Polypharmacy – Taking Too Many Medicines

One of the questions I get all too often from my patients, particularly the older ones who are way too many medications, is “Will this new medicine react with the ones I’m already taking?”

I answer by telling them, “Scientifically, we know how one medicine reacts with another. When you add a third one though, everything we know goes out the window. How about if you’re already on ten or more medicines?”

Sadly, many of our parents and grandparents, are on way too many medications. And this phenomenon has already trickled down into our generation and that of our children! I routinely see college students who are on 3-4 medications: an anti-depressant (seems like these are almost as universally used as aspirin used to be), an ADHD medicine (seems pretty standard for a lot of kids these days as well), birth control for many girls and then whatever variety of meds they may be on for asthma, allergies or other medical conditions. Our bodies have literally become pharmacies and then we wonder why we get so sick!

Statistically – especially for the providers out there – the likelihood of a patient complying with a regimen of medical treatment goes down by 50% when you reach four daily medicines. That means that half of your patients (who are on at least 4 meds) will be taking medicines not at all, haphazardly or in the wrong way out of confusion, forgetfulness or carelessness.

How to solve the problem? From a patient perspective, talk to your provider if you are concerned that you are on too many medications. See if there are any combination products that can help you lower the number of medicines that you are on. Secondly, remember that not every problem requires a pill or prescription. This is especially true when it comes to medications for depression. This is a serious subject though which I hope to write a proper post on soon.

From the provider perspective, remember to do no harm. Closely examine your patient’s medication list to make sure there are no redundancies – a very common occurrence. Also, try to help your patient’s find non-pharmacological ways to deal with their problems.

A friend sent me this great video made by Cafe of Life that probably says it better than I ever could – hope you like it as much as I did. Click here to watch.

Laying on of the Finger

Part of my mission with this blog is to help those outside of the medical realm to understand how much BS we often have to sift through in order to get to the bottom of things. Case in point, I get word that EMS is bringing in a potential “neurological injury”.

Let me tell you, neurology and nerve injuries are not on anyone’s list of favorite things to deal with in medicine. They’re confusing, complicated and then you have to deal with neurosurgeons – the medical equivalent of getting sodomized with a baseball bat. So, needless to say, I was worried.

Finally the patient rolls in, appropriately strapped to a spine board and in cervical precautions. He looks scared and worse yet, he’s not moving. He’s a young person, maybe in his mid 20’s, which makes it a recipe for true disaster. So, I carefully start getting the story.

Turns out that John and his girlfriend were having some fun at home and started chasing each other around the dinner table. But then suddenly John hits something and crashes to the ground, unable to feel anything below his waist. His girlfriend starts to panic and calls 911.

My first instinct was to get on the phone with neurosurgery, and get this guy into the right hands ASAP.  But the image of a baseball bat makes me think that I should at least do a thorough neurological exam on this guy first. I start with his cranial nerves, which seem normal above his waistline. Beyond that though, he has no pain response, no movement and no sensation whatsoever in his legs. I’m starting to sweat.

Last on the list though is to check rectal tone. When someone is truly paralyzed below the waist, they almost always lose their muscle tone in their anus and rectum, as well as losing control of their ability to control their bladder. Put simply, they urinate and defecate on themselves. Yet John’s tighty whity’s are Clorox clean. Hmmm? Maybe he was lucky enough to preserve this area I’m thinking. But, like it or not, I have to do the rectal exam.

As I start pulling his underwear down, for the first time it seems, John starts to look anxious. “What … what are you doing??!!”, he blurts out.

I explain, “I have to do a rectal exam … basically involves me putting my finger in your ass to check your muscle tone. It will help me to understand your degree of paralysis.” I have the nurse put the lubricant on my finger and just as my cool, gloved finger touches his anus, something miraculous happens.

John’s butt cheeks clench so tight, and his previously “paralyzed” legs snap shut and come off the backboard with truly impressive force.

So all was well in the ER. I wasn’t going to get sodomized by neurosurgery after all, John had a “miraculous” recovery and I temporarily became known around the ER as “Jesus”.

What had happened? I will never know for sure, but I’m pretty sure John was alright before EMS even arrived to his house. How far could this ruse have gone? Who knows? Why was he faking it? The promise of a disability check, for sympathy, thought it would be a good joke – your guess is as good as mine, but he wasn’t the first and he unfortunately won’t be the last person trying to pull the wool over our eyes for some alterior motive.

Nude Psychiatry

Shirt and shorts required.

I had this patient come in for a fall this weekend – seems like everyone was falling for some reason. He was in his sixties and had recently lost his job as a marital counselor because the foundation he worked for lost 1.5 million dollars in the Bernie Madoff scandal. Till that point, he had been sober for eight years, but the news was too much for him. So he went to the bar and got hammered.

Came home totally stinking drunk, and freshly unemployed to boot, so his wife said she had enough of him and told him to get out. So the marriage counselor was having marriage problems and not approaching them in the way that he probably advised others to do (at least I hope not).

Since this poor soul had fallen while drunk, the nurse asked him to get into a gown so that I could check him for injuries from the fall. I walk in and find a pleasant gentleman sitting on one of the chairs in the room. As we get into the physical exam, he tells me about some bruises and abrasions he suffered from the fall and proceeds to lift up the gown to show me his abdomen.

He didn’t tell me though that under that gown, he was totally naked. Just naked and casually sitting on a chair reading a magazine. Personally, I don’t prefer that any of my skin touches anything in an ER patient room.  But he, on the other hand, didn’t seem to mind plopping his naked genitals (i.e., free-birding) right down on that cloth lined (read absorbent) chair that others before him had bled, vomited, urinated and God knows what else on before. Either that or he really trusts generic hospital brand Lysol.

This reminded me of a patient we had a few months back in our psych room. She was about 50 and depressed. One of my colleagues went in to see her and being that it is the psych room, it is monitored on CC TV. As he was interviewing her, I noticed from my peripheral vision that she was successively taking off her clothes. Right down until she was totally naked and just sitting there answering his questions. It was a most unusual site to behold.

I mentioned this encounter to one of my other colleagues who is a serious triathlete. He told me that this was nothing compared to the guy that visually tortured him for months when he used to go swimming at the YMCA. This guy used to strip down to nothing but his socks and shoes and spend a good half hour riding the air-dyne (fan bike) in full view of all to behold. Not a nice image.

So, all-in-all, not sure if these are just nudists who happened to need to come in to the ER or what? But there is no doubt that we sometimes get to see way more of our patients than we ever intended to – and in most of these cases, have to live with the nightmares.