Q. My doctor wants to do cholesterol tests every three months, even though I don't want to take any medicines to lower it. I'm worried that the drugs might damage my liver. My cholesterol level is around 220, which I don't think is too high because I have a high level of "good cholesterol." My insurance won't pay for testing every three months, but my doctor says it's necessary.
Should I switch to a different physician who will abide by my wishes? How often should cholesterol testing be done?
A. To start, if you and your doctor can't see eye to eye on something that's important to you, then that's a sign that you may need to see another physician--if only to get a second opinion.
As a rule, you and your doctor should agree on a course of treatment for whatever problem you're dealing with. If not, I think it's worth further discussing your concern with your physician. You may not have fully understood each other's concerns, and it's important that you give each other the chance to express them. After that, you can decide whether you can work together or not.
Next, your question raises several important points about cholesterol testing and treatment. The National Institutes of Health recommends that all adults get their total cholesterol level checked, along with their HDL cholesterol, also known as the "good cholesterol." If the total cholesterol is below 200 and the HDL is normal, it's recommended that you repeat the test about every five years.
If the cholesterol level is high or the HDL is low, you should have further testing to see what the LDL, or "bad cholesterol," level is. That's because the guidelines for treating cholesterol with diet or drugs depend on the level of LDL, not the total cholesterol level. In fact, you can have a high total cholesterol but not qualify for treatment. This can happen if your LDL is normal but your HDL is high, which is a good thing!
Because your HDL is high and your total cholesterol is only slightly elevated, there's a good chance that you don't qualify for treatment. Ask your doctor what your LDL cholesterol level is, and whether it's low enough that treatment wouldn't be recommended.
If with routine testing your total cholesterol is borderline (between 200 and 240), you should have it checked more often than every five years--around every one to two years. If your LDL is high, treating it depends on how high it is and whether you have any other factors that increase your risk of heart disease. Risk factors include high blood pressure, diabetes, smoking and a family history of heart disease at an early age.
Treatment for high cholesterol starts with diet. If changing your diet isn't enough, then there are several medicines you can take. Once you're getting treatment for high cholesterol, it's recommended that you have blood tests every three to four months to see how you're doing. But in your case, it doesn't make much sense to keep measuring your cholesterol if you're not on any treatment.
If you were on treatment, I would think that most insurance companies would pay for the recommended measurements.
As for liver damage or other side effects, it's important that you know what to look out for when taking any medicine. There are several different types of medicines for treating high cholesterol, and not all affect the liver. If you're worried about that particular side effect--which doesn't occur too often--you can take a different drug to lower your cholesterol. Also, if you do take one of the cholesterol drugs that can affect the liver, your doctor can do some blood tests to see how your liver is doing.
The bottom line is that you should check to see whether you qualify for treatment or not. If so, you can discuss different options with your doctor. However, it's important that you feel you and your doctor understand each other and are working together to enhance your health.
Help for Poison Ivy
Q. What's the best treatment for poison ivy? I dread getting this itchy rash each summer.
A. For really bad poison ivy, steroid pills like prednisone work best. For mild outbreaks, you can get relief with various creams, including steroid creams and calamine lotion. You can also use any of several nonprescription creams, lotions or sprays containing topical anesthetics and other anti-itch ingredients. However, none of these will make the rash clear up any faster. For that, you need steroids. These will counteract the allergic reaction you're having to the similar substances found in poison ivy, oak or sumac.
Even with treatment, poison ivy can linger for a week or two. But steroids will clear it up faster by a few days, and help relieve the itching. Doctors will usually prescribe steroids for large outbreaks, or poison ivy involving the face or other sensitive areas.
To keep from getting poison ivy in the first place, you can use a preventive cream or lotion that keeps the oil from getting on your skin. One of these nonprescription products is Ivyblock.
Jay Siwek, chairman of the department of family medicine at Georgetown University Medical Center, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
Consultation is a health education column and is not a substitute for medical advice from your physician. Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, DC 20071. Questions cannot be answered personally.