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Prescriptions More Common Than Explanations

I always tell you to talk to your doctor before taking any medications or supplements or latching on to a diagnosis. As well-intentioned as these pronouncements are, I sometimes feel like I’m doing the same CYA that drug companies do in ads. Really it’s that I want you to be safe and hope that a doctor’s input may help.

I know even that may be a long shot, a belief backed up by a recent study. The findings indicate that many doctors prescribe medication without explanation of the drug’s purpose and side effects or even it’s name. According to the New York Times article on the study:

“Although there were variations, depending on the type of medicine
prescribed, 74 percent of the doctors mentioned the trade or generic
name of the medicine, and 87 percent stated its purpose. Sixty-six
percent said nothing about how long to take the medicine, 45 percent
did not say what dosage to take and 42 percent failed to mention the
timing or frequency of doses. Physicians mentioned adverse side effects
only 35 percent of the time.”

So you can’t always rely on your doctors for information on drugs, is there anyone who can help?

Check with your pharmacist. They are trained to know drugs inside and out. Many enter the field with a goal of helping people, but the reality of the job doesn’t involve much of that. Most pharmacists I’ve met are more than happy to explain medications — even if they are over-the-counter — and answer questions. If the pharmacist at your local Walgreens is a dud, try the Walgreens that’s two blocks down the street!

Talk to a friendly person in your doctor’s office. Maybe you get along great with the nurse who takes your blood pressure; it can’t hurt to ask for clarification that you don’t get from the doctor. In some offices, a physician’s assistant or nurse practitioner returns phone calls for the doctor. You may find that they have more satisfactory answers to your questions. If you get along well with the PA or NP, why not consider making your next appointment with him or her? Or if you’ve always seen the head honcho of the practice, you might consider seeing some other doctors in the practice. They may be less harried and, thus, have a more patient-friendly demeanor.

A naturopathic doctor is another option. By focusing on the person instead of the patient, much of the appointment is about addressing the person’s questions and concerns. Licensed NDs are trained to integrate their treatments with those of western medicine — understanding pharmalogical treatments is a vital component of this practice.

Last but not least, ask your doctor! Yes, it seems like the job should require such explanations, but it’s also a high pressure job. Haven’t you ever forgotten to explain things to your co-workers, employees or clients? Being a recipient of information is as big of a job as being the giver of that information. You aren’t a passive recipient. You’ve got to ask your questions to have them answered. Of course, if your doctor consistently comes up short, it’s probably time to look for a new doc.

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Following Directions for Better Health

Taking meds exactly as prescribed may have a placebo effect of its own. An analysis of 21 clinical trials shows that whether participants took the active drug or a placebo, those who took the drugs as prescribed had 44% fewer deaths than those who didn’t follow the instructions.

The author of an editorial that accompanies the study, which was published in the July 1 issue of the British Medical Journal, asserts that this is evidence of the mind-body connection of the feeling of being cared for by one’s doctors and caring for oneself.

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Toxicity of Tylenol

Before I was diagnosed with migraine and CDH, OTC painkillers were my constant companion. It was in the pockets of my jeans, buried in the bottom of my backpack and in little plastic bags strewn about my car. I’d find pills nestled in the carpet and in my bed. You get the point.

Even though my drug of choice was sold OTC, I knew that I shouldn’t take as much as I did as often as I did. But the risks were vague enough for me to ignore them. I’m not nice enough to let you ignore them too.

Get this: Overdoses of products that contain acetaminophen account for 40 to 50% of all acute liver failure cases each year in the United States. A recent study in the University of Michigan Health System showed that about half of these overdoses were the unintentional side effect of treating an ailment, like headaches. The researchers deemed these cases “therapeutic misadventures.” (Isn’t that a perfect description? It conveys the situation so clearly.)

Even if someone is careful to stay within the prescribed daily dosage of Tylenol, there’s a risk of accidentally combining it with any one of a number of other drugs that have acetaminophen as one component of many. More than 150 OTC drugs, from cold treatments to sleep aids to fever reducers, contain acetaminophen. Midrin, a prescription migraine abortive, has acetaminophen in it, as do many other prescription drugs, including painkillers.

You aren’t doomed to liver damage or failure if you take Tylenol. The University of Michigan offers these guidelines to keep yourself safe while taking acetaminophen:

  • Before taking acetaminophen, tell your doctor if you have ever had liver disease or if you drink alcohol daily or on a chronic basis
  • Carefully read the labels on all medications so you are aware of their acetaminophen content (both prescription and OTC)
  • Acetaminophen is found in Tylenol-brand products, some varieties of Excedrin, FeverAll, Genapap, Percocet and more
  • It is included in combination products, such as Midol Teen Menstrual Formula Caplets containing Acetaminophen and Pamabrom
  • Many prescription pain relievers also contain acetaminophen, such as Lorcet Plus, Darvocet and Vicodin
  • In case of an overdose, call your local poison control center at (800) 222-1222
  • Keep medications locked up or out of reach of children.
  • Do not take the full day’s dose of acetaminophen at one time; space it out over the course of the day

All that said, if you are taking enough Tylenol or any OTC painkiller to be worried about liver damage, you’d probably be best off seeing a doctor about your headaches. You could be having rebound headaches or you could be treating yourself for the wrong problem . It can take a lot of time and energy to find a healthcare provider that you like and a course of treatment that’s effective for you, but you’ll feel best in the long run if you make this commitment.

11/4/08: I’ve closed comments on this post because of excessive spam.

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Comprehensive Drug Information

DrugBank is an all-in-one resource for patients and healthcare providers alike to look up detailed chemical, pharmaceutical, medical and molecular biological information on nearly 4,100 drugs. I looked up a couple common headache drugs and am impressed with the results: Topamax, Vicodin (which brings up results for acetaminophen since it is one component of Vicodin) and Imitrex. It also links to popular drug sites, including Drugs.com and RX List, for when readers want more information.

via ChronicBabe

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Pain Patient or Criminal?

Punishing Pain, an op-ed piece The New York Times published yesterday, describes one man’s struggle to get adequate pain relief. It’s a fight that ultimately landed him in jail. You’ll have to register to read the article, but it’s worth it.

“When I visited Richard Paey here, it quickly became clear that he posed no menace to society in his new home, a high-security Florida state prison near Tampa, where he was serving a 25-year sentence. The fences, topped with razor wire, were more than enough to keep him from escaping because Mr. Paey relies on a wheelchair to get around.”

Linda25 shared this article on the BrainTalk forums.