To Your Good Health
DEAR DR. ROACH: I have had low GFR readings ranging from 53 to 37 for the past 15 years. I’m an 87-year-old female in good health. I do strength training and Pilates, and am quite active walking my dog and doing my own yardwork. I’ve had heart disease for 10 years with no symptoms, and echocardiograms are normal.
My cholesterol runs around 180, and my blood pressure fluctuates from 137/68 to 150/75.
I take lovastatin and lisinopril daily. My doctor is not concerned about my numbers as long as there are no significant “spikes” or “drops,” and he stresses the importance of drinking plenty of water. When I’m extremely sore I will take an Aleve tablet, only once during a fourto six-week period, as I know NSAIDs are not good for the kidneys, especially with readings like mine. I sometimes take an occasional Tylenol.
Am I doing all I can to help myself? I prefer not to take medication for my GFR, nor does my doctor recommend it.
We monitor it with frequent bloodwork but the past two readings four months apart were 37 and 41. — I.F.
ANSWER: Recent changes in reporting kidney function have caused many of my own patients as well as readers of the column to be concerned about their kidneys. Kidney function always decreases as we get older. In many cases, people can develop what is called stage 3 kidney failure as part of normal aging. What can be very important to look at is the rate of decline: Since yours seems to have been fairly stable over 15 years, the likelihood of you going on to need dialysis in the next 15 years, when you will be over 100, is quite low.
Your doctor HAS you on a medicine to help your kidney function: lisinopril, which has been shown to protect the kidneys. Although, it’s most effective when the drop in kidney function is associated with protein loss in the urine, which may or may not be the case in you.
Avoiding kidney-toxic drugs — of which NSAIDs, including ibuprofen, are the most common — is critical. One a month seems low risk to me.
The only thing you haven’t mentioned is diet. Switching from animal protein to plantbased protein has been observed to reduce risk of progression in kidney disease. I do not recommend an ultra-low protein diet, however.
DEAR DR. ROACH: My question is in regard to cholesterol levels and whether a very high HDL can actually be dangerous. My HDL is 102, and has always been on the high side. My LDL is 119 and triglycerides are 69. My total number is 235. My total number appears to be high because of a high amount of the good HDL.
Although I am a healthy eater and do moderate exercise for a 73-year-old woman, I assume my body makes a high level of cholesterol, and would appreciate your thoughts on this issue. — B.
ANSWER: In general, high levels of HDL cholesterol (think “H for healthy”) reduce heart attack risk. However, there are a small number of people with a genetic mutation in whom high levels of HDL cholesterol actually increase heart risk.
This is present only in a few percent of people with high HDL. People with high HDL and known heart disease should be evaluated by an expert.
Your level of 102 is very likely to represent health, not disease. If your family history is favorable for heart disease, it’s extremely unlikely that you need to worry about this high level of HDL.
DEAR DR. ROACH: I’ve had regular swab tests for COVID-19, which have always been negative. The last one was just a few days ago. I had an antibody test six weeks ago that also was negative, but my antibody test this time was strongly positive.
I’ve been very careful about protecting myself and I haven’t had any symptoms! I’m scheduled to get my first dose of vaccine tomorrow. What should I do? — C.W.
ANSWER: With frequent negative swab tests and no symptoms, your likelihood of having had COVID-19 is lower than the average person in your community. But if your community has been hit hard, as most have, there is a good chance that you recently had an asymptomatic infection.
The antibody test result you sent showed a strongly positive result using a very highly specific laboratory assay. Although it is possible this is a false positive test result, I suspect you had a true COVID-19 case so mild that you noticed no symptoms.
You probably have some immunity against another case of COVID-19, but that immunity may wear off quickly. I recommend you get your vaccine as scheduled. It is safe to get the vaccine as long as you have no symptoms. However, people who were treated with a monoclonal antibody for their case of COVID-19 should wait 90 days before getting the vaccine.