March 16, 2017

I'm Still Here but with a New Right Hip and a New Microphone for my Dragon

It's been over three weeks since my last blog post. I've started getting phone calls and emails from friends concerned that I might have had a setback after my hip replacement. Others hadn't even heard about the surgery.

Actually, my silence had nothing to do with the surgery or my health. I had decided to replace the microphone I'd been using with my Dragon voice recognition software with a wireless headset microphone from Sennheiser. You could not believe how difficult the new installation was for this 87-year-old man with Parkinson's. Fortunately Sennheiser's support staff was incredibly helpful and patient. I've been using the new microphone for several days, and I'm very happy with it. But this effort most definitely should not have been a self-help project!

Here's a quick update on my recent health happenings. It's been an interesting start to the new year.

The Hip Replacement
January 20th -- Inauguration Day -- was not a good day for me or for the nation. I fell at home and fractured my right hip.

This setback was just the start of a series of problems I encountered over the next few weeks, all because of prescribed drugs.

Are Your Prescriptions Killing You?
That's the title of a 2012 bestselling book by Armon B. Neel, a fifth-generation pharmacist. In 2010, the American Society of Consultant Pharmacists gave him its annual achievement award. As a consulting pharmacist, he visits hospitals and nursing homes daily and counsels patients on how their prescriptions could be interacting dangerously. Neel also suggests how people might be able to reduce the number of medications they take.

In his book, Neel describes the risks, dangers, and benefits of prescription drugs. He explains what factors must be taken into account when medical professionals prescribe meds for older patients, and he details the catastrophic consequences that can occur when those healthcare pros aren't vigilant.

Neel is a pioneer in the field of geriatric drug therapy. Enter his name in the search box above and you'll find links to several of my blog posts inspired by his book.

I thought about this book often during the events of the past couple of months.

Prescribed Drugs and Me
So far this year, I've experienced three incidents caused by new prescription drugs. They didn't kill me, but they sure as hell didn't do me any good.

1) Tolterodine
As I mentioned in an earlier post, it seems pretty clear that the fall that fractured my hip was related not to my Parkinson's, but to an unusual side effect of a new drug I'd begun taking. As an incontinence treatment, my urologist had prescribed tolterodine, which resulted in hyponatremia, a drop in my sodium level. In turn, I also experienced some serious new problems with my balance.

Although a Google search revealed some links between tolterodine and hyponatremia, my reaction to the drug was uncommon, and I certainly can't fault my urologist for prescribing it.

2) Hydrochlorothiazide
This blood pressure (BP) med set off a new, more frequent and intense round of so-called "orthostatic hypotension," which has become my worst health problem these days.

A quick BP review -- For years, I took the over-the-counter serotonin booster 5-HTP, which for me dealt effectively with three of the major non-motor side effects of Parkinson's: insomnia, constipation, and depression. But this supplement also raised my blood pressure. When my doctors saw those elevated BP numbers, they urged me me to stop taking 5-HTP.

They were even more concerned about another decision of mine: to stop taking any BP pills. I was seeing more and more reports from medical authorities suggesting that most seniors 75+ with no history of cardiac issues really don't need BP meds. Increasingly, I'm even seeing studies that indicate people 85+ with elevated BP tend to live longer than their more "normal BP" counterparts.

Those BP guidelines have not become the common wisdom. Most healthcare practitioners continue to follow this guideline :
The American Heart Association maintains its recommendation of initiating treatment — starting with lifestyle changes and then medication if necessary — at 140/90 until age 80, then at 150/90.
Dr. BP, my blood pressure doc, was willing to work with me on the 5-HTP and told me he would't lose any sleep if I decided to stop taking the any BP meds, though he didn't recommend it. (I wish I had this sort of relationship with other healthcare professionals.) But as I began having more regular and scarier pressure spikes, Dr. BP became more concerned about my use of nifedipine, a drug that quickly lowers BP.

A few days before my release from rehab after my hip replacement surgery, he reminded me that I hadn't been using 5-HTP for several weeks and I was getting good BP readings without the high spikes and I therefore hadn't needed to use the nifedipine. He prescribed two BP meds:
  1. the diuretic hydrochlorothiazide (HCTZ), and 
  2. the angiotensin-receptor blocker irbesartan (Avapro). 
So, just as he had gone along with my decision to jettison the BP pills, I decided to give the new meds a try. Almost immediately, I experienced serious attacks of low blood pressure and dizziness. I stopped taking both pills (although it later became clear that HCTZ was the real culprit).

I had occasionally experienced similar attacks over the years. Dr. BP labeled these episodes "orthostatic hypotension" -- dizziness with risk of fainting, which elderly people often experience when changing body position, especially from sitting to standing. I've questioned this diagnosis for my episodes. While they sometimes coincide with changing body position, they also have occurred when I'm simply sitting in a chair.

The attacks I experienced after taking HCTZ were more intense than before, and much more regular. After I returned home from my operation and rehab, the incidents happened every morning for over two weeks, and made simply getting out of bed and moving to the bathroom a real trial.

I discovered that the best remedy was taking a small amount of 5-HTP, once it became clear that the siege was going to continue. Within about 30 minutes of using small bits of 5-HTP, I'd usually feel OK. On one occasion, instead of 5-HTP, I used the over-the-counter salt tablets Dr. BP had recommended. But it took nearly three hours before I regained my sense of balance.

These incidents still occur, but not as often or intensely. Still, they top my list of serious health issues.

3) Tramadol
Included in my discharge papers from Sibley Hospital was a prescription for the pain medication tramadol HCL, which I hadn't taken in the hospital or during rehab. I wanted to check out this surprise prescription by doing some research on Google. So I placed the pills on my desk next to the computer. Unfortunately, they were next to my regular carbidopa/levodopa pills, which I take for Parkinson's.

Yep, you guessed it. By mistake, I popped two tramadol pills instead of the carbidopa/levodopa. I'd been having a good day. But soon after taking the tramadol, I started feeling very strange and experienced a near-fall soon after.

So I checked out tramadol on Drugs.com. Just reading its "important information" scared me. I'm glad that each of the many times I was asked to describe the pain I was feeling, I said I wasn't feeling any.

But the hospital decided to send me home with a tramadol prescription anyway.

2 comments:

rush my essays service said...

Aging is itself a disease and here you have Parkinson too. I hope and pray that you may get best of health and strength to fight with it.

Colorado Signs said...

I wish you all the very best of luck with your health and recovery. It is very difficult to counter multiple illnesses. Therefore drugs may also counteract.

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