Your Local Pharmacy, Your Doctor and Medications-Protect Yourself, Part 1

Many people have to take a great deal of medication. Sometimes they take SO many, they don't realize that these medications could be causing more harm than good. After working both on the Pharmacy side and the Doctor side, I want to tell you some things that you may not know, and some things they may not want you to know! I may get blasted for some of this, but you DO have rights that you may not know you have. When taking medications, especially with the elderly and those too trusting, you may be being overmedicated or suffering needless side effects. I am here to show you how to arm yourself with loads of information. Information is your key to safety when taking both "over the counter" (OTC), and prescribed medications (RX'S).Please read carefully, as I feel this is VERY important. My own mother DIED as a direct result of being over-medicated. Please share this info with anyone you think it could help. I may have to break this up into 2 hubs, or it will be very long, we'll see. Bear with me as this may get technical and a little hard to follow, but it is a true-life example of what can happen! Here goes:

Patient A, is a 55 yr. old female with heart disease, high cholesterol, bipolar disease and anxiety disorder, as well as insomnia. The bipolar disease is the more depressive type, with more periods of depression than the "manic highs" so many think of. She also suffers from lower back pain and muscle spasms in her lower back because of a congenital deformity of a vertebrae in her lower back that has been proven by an MRI. To treat the heart disease, she has been given 2 blood pressure medications, a blood thinner, and had a heart stent installed to cure a clot in a vessel in her heart. She has also been given a cholesterol medication to control high cholesterol, a strong and possibly addictive anti-anxiety medication, Geodon for her depressive state, an opiate based and addictive pain medication on a continuing basis and a possibly addictive muscle relaxer for the muscle spasms, again on a continuing basis, along with a supposedly non-addicting, popular sleep medication that is a sedative-hypnotic. What is wrong with this picture?

First of all, Patient A is going to become addicted to at least one or more of three of the medications, since all three are given in amounts where they can be taken more than once a day, and all three come with refills for 6 months at a time. That is the longest a patient can go without seeing a doctor for a controlled substance, unless it is a Schedule II medication, which can have NO refills and the patient has to go back each month. This is because Schedule II meds are especially addicting, and the doctor has to closely monitor the patient for signs of drug abuse, etc. These are laws the doctor has to abide by, or they will lose their license. Same rule for the other controlled drugs that have to have new RX's written each 6 months. Non controlled drugs can have up to a year's worth of refills. Just FYI if you didn't know.

The second thing wrong with this picture is the Geodon that was prescribed for DEPRESSION. Geodon was originally developed to treat SCHIZOPHRENIA! This is a classic case of "cross utilization of a medication". This is done more often than people realize. Sometimes drugs are used to treat something other than what they were originally developed to treat, and in my experience, it seldom works, and often creates more problems than it solves. I will tell you what happened with Patient A as a result of doing this very thing. First of all, Patient A had absolutely no signs of having schizophrenia. After taking Geodon for a short period of time, Patient A developed a difficulty swallowing and some hand tremors or shaky hands, and her anxiety level increased, plus she started to have some rather "high" periods similar to manic highs. Instead of checking all the different and sometimes rare side effects of the drugs already prescribed to Patient A, the Dr. prescribed Cogentin because he thought it would help with what seemed to be spasms of the Patient's esophagus causing the difficulty swallowing, as well as the hand tremors. Cogentin is used to treat PARKINSON'S DISEASE SYMPTOMS! Patient A had no symptoms or reasons to be treated for Parkinson's Disease other than a difficulty swallowing and her hands were shaky. A little secret the Dr. didn't know about Patient A's lifestyle was that Patient A got pretty tipsy (and then some...) every night on VODKA! Patient A was drinking nightly while taking all of these medications and her doctor had no idea. Now, Patient A was being treated for 2 diseases she didn't have, simply because of side effects from 1 medication she was taking, plus the fact that the doctor didn't know her little secret!

Here is where it gets really scary. A couple of weeks later, Patient A goes to her cardiologist for a check-up. She tells HIM about the difficulty swallowing and HE prescribes Reglan. a drug used to treat heartburn, acid reflux, and other stomach problems. He knows nothing about the other drugs Patient A is taking, and must not know all the side effects Reglan can have in some people. He does know she has "an occasional drink", but not the real truth of the matter. By now, with all of these medications, you have probably lost track of what Patient A is taking, and Patient A has lost track of reality! Patient A is like a walking (barely) zombie! This is NO stretch of the truth. Patient A has become a shell, with the lights barely on, and no one home. She is literally barely functional.

Finally, Patient A calls me. She calls me, because after a few MONTHS of being like this, somehow she finally realizes she isn't quite right. She still has problems swallowing, can't concentrate or focus, and talking to her is difficult at best. She sleeps the majority of the time, night and day, basically only waking to take her meds and eat, when she can choke something down. Patient A knows that I research EVERYTHING about EVERY DRUG I TAKE. I get a list of everything she is taking, and go to work. Two days later, I'm through and have identified the problem. First of all, Patient A is clearly on way too many drugs, and the side effects of some of them caused the original swallowing difficulty and the tremors. I tell her what the Geodon was originally developed for and it's side effects, one of which can lead to difficulty swallowing! It is a rare side effect, but a side effect just the same. Any drug (just about) developed for psychiatric disorders (especially anti-psychotics and those for schizophrenia) also comes with the danger of possible tardive dyskinesia, as well as the Reglan. Cogentin can cause loss of memory and confusion, as well as the tremors it is supposed to treat! I tell Patient A that if it were me, I would talk to my Dr. about changing off the Geodon onto something else. She does this, and within a few weeks, the difficulty swallowing is going away. She also stops the Reglan and Cogentin, and starts coming back to reality. After several months she is quite a bit better, but still not quite as good as before all of this started. To be perfectly honest, some of the side effects, such as tardive dyskinesia can be permanent. This is just one example of medicating the side effects of drugs with more drugs, that cause more side effects, which combined with the other RX's and the drinking involved with Patient A, could lead to possible permanent phisical and neurological problems least of all, and death at the worst from a basic overdose.

To refresh your memory, you might want to look over the original problems this Patient A had. They were actually easy to treat, but between going between 2 doctors, and being prescribed drugs that the patient didn't inform herself about, it led to all the problems I described. A true, and sad thing that happens all too often. Now-How do you protect yourself from this happening to you or someone you love? I'll tell you how.

 When you go to your doctor, make sure to be very clear about all of your symptoms. Also be HONEST about your lifestyle, and if you have more than one Dr. each of them needs to know ALL THE MEDICATIONS YOU ARE TAKING. Gather up all of your prescription bottles and take them with you if you need to. The Dr. is not there to judge you and can't read your mind, so be honest about things like drinking, smoking and any drug use. Your life depends on it. When the Dr. writes you a prescription, ask them to go over any side effects it may have. Here is a little secret though-The Dr. doesn't KNOW ALL OF THE SIDE EFFECTS THAT MEDICATION MAY HAVE! He/she may know the most common ones, but there are many more that they don't know about. They are human and can only do so much. You also have a responsibility to yourself to educate yourself. Have the Dr. go over the RX they have written, pronouncing the name, going over the directions, the quantity and how long you are supposed to take the drug. This is especially important if you are getting a new medication. Most of the time, you are not going to be able to read the prescription the Dr. has written, so make sure you understand before you leave the office and go to the pharmacy.

One thing you should know. Doctors get visits from representatives of Pharmaceutical companies all the time. The "drug reps" as they are known, are peddling whatever the new drug du jour is for their respective company. They do this and talk with the doctor about all the wonders of this new drug, so the doctor will write prescriptions for these drugs and therefore their company will make more money, resulting in commissions for these drug reps. Each drug rep leaves a bunch of free samples with each doctor, and often the doctor will give these out to their patients for free, so they don't have to go to the pharmacy. When peddling their respective drugs, these drug reps are the ones primarily responsible for telling the dr. about the side effects of the drug, so therefore, it is to their advantage to make the drug sound as wonderful as possible. This is why a really busy dr. may not know all the real side effects of the drugs. They may be putting too much faith in the word of the drug reps, may be too busy to research the drug in depth themselves, and really, it is the pharmacist that you need to talk to about all the side effects anyway, as well as educate yourself when you get home. I will write more about the pharmacies role in your health in the next hub, as this one is getting way too long.

Read part two of this about how to really be educated at the pharmacy and at home in Part two. If you have any questions or comments, I would love to hear them!