Saturday, July 21, 2012

I'm Not a Doctor, but SOMEBODY Has to Read the PDR

There are two courses I've taken at some point in my schooling that I use almost every day. Typing is one. I took my first typing course on an old fashioned Royal [see picture] in 7th grade, when I was writing for our school newspaper. 

            In high school I graduated to a fancy electric typewriter and took a whole year of stress-filled speed tests from the flamboyant Mr. Brown, who was also partial to wearing brown suits, as he instilled a fear of failure in all his students. I thank him every day for the terror he elicited from each of us, because nobody has ever typed faster or more accurately than his frightened students. From high school essays to college term papers to print ads and radio/tv commercials to videos to facebook and my blogs, I've been typing something every day at 80 wpm for more than fifty years. 
           The other course I use daily is microbiology. Learning how microscopic bugs can mess with your body meant that I would be able to understand what drugs doctors were prescribing for me and my family. And why. I could also ask the docs questions and understand the answers better than most.  
           Taking micro also meant that I could understand a big chunk of the tiny print in those inserts that come with your prescriptions. The ones you never read. The inserts are also published in the Physicians Desk Reference or PDR [also], which, unfortunately, many docs don't bother to read either, often getting their cursory information from the pharmaceutical reps. 
           The first time I challenged a doctor was when our pediatrician prescribed erythromycin for a confirmed strep throat. I had a girlfriend who was prescribed the same drug for strep throat and she was fighting rheumatoid arthritis within three weeks. Erythromycin is the drug of choice for Legionnaire's disease, but it is arguably not efficacious for strep. 
          Standing at the desk in a waiting room full of people, I practically shouted, "Why are you prescribing an ineffective broad spectrum antibiotic when we know it's strep?" He wrote a prescription for amoxycillin. The receptionist was bug-eyed. 
           A decade later, a urologist became concerned that my creatinine levels were high. He had been consulted when nobody could figure out how to control my blood pressure. Creatinine [not to be confused with creatine] measures how well your kidneys are doing their job, i.e., removing waste products from your body. Basically, if your creatinine gets too high, you're dead. 
          1.0 is usually considered the max for a healthy person. Mine was 2.3. I told the consulting doc, a professor of medicine at NU by the way, that the drug I was on produced elevated creatinine levels. It was a side effect. He had no clue. I told him he could read it in the PDR. Instead he took me off the medication and ordered a 24-hour test to confirm what I had said. 
          Off the meds, my kidneys were functioning normally. 
          When a medication caused acute pain after I ate, I knew from reading the PDR it was pancreatitis, one of its unpleasant side effects, and stopped taking it. This knowledge came in handy years later, when my father was hospitalized for acute pain after eating. But his doctors couldn't find anything after a hospital stay for multiple tests and sent him home. My stepmother was beside herself and called me. I asked what medications he was on and realized he was on one [like mine] that TA-DA! caused pancreatitis. And the problem was solved. The irony in all this is that my dad was a doctor.
          At one point, my OB-GYN prescribed a diuretic for me. I told him I would let him know whether I would take it AFTER I read the PDR. When a drug exhibits some dangerous side effects, like say, cancer or death, the PDR adds a black box warning above the information -- so there's no need to read any further. That diuretic was dangerous enough that there was a black box warning about kidney cancer. So no, I didn't take it. But you might have.
           At 1:00 AM on a Saturday night/Sunday morning, I was taken by ambulance to the emergency room with acute gastric distress. At 4:00 AM I started passing blood and they admitted me. I had all the hallmarks of hemorrhagic salmonella food poisoning. Like the people I shared salsa with the night before. But they just didn't get it as bad as I did. 
          However, the lab was closed until Monday. So it would be more than thirty hours before the specimen was examined. Unfortunately, you have to test for salmonella within 24 hours. I knew this from microbiology. According to the hospital I was negative for food poisoning, despite my protestations to the contrary. So they started considering diverticulitis and inflammatory bowel disease, neither of which I've had before or since. After recovering, I wrote to the president of the hospital [who else?] to point out the lab's error. I got a letter back confirming that the lab should have checked the specimen sooner. [I don't know how, since they weren't open.] Wish I still had that letter.  
           A friend's mother was medicated with an anti-depressant. I was visiting and noticed that her hands were palsied. And she sat around like a zombie. Her children chalked it up to the series of strokes she had suffered. I read the PDR. She was WAAAAY overmedicated. They changed her medication.
          I sprained my ankle playing tennis. The orthopod prescribed NSAIDs for the swelling. I said NSAIDs were contraindicated with the medication I was on. He challenged me, saying he had been prescribing NSAIDs with that medication for 20 years. I said there was a warning in the PDR. He said, "What year PDR were you reading?" 
          [Haaaa. I thought that comment was pretty funny. In my experience, except for adding a black box warning, I've not noticed ANY changes -- ever -- in PDR drug information from year to year. Except to add more drugs.] So I looked up the NSAID contraindication reference in the latest PDR and faxed it to him. He charged me $45 for the office visit. I charged him $45 for my research.
          After my hip surgery, the drug protocol included a medication that made me dizzy, so I didn't take it after the second day. It also gave me a mouth full of cold sores, messed up my critical thinking, and kicked in an arrhythmia. But no one thought those additional problems were related to the drug. Until I read the PDR. They were listed under "rare side effects." Lucky me. I made sure I didn't get that drug after my next hip surgery. Voila. Not a single problem. 
          Turns out that one of the drugs I take for blood pressure causes TYPE II diabetes in 50% of the people who take it. But this is anecdotal. It's not in the PDR. 
          Nobody in my family has ever had or been at risk for diabetes. I did have one aunt who should have had it -- she was 5'4" and weighed over 250 pounds, but she never got it. Meanwhile my internist was telling me that my lab tests said I was on the cusp of being pre-diabetic. WTF. It didn't make sense. So my first thought was my medication. One google search and there it was ALL OVER THE PLACE -- the entire class of drugs, i.e., every single one, not just mine, caused 50% of users to acquire TYPE II diabetes. Naturally, my doc didn't have a clue about this. And since it was on the internet, and not in JAMA, it couldn't be true.
          The other drug I take elevates uric acid. For someone who doesn't drink or smoke, and lives on fish and chicken, I'm this close to having gout, a side effect. Good times.
          I had an infected tooth over a long holiday weekend, so I was sent to the ER for antibiotics. They prescribed Penicillin V, which is notable because it's old school penicillin for gram positive bugs only, but it supposedly gets absorbed very well. However, I challenged a doc in the ER with why they didn't prescribe a broad spectrum antibiotic, like Augmentin [for gram positive/negative bugs and a big virus or two], especially since I had joint implants. She said that the penicillin I was on was capable of killing some of the same anaerobic bugs that a broad spectrum antibiotic would take care of. As soon as I left, I checked the PDR. Penicillin G can get some of the anaerobes. But not Pencillin V. So she was bull shooting me. After ten days, when the Penicillin V didn't work, my internist switched me to Augmentin, without me saying anything. Really. I never said a word.
          Which brings me to the latest drug I won't be taking. I went to a specialist about having a procedure that would get me off the drug that makes me susceptible to TYPE II diabetes. Except I'm not really far enough along to warrant the procedure. So the doc's nurse practitioner emailed me and suggested I try a new medication. Where should she send the prescription? I said I'd let them know after I read about the drug. 
          I didn't even get to the PDR. One google search and I found a warning from the FDA and three articles written by doctors, assuring me that if this drug isn't fatal, it's can mess with my liver or cause chronic heart failure. I emailed the nurse practitioner to say that there were two chances of me ever taking this drug -- slim and none.
          Needless to say, that doctor wants to have a chat.        


Jon said...

No doubt about it - - you're a doctor's worst nightmare. Few mortals would dare to question their divine authority or fail to obey their omnipotence.
Bravo! (or Brava) for having the guts (and intelligence) to stand up to them.
My grandmother often said that graveyards are filled with doctor's mistakes.

As for Royal typewriters - - I really miss those days. I learned to type in the 8th grade. Me and a black guy named Kenny were the fastest typists in the class.

(the teacher, Miss Harlow, is probably deceased by now).

Marathon Financial Group, Inc. said...

Goll-y you've been in a mess of medical situations!

Besides my own typing class and psychology (the two classes that taught me stuff I use every day)I may have learned the most EVER from your blog. Thanks for sharing.

And being devilishly funny about it.

bbegin said...

Judy, that's such common sense! And terrifying how few people, including doctors, don't have it.
Thanks for elucidating us!