A Letter from A Former Medical Colleague on Her Health Problems

 

I received this letter from a former medical-scientific colleague of mine (her name I withheld for professional ethical reasons), but she gave me the permission to publish her letter to me  in pink below.

Dear Dr Lim,

I am so sorry for not being in touch for a long time.

I sincerely hope the problem with your leg has been resolved.

I fractured my right wrist and a deep cut on my right eyelid which required 9 stitches recently.

I had surgery to put in a titanium plate. I am recovering well; range of motion is getting better, but I still need to do exercises to regain strength on my right hand.

Dr Lim, may I consult you on my results of cholesterol and glucose levels.

I saw an Endocrinologist on 27/11/23 and my results are as in the Table below.

The Endocrinologist prescribed Rosuvastatin Sandoz 10mg, once a day. 

Till date I have not started this medication.  Do I need to start this statin?

For the last one week, I have had a stomach-ache when I wake up, loose stool and a bit dizzy. 

I have had a right frontal dull headache since mid-morning (I have this type of headache on and off). Fingers on my right hand are numb now. I am not sure the numbness is due to my injured right wrist. I still have stiffness and slight numbness on my right-hand fingers in the morning. 

Dr Lim, I really appreciate your kind advice.

Thank you very much,

(Signed by my former medical colleague)

 

Here’s my reply and advice to her in blue:

My dear Colleague,

I am sorry to hear about your fall, the surgery you underwent, the numbness of your right hand and right fingers, and your occasional headache.

Your numbness is almost certainly due to the pressure by the titanium plate exerting on the median nerve on the flexor muscles of the forearm and hand. There may be some inflammation there that may increase the pressure over the nerve for which you may need some antiinflammatory medication.

It may go away after some time with physiotherapy and hand exercises, else go back to your surgeon if it does not improve over time.  

Meantime take Dyna Vitbion Forte tablets ( Vit B1, Vit B6 and Vit B12) tds (3 times a day) for your numbness.  

As for your headache, your symptomatic presentation sounds to be typical migraine. Take the herbal medicine called “feverfew” one – two tablets in the morning. Try the local pharmacy to get feverfew, else buy them online.

Also try to avoid harsh drugs for migraine and chronic headaches like acetaminophen, ibuprofen, triptans or erenumab, fremanezumab and galcanezumab.

Try also to avoid foods like aged cheeses, alcohol especially red wine, chocolate, cured and processed meats containing nitrates, nitrites, and MSG. Also avoid artificial sweeteners, smoked fish and food containing yeast extract, and also contraceptive pills which may not apply in your case.

As for your total cholesterol, a trend during these 4 years showed your total cholesterol was hovering around 9.3 mmol / L when preferably it should be less than 5.2 mmol / L.

But total cholesterol level per sec does not mean anything desirable or undesirable since your HDL averages at 3.2 mmol/ L when the optimal HDL cholesterol level for females should be between 1.2 - 1.3 mmol/L. Yours was very good.

What is important to know is that HDL cholesterol levels are just one part of the overall cholesterol profile.  The lipid profile should include levels of LDL cholesterol, total cholesterol, and triglycerides, in addition to HDL cholesterol.

But your more harmful LDL was 5.75 mmol (which was given there as null for normal level). The optimal LDL cholesterol level should be less  than 2.6 mmol/L which means it may be harmful if you let this LDL to be oxidized by free radicals into gummy plagues that may  block your coronary arteries of your heart that may result in  cardiovascular events such as angina pectoris (chest pains) or AMI -  heart attack, or a stroke in the cerebral vessels in your brain. The risk is there if accentuated by high blood pressure.

However, your total /HDL ratio was 2.9 when it should ideally be less than 5.0. Overall, your blood cholesterol level is not very desirable if cholesterol was truly the cause of coronary heart disease? See my comment and opinion on this here:

https://scientificlogic.blogspot.com/search?q=cholesterol

See also my letter to Consultant ENT Surgeon Professor Andrew about: 

The Truth about Cholesterol, HDL and LDL and Heart Disease here:

 

https://scientificlogic.blogspot.com/search?q=The+Truth+about+Cholesterol%2C+HDL+and+LDL+and+Heart+Disease

Your FBS (fasting blood sugar) was 6.65 when the normal fasting blood sugar range is approximately 3.89 to 5.49 mmol/L. but given there as less than 5.6 mmol / L. A fasting blood sugar level of 6.65 mmol/L may suggest impaired glucose tolerance or mild diabetes or pre-diabetic status. However, a single elevated reading may not be sufficient for a diagnosis. Other tests such HbA1C as a long-term duration of existing diabetes showed that your HbA1C from 25/7/2019 till 14/11/2023 hovered around an average of 5.65 % which is not too bad when the normal HbA1C is 5.7 %. I think you are just at the border line (pre-diabetes status). Pre-diabetes and Type 1 diabetes can be addressed through dietary means including using botanical medicine such as consumption of bitter gourd, fenugreek (Trigonella foenum-graecum): Fenugreek seeds have been studied for their potential to lower blood sugar levels. They may also help improve insulin sensitivity, cinnamon (Cinnamomum verum): Cinnamon is a spice that has been studied for its potential to improve insulin sensitivity and lower blood sugar levels, ginseng (Panax ginseng): Some studies suggest that ginseng may have anti-diabetic properties and could help improve insulin sensitivity, aloe vera (Aloe barbadensis miller): Aloe vera has been studied for its potential antidiabetic effects, particularly in type 2 diabetes, berberine: Although not a plant per se, berberine is an alkaloid found in several plants, including goldenseal and barberry. It has shown promise in improving insulin sensitivity and glucose metabolism, turmeric (Curcuma longa): Curcumin, the active compound in turmeric, has anti-inflammatory and antioxidant properties and may have potential benefits in managing diabetes.

Some nutritional products like a combination of chromium and niacin called ‘glucose tolerance factor (GTF) help dramatically. 

I have a lot of clinical experiences using chromium and niacin to manage diabetes among staff and colleagues working with me at the Institute for Medical Research in the 1970’s to 1980’s. The clinical efficacy with GFT is very high and impressive.

But I don’t think you need to take anti-diabetic drugs such as sulfonylureas (glipizide, glyburide, gliclazide, glimepiride), meglitinides (repaglinide and Nate glinide, and the more popular biguanides (metformin) normally prescribed in Malaysia or even using thiazolidinediones.

Try to avoid using all these antidiabetic drugs. They don’t “cure” diabetes, as they need to be taken every day just to control it.  I don’t suggest you use all these drugs either as yours is just pre-diabetes that can easily be controlled by nutritional and dietary approach.

As for your blood cholesterol I don’t think Rosuvastatin, Atorvastatin (Lipitor), Simvastatin (Zocor), Pravastatin (Pravachol) or any of these statins are necessary as they can damage your liver.  Use dietary approaches such as oats and barley.

 These whole grains contain beta-glucans, a type of soluble fibre that can help reduce LDL (low-density lipoprotein) cholesterol. Consume fatty fish rich in omega-3 fatty acids found in fatty fish like salmon, mackerel, and trout may help lower triglycerides and increase HDL (high-density lipoprotein) cholesterol. Then nuts like almonds, walnuts, and other nuts are rich in monounsaturated and polyunsaturated fats, which may help lower LDL cholesterol. Cook food in olive oil especially extra virgin olive oil, a source of monounsaturated fats that may contribute to heart health. Plant sterols and stanols, compounds found in small amounts in various plant foods They can help lower LDL cholesterol. Avoid margarine, white refined sugar especially. Use raw garlic as some studies suggest that garlic may have a modest cholesterol-lowering effect. I suggest turmeric that has curcumin, the active compound in turmeric with antioxidant and anti-inflammatory properties that may have cardiovascular benefits. All raw vegetables are very rich in antioxidants that will prevent the oxidation of harmful LDL cholesterol into gummy products that may stick on to the coronary blood vessels as plagues. Drink green tea as green tea contains antioxidants called catechins, which may contribute to heart health.  Apples or any tropical fruits that contain soluble fibre, which can help lower cholesterol levels. Lastly, I suggest consuming legumes such as beans, lentils, and chickpeas are rich in soluble fibre and can help lower cholesterol levels. Fruits like avocado that are high in monounsaturated fats and may help improve cholesterol levels. Some studies suggest that cinnamon may have modest cholesterol-lowering effects. So do psyllium husk and oats.

!00 mg of aspirin (standard dose of aspirin is 300 mg) a day after meals to thin the blood is useful against heart attack and also against colon cancer. Salicylates (in aspirin) are also found in abundance in curry powder. The Indians who eat curries everyday have the lowest rate of colorectal cancer, but the Chinese who don’t eat curry or very seldom, have the highest statistics in colon cancer incidence.  

Do this instead of all dosing yourself with all those statin drugs as they may harm the liver with long-term usage.

Kind regards and get-well dear.

Lim ju boo