Good morning so far. Started with prayer and meditation, including progressive relaxation, where you start with your toes, let go of any tension, and gradually work through the rest of your body. I first experienced progressive relaxation in the est training back in 1980; they didn’t call it that, as I recall, but that’s what it was. “Locate a space in your feet . . . locate a space in your ankles . . .” When it would come to “locate a space in your genitals,” I’d feel a vague discomfort or tinge of shame. Almost 30 years later, it’s nice to note that I can “locate a space” in my genitals and they are just there, like my toes or fingers.
I haven’t regularly meditated for a long time. What prompted me was the realization that perhaps the best gift I can give to myself, and those around me, is to reduce the stress in my life.
I’m one of those people whom for various reasons, such as childhood traumas and evidently genetics, tend to overreact to circumstances, worrying a lot, sometimes obsessing, and then feeling overwhelmed and avoidant. “Generalized anxiety disorder.” “Major depression with recurrence.” Medications help. A lot. But they don’t do everything.
A nurse at my doctor’s office called yesterday. My cholesterol is too high and the doctor wants to talk to me about going on a cholesterol-lowering medication–a statin drug, I presume.
I love my doctor. He is calm and patient, really listens, and doesn’t stiffen when I ask lots of questions stemming from my reading about health issues, especially reading that challenges orthodoxy. He doesn’t get defensive or exasperated or dismissive when I pass along ideas from my sister, a physician. He also makes sure that there is time blocked off in his schedule every day for “call ins,” people who are sick and need to be seen that day.
If I (or any of his other patients) was sick, I could get an appointment today. To talk about my cholesterol, I have to wait three weeks to get in. Fair enough.
I asked the nurse, who is mailing me the full test results, about my HDL (the so-called “good” cholesterol) and my triglycerides. My HDL is 51, my triglycerides aroung 100. That’s a good (if not ideal) ratio, from what I’ve read, and a growing number of doctors and researchers think that triglycerides and the triglyceride to HDL ratios are a more accurate predictor of heart health than total cholesterol or the level of LDL (the “bad” cholesterol). My triglyceride to HDL ratio is about 2, which is good. My blood pressure is usually around 110/65 or so, often a bit lower, which is very good.
There is a lot of controversy over how much statin drugs do, and in what populations they do the good. The best summary I’ve found is this famous (among those who are involved in the debates about cholesterol) Business Week cover story, Do Cholesterol Drugs Do Any Good?. One hypothesis gaining momentum is that much of the good that statin drugs do, for those they do help, is in reducing inflammation. In other words, as I understand the argument, lowering total and LDL cholesterol doesn’t do all that much, but reducing inflammation does. (For example, there are lots of heart attacks that happen to people with low LDL, and lowering LDL through non-statin drugs doesn’t consistently improve heart health.)
So here’s the thing for me. I have a good HDL level and a good HDL/triglyceride level, excellent blood pressure, and an excellent resting hert rate (around 60 bpm). So there’s no sign of inflammation (as far as I know). In the research I’ve done–and I’m pretty good at find good summaries of research–I haven’t found any evidence that statin drugs have been proven to have any benefit for middle-aged men without heart disease, fairly low blood pressure, and a good blood lipid profile other than an elevated LDL level (by the current orthodox standards). And there are lots of potential side effects.
So I will go in and talk to my doctor, and probably test his patience once again as I challenge him to convince me that there are proven potential benefits to taking a statin drug for a person with my lipid profile and blood pressure, and that those potential benefits outweigh the risks.
Clearly, the standard of care is to put anyone with high LDL on a statin, and I imagine that for some doctors, there’s a fear that if you don’t do that, and the patient has a cardiac incident later on, you could be subject to a malpractice complaint. I don’t know his position, I’m just speculating, broadly. But if we can’t agree on this, I’ll be happy to write him a letter to put in my chart thanking him for advising me to take a statin and explaining that I refuse to do so. Then if I do keel over from a heart attack, he’s protected. (His lawyers or insurance company researchers could also just read my blog.
I’d like to improve that triglyceride to HDL ration and bring it below 2, raising my HDL level further, making it a higher percentage of my total cholesterol; there seems to be growing evidence that the the ratio of HDL to total cholesterol is also important. But I’m absolutely confident that I can do this through making my diet more consistenly healthy and exercising regularly (which I have not done for years). I’ve had some serious falls off the low-sugar, low-flour bandwagon in the last six months, and this is good motivation to recommit to healthy eating and exercise.
Back to meditation. Stress is as big a risk factor as there is for heart problems, as well as triggering anxiety and depression. I’m not willing to change the circumstances of my life–college teaching, running a concert series, beng the senior warden at the Episcopal church I belong to. I can, though, take responsibility for and be intentional about how I respond to the stress factors in my life, and meditation and prayer are important components of that.
So on to the work of, well, relaxing.
(By the way, while I’ve done a lot of independent reading on health issues, I’ve learned the most about what issues to research from Jimmy Moore’s blog and podcasts. He’s the one who introduced me to the triglyceride/HDL ratio issue, for example.)