Managing Up
When one is an employee in a typical hierarchical organization, the concept of “managing up” helps increase one’s value and align one’s priorities with those of the team. Rather than just doing one’s job description and taking orders, pay attention to what your boss should be doing. Boss may need a helpful reminder or suggestion. If done well, boss will appreciate it, and things will go better for the team.
In our “health care” system, one had best manage one’s own caregivers. Their agendas may need guidance. They have other patients and concerns. They may not be up-to-speed on relevant information. Doctors come across as know-it-alls, but they should be able to explain the reasoning behind their recommendations.
I first met my primary care physician at Kaiser in 2015, after a company restructuring landed me there. Given my high cholesterol, age, sex, and family history, she prescribed a statin. I did not fill the prescription, but wrote a letter explaining that I believed eating whole food, plant-based, would obviate the need for the medicine. She could not force me to take the statin, so acquiesced to my plan of retesting my lipids. The retests did not show improvement, so we remained at an impasse. No one ever answered the points in my letter. No one explained how I could have high cholesterol while eating whole food, plant-based. There was no meaningful dialog.
My cholesterol remained high well into 2023. Then I learned about familial hypercholesterolemia and how I likely had it. I had some outside health screens done, that opened my mind a bit. When I gave Kaiser the results, they ordered detailed ultrasound scanning of my carotid arteries and my abdominal aorta. This would not have happened had I not managed my own health care.
Ultrasound results
May 2023. Right carotid bulb demonstrates mild calcified plaque. The right internal carotid artery (RICA) demonstrates a 1-15% stenosis. Left carotid bulb demonstrates moderate heterogeneous plaque. The LICA demonstrates 16-49% stenosis. Intimal thickening and antegrade flow on both sides. Impression: No hemodynamically significant carotid stenosis demonstrated bilaterally.
Many measurements were taken in the area of the abdominal aorta, and no evidence of aneurysm was found there.
One Cholesterol Data point with statins
When I donate platelets once a month, LifeStream runs a non-fasting total cholesterol test on my blood. In 2023, the results were around 200.
| Test Date | Value |
|---|---|
| 04/05/2023 | 203 |
| 03/15/2023 | 205 |
| 02/01/2023 | 193 |
| 01/03/2023 | 212 |
On May 3, 2023, the value was 134. So, there is just one data point, but it certainly appears that the statin I have started taking is having the intended effect of reducing my blood cholesterol.
Side-effects?
Prior to starting statins in 2023, I had a strain in my left elbow. As I write this, that has cleared up, but I have pain in my neck and right shoulder, that may have been caused by compensating for the elbow. I started taking statins just after the neck and shoulder pain began. I can’t be sure if the statin is part of the problem or not. I have started taking CoQ10 supplements, and I can’t tell if they are helping. This will likely pass in time. I have had similar pains in the past that went away on their own. Ice helps. Chiropractic has not helped for this. I am considering trying acupuncture.
