Stopping Statins

Once you start taking a statin drug to lower your cholesterol, can you ever stop?
http://www.consumerreports.org/cro/news/2010/07/q-a-stopping-statins/index.htm

Are you taking the right treatment for your high cholesterol?

http://www.consumerreports.org/cro/2014/03/treating-high-cholesterol-with-statins/index.htm

Can cholesterol-lowering statin drugs cause memory problems?

http://www.consumerreports.org/cro/news/2012/09/can-cholesterol-lowering-statin-drugs-cause-memory-problems/index.htm

atorvastatin 80 mg tablet Instructions: Take 1 tab by mouth daily.

Prescribed by Scott Luria, MD on 12/23/2014

Full Report http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/StatinsUpdate-FINAL.pdf

I took the http://tools.cardiosource.org/ASCVD-Risk-Estimator/ with these data from Thu Jan 29, 2015 
Total cholesterol is very very low. What do we make of that?

Component Results

	Component	Value	Range & Units	Status
	Cholesterol	101	mg/dl	Final
	Comment:
	Desirable:<200 br="" style="border-radius: 0px !important; margin: 0px; padding: 0px;">Borderline High:200-239 High:>or=240
	Triglycerides	53	mg/dl	Final
	Comment:
	Normal:<150 br="" style="border-radius: 0px !important; margin: 0px; padding: 0px;">Borderline High:150-199 High:200-499 Very High:>or=500
	HDL	51	mg/dl	Final
	Comment:
	Low:<40 br="" style="border-radius: 0px !important; margin: 0px; padding: 0px;">Normal:40-60 Desirable: >60
	LDL, Calculated	39	mg/dl	Final
	Comment:
	Optimal:<100 br="" style="border-radius: 0px !important; margin: 0px; padding: 0px;">Near Optimal:100-129 Borderline High:130-159 High:160-189 Very High:>or=190
	Chol/HDL Ratio	2.0		Final
	Fasting?	YES		Final
	Non HDL Cholesterol	50	mg/dl	Final
	Comment:
	Desirable:<130 br="" style="border-radius: 0px !important; margin: 0px; padding: 0px;">Borderline:130-159 High: 160-189 Very High: >or=190

February Update

It's been a while since I found enough to write about to post an update. Now it has been 2 months since my heart attack on December 12, 2014. I spent a week in the hospital, the first 2 days really out of it. The docs thought I had had a seizure, but they could not find an obvious cause, so they treated me for several potential causes. To be safe, they put me on Keppra, an anti-seizure medication, which is very powerful and made me overreact to irritants. I lobbied to get off Keppra. I followed an abbreviated weaning schedule to cut down and then off. My neurologist proposed a less abrupt schedlule, but the result was the same. No seizures. Much more controllable irritation.

Second Opinion: I decided that another set of tests and scans would most probably give as anomalous results as the materials we have now. A counsin I have been in touch with through my genealogy work offered to look over my records and has made some helpful suggestions.

Cardiac Rehab Progress: I have been going to Phil Ades' well-recognized cardiac rehabilitation program. He argues that CR is a much more cost effective way of dealing with cardiac trouble than high-tech, high-price procedures. Once you have a stent, you can prevent the next event or even reverse the build-up of plaque by losing weight, getting fitter, reducing blood pressure ....  along with lowering cholesterol with medication.

Speech and Language: The therapist called to talk about our upcoming appointment. After we spoke for a while she allowed as how I might not need her services. So she sent a hint sheet. Drink enough water. Try to find a synonym when you can't find the exact word -- the word will come later. If you want to help me practice my word-finding language skills, give me a call.

Executive Functioning: Another change has been in my ability to organize things. Putting together a list is a good way to deal with projects that have multiple steps. Practice recovering from distraction. Now there's the challange. Or maybe avoid distraction.

Stress Management: One of the most interesting pieces of the rehab program is a series of 5 classes on how to manage stress. A psychiatrist who had a heart attack 20 years ago is giving back to the program by offering these sessions, along with a colleague. He cited Hans Selye's general adaptation syndrome. What I learned: When we are going around the circle sharing what makes us stress, we are each thinking about what we are going to say instead of paying complete attention to what is being said.

There is a large variety of ways people get heart attacks. Although Type A "doers" are stereotypical, our rehab group has a good showing of procrastinators and people with family situations (drugs, deadly disease, demented parents) that bring stress. I might think I don't belong here because I am very fit, I know the literature, I got a mantra in the 1960s and do yoga meditation for a short while each morning, and I ride my bike to counteract anxiety and depression, yet I got a heart attack. I wonder if each of us thinks they are a special case until we get into such a group.

There are many factors leading to cardiac artery disease, some of which we can control, and some we cannot . (such as genetics). I feel much better now that I am off the Keppra, but the challange now is a abscess or lesion on my foot that makes it hard to exercise. I am back on antibiotics to counteract the swelling and redness. When people hear about the lesion and the neuropathy, they think "Diabetes." But the definitive tests do not bear out this diagnosis.

In any case, I am doing much better.

Jacobowitz in 1848 Hungarian Census

1848 Conscriptio Judaeorum from Szobrancz

Thanks to Vivian Kahn for this image and for the transcriptions below.

 

Vivian Kahn, February 6, 2015.

Members of household #10 in this page from the 1848 Conscriptio Judaeorum from Szobrancz are as follows:

Jakuboviss Aron 41 born Vajnatina, tailor [1807]
Neuman Fani 34 b. Szobrancz [1814]
Jakuboviss Nahum 13 b. Sobrancz [1835]
—Hersko 11 (all children born Szobrancz) [1837]
—Hani 8 [1840]
—Zsuszi 6 [1842]
—-Ester 3 [1845]
—Farkas 1 1/2 (Farkas means Wolf in Hungarian) [1846]

Detail

=============================

Are these the same Jacobowitz family that we already have, thanks to the Krongelbs, Jiri Jakubovics, and Kovac Lewis? Here is my analysis of the

1848 CONSCRIPTIO JUDAEORUM FROM SZOBRANCZ

alongside information from records we already had.

Birth Date	Person	Birth Place	Parents	Documentation
1807	Aron Jakubovics	Vajnatina		1848 H Census age 41
1807	Aaron Jacobowitz			estimate
1809-1810	Fannie Klein		Jonas Klein; Mema Jeni Mittelman	estimate
1814	Fani Neuman	Szobrancz		1848 H Census age 34
1834	Herman		Aaron and Fannie	Arnold's note
1835	Nahum	Szobrancz	Aron and Fani	1848 H Census age 13
1836	Saly Ziszel	Szobrancz	Aaron and Fannie	Vivian Kahn
1837	Hersko	Szobrancz	Aron and Fani	1848 H Census age 11
1840	Hani	Szobrancz	Aron and Fani	1848 H Census age 8
1842	Zsuszi	Szobrancz	Aron and Fani	1848 H Census age 6
1844	Chava Sofie	Szobránc	Aaron and Fannie	Hungary (1900 US Census)
1845	Wolf	Szobránc	Aaron and Fannie	Death Cert
1845	Ester	Szobrancz	Aron and Fani	1848 H Census age 3
1846	Farkas/Wolf	Szobrancz	Aron and Fani	1848 H Census age 1 1/2
1848	Bernath	Szobránc	Aaron and Fannie	US Census and 1903 Naturalization

========================================================================

I think we are dealing with two families, who may both be from Szobrancz. The family of Aron Jakubovits and Fani Neuman are in tan, and that of Aaron Jacobowitz and Fannie Klein are in blue.

---------------------------------------------

Suppose One Family		Parents for Herman/Hersko and Farkas/Wolf?
1807	Aron Jakubovics	Vajnatina		1848 H Census age 41
1809-1810	Fannie Klein		Jonas Klein; Mema Jeni Mittelman	estimate
1814	Fani Neuman	Szobrancz		1848 H Census age 34
1835	Nahum	Szobrancz	Aron and Fani	1848 H Census age 13
1834-1837	Herman/Hersko		?	Arnold J./1848 H Census age 11
1836	Saly Ziszel	Szobrancz	Aaron and Fannie	Vivian Kahn
1840	Hani	Szobrancz	Aron and Fani	1848 H Census age 8
1842	Zsuszi	Szobrancz	Aron and Fani	1848 H Census age 6
1844	Chava Sofie	Hungary	Aaron and Fannie	Hungary (1900 US Census)
1845-1846	Farkas/Wolf	Szobránc	?	Death Cert/1848 H Census age 1 1/2
1845	Ester	Szobrancz	Aron and Fani	1848 H Census age 3
1848	Bernath	Szobránc	Aaron and Fannie	US Census and 1903 Naturalization
	9 children

========================================================================

I found the records below in 2011, but did not know what to make of them. Now that we look at the 1848 Census and the birth dates, it appears that none of the people below are represented or indexed from the 1848 Conscriptio Judaeorum above. 

===========================================

Josef, Frimet age 35 (head?) b.Prekopa, Hungary [1813]

Jakubovics, Sari? age 10 b.Prekopa, Hungary [1838]

Jakubovics, Rebeka age 6, b.Prekopa, Hungary [1842]

Jakubovics, Abraham age 4 b.Prekopa, Hungary [1844]

Jakubovics, Sija age 2 b.Prekopa, Hungary [1846]

===========================

Jakubovits, Aron age 42 b.Poruba, Hungary [1806]

Eisenstad, Juli (wife?) age 35 b E.Gyarmath, Hungary [1813]

Jakubovits, Herman age 14 b.Rohamor?, Hungary [1834]

============================

Siminovits, Chaim age 45 (head?) b.Szenna, Hungary [1803]

Jakubovics, Betti age 30 (wife?) b.Szeretva, Hungary [1814]

Siminovics, Laja age 8 b.Rebrin, Hungary [1840]

Siminovics, Maria age 3 b.Rebrin, Hungary [1845]

Jakubovits, David age 25 b.Benetine, Hungary [1823]

Lejbovits, Rozi age 28 (wife?) b.Ruszkotz, Hungary [1820]

=====================================

Jakubovits, Mozes age 55 b.Tiba, Hungary [1792]

Propper, Bori age 50 (wife?) b.Hommonna, Hungary [1798]

=======================================

========================================

Jakubovits, Hersko age 32 b.Orechova, Hungary [1816]

Gluk, Saindlya age 28 (wife?) b.Volya, Hungary [1820]

Jakubovits, Ester age 10 b.Szobrancz, Hungary [1838]

Jakubovits, Hani age 8 b.Szobrancz, Hungary [1840]

Jakubovics, Sofia age 4 b.Szobrancz, Hungary [1844]

(born the same year as Chava Sofie Ecker JACOBOWITZ)

Jakubovits, Josef age 3 b. Szobrancz, Hungary [1845]

Jakubovitz, Herman age 40 b.Hommonna, Hungary [1808]

Szelman, Seindla (wife) age 32 b.Jenke, Hungary [1816]

Jakubovitz, Lipot age 14 b.Palotz, Hungary [1834]

Jakubovitz, Ilona age 11 b. Jenke, Hungary [1837]

Jakubovitz, Rozsa age 8 b.Jenke, Hungary [1840]

Jakubovitz, Berko age 7 b.Jenke, Hungary [1841]

Jakubobvitz, Eszter age 2 b.Jenke, Hungary [1846]

==================================

Jakubovitz, Zselman age 56 b.Solynus?, Hungary

Jakubovits, Bernat age 16 (son) b.Revisce, Ung [1832]

Jakubovits, Izsak age 3 (son) b.Revisce, Ung [1845]

Jakubovits, Klara age 2 (daughter) b.Revisce, Ung [1846]

Jakubovits, Lotti (daughter) age 8 b.Revisce, Ung [1840]

Jakubovits, Chaim age 53 (self) b.Revisce, Ung [1795]

==================================

Jakubovits, Herman age 4 (son) b.Ungvar, Ung [1844]

Jakubovits, Mojses age 10 (son) b.Ungvar, Ung [1838]

Jakubovits, Salamon age 15 (son) b.Ungvar, Ung [1833]

Jakubovits, Sali age 2 (daughter) b.Ungvar, Ung [1846]

Jakubovits, Leo age 44 (self) b.Ungvar, Ung [1804]

Second Opinion

Eli argued strongly that I should seek a second opinion on the seizure/stroke/cognitive impairment issue surrounding my cardiac event. When he runs into a programming problem, he does better to pay an expert than to try suss it out by himself.

That very afternoon I got a letter from my insurance offering a 'case manager' service. Immediately, I called. The lady said that my Primary should be acting as a quarterback in coordinating meds and services. But he defers to the neurologists and cardiologists. I am entitled to a second opinion (does this imply that the insurance will pay?) Eli had found a name of a doc in the Boston area through a friend of the son of a colleague....  How should I approach this guy? Is he even the expert I want? I Googled him and was unable to assess his expertise. The sites involved with seizure seemed to presume epilepsy and would offer advice on how to deal with it. There is no evidence that I had a seizure except my behavior.

The Internet approach seems haphazard and amateurish. Why not involve the experts?

The insurance case manager offered that the neurologists should be interested in a second opinion, too, since they concur that they don't understand what is going on. So I asked my neurologist to recommend a practice for another opinion. At first he seemed a bit defensive, but he dealt with that well, and he started checking around.

We have been communicating by phone, but for the first week he did not return my call. His name did not drop down on the hospital's MyHealthOnline electronic messaging system. Only some results are posted there in any case. Some records have to be transcribed by hand before I can see them. I got a copy of my MRI scan as a video on a CD. My iMac  can't read it, so I have to get the video converted. Another interesting task.

I have not seen the results of the EEG or of the 24-hour urine sample yet. Linda said that getting detail from an EEG was like trying to tell what was going on at a football match by listing to the roar from outside the stadium. The results were normal enough that I can back off on the dose of Keppra, for which I am thankful. I think that med was having serious side effects.

Right now I am dealing with a wound on the bottom of my left foot. Since I have a neuropathy, I was not able to feel when things started to go wrong. Did I mention the neuropathy? It was frustrating to have the head of Neurology focus on that and on my Bells Palsy from the 1970s rather than address the seizure/stroke/head issues I was most concerned about.

If we find an appropriate person to give a second opinion, the test results and EEG will be made available. Electronic records should make it easy to share information at a distance. Will they want to see me in person?