Saturday, September 10, 2011

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.

17 comments:

  1. Your posting today is going to help all your readers.

    It is so important that we become our own advocates. Only in the past few years have I learned to question doctors when they prescribe medications or operations or procedures. And always this is hard because they have always been such authority figures in my life.

    But as you said, we know our own bodies. We know how they feel on any given day. And if we don't know, then we must become friends with our body and learn from it.

    Having spent several years in the convent where being ill was seldom noticed and having been told always to distract myself when I had asthma attacks, I never was a friend to my body until my first acute rotational vertigo episode of Meniere's Disease. Only then did I begin paying attention to what my body was telling me each day.

    Thank you so much for your advice to all of us to ask questions about side effects and the medication we are advised to take. I'm going to remember this when I see the doctor next week.

    Peace,

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  2. Wow!!! I am thankful you weren't killed in that wreck. I say a hearty AMEN to what you say about our own responsibilities for our health and in regards to what doctors tell us.

    I've lost about 170 lbs., well more than I weigh now, and my doctor still had me on the same dosage I was on before I lost weight. I finally passed out one day in church, and like you, had to go through all the cardiac studies, etc., although I knew it was my bp meds.

    I keep an eye on my parents and my inlaws and the meds they take for that very reason, so that they are not getting too much or the wrong thing.

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  3. So important! Yes, ask questions, make life changes, continue to be active in decision making.
    Hubby and I are beginning to visit doctors together,becoming each other's advocate and list makers.

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  4. Excellent! This blog post should be required reading for everyone!

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  5. Very good advice. I'm going to have a heart to heart with my doctor next week when I see him.
    Jann

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  6. I'm sorry to say this, but doctors are not always experts on the medicines they prescribe. They rely on the salesmen to inform them. They don't inform themselves on medicines they prescibe. Buying the latest "Pill Book" that tells all side effects and drug interactions is a must before accepting what any doctor prescribes. I worked for a big medical conglomerate. I know first hand from my job that doctors get perks to prescribe. I'd get calls from some of them making sure I got their list each month of prescriptions they wrote. They wanted those trips to Hawaii and Mercedes. Sorry, that's the fact. All medical providers aren't made the same. Some are good people and some are well, more interested in what they get out of people than curing them. I call it farming patients.

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  7. Excellent post and timely. I have had several friends hospitalized as a result of being over prescribed.
    That was awful what happened to you and I know you are not alone. I am really lucky in that I take no regular drugs but that could change with my next breath.
    It is hard to do but you are so right. We need to question. I will try to remember that when the time comes. Thank you.
    Arkansas Patti

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  8. Well said. I so agree with you. We must question our doctors and become our own advocates. I was once put on verapramil for an irregular heart and for a racing heart. When I couldn't even walk across campus from my car to my office, I made an appointment with a new doctor. The first thing he did was take me off that medicine.

    I am not one to go for medicines if I can change my life style. I don't like the side effects from meds, and it seems if there is a side effect, I get it.

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  9. Yep. I coughed for nearly two years before a technician at a blood drive asked me if I was taking lisinopril for my blood pressure. After talking to my doc, I weaned off and then experimented with alternatives. Wonderful not to have that cough!

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  10. I am so glad you are ok but today one has to remember pharmaceutical companies push their products on doctors to sell.
    We trust they want what is best for us but instead it pays for them to keep you needy and buying.
    The doctor should have stopped the medication.

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  11. You are so right! We need to make life style changes and stop taking so many pills. But it takes a while to realize this (at least for me). And we need to ask more questions. Doctors are not "holy" and we CAN question their prescriptions for us!
    I´m glad you were ok after the crash!

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  12. Thanks so much to all of your for your kind and insightful comments! Barbara and Lady's Life, you are so right! There are way too many incentives for doctors to over-prescribe and we need to be our own best advocates. Sally, I'm interested and horrified that you had a similar experience with verapramil! And Shelly, OMG! 170 pounds?? You're a true inspiration!

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  13. Brilliant post - you have made us so much more aware. My husband and I both had a cholesterol number of 8, not responsive to diets, so we reluctantly went onto pills (after ten years of resistance). I tried to tell the doc that 8 is simply my number and I was fine with it - the women in my family have all lived to their nineties - but I submitted because the 'current thinking' is so adamant about one's cholesterol count. I still think it is this decade's obsession and the word in ten year's time will be "We used to think...."

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  14. I have "white coat syndrome". I often pass out when I get my blood drawn or sometimes even when getting a simple blood pressure test. It's very embarrassing, seeing as how I'm 64 years old!

    God bless and have a great week :-)

    ~Ron

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  15. This is an extremely important post, Kathy, and I hope others will take it to heart. I have many prescriptions, but my doctor knows that 1) I don't like to take any more than possible and 2) that I am responsible and will indeed take the meds that help. He listens to me. I've never had a problem, but I know if I did, he'd be all over it in a New York minute. That's great comfort to feel that comfortable with your physician. Of course, there was a time when I wouldn't have had the nerve! That was then, this is now.

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  16. Excellent reminder post. I am glad you are OK and were not seriously hurt in your crash. How horrible! Take care Dr. Kathy!

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  17. An important post, Kathy. Despite a somewhat chequered health history, I have steadfastly resisted going on blood pressure medication, preferring instead to try to lower my borderline high blood pressure by losing weight. It took time and determination, but over almost 2 years I managed to lose 30lbs and my blood pressure dropped within safe limits. My GP has not yet mentioned statins to me, probably because he knows what my reaction would be :-)

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