We’re just never off duty! (From Bradford Telegraph and Argus)

We’re just never off duty!

7:33am Tuesday 2nd December 2008 in Doctor Tom By Dr Tom Smith

One of the problems of being a doctor is that we can’t forget who we are, even when we are off duty.

Recently I met an old friend for the first time in ten years. I noticed that he had little raised yellowish fatty streaks on both upper eyelids, near the margin with the nose. They had appeared within the previous two years. As he was now 55 he thought they were just a part of the ageing process.

He was wrong. They were small ‘xanthomas’. These are fatty deposits in the skin that are almost always caused by a raised cholesterol level. He was slim, fit, and had had no symptoms – no chest pain, no breathlessness, and no feeling of ill-health. So he was doubtful about seeing his doctor about such a small thing.

However, he did do as I asked him to, and saw his own doctor. My worries were justified when he was told that his total blood-cholesterol (TC) level was more than 9.5 millimoles per litre, well above the higher limit of the normal range, and giving him a very high risk of a heart attack in the next few years. He is now on a statin drug, with a TC below 4.5mmol/l, and his heart attack risk is a tenth of what it was.

He had inherited the tendency to have abnormally-high blood-cholesterol levels. People like him are labelled as having ‘primary hyperlipidaemia’.

They are usually diagnosed at a younger age than my friend, because they begin to have symptoms, often of heart disease or stroke. He had been fortunate still to be healthy when his condition was diagnosed: the statin will substantially lower his TC level and consequently his risk of early death or disability.

It was just luck that we met at the right time.