What side effects?

When I was a brand-new doctor, medication was magic. I loved how giving a shot of Lasix to a patient drowning from heart failure could make him able to breathe again. Or how a shot of Demerol made furrows of agony from a kidney stone dissolve into relaxed sleep.

So I developed a sort of skepticism when a patient would bring in a list of drug intolerances. Some of these proclaimed “adverse effects” were eye-rollers. One pill took away the ability to read the future. Another pill took away libido. Another pill caused sexual dreams. (“That’s an adverse effect?!” I asked, incredulous.) One guy couldn’t take a pill because it made him feel sluggish, but when we stopped it, it made him jittery. (I thought to myself, “Oh, puh-leasse!”) My other young colleagues and I used the dictum that three or more drug intolerances indicated that the patient was a little nutty.

But, ahh, how age and wisdom change perspective. I myself had to stop taking Lipitor and Crestor because they caused me severe muscle pains. (Adverse effect 1 and 2.) When I had Lyme disease, I popped my doxycycline, just swallowing it, twice daily. “Water is for sissies,” I thought, until I got erosive esophagitis. (Adverse effect 3.)

I had put myself on propranolol to prevent my migraines a few years ago, but it made me feel sluggish. (Adverse effect 4.) So I stopped the medication. Because propranolol blocks adrenaline’s effect, it is supposed to be discontinued gradually to prevent the rebound “fight-or-flight” reaction. But weaning is for sissies, I thought, so I just stopped it, cold turkey. The next day, I was making a pretty routine phone call when I became so nervous that I felt I couldn’t breathe, my heart was pounding; I had had a panic attack. The same med that made me sluggish, made me jittery (hmmmm).

Of course, my migraines came back. I read that Paxil, an SSRI antidepressant can prevent migraines without the sedating effect of some other anti-migraine meds. Sure enough, my migraines went away. But so did a lot of emotions. I was super, super chill, which was cool. But certain things I just didn’t care about. Now, I happened to be married to a smokin’ hot Italian goddess whose charms have been known to make my legs weak. But once Paxil happened, a scantily clad Venus Herself could be giving me the “come here, big boy” with her index finger and I still would have said, “Naaaahh, I’m good.” (Adverse effect 5.) Stopping Paxil is also supposed to be a taper. Not being very smart, of course, I stopped it cold turkey, only to find myself feeling tossed on hurricane-force waves on the mighty sea, even though I was lying on the couch of my living room.

Aside from the awareness that I’m a rather slow learner (which any of my teachers would confirm), I also have grown to respect the medication I prescribe, as well as their side effects. Let’s face it, they work by blocking the normal functioning of a protein the same way that poison does. So last week, a patient came in with a page and a half of side effects to medications that she showed me. I ticked through each drug and side effect. And I nodded knowingly.

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