I recently experienced several adverse medical events that I now can add to the, already too long, list of earlier events. Since year 2000, the list now includes: prostate cancer, heart attack, mini-stroke (TIA), Parkinson’s disease, and two bad reactions to my medications. I have learned a lot from these events and that is what this post is all about.
The doctors and Nurses
I want to make it very clear I hold my Doctors and Nurses (past and present) in very high esteem! I owe my life and my present good health to them and I will never forget why. Keep this in mind as you read what is to come.
Medications and adverse events
I take ten medications throughout my day, every day, by the clock. These medications are prescribed for me by a Cardiologist and a Neurologist. I also have a primary care Doctor. Each of these ten medications has the capability of producing major effects within my mind and body – mostly good, but some not so good. Since all Doctors have an ethical duty to “do no harm”, they obviously must come to the conclusion “the good” out-weighs the “not so good” for the medications prescribed. Based on my experiences of late, the “Practice of Medicine” in the United States does not offer much help to Doctors as they try to adhere to the dictum “do no harm”. For instance, my cardiologist and I first met as he prepared to insert the stent that stopped my heart attack. There is no better recommendation for a Doctor than saving one’s life; I decided to stay with him for my follow-up care. However, this decision meant my prescribing Doctor would not know me as a person and I would not know him well. My other two Doctors know me well in their individual clinical settings, but do not share this knowledge with each other let alone with my new Doctor. There just is no practical, routine way to do this. This means my new Doctor would have to depend on my unsure memory for my medical history, the heart attack related testing that was done, and what he could glean from a brief clinical observation. This at the time when my Doctor needed all the information he could get to prescribe the best possible treatment for me – the post-heart-attack patient. In addition, there is, I suspect, a paucity of reliable drug information concerning the effects of age, gender, genetic differences, long-term use, drug interactions, differences between “me too” drugs within a class of drugs, and safety in general. The “paucity” problem is further exacerbated by the conflicts of interests that exist within the relationships between drug manufacturers, the FDA, medical insurers, and the medical industry that cast the shadow of doubt over the veracity of the drug information that is available.
All that stands between me and a medical disaster are my three doctors. Armed with only their Medical “Horse Sense”, accumulated through their training and practice of the art of medicine, they have managed to formulate treatment plans for me which are working well with few of the “adverse events” I might well expect. One of the two “adverse events” I have experienced was clearly my fault. After three years of taking my Parkinson’s medications, I “determined” that one of them was the “cause” of my extreme daytime sleepiness. Without consultation with my Neurologist, I abruptly stopped taking the “offending” medication. Although my daytime sleepiness was greatly reduced, I managed to screw myself up to the point where I did not know up from down. I waited six weeks, until my next scheduled office visit, before seeking my Doctors help. For a guy who takes some pride in reasoned action, this was a maximum level of dumb! Not only did I put myself at risk, I broke faith with my obligation to follow the treatment plan. I apologized to my Doctor even though he said it was not needed – I felt better doing so. My Doctor modified the treatment to the extent that I am still on the same drug with the difference being I take less at more frequent intervals. With the help of lots of coffee, it is working for me now.
My second “adverse event” did not happen due to anyone’s “fault”; it just happened. After taking a drug to reduce my heart rate for two years, it failed me badly. Recently, when I arose from my bed in the very early hours to pee, I noticed my feet and lower legs were grossly swollen. After clumping my way to the toilet and returning, I sat down to feel for my pulse and had trouble finding my normally strong pulse. I reminded myself what the Paramedics have drilled into my wife and me: “DO NOT WAIT! CALL 911 AT ONCE!”. So I did! What they determined sent me to the Hospital for three days; what I presented to them was consistent with congestive heart failure so away I went. After treatment, tests, and observation, it was concluded my heart rate medication, not a heart attack, was the culprit. In an abundance of caution, with which I agree, my cardiologist withdrew the medication from my treatment plan. I have been fine since release from the Hospital.
My third adverse event – a T.I.A. (aka mini-stroke)
It was morning when I noticed my right hand was not functioning well, even after allowances for the now familiar effects of Parkinson’s were made. I also remember not thinking clearly – slow and confused is an apt description. My wife also noticed my low-key distress and asked me what was wrong. I think I said something which added up to:”I’m having a stroke. Call 911″ I never lost consciousness, experienced pain or felt any panic – just a confused sort of resignation at my plight. The Paramedics did not take long to get me on my way to the closest Hospital with an open stroke center which was a comfort to me as time was critical for me. There are two kinds of stoke. There is the kind caused by clots and the kind caused by bleeding. It is critical to differentiate between the two early after the stroke starts to reduce brain damage and avoid the fatal mistake of getting the choice of treatment wrong. A stroke center is the place to be taken as quickly as possible. Trust me; I know I am right.
Soon after I arrived at the E.R., my symptoms began to lessen. I was relieved to learn that meant I would escape brain damage, but would have an increased risk of a damaging stoke in the future. That was good news given the other possible outcomes! It was explained to me that a wayward blood clot, from who knows where, had blocked one of the arteries in my brain. In that sense, I had a stroke. It was dumb luck that the clot broke up of its own accord. For the record, I experienced a Transient Ischemic Attack, aka a T.I.A. I seem to have escaped any brain damage according to the tests my neurologist performed on me. However, I reserve the option to claim I am brain-damaged if, in the future, there is some tactical advantage to be gained.
What have I learned?
Here is what I learned and I offer for your thoughtful consideration:
1) You and your family know the early signs of heart attack and stroke.
2) Be ready to call 911 at the first suspicion of heart attack or stroke.
3) Follow your Doctor’s treatment plan.
4) Do not be a fool by making your own medical decisions.
5) Keep your chin up! A good attitude is very helpful to those who are trying to help you.
6) Keep your good luck charms close to hand – your will need them.