The statin madness infecting the greater part of the tribe of physicians has finally reached out and touched me personally.

We all hear horror stories about all kinds of occurrences, but, although we feel empathy for the victims, we don't truly understand until it happens to us directly.

I've railed in numerous posts and to anyone who would stand and listen to me about the idiocy of prescribing statins to the vast majority of those they're prescribed for. I read comments from female readers of this blog telling me how their doctors are insisting they go on statins despite there not being any evidence that statins provide any benefit to women. I hear about young men with no history of heart disease but minimally elevated cholesterol levels being put on a statin with the understanding that they need to be on this drug for life. This despite there not being any evidence that statins prolong the lives of those young men who take them.

Based on these examples and a thousand others, I've become convinced that prescribing statins is a reflex action for many doctors. And I have to shake my head because these are not benign drugs. In fact, they come with a contingent of fairly serious side effects, many of which can last long after the drugs have been discontinued.

But only now do I truly understand how dismally, unthinkably, reflexively stupid some doctors can be.

Here's what happened.

My father, who is almost 86 years old, has been afflicted with a serious degenerative neuromuscular disease for many years. At this point, he is virtually totally paralyzed. He can move his left arm at the elbow maybe two inches, but that's it. He can breathe, chew and talk, though his formerly deep voice is now barely a whisper due to the partial paralysis of his vocal cords. He requires round the clock care, which my sister and a cadre of paid caregivers provide. When we can, MD and I go to Michigan to do our turn of waking up every three hours during the night to turn him.

He recently had a very mild heart attack. It was the kind that doesn't really change the EKG reading but does cause some heart muscle death as evidenced by elevated enzymes. He was in and out of the hospital in a few days and back home seemingly none the worse for wear.

MD and I arrived a couple of days before Thanksgiving, and he appeared to be his normal self. Over the long Thanksgiving weekend, I noticed the urine in his catheter had turned a sort of darkish mahogany color. For several years, he has had an indwelling catheter placed directly into his bladder through his abdominal wall. One of the concerns of patients with permanent catheters is urinary tract infections, which he gets occasionally. So my first thought was that he had developed an infection. But he didn't have any of the symptoms he normally has when he develops an infection. No fever, no bladder pain, no back pain. He felt OK - or at least what passes for OK in his state.

I was running through the list of everything that could cause such urine discoloration. One cause can be from drugs that are metabolized and released via the urine. I asked my sister if my dad was taking any new medications. She retrieved his discharge orders from the hospital. When I read them, I couldn't believe my eyes.

He had been put on Lipitor upon discharge. And a large dose at that. 40 mg, which is half of the largest dose available. I immediately discontinued his dose and had the remainder of the pills destroyed so one couldn't be given to him accidentally.

And it wasn't even a thinking decision. The statin is hardwired into the discharge orders of everyone leaving the hospital after a heart attack. You can see below how it was done. This particular order spanned two pages, so I've sort of cobbled them together for better readability.

As you should know from reading this blog, the second sentence in these orders is a total and absolute lie unless you are a male under 65 years old, which my father at almost 86 is not.

Not only that, take a look at the recommendation for diet for those being discharged after having a heart attack.

Do these people not keep up with the literature?

Once I realized he had been taking a statin, a whole new possibility for his dark urine open up for me. He could have rhabdomyolysis. Rhabdomyolysis is a rare but frequently fatal reaction to a statin drug. It comes about if the drug causes muscle breakdown as it does in many people. Which is why a good percentage of people on statins have muscle pain and weakness. Most don't break down a significant enough amount of muscle to cause problems. But some do. And those who do break down a lot of muscle release it into the blood stream where it wends its way to the kidney. The elevated protein from the muscle breakdown can the clog the kidneys and actually destroy them. Some people have to go on dialysis, others die before they get that chance.

One of the signs of rhabdomyolysis is a dark, mahogany-colored urine. As you might imagine, I became concerned. I know rhabdomyolysis is rare, but since the consequences are so disastrous, I wanted to eliminate it as a concern. Which can be easily done with a urinalysis. The best way is a blood test combined with a urine myoglobin, but I figured just a standard urinalysis that checked for protein would be okay. Unless he had a huge amount of protein in his urine, I didn't really need to worry.

In my years in practice, I have had many, many doctors from out of town call me and ask if I could run a lab for them or do a quick X-ray or whatever, and I've always been more than happy to do so.

The doctors that I contacted in the area of Michigan where my folks live do not operate by that same code of professional courtesy. I called several urgent care centers, told them I was a physician from out of town and that I would like to bring a urine specimen from my paralyzed father in for a simple urinalysis. In each case, I was told that I would have to pay for the urinalysis and pay for the office visit and bring my father in.

I didn't care about paying for the urinalysis or the office visit and told them that. As I explained, my problem was getting him there. He is totally paralyzed, which means we can't just throw him in the car and drive over. We have to call and ambulance, get him loaded, drag him to the office, get him unloaded, get him in, get the urine, then do the whole thing in reverse. A major production just to get a simple UA.

No dice. Totally indifferent and absolutely not helpful.

I then called the doctor on call for his medical group. She called back, but didn't have his chart available because she was working out of a town a hundred miles away. After I badgered her, she finally sent me to a lab halfway across town where I could get a carry-in UA done. I got the specimen and headed off. When I got there, I was met again with total indifference. There were no records for my dad. And the on-call doc hadn't called the order in for the UA. When I finally got back through to her, I passed the phone to the gum-smacking, totally disinterested receptionists who took the order.

Of course, no one called me back with the results. I would really have been going ballistic had my father had any symptoms at all, but he was fine. Early Monday morning the home-health nurse came by to replace his catheter, which was a week overdue because she had been on vacation. When she pulled the catheter, it was obvious that it had been partially dislodged, probably during one of the bed changes or nightly turnings. Hell, for all I know, I did it.

Once he got his new catheter in place, his urine cleared and has been fine since. And just last night - Thursday evening, five days after I dropped off the urine specimen - I got the results. Only +1 protein, so certainly not rhabdomyolysis. Had I been able to get just a simple UA on Sunday, I could have saved myself a lot of angst.

The whole experience enlightened me as to what medical care is like now (at least in that part of Michigan). Sadly, it's probably going to get worse.

But back to the statin prescription.

How could any doctor in his/her right mind write such a prescription for an 86 year old, totally paralyzed man who has normal cholesterol? Even one who has elevated cholesterol? After about age 50, the higher the cholesterol, the greater the longevity. So, again, why would anyone write a prescription for a non-benign drug to an elderly patient? Plus, the chance for rhabdomyolysis is greater in the elderly who take statins as well as those who are taking a ton of other drugs, as is my dad. It's a set up for disaster with no potential upside to balance the risk. It is blind stupidity to prescribe a statin under these circumstances.

And not just any old statin. The script was for a large dose of Lipitor, a fat-soluble statin. Fat soluble statins are much more likely to be involved in drug interactions, and they can induce insulin resistance and possibly cause diabetes. If you're going to give an unnecessary drug, why wouldn't you at least give one with the fewest side effects?

There are seven statins available right now. Five of them are fat soluble and two are water soluble.

Fat soluble statins

Atorvastatin (Lipitor)
Cerivastatin (Baycol)**
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Simvastatin (Zocor)

Water soluble statins

Pravastatin (Pravachol)
Rosuvastatin (Crestor)

I doubt that one doctor in 500 who prescribe statins know there are lipid soluble and water soluble and which are which. Now you're ahead of the game.

If I had to take a statin or prescribe on, I would certainly take or prescribe a water soluble one. These drugs pretty much pass through the kidneys unchanged, and since they don't have to be metabolized in the liver, there is less likelihood of serious liver problems, which are a problem with the lipid soluble statins. And, as I mentioned above, the lipid-soluble statins are more inclined to cause drug interactions, insulin resistance and probably diabetes. Why use them at all?

Here is another list you might find helpful if you or someone you know is on a lipid-soluble statin and would like to switch to a water soluble one. These are the five most commonly prescribed statins. All these doses are equivalent. So if you're on 40 mg of Zocor, then ask your doc to change you to 10 mg of Crestor or 80 mg of Pravachol. Remember, only Crestor and Pravachol are water soluble.

Dosage equivalents

Crestor 10 mg
Lipitor 20 mg
Zocor 40 mg
Pravachol 80 mg
Mevacor 80 mg

Here is a link to a comment in a previous post followed by my response. You can see the difference in outcome with a lipid- vs a water-soluble statin.

Lipid (fat) soluble statins make their way into the cell membranes, which are basically fats. But fats that are highly functional in terms of their relationship to the cells they enclose. Anything absorbed into fatty tissues is more difficult to get rid of than that absorbed into a water-based part of the cell. Whenever I think of these drugs socked away in the fat cells and cell membranes of the people who take them (unnecessarily), I always remember the words of Dr. Ernest Curtis, cardiologist and author of The Cholesterol Delusion, a book I highly recommend:
As severe as some of these short-term side effects can be, they pale into relative insignificance when compared to the potential long-term problems. The chief difficulty here is that no one knows what the long-term effects may be from altering the basic biochemistry of the human body over a period of time. Because cholesterol is the key element in the formation of cell membranes, which are the protective coat for the cells, it may be that blocking cholesterol's production will weaken the protective barrier and allow the entry of toxins or carcinogens that were previously excluded. There are disturbing reports of increased cancer in some cholesterol-lowering studies, but, in fact, this process may take many years to play out. It's enough at this point to acknowledge that the long-term effects are completely unknown. This is a risk that should receive serious attention before half the population is placed on these drugs, that, in effect, accomplish nothing more than low-dose aspirin or an extra glass or two of water each day.
** Cerivastatin was voluntarily withdrawn from the market in 2001 due to excessive deaths from rhabdomyolysis.