The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:
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Requests for advice and / or encouragement. On basically any topic and for any scale of problem.
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Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.
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Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.
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Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).
Jump in the discussion.
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I am worried about my heart.
I'm in a well compensated but demanding phase of my career. A promotion is on the cards, but hours are long. I have a chip on my shoulder, so the promotion is as much about career advancement as much as proving something to myself. It has taken a toll on my body. My weight has gone past 200 lbs and stayed above 200. Workouts, sleep and diet are all suffering. I don't like it.
I have a benign heart condition (Mitral valve prolapse) and South-Asian fat distribution puts me at elevated risk of heart disease. Then last year, my cholesterol went past the normal range. I've ignored(with her knowledge) my doctor's precautionary recommendation to use statins. The idea of a 30 yr. old being on permanent medication scares me.
For a bit, I put health first, and it worked. I lost 10 pounds and reached solid conditioning. Since then, my weight & conditioning have suffered as work has piled up. I have delayed my most recent blood test because I am worried the numbers spell disaster for me. Not a good look.
That brings me to last week. I have felt some tightness in my chest. Now, the location switches between the left and right side, so I'm sure it's some combination anxiety (too much coffee) and bad sleep & diet induced digestion issues.
But it scared the living shit out of me. Man, what am I doing ? I'm a grown man. I worked this hard to get to enjoy life and escape my 3rd world hell hole. I have my whole life in front of me. Need to get my priorities straight.
Oof. For what it's worth, I wouldn't jump from "twinges of pain in my chest" to "oh god I've got a cardiac problem" given your background and age, and it's a very good thing you know it's most likely due to anxiety and stress.
That out of the way, I do not think there is anything wrong with being a 30 yo on permanent medication. You need to eat food and drink water anyway, a small pill or two has... negligible effects on your QOL, and the main reason you end up wanting/needing to take one is to improve or at least maintain your health. If you live long enough, you'll acquire a list of mandatory medication, though at that point it's more likely to be your doctors headache than yours.
Statins are not bad drugs. I am not a cardiologist, but I strongly suspect you'd benefit from taking them, and apparently your doctor agrees too. You shouldn't expect side effects more significant than muscle aches for a few days, and they're cheap. Go for them. They have my endorsement, and you can stop if you can't tolerate them.
Ffs, I'm getting a migraine while typing this. There's a hole in my vision. It's not fair to blame you, so I'm joking when I say that you've made this more of my headache than your own. I'm not sure which one of us has it worse, what I'd give to be 25 and free of anything but ADHD and depression (sad haha).
Then there's the GLP-1 stuff. Wrangle yourself some semaglutide or the new stuff, they'll keep your weight down, help with the cholesterol too indirectly, and just keep you in better health overall.
I quickly looked up statin side effects, and I know they tend to exaggerate in a lawsuit-happy society, but liver damage, muscle damage and type 2 diabetes do not sound like nothing. Most of currently available medicine are kind of blunt tools, which mess with many extremely complex chemical processes in the body, some of which may be beneficial for us, but other may be not. So I think being careful about messing with one's body chemistry is a prudent approach. Sometimes you don't have a choice - if somebody has cancer, mediterranean diet and exercise is not going to save them, but modern drugs might. But there are costs to that. I think we should not be dismissing those costs lightly.
I am not saying they are nothing. But statins are the annoying kind of drug where the benefits are hard to perceive on an individual basis, but we have strong evidence does help at a population level. And the harms are even more rare, barring the more common transient stuff like muscle aches.
In more formal terms, the NNT is high, and so is the NNH. But the former is still significantly smaller than the latter, almost by an OOM. Both are diminished by his age and reasonably good health, at least on the basis of information provided, but I would be rather surprised if it came out to a complete wash or net harm (however small).
(I have neglected to specify that NNT and NNH require specific metrics or endpoints to assess, but I'm talking about the serious stuff, like number of cardiovascular events avoided in expectation or new onset T2DM/rhabdomyolysis)
As it stands, I think that @DirtyWaterHotDog is an intelligent sensible individual, and that their doctor has done due diligence before making the recommendation. I'd love to see an explicit QALY calculation, but let's be honest and admit that those are desirable but not strictly necessary, assuming a competent doctor exercising clinical judgement. I'm sure he's going to do his own research instead of deferring entirely to an argument I made while suffering from a serious migraine (even if I think that my advice is fine). I see no significant risk from initiating them, since they're easy to start and easy to stop if the most likely side-effects become annoying. The benefits are also probably small, but I think his actual doctor has a better picture than I do, and I see no real reason to disagree with them.
(If I was his actual doctor instead of a friendly stranger on the internet, I would be poring over the reports and calculating QRISK scores.)
Thanks for information btw.
As it stands, I have updated by priors. Reduced my apprehension towards them and calibrated the urgency to get on them.
I am setting a concrete deadline for end-of-year to get my cholesterol & weight in control. If it doesn't work, I'll take my doctors advice on statins.
I'm skipping GLP-drugs because I want to solve the root cause, not just the symptoms. Sleep, diet and work outs first. Rest will follow.
Note that I'm not strongly endorsing the statins. But your actual doctor probably knows your situation better than I do, and I trust them by default. More importantly, in a way, you can just quit if the side effects are more nuisance than the (small) benefits are worth.
Why not both? Seriously, even if you don't "need" them like someone with someone who is outright obese and diabetic, they'll help. There is no reason to think that you can't also make lifestyle modifications alongside them, and those are laudable goals anyway. You'll almost certainly lose weight, and it'll help the cardiovascular stuff. If your sleep is hampered by something like sleep apnea (which I do not know you have, but is not unlikely), then the weight loss will help with that too. It's easier to exercise and diet if you've already lost some weight and don't feel as hungry. The drugs should be easily affordable for you, you make a lot more money than I do.
If you had to choose between statins and semaglutide on my recommendation, then I would rather you pick the latter. Just talk about it with your doctor, as and when you see them again. If they advise against it, eh, that's fine by me.
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