my health still lies in the thoughts and advice of the established medical community. Of course, I can clearly state I'm glad it does. With two C-sections under my belt, if the medical professionals hadn't discovered how to do those eons ago, I would be dead. Heck, I wouldn't even be here at all because I was born by C-section myself 56 years ago. And last year when my thyroid formed a growing nodule, a skilled surgeon excised it and now I'm on medicine to suppress my thyroid activity because pathology showed the nodule was the type that could have advanced to cancer. Thank God for medical science.

There are parts of medical science, though, that are just statistics, and stats are fickle. Researchers do their thing, have these studies, try to do them right, publish their findings, and regular family doctors read the interpretation and make their decisions accordingly. Of course, studies are always flawed in some way, because there is no perfect study. Maybe most of them have been done on men, and you're a woman. Maybe most have been done on folks in their 40s, and you're in your 50s. Maybe the starting assumptions were flawed. Maybe even the study was backwards - in other words, are the findings there because of some other reason and therefore correlate as a result of the problem and not the cause?

By now you are probably aware of the calcium study, which is making a lot of physicians tell their female patients to quit taking calcium supplements and only get calcium from their food. This is quite surprising, of course, since for years the same docs have been telling us to take calcium supplements for our bones. It turns out it is not getting in our bones; it is getting in our hearts instead, and the calcium from food doesn't have the same heart risk result. So I've quit taking calcium pills.

I don't fault the medical community for that turnaround. New studies, new data, and WHAM - new advice. I like progress. I'm glad we aren't subject of "blood letting" for every disease under the sun. I'm glad they grew out of that, I'm happy that they acquired more knowledge.

But in the end, it's just a guess, isn't it? "Right now, today, November 13, 2010, at 6:30 a.m., we think ________ is the right thing to do. Tomorrow it may be different." This is the message from the medical community. It's not their fault; it is just the way life is.

Everything in life is a gamble. Forget the casino, the lottery, and the stock market - those are just gambling's poster boys. Every decision we make, we weigh the options and decide whether to take the risk. Should I marry this person? Should I sell this house and buy another one? Should I have kids? Should I take this job? If I invest money in buying this dress pattern, fabric, and notions, will I have the skill to make it? Should I follow my doctor's advice or listen to my gut instinct? Place your bets, folks!

I once read a definition of insurance - life insurance, house insurance, car insurance, medical insurance - you name it. Paraphrased, it said insurance is something you hope you never have to use. By buying it, you are betting you'll need it. The insurance company is betting you won't. You hope they win and are paying them to think that way!

This is why all the studies in the world can't explain why a smoking, drinking man lives to be 100, while another man who follows the medical straight and narrow dies in his 60s. The stats just don't add up. Then you have to crunch more numbers, decide on how much genetics is worth, how important attitude and psychology are to longevity, accidents, and just fate. We can't explain everything, and neither can doctors and researchers. It's all a best guess and that can change on a moment's notice.

The gist of all this is that I've been asked to go on two statins because my LDL is too high, although advanced lipid testing shows that the LDLs are type A and are the good, fluffy, benign particles, and my triglycerides are low, low, low, HDL is high, high, high, all of which is great, great, great. The doc is looking at the studies mainly done on men about what causes heart disease and the current thinking on what all those numbers mean and the current advice on what to do about it. He has years of experience, many studies with acronym names, and he has crunched a multitude of numbers. In the end, though, he admits reluctantly that it is still a best guess. Worse, it's unprovable in the end. If I do take statins and live a long, healthy life, is there any proof that without the statins I would have died early? No. You can't prove it one way or the other. I would just be another uninterpretable statistic.

My lipid specialist doctor is intelligent and trying to do the right thing. I, however, am ultimately responsible for my own body and health decisions. I am choosing at this time, I think, to wait on any kind of medication. It's a gamble to think I don't really need it and that the side effects would be worse than the benefit, but it's just another example of the gambling we each do on a regular basis. It's just a little scarier.


Cuidado said...

I've not heard the new calcium study.

Carol Tiffin James said...

If you google calcium supplements heart disease, you'll see a bunch of stuff about the study. It's apparently serious enough that our docs at my hospital are telling their patients to stop taking the calcium supplements and just take vitamin D by itself.