May 31, 2013

I'm Feeling Better, but Why? The Perennial Mystery

I posted yesterday about a week-long spell of not feeling up to par -- a par that keeps changing. Today, I'm seeing some progress. This experience is typical of the often mysterious ups and downs we experience as we age.

I recalled some lessons I'd learned -- and forgotten -- and I picked up some new information. Here are some of the issues involved in my recent roller coaster ride.

Checking for Drug Interactions
I recounted yesterday my finding out, courtesy of my CVS pharmacist, that the pain pill prescribed by my internist had the potential for reacting adversely with the Parkinson's meds prescribed by my neurologist. After researching drug interactions, I reread the chapter on over-medicated seniors in the book Are Your Prescriptions Killing You? 

After, I vowed to restrict my pill popping -- of prescribed meds and over-the-counter supplements -- to the absolute minimum.

Here are several user-friendly sites you can use to check for possible adverse drug interactions:
  • Medscape has a good drug interaction checker. I often start any medical research with Medscape; it beats WebMD by a long shot for accuracy, currency and depth of info. I wish I were more adept with apps for my iPhone, since I just got a promo email from Medscape offering its free app on clinical care that includes the drug interaction checker and much more. It's the fastest growing medical care app, used by over 3 million healthcare professionals.
  • Another easy-to-use drug interaction checker is provided by www.drugs.com
  • The nurse-practitioner at my CVS Minute Clinic thinks highly of Epocretes drug interaction checker. It's available online after a free registration. But what she likes is their app that has some nice features in addition to the drug interaction checker. 

Blood Pressure Meds and Readings
Since part of my recent malaise involved the low blood pressure readings I was getting from my new blood pressure meds -- Azor and Hydrochlorothiazide -- I called my bp specialist. We agreed to cut the Hydrochlorothiazide dose from the 25mg to 12.5mg. 

This is one more example of what I've found with most of my prescribed meds: taking half of the prescribed dosage often works best for seniors or at least for this senior. 

While I had him on the line, I told my bp guy my understanding of the current thinking on desirable pressure for someone my age with no history of heart disease: any systolic (upper) reading between 120 and 140 is good, and 140-150 is acceptable. He replied: "You're absolutely right."

One reason I asked for this confirmation is that medical authorities typically insist that everyone should aim for a systolic reading under 120. TV's Dr. Oz made that recommendation for seniors in a recent AARP Bulletin article. It's bunk.

My current readings are in the 130s and 140s, so I may hold off for awhile before resuming the bp meds.

I Forgot: NSAIDs Are a No-No
When my pharmacist told me of the potential adverse reaction from my Tramadol pain pill, I did a Google search on over-the-counter pain pills to use as a stop-gap before seeing my internist about a new prescription. Motrin got a good review so I started taking it. I'd forgotten my own blog post on NSAIDs -- "One of the most dangerous classes of drugs for older people"! The quote is from Neel's book, which devotes a chapter to the problems with NSAIDs like Motrin.

I've switched to an acetaminophen which gets Neel's seal of approval. 

Another Positive Experience with the CVS Minute Clinic
Not long ago, I wrote favorably about my first visit to a CVS Minute Clinic. This week, I checked in with them again on several issues, since I'm in an "internist interregnum." (http://bit.ly/11s6PaH.)

I saw Kate, the same nurse-practitioner who helped me before. It was another positive experience. These walk-in clinics, growing in popularity, can not treat chronic illnesses . . . no doubt due to lobbying by physicians. Efforts are apparently being made to change this restriction. But for now, they couldn't do anything about my pre-existing hypertension or back pain.

We focused instead on the cough I've had for weeks. Kate gave me a thorough examination and concluded I probably had a sinus infection. She wrote a prescription for "amox tr-k clv," a pill I take twice a day for five days, and for a nasal spray to use once daily for a month.

I got the prescriptions right after my clinic visit on Wednesday. Kate called on Thursday to see how I was doing. I told her I was feeling much better already, just as she'd predicted.

Azilect, 5-HTP and Me
This was probably my most important lesson of the week. But since I've often touted 5-HTP, I don't want to bury that lesson here. So I'll post a separate piece about it on Monday.

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I had first thought my malaise was due to interactions among my current meds for my chronic conditions. Now, it looks like I needed a new med for the sinus infection. This new prescription is for short-term use, after which I can revert to my "less is more" take on pill popping.

This health flare-up is "small potatoes" compared with the major issues many of my friends are dealing with. Still, it's a cautionary tale for all of us seeing different doctors who prescribe different drugs. Patients -- already struggling with issues that need attention -- aren't necessarily in the best position to decide if a newly prescribed medication might interact dangerously with another drug they're already taking. But we may have to take charge of this if no one else is doing it.

1 comment:

Maxx Well said...

Thanks for sharing.

Here's also an article about medical apps for iPhone.

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