April 23, 2012

My Game Plan for Managing All the Pillls

In my last post, I wrote about the over-medication of seniors. Today, I'll take a look into my own medicine cabinet and then describe some of the things I've done to manage this pharmacy. Here's what I'm taking:
  • Like most everyone I know, I've been taking prescription medication for years to regulate my blood pressure and cholesterol. Controlling the cholesterol has been easy. I started with Lipitor, and it has kept my cholesterol in a good range. I switched to the generic this year when it became available. Regulating the blood pressure also was easy until I developed a chronic cough with a med that had been doing the job. My internist then had me try several different meds that either didn't bring down the numbers, or caused side effects. We recently found one - Tribenzor - that brought the numbers down nicely, but I began to experience some nausea and general malaise. 
  • Insomnia has always been a recurring problem, particularly when I travel (which I do a lot). Vodka was my sedative of choice until I stopped drinking 34 years ago. Since then, I'd often resort to Tylenol PM, and -- when that didn't work -- I'd try Ambien. In 2006, I went through what I dubbed  "The Summer from Hell" -- several months of insomnia, depression, and panic attacks unlike anything I'd ever experienced. I'm now convinced the problem was triggered by abuse of Tylenol PM and Ambien during and after one of my trips to Asia.
  • My diagnosis with Parkinson's Disease in 2009 brought a new array of meds. For the PD itself, I was prescribed Sinemet (the brand name for the "Gold Standard" PD med combining carbidopa and levodopa). The prescription was the regular dosage (25mg carbidopa, 100mg levodopa) three times a day, plus the "extended release" double dose at bedtime to carry me through the night. I later switched to the generic carbidopa/levodopa. This prescription is almost always accompanied with a prescription for the exorbitantly priced Azilect. 
  • Depression usually accompanies PD, and my case was no exception. Initially, I was prescribed the antidepressant Elavil. It helped with my mood and sleep, but it also caused weight gain and morning fogginess. Because there were also warnings of possible cognitive side effects, I switched  to the over-the-counter 5-HTP, a serotonin booster.
  • Last but not least is the lower back pain -- the most disabling of all these ailments. Initially, it was attributed to a fractured vertebra after my car crash last August. The vertebra has healed, but the back pain remains. The continuing discomfort is now attributed to rheumatoid arthritis. I've been treated at Sibley Hospital's pain management clinic, but we haven't found anything to alleviate the pain. Then I discovered curcumin (and consulted "the best physical therapist in the world").
  • Oops! I almost forgot an added starter. I had my annual eye exam a few weeks ago and the eye doctor found early warning signs of macular degeneration. He advised taking an over-the-counter supplement with a particular combination of vitamins and minerals that has been found to ward off this condition, but only in 19% of those in danger. Researchers, while capable of such specificity in citing that percentage, still don't have a clue as to what determines who falls into the 19% or the 81%. So my guy said, since there aren't any known serious side effects, I might as well take the supplement on the chance I'm a 19 percenter. Several brands of the supplement are  available; I chose Ocuvite.
Here are some of the things that have helped me manage all these pills:

Less Is More -- More Well-Being at Less Cost
I've long suspected that the standard dosage prescribed by doctors for many medications is greater than what's needed for many of us elderly. I've seen some research that substantiates my suspicion.

Also, the more prescribed medicines and over-the-counter supplements one takes, the greater the danger of adverse interaction. So I try for the lowest effective dosage of anything I take... and for as few drugs and supplements as possible. 

Here are a few examples of ways this strategy has paid off:
  • Azilect, the medication usually prescribed along with carbidopa/levodopa for Parkinson's, is my most expensive drug by far. A 90-day supply costs nearly $1,000. Initially most of the cost is covered by Medicare and my secondary insurance, but the nearly $2000 paid for 180 days takes me two-thirds of the way to Medicare's "donut hole," when it stops reimbursing for drug costs. This year, I'll fall into the donut hole when my payments for drugs reach $2930. My Azilect prescription from the outset was for 1mg. But when I researched Azilect, I noticed that the standard prescription is either 0.5 or 1mg.  So I asked my neurologist if it would be OK if I split the 1mg pill and took only half each day. He said OK. Now my $1000 Azilect prescription will last for 180 days instead of 90. Less is more!
  • As noted above, my GP and I have been trying to find a drug that will keep my blood pressure down but not cause a chronic cost or other side effect. We thought we'd found a winner in Tribenzor which was very effective right from the start in bringing the blood pressure down. Unfortunately, I soon began to feel nauseous after taking it, but I was reluctant to give up on something that finally was working. So I've tried cutting the pill in half. I check my blood pressure at least daily with a home monitor and the half dose works most of the time. When I get a couple of consecutive readings above 140 (the top, systolic number), I take the full pill for a day or two. The adverse side effects have gone away, the blood pressure readings are good, and -- once again -- I've cut the cost of an expensive prescription drug.
I Try To Take an Active Role in Medication Decisions
Each of us has a unique response to diseases and ailments, and our reactions to drugs and supplements are similarly unique. Health care providers try to take into account what they know about us as individuals, but their choice of treatment options necessarily is based largely on what's been found to work for most patients. So it's not a "given" that what my doctors prescribe for me will fit my one-of-a-kind make-up. 

As I've described before, when I had problems with the old-line antidepressant Elavil that was prescribed for my Parkinson's-related depression, I decided to experiment with the over-the-counter serotonin booster 5-HTP, which I had tried with some success in dealing with an earlier depression. I was careful to review this shift with my neurologist. He not only OK'd this plan but began suggesting that some of his newly-diagnosed patients with Parkinson's also give it a try.

Self-Medicating Requires Self-Monitoring and Self-Discipline
Sticking with my 5-HTP experiment as an example, I started with the minimum dosage available -- 50mg. It boosted my mood, helped me sleep, alleviated my constipation, and resulted in my losing 10 pounds. I was delighted with the results. So, with my inherent belief that anything worth doing is worth overdoing, I soon was taking a mid-morning pill in addition to my bedtime 5-HTP. Sometimes I'd pop a 100mg pill at bedtime.

Soon I was waking up early in the morning with a burst of what seemed to me were highly creative new ideas. My pre-dawns were lit up like a July 4th fireworks display! And I enjoyed some euphoric mornings. But then early one afternoon I nearly passed out and, checking my blood pressure, found it something like 210/95. I called the rescue squad and was taken to the nearby Sibley Hospital emergency room, where I was checked out and discharged after a couple of hours when the blood pressure readings came down and no cause for the pressure spike was found.

It took a similar incident a few weeks later for me to realize that these blood pressure spikes were directly related to the overuse of 5-HTP. I had read about "serotonin syndrome" -- a euphemism for serotonin OD, so I decided to give up on the 5-HTP.

But later when my mood began to darken and my sleep became more erratic, I decided to experiment with returning to 5-HTP... but by taking the 50mg pill (the lowest dose available) and splitting it so that I was taking only 25mg at bedtime. I carefully monitored my blood pressure at the time and have continued to do so. This minimal dose of 5-HTP doesn't appear to affect the blood pressure.

Why not just abandon the 5-HTP? I rationalize that if I did that, sooner or later I'd be asking for a prescription for an antidepressant. I figure I'm safer with the known pros and cons of 5-HTP than trying a prescribed antidepressant. I'm sure you've listened to the TV commercials for antidepressants that are followed by the lengthy FDA-required list of possible side effects.No pill is risk-free.

What Works for Me Will Not Necessarily Work for You
This also is a lesson learned from my experience with 5-HTP. Based on my own experience with and research into the tie-in between serotonin and Parkinson's, I thought I'd found THE answer to Parkinson's-related depression. One reason I started this blog was to sound the trumpets for this magical potion.

I began touting it to many of my friends, particularly those with Parkinson's. Several tried it, but nobody had the positive experience I did. Not one.

Bottom Line (for Me) on Managing Medications
Whether it's a prescribed medication or an OTC supplement, I need to monitor closely and carefully how my body is reacting. Given my ever-retreating memory, I'm sending myself a nightly email reviewing the health-related highlights of the day.

Less is more, so always try to take the minimal dose that works.

Fewer is better. The more medications and supplements I take, the more chance of adverse interaction.

Few of the claims for dietary supplements have been verified by medical research. But that doesn't mean the anecdotal reports of dramatic gains from taking a particular supplement are bogus. For example, the success  I've had with 5-HTP apparently is fairly unique.

Which brings me to my latest experiment with self-medication.  My recent posts on curcumin's potential to remedy a long list of ailments -- see http://bit.ly/HTDdgO  -- led me to experiment with a curcumin-enhanced-by-piperine supplement. I'll report on this in a few days. Stay tuned.

Meanwhile, I'd love to hear your thoughts and experiences. How do you manage YOUR meds? All comments most welcome!

1 comment:

Anon said...

signed up for your blog a few months ago and am enjoying reading it. Just
wanted to say that the recent info about emailing yourself every night about
health-related highlights of the day is brilliant! I hope I can remember to do
it when I start having scrip-related side effects!