There didn’t used to be a part 3 to this story, but when I took my current position at the University of Toyama, I had to change doctors, from my pulmonologist in Nagano to a pulmonologist in Toyama. I asked my Nagano doctor to write a referral letter for me and presented it at the University of Toyama Hospital, and was soon assigned a pulmonologist who took over the management of my asthma medicine. After seeing him a few times, he said that my recommendation letter mentioned high cholesterol, but that his speciality is pulmonology, and so rather than try to manage my cholesterol, he wanted to refer me to a lipid specialist.
I reluctantly agreed, and the lipid specialist first wanted to do another blood test to check my cholesterol levels. I went in and had the test done, and when I met the lipid specialist, he said that yes, my cholesterol levels were high, which made feel rather upset, but then he asked if I had eaten breakfast the morning that I had my blood test done. I replied that of course I had eaten breakfast. I eat breakfast every day. It’s supposed to be healthy. He said that the cholesterol levels should be a person’s fasting cholesterol, not their cholesterol after they’ve eaten, and so he asked me to have the blood check done again.
At our next appointment, he checked my fasting cholesterol levels and said they were borderline high, but not so high that I would need to take medicine, and recommended that I keep trying to eat healthy and exercise.
So in the end, after I finally saw a lipid specialist, the final verdict was that my cholesterol wasn’t that high after all. The problem was instead that no one had told me I shouldn’t eat breakfast on the day my cholesterol levels are checked until I finally met the lipid specialist.
I wonder what the message of this story is? That specialists should stay within their field of speciality when treating patients, as my pulmonologist in Nagano never mentioned seeing another doctor about my cholesterol, while my pulmonologist in Toyama said it wasn’t his speciality and so he didn’t want to try to treat it? That very simple miscommunications, such as the directions to not eat breakfast in the morning can have a huge influence on test results? I think that certainly doctors and pharmacists should explain the potential side effects of the drugs they prescribe and dispense, especially considering my experience.
Overall, I’m glad my first pulmonologist in Nagano pushed me to do exercise. Cycling has been an overall boon to my health, although I certainly could have done without the episode of drug side effects that I experienced. My guess is that my cholesterol really was very high around the time that he first checked it, but I ate breakfast every time he checked my cholesterol, so I’ll never really know what the numbers should have been.
If you’re interested in the topic of the treatment of high cholesterol, the US recently overhauled their guidelines. There’s a really engaging explanation of the new guidelines and their implications for treatment on the UCTV website presented by Dr. Robert Baron, UCSF Professor of Medicine.