Doctor, Does This Drug Have Any Side Effects?

Standard

cartoon-doctor

Hello again. It’s Dr. Louella, just winding up my weekend here. I’m a bit tired but still very much excited that I got some time to do this post.

You see, yesterday I was musing on a young patient I had seen earlier this week. He had asked me one of the most frequent questions I get from patients.

But let me give you the context of this case first. It was another busy chronic disease clinic. The ‘patient care attendant’ told me about a walk-in patient to be seen who had chest pain.

I asked for his age. He was 22 years old. Cool. I ordered an ECG ( EKG, electrocardiograph; or ‘heart tracing’) and said that I would see him later.

A few patients later they brought a perfect ECG for me in ‘normal sinus rhythm’ with no abnormalities. Good. No serious heart problem. I saw him a few patients after that.

Normal-Master

He was a healthy looking young male. It was easy to make the diagnosis. He told me he had central chest pain. I asked him why (because most of the times patient already know the cause). He confessed to having lifted some heavy boxes of meat the day before.

I did a brief examination of the heart, lungs and chest wall. He had a muscular strain. Case closed.

But not quite. When I attempted to prescribe an analgaesic (pain killer) for him I was confronted with the oh too familiar question…

“Does this drug have any side effects, doc?”

I think this is where public education should step in because I am asked this question repeatedly nowadays. People need to understand these simple concepts so they can make informed choices.

I start by replying, ‘Of course. All tablets have side effects.  If you look in my book right here (the British National Formulary on my desk), each drug has a long list of side effects.

And there is no way for anyone to remember all of them. That’s why I walk with my book. Doctors usually know the most common and/or most serious effects.

BNF 2009

I like to refer to them as potential or possible side effects because it does not mean that you are going to get them.

Research is done so they know how many people suffer with each side effect of a drug and it is usually a very small number, like 5% or 0.5%. If many people are affected they wouldn’t allow the drug to be sold.

Now for the most, you may get one side effect of a drug. Or if you are really ‘bad lucky’ (Trinidadian for ‘unfortunate’) you may get two.

No one can predict whether you will get a side effect. It is only if  you use the drug you will know the effect. If something happens we  will deal with it. But we would not want to lose the benefit of this drug for no reason.’

Now there are some conditions where I can tell patients that using a medication is optional, such as for pain, itch or stomach discomfort but for diseases such as diabetes and hypertension which can ravage their lives, I urge them to take their pills everyday.

Many of our patients have heard from friends and family that these medication damage their kidneys and liver. They often do not take them as a result, or take them intermittently to mitigate these supposed effects.

Liver and kidneys

I stress to them that chronic diseases (especially diabetes and hypertension)  are the ones that have been proven to damage their organs. The pills are given to them to protect them.

Yes, sometimes the pills themselves can damage organs but this is rare compared to diabetes and hypertension which ALWAYS impair kidneys, whether to a minor or great extent.

People get complications and die of chronic diseases all the time. I don’t really hear of people dying from their medication. But I know it probably happens.

Our patients are also exposed to television advertisements where side effects of drugs are rattled off. But without the explanation I gave above we can see this turning people further away from conventional medicine if they believe that all these negative effects would happen to them.

The young man I saw that day accepted my prescription in the end. He understood that the likelihood of him getting a side effect of the drug was slim and we would deal with that if and when it occurs.

I also explained to him that although he was young and fit there was no reason to strain his body beyond its capacity as he had done recently because he would suffer for it. Damaged muscles often take several months to heal.

chest-muscle-strain

Unlike the young man, some patients turn to alternative medicines. They are free to do so but I let them know my position on it.

I let them know that the medicines we use originally came from plants but they have been purified and from them synthetic ones were made.

All our drugs are extensively researched and the effects documented. Yet allopathic medicine is still far from perfect.

Many herbal products are not purified and contain several chemical compounds with varying effects. There is very little in the way of formal study of these chemicals.

Claims are based on anecdotal accounts (of people’s personal experiences) rather than on large controlled studies. Anyone can sell anything and claim anything about them because there is no regulation of these products. But not everything ‘natural’ is safe.

Alternative-Medicine-of-Pros-and-Cons

But the thing is, it’s not that herbal products don’t have side effects. It’s just that the people distributing them don’t know, so everyone pretends like they don’t. And when people experience them, does anyone sue the herbalist? No! But sue your doctor, because he is rich!

Never mind that, if you see Dr. Louella dying, bring me the tablet, bring me the ‘erb, the weed, bring anything!!!

But while I’m living and can make a rationale choice, bring me the evidence to support your medicine!

Dr. Louella saying, do enjoy your day! Laugh! Sing! Dance! … I do!!!

1098096_10151778645293588_2106210918_n

But No One Told me I am Diabetic, Doc!

Standard

Hi. It’s Dr. Louella in a sombre mood today. I keep thinking about this patient I had today in chronic disease clinic; a young guy in his thirties.

No drama here. I started off with my usual verification of what the patient suffers with. I’ve been doing that a while now, since discovering that patients attend our clinics for years with only a vague idea of what they’re being treated for.

I don’t know if it’s a Trinidadian thing with the responses I receive but I’ve asked this question so many times that I’m no longer surprised…

hospital

‘What are you suffering with sir/madame?’

Some patients get offended. They start to stammer that I am the doctor and therefore I should know. So I let them know it’s a big file (we use handwritten patient notes) and we would move a lot faster if they tell me rather than me having to go through all these notes.

Furthermore I remind them that they are the patient. It is their health and their responsibility to know what they are afflicted with.

‘So, would you like to tell me, sir/madame, what are you suffering with?’

There are other patients who begin everything with ‘they say’. For example that, ‘They say I have diabetes’. When I try to confirm that they mean that they have been diagnosed with diabetes, they respond consistently, ‘So they say’. So in my estimation, they are in huge denial!

Sometimes I would make a check in the notes only to find that they have had this said to them for five years or more. I let them know that ‘they’ say it only because it is true and it’s very important they learn to accept it and deal with it.

Then there are those patients who try to respond correctly but leave out diagnoses. When I check the notes there may be an additional diagnosis such as ischaemic heart disease or chronic kidney disease that they are clueless about and which they sometimes deny vehemently.

So then I need to backtrack to find out where that came from, if they were diagnosed at hospital or presumed to have the disorder or what. I need to know if a diagnosis is true or not to convey this to the patient sitting in front of me.

Stapel

Finally there are patients who give additional diagnoses to what are documented. Something may have happened since the last visit or more likely they had been suffering with some disorder and didn’t think it necessary to inform us.

Our patients attend several different doctors, clinics and institutions simultaneously. Very little official information is shared between these groups.

It is often up to the patient to let us know what is going on. To some of them it is a secret. Others forget or don’t think it relevant. Me, I grab up this stuff, because I want to know everything.

I use the diagnosis as a starting point to inform and educate the patient. It’s not that you maybe sometimes could probably have hypertension. You HAVE it and you need to deal with it. It’s not about a bunch of numbers but really debilitating complications that you could get but we are trying to prevent.

Getting back to the case at hand… When I had my usual discussion with this young man about his diagnoses today, I was a bit thrown. He knew he was overweight and had elevated cholesterol but knew nothing about having had diabetes.

But it was staring at me in his notes! He was newly diagnosed as a diabetic on the previous visit. Apparently he had not been told. Oops! That was a problem. And he seemed intelligent enough that he would have remembered.

CR112K13-LT-AccuChek-Aviva

I proceeded to take the time to double check his blood investigations. Those results pointed to pre-diabetes, which as I explained to him, was in between ‘normal’ and ‘diabetic’. He was becoming diabetic. Steps had to be taken to try to prevent, or at least delay, full blown diabetes.

(The term ‘Impaired Glucose Tolerance’ is an older term that was and is still used for this condition. I much prefer the simpler ‘pre-diabetes’ when dealing with patients as ‘pre-‘ indicates ‘before’.)

While advising the patient about his condition, I needed to reassure him as well. He had been started on the appropriate medication (metformin). I actually increased his meds for now because his glucose level was high.

I advised him strongly about weight loss, that that in itself may reverse his condition and referred him to the dietitian (they make our life so much easier).

I spoke a lot about exercise because I know that if you’re not into it, it could take you a while to get started. I wanted to get him thinking that this thing was doable.

I threw out different ideas of different types of exercise he could attempt and explained how the day-to-day routine he described was physical activity but not intense enough to be classed as exercise. And he had the size to show for it.

A_Black_and_White_Cartoon_Overweight_Man_Jogging_Royalty_Free_Clipart_Picture_110117-172043-033053

In the end he was really grateful for the information. But of course, other patients were waiting.

I really feel passionate about helping younger patients prevent and manage chronic diseases. That’s why I spend extra time with them.

It is often more difficult for them to come to terms with their illnesses than older adults. They want to enjoy their youth and do not want to be saddled with strict diets and medication.

I let them see that I take their health seriously and they should too. But I also try to inspire hope within them because without it they wouldn’t even try.

I will continue to ask patients the question ‘What are you suffering with’ or seek verification from the patient as to his/her diagnoses because it is important. It is only when people properly understand what is going on with them can they make informed decisions and live healthier lives.

I feel better now that I’ve shared that. I’d like to think I am making a difference in this world, one dot at a time. Dr. Louella is out!!!

1098096_10151778645293588_2106210918_n