Danger: Rx Side Effects

The earnest young doctor had all the best intentions. "Your blood pressure is still a little high," he said. "I would like to increase the dosage of your medication."

I nodded meekly, loathe to mention that I have pronounced "white coat syndrome" and my blood pressure always escalates during a medical visit.

It was only when I picked up my new prescription and saw that the dosage had been doubled that alarm bells rang and I rebelled with a phone call to the doctor and a plan: to see, at long last, if lifestyle changes could preclude the necessity of more -- or maybe even of any -- medication.

Doctors and patients alike today have become increasingly reliant on an array of medications for a myriad of conditions and ailments of late middle age.  So many of these are lifestyle related and may be resolved, fully or in part, by changing our lives in lieu of popping a pill.

But saying "Wait!" or "No!" or "Why?" can be hard.

I remember another time when I should have questioned a doctor's decision -- but didn't.

My regular physician was on maternity leave and I went to the doctor filling in for her for a flu shot that fall. He took my blood pressure and shook his head. "Your blood pressure is a little high," he said. "I'm going to change your medication to something different and see if that will make a difference."

I nodded meekly, filled the prescription and continued on with my busy life.

I began to feel increasingly fatigued. But fatigue was my middle name in the fall of 2002.  I was working several jobs, including one 60 hour a week marathon at a chain of psychiatric clinics spread over greater Los Angeles. I drove the freeways at all hours, commuting from one clinic to another, seeing dozens of patients a week. I was also working a part-time regional admissions job for Northwestern University, attending college fairs in California, Arizona and Nevada many evenings and weekends. And I was writing a book on a tight deadline.

The first clue that something might be amiss was the reaction of my admissions office colleagues at Northwestern when I visited the office near Chicago for a series of meetings in late October.  Carol Lunkenheimer, then Dean of Admission, looked closely at me as we talked and laughed over lunch. "Are you okay, Kathy?" she asked quietly, reaching across the table to put her hand on mine. "You're white as a sheet. You look like you're about to faint." I was stunned and promised Carol I would check with my doctor when I got home the next day.

When I called him, he said "You've only been on verapramil for three weeks. Give it another week."

"Oh," I said. "I really don't feel well. Are you sure?"

He was sure.

The next night, after getting up to use the bathroom, I collapsed in the hallway.  "It's nothing," I told my thoroughly alarmed husband. "I'm just tired and half-asleep, that's all."

Two days later, I was driving on a surface road from my home to the local bank. I felt fine. No trace of unusual fatigue or dizziness.  I watched the traffic on the other side of the divided road starting to back up and decided I would take another route home.  It was my last conscious moment before the crash.

I came to about half a mile down the road. I was hanging from my seatbelt, lying over into the passenger seat. The hood of my beloved blue Honda Civic was crumbled and reaching skyward. A young man and woman had opened the driver's door and were hovering over me: "Are you all right? Can you hear us?" they cried.

Gradually, as consciousness returned, I was able to fill in the blanks: I had driven nearly half a mile unconscious, finally crashing into the young couple's SUV -- barely dented -- at a stoplight.  No one was hurt.  My car was totaled. And my life changed immensely -- both short-term and long-term.

Short-term, though I knew immediately that I had passed out as a side effect of the blood pressure medication, the doctor insisted on administering a battery of tests -- from a full spectrum of cardiac studies to a sleep study -- before determining the cause of my loss of consciousness.  In the meantime, my drivers' license was suspended for five months, making commuting to my various job posts a nightmare of buses and trains and my dear husband's generous help.

And when the cause was found to be due to the blood pressure medication, my insurance company increased my auto insurance rate from $620 annually to $2895 annually for three years due to my license suspension. (Many insurance companies don't make a distinction between a prescription drug mishap and an illegal drug related accident -- and perhaps they're correct: the results of both can be deadly.)

Long-term, the incident has helped to change my way of thinking about prescription medications and about choices. Thinking back, I feel I was as culpable as that careless doctor: I didn't question him. I didn't listen to my own body. I didn't trust my own sense -- and the observations of those close to me -- that something was terribly wrong.

Unfortunately, that's too typical.

In an article in this month's AARP Bulletin, experts are quoted estimating that tens of millions of people in this country are suffering every day from unrecognized prescription drug side effects. And Gordon Schiff, M.D. of Harvard Medical School states that "There are a lot of people taking drugs to treat the side effects of drugs."

It can become a health-destroying spiral.

So what can we do?

We can ask questions like "Why are you prescribing this? What are the side effects? How will this drug interact with other medications I am taking? Are there alternatives to medication?

We need to know side effects -- paying attention to those info sheets from the pharmacy and being alert for symptoms.

We need to pay attention to our own bodies, to the subtle and not so subtle signs that something isn't right, that something, in fact, may be very wrong. Doctors are experts on medicine, but we're the experts on how we feel.

Last, but certainly not least, we need to make lifestyle changes in lieu of popping too many pills: taking drastic measures to cut carbs and sugar and step up our exercise and lose excess weight when the doctor says we are pre-diabetic instead of relying on medication to lower our blood sugar levels. We need to get serious about stress management, weight control, diet and exercise if high blood pressure is a problem.

Our efforts may not totally preclude the use of prescription drugs, but working in collaboration with our doctors and taking an active role in our own health care simply makes sense.