Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Bile acid sequestrants such as Cholestyramine (Questran), colestipol
(Colestid), and colesevelam (Welchol) are medications for lowering LDL
cholesterol. Bile acid sequestrants bind bile acids in the intestine and cause
more of the bile acids to be excreted in the stool. This reduces the amount of
bile acids returning to the liver and forces the liver to produce more bile
acids to replace the bile acids lost in the stool. In order to produce more bile
acids, the liver converts more cholesterol into bile acids, which lowers the
level of cholesterol in the blood.
Bile acid sequestrants have modest LDL cholesterol-lowering effects. Low
doses (for example 8 gram/day of Cholestyramine) can lower LDL cholesterol by
10%-15 %. But even high doses (24 gram/day of cholestyramine) can only lower LDL
cholesterol by approximately 25%. Therefore, bile acid sequestrants used alone
are not as effective as statins in lowering LDL cholesterol.
However, bile acid sequestrants are most useful in combining with a statin or
niacin to aggressively lower LDL cholesterol levels. The statin-bile acid
sequestrant combination can lower LDL cholesterol levels by approximately 50%,
lower than a statin alone. A statin-niacin combination can substantially reduce
LDL cholesterol and elevate HDL cholesterol.
What are the side effects of bile acid sequestrants?
Bile acid squestrants are not absorbed into the body and therefore they do
not have systemic side effects (affecting other organs). Therefore, their most
common side effects are gastrointestinal; constipation, abdominal pain,
bloating, vomiting, diarrhea, weight loss, and excessive passage of gas
(flatulence).
Bile acid squestrants can bind to and decrease the absorption (and hence the
effectiveness) of other drugs, such as warfarin (Coumadin), thyroid hormones
(Synthroid, Levoxyl), digoxin (Lanoxin), thiazide diuretics (Hydrodiuril,
Oretic, Dyazide, Maxide), and many others. Therefore, these medications should
be taken 1 hour before or 4-6 hours after the administration of a bile acid
sequestrant.
Bile acid squestrants reduces the absorption of vitamin A, D, E, and K.
Long-term use may thus cause a deficiency of vitamin A, D, E, and K.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include: intermittent claudication, rest pain, numbness in the extremities, and more. Treatment for peripheral artery disease include: lifestyle measures, medication, angioplasty, and surgery.
When a portion of the brain loses blood supply, through a blood clot or embolus, a transient ischemic attack (TIA, mini-stroke) may occur. If the symptoms do not resolve, a stroke most likely has occurred. Symptoms of TIA include: confusion, weakness, lethargy, and loss of function to one side of the body. Risk factors for TIA include vascular disease, smoking, high blood pressure, high cholesterol, and diabetes. Treatment depends upon the severity of the TIA, and whether it resolves.
Heart attacks are the major causes of unexpected, sudden death among men and women. A heart attack is also a significant cause of heart failure. Learn the risk factors for heart attack such as high blood pressure, diabetes, and other heart conditions. Lowering your risk factor, lifestyle changes, and in some cases medication are the most effective way of preventing a heart attack.
A heart attack is a layperson's term for a sudden blockage of a coronary artery. This photo essay inlcudes graphics, pictures, and illustrations of diseased heart tissue and the mechanisms that lead to coronary artery disease, and possible heart attack.
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