by Tony Cusano | Mar 4, 2019 | Public
Many people are aware of the controversy over the use of statins for preventing cardiovascular events in patients at high risk but who have not had any previous known heart disease.
This clear and thorough presentation of the controversy illustrates both its complexity, and why it is critical that you and your doctor make a collaborative shared decision before using statins to reduce your cholesterol as a way to prevent cardiovascular disease.
The benefit of statins is unclear compared to their risks. In this setting of medical uncertainty, it is critical that your own values and goals guide the decision on whether to take them or not.
It is important to recall that there are alternatives to taking statins like exercise and diet for preventing cardiovascular disease, and although they are difficult to execute, they likely carry less risk.
Some may prefer to take their chances with medications that clearly have some benefit, but others may prefer to make stronger efforts at lifestyle changes.
A collaborative decision with your doctor allows you to make the choice that you prefer, rather than the one that experts who don’t know you have promoted.
If you were not sure about how to collaborate in this way with your doctor, we can help. Email or call for a free consultation regarding our education, coaching, and advocacy.
by Tony Cusano | Feb 17, 2019 | Public
The culture of medicine has blinded many doctors to the substantial risks of taking the powerful fluoroquinolone antibiotics. They are effective, generally well tolerated, and appear quite safe.
But the FDA has ramped up its warnings to avoid using them when alternatives are available. Unfortunately, many of those have their own risks and tolerability issues. Doctors like the simplicity that using Fluoroquinolone antibiotics provides.
The only way to be sure you or a loved one is taking the best medication for a routine, or even a complex infection is to collaborate with your doctor to make a shared decision that accounts for all of the benefits, risks, alternatives and unknowns. It seems like a lot for a sinus infection, but as the article shows, it’s critical to assure that your doctor has listened to and considered your individual values and goals.
If you’re not sure if or how to ask, we can coach, educate and advocate.
Call or email for a free initial consultation.
by Tony Cusano | Feb 13, 2019 | Public
LASIK eye surgery is very popular and when it works as intended, very helpful. However, a a recent controversy raised by one of the original FDA group who studied and approved the procedure reveals the need to apply a rigorous analysis of the benefits, risks, alternatives and unknowns of undergoing the procedure yourself.
One claim for a low serious complication rate of 1/1000 is 0.1 %, and when that is applied to the 10 million procedures per year, it adds up to 1000 people per year who are harmed by the procedure.
That averages out to 20 people people each week.
That’s not to say it’s not worth doing it, but a rigorous judgement of whether the small risk is truly worth the benefit is important to avoid devastating regrets.
If you feel uncomfortable about how to share the decision fully with your doctor, contact us for a free consultation.
by Tony Cusano | Jan 21, 2019 | Public
The last place in medicine we expect any new discoveries is in anatomy. But in the last year there have been two stunners. Scientists found an invisible network of channels that course through our bodies opening all sorts of possibilities for how our cells communicate and function, and how medications circulate.
And recently scientists have discovered similarly invisible channels in solid bone, again opening up huge gaps in our understanding of the blood and immune system, of bone itself, and of how we handle medications.
These discoveries remind us of the importance of a thorough understanding of the benefits, risks, alternatives and unknowns involved in any medical decision, and of collaborating with doctor to share such decisions so they follow your own values and goals.
We can educate, coach and advocate to help with your collaboration.
Email or call for a free initial consultation.
by Tony Cusano | Jan 20, 2019 | Public
We all want to promote a healthy cardiovascular system to prevent one of the most common causes of death and disability we face as we grow older.
Doctors try to help by measuring risk factors and providing treatments to reduce the risks. While many medications are available to help, they also carry risks of toxicity, many of which such as muscle changes or diabetes are well known, while others such as cognitive decline or cancer risk are hinted at but not clear (keep in mind that nearly all the statin studies show more reduction of CV deaths and events than overall, leaving open the question of why the CV risk reduction did not lead to the same overall risk reduction).
Lifestyle approaches have always proven very helpful for risk reduction, but much more difficult to implement in the modern American socio-economic workplace and over-scheduled lifestyle environment.
A recent study of the difference exercise makes beyond simple weight control suggests but does not prove that it is better than statin therapy for reducing CV risk, though certainly we know it carries minimal risk compared to medications.
If your doctor has found that you have elevated risk factors for cardiovascular disease it’s critical to compare the benefits, risks, alternatives and unknowns of lifestyle change to the use of medications, and to share the decision on which treatment plan to undertake.
Insurers and the government currently apply enormous pressure on doctors to use medications to reduce CV risk. That certainly can help manage the overall health of the population they must manage. But any individual should chose the balance they want to strike by collaborating with their doctor to make a decision that honors their own values and goals. The study linked above shows that diet and exercise can provide an effective alternative to medication.
Exercise has many proven benefits, so regardless of your medical decision regarding CV protective medications, don’t let the false sense of security a trim physique or prescribed medication provide mitigate committing to it.
by Tony Cusano | Dec 30, 2018 | Public
The FDA recently issued a warning about the old and very commonly used antibiotics like ciprofloxacin.
The side effect is rare, but the loss ratio of aneurysm rupture is devastatingly large.
Anytime you need to make a medical decision, even one that seems as trivial as taking an antibiotic, be sure to fully understand the benefits, risks, alternatives and unknowns. And share your values and goals with your doctor so the decision is right for you.
We can help if you feel uncertain how to do that.
Email us, or call 203-692-4422 for a free consultation.
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