Although not directly applicable to PMR/GCA probably a lot of us may have this happen to us.
Consider, for example, a man in his late seventies, fit and active, “routinely prescribed” (like so many of his age group) a cholesterol lowering statin. Two months later, he consults his doctor with muscular aches and pains for which, in the absence of any obvious cause, he is advised to take the anti-inflammatory ibuprofen. Two months after this, summoned to the surgery for a flu jab, the nurse finds his blood pressure to be raised, warranting a daily dose of the antihypertensive thiazide diuretic, bendrofluazide.
Another three months passes and he is woken at night with an excruciatingly painful big toe, correctly diagnosed as an acute attack of gout warranting treatment with allopurinol. When he returns a few weeks later, the doctor checks his blood sugar, previously normal, but finds it to be raised, resulting in a prescription for the antidiabetic drug metformin. Soon after, he develops diarrhoea for which, again in the absence of any obvious cause, he is advised to take loperamide.
Always consider whether any new condition might be the result of an existing treatment
At this point he inquires: “Why do so many things seem to have gone wrong recently?” but is reassured that, at his age “these things happen”. And anyhow, gratifyingly, each of his several medical problems have been satisfactorily dealt with. But were one to scrutinise those several consultations in any detail, it is possible to discern a cascade. The statins were responsible for the muscular aches and pains. Their treatment with anti-inflammatories can raise the blood pressure, hence the prescribing of the antihypertensive thiazide diuretic. This can raise both the uric acid level (hence the attack of gout) and blood sugar (hence the diabetes). The treatment for the latter with metformin caused the diarrhoea – hence the loperamide.
By Dr James le Fanu
Written by
piglette
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An elderly family member collapsed on holiday in Spain. The hospital doctor was horrified to discover he was on 10 (ten) different medications. They took him off everything and started from scratch: 3 weeks later he went home, better than he had been for years and 30 lbs lighter (all fluid) and on one single drug!
There has to be a good reason to start something else. Pred may be not ideal but it does the job on its own! I'm not entirely sure how they managed to dispense with one of the BP meds after the pacemaker though!
OH has been on his for ages so.doubt anything is causing too much aggro and apart from him being more of a pain in the backside i havnt noticed any changes. Mine are not so clear. Before pred it was just amitriptyline and tramadol and everything seemingly under control, now its the above plus pred, mirtazipine, anti diarrhoea, calcium!!
I have always asked myself , can this be because of the new drug or how my combination of drugs have changed and then also asked the GP. They often just treat the symptoms directly and never question the current medication unless they are doing a review , and even then they may not have the knowledge to see what is going on.
I reviewed my Mum's drugs at the end of last year as everything seemed to be getting worse and she was on 15 medications. 3 of the 15 were known to counteract with some of the others but she'd been on them that long they had forgotten about that part of her prescription history.
She's now on 9 drugs , and although has a long way to go her various minor symptoms have reduced or certain side effects gone entirely.
It's sad that we have to remember to ask these questions , push for our annual prescription reviews and the blood tests that monitor them , but it's really important and can save us a lot more issues arising , improve our General Health and often reduce the amount of different drugs we need too.
My OH is accompanying his step dad to his next GP appointment in January. He is 69 and been on a statin, a medication for high blood pressure, two oral and one injectable for diabetes, for at least 10 years.
He had experienced a 40 pound weight loss in the last 1.5 years, unexplained, and now occasional diarrhea and last week he vomited once while walking to get the mail. He also gets hot and light headed at times.
With the weight loss it would seem to me that this would affect the dose of his medications. I lost 32 pounds and got off my high blood pressure meds completely. Before I did I would get light headed/dizzy because the medication was lowering my bp when I no longer needed it to. Sure enough when I checked it, it was low.
We are trying not to jump to bad conclusions but I fear something is seriously wrong. He only weighs 171 now, down from 213 about 15 months ago. It reminds me of my dad when he had pancreatic cancer.
So hoping with my OH present, there will be a review of his medications and some investigatory tests to find the cause of the weight loss.
Has he been trying to lose weight at all? I would consider not investigating that sort of weight loss for no reason as rather negligent on the part of a doctor. Or does the doctor not "know"?
He has not been trying to lose weight (indeed he eats lots of processed foods including white bread, pasta, etc, unless he dines upstairs with us). Nor has he been completely forthcoming with his doctor about some of his symptoms. He was even trying to create a more favourable blood sugar level by adjusting when he took his injectable medication for diabetes right before his 3 month bloodwork (sigh).
His GP is also fairly new and took over his care two years ago when other issues were not present. Our step dad was happy that his new physician simply continued to prescribe his medication and didn’t ask him many questions so he would be in and out of the doctors office in 5 minutes.
The last two visits something showed up on his bloodwork and he was sent to a specialist about his thyroid. Apparently his pituitary is “overactive” and this spurred my OH to accompany him to this appointment where weight loss was discussed (my OH had to clarify that his step dad was not trying to lose weight).
Bottom line we have talked with him about being honest with his doctors so they can best treat him. OH will attend appointments from now on as his step dad is now scared and concerned, but still seems to not want to know....some patients are just like that. We do what we can do, and will continue to support him despite the outcomes.
Now if we could just get him to slow down on his pack and a half daily smoking!
Thanks for your response. I know not directly related to PMR, but the stress associated with supporting ill parents/loved ones, has been highlighted in previous posts as it takes its toll on everyone involved.
My retired healthcare professional is like that - his argument is that he survived cancer 25 years ago so obviously that makes the worst diet in the world OK (although he doesn't drink coke!) ...
They sent me home from hospital with 6 new drugs. Before, only the steroids and the calcium. After I see the specialist nurse today for my follow up I’m only going to take 3 of them whatever they say. I’ve researched it thoroughly.
I'd rather the bisoprolol to lansoprozole (and yes, I know they do different things!) - I've never had any problem at all with bisoprolol. And statins, no way!
They sent me home from hospital with a load if different drugs, my sister and I spent hours trying to sort them all out. We would say time for the little yellow ones or the big pink ones etc!!
How true!!!! I've got to the stage where I tackle the GP on every front, I want to know the in's and out of everything. You can tell they don't like it but you know what I don't care it's my body! To be honest I get more info from this forum together with the info I gather from the internet, I have an idea what's going on. Every time I go to the surgery, explain the symptons and the next thing they are on their computer, really! and they read from the computer,
Bearing in mind in took me at least a week to see the doctor!!!!
Many years ago my husband had his first stent in Harefield Hospital and they put him on statins. He complained about his aches but non of the Doctors took him off the statins. I told him to stop taking them - but he and I have different views on medication and he continued. The result being today he can hardly walk. The Doctor had me in a few years ago and tried to persuade me to go on them. You can imagine what I said.
From what I remember he carried on for about three years. Now of course it very much affects both our lives. He had learnt by the time of the second stent and managed perfectly well without them. I always listen to what people say but it is good to make up your own mind. One Consultant I saw a little while ago said to me I could recommend - I forget the name of the drug - but she said I know you won't take it.
This was in The Telegraph yesterday, written by James Le Fanu.
He writes frequently about people being prescribed multiple drugs. It also highlights the responsibility of patients to question what is being prescribed, and if it is appropriate for their specific condition.
Totally agree! Even after trying a naturopath, I had to do my own research about supplements he recommended and found serious potential side effects with them, so refused to take them. I was pushed so many different drugs over the past years which, had I taken them, would have made me much worse off today.
Yes, yes, yes. Thx for posting. Have been fighting this for years. Still say no. Some times not soon enough. Then I pay the price for awhile. 🤗.
....which is precisely why I refused all the meds the GP was trying to force on me to solve the problem of each of a string of drugs he wanted to prescribe to to counter the possible effects of the previous one mentioned. He treated me as if I was going senile when I declined all except the pred and gave me the prescriptions anyway which I did not cash in. The only difference between your scenario and mine is months compared with just minutes.
Outrageous that the pharmaceutical companies are effectively able to push ill health at people to keep their balance sheets well into the black, and that they won't fund any research into anything natural which they cannot patent and from which, therefore, they cannot profit.
Last gripe of 2019!
I am happy to say that I am free of the dreaded steroids, and, for the moment, the same can be said of the PMR as of the end of May this year. I wonder if I would be in the same position if I had accepted all the drugs? I will write a detailed account of my journey in due course in case it could be helpful to others on the same path.
Happy New Year and better health in 2020 for all. Take care all.
We took care of my aunt for 13 years. Towards the end the nursing home doctor ha her on 17 prescriptions. We were able to get her off some of it but not all.
I have witnessed the spiral own many times with others, and have witnessed the attempted onset with my self. I am on prednisone, valsartan for high blood pressure, and pepcid ac for my stomach. I try to keep it at just the three, even though the medications do cause side-effects, I try to modify diet to keep complaints at bay. The spiral down of prescription medications is scary. Good post.
Great post~! Except for pred, Actemera, Asprin, Calcium....most of my meds I have been taking since 1955. Recently I switched to a geriatric practice and as soon as we believe the GCA is stable and taper complete, he is going to re-evaluate all of my meds which are interacting in a less than favorable way. Yippee~!!
HaHa...yes, I know...long time~!!! When I was fifteen I had some grand mal seizures. Back then tests were pretty prehistoric and medicines somewhat limited. After trying different meds, they settled on Mysoline which is today's Primidone and Clonopin/Klonipin aka clonazepam which worked. I then had one seizure when I was 45 and had great control to age 79 until I got loaded with methylprednisolone which watered down the effectiveness of the light meds. While taking 120 mg methyl per day I was started on Keppra and NO seizures. Through the years I picked up diuretic, bp meds, had bleeding ulcers twice (over 30 years ago), diverticulitis...etc. etc. When the geriatric physician reviewed my meds he said that once I am stablized he is pretty sure we can get rid of some of my 'accumulated' meds.
Live long enough and it is so easy to collect lots of meds...especially if you see specialists who are so focused on only what they are treating.
Yep, it has been 65 years...and I'm still trucking~! xo
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