Health: Adverse Prescription Drug Interactions

Little did I know when I wrote Health: Faint Warning - Adverse Drug Reactions last February that I would be personally immersed in a struggle to help my mother overcome adverse drug reactions in August. The problem was so severe that a heart attack or stroke would not have been surprising had the problem been left to fester. My mother is now home from the hospital and out of immediate danger, but she still has a number of weeks before the medications prescribed by her family doctor will leave her system. Imagine, an 83 year-old woman suffering through withdrawl symptoms. She is now eating again and is rehydrated. Based on my own experiences, I would like to share some personal advice on this issue that may be of help to anyone dealing with prescribed medicines...

Family: Make prescription medications a family issue that is openly discussed. Each prescription medication has a wide range of potential side effects that are often documented. However, the issue of adverse reactions across multiple drugs is less known and in my experience poorly documented. Creating a sense of openess in the family about medications allows for a greater sense of awareness that may help stop adverse reactions before they continue on for too long.
Friends: Make prescription medications a topic of conversation with friends. This is especially important for elderly people and perhaps even vital if they share the same family doctor. Avoid doctor bashing, it is unhelpful, but do question how and why the doctor has prescribed the medications s/he has. Look for patterns, they might be revealing.
Community: Adverse reactions to prescription medications is also a community issue, and if we seek to build vibrant communities such as those wonderfully described by Tamarack and Philia, and we need to, then developing a greater sense of community engagement and resilience in the face of adverse drug reactions is critical. This may result in the formation of grassroots special interest groups and regular contact with local media resources.
Education: If education proposes to prepare students for the future, then we need to ask education officials why the science, economics and personal ramifications of prescription medications do not appear in the curriculum - anywhere. Is this not an important lifeskill that may have more to do with survival than Shakespeare or the War of 1812?
Weblogs/Websites: A great deal of health information about prescription medications is currently available on the Internet, yet there is a lack of authentic, personal and grassroots accounts that reveal the underlying reality of all this. If you, a family member or friend is on multiple prescription medications then please share your experiences (positive and negative) with the online community. If the Internet does in fact make a valuable contribution to our lives, then sharing authentic learning experiences with prescription medications is one issue that can clearly help people.
Family Doctors: I believe family doctors always do their best and entered the medical profession as a means to help people live better lives. However, this does not mean that we should put complete faith and trust in every decision they make. Questions need to be asked and answers need to be provided that are not shrouded by medical jargon. For example, if someone is on a variety of prescription medication then you might ask, "Please describe to me how this collection of prescription medications will interact with each other and what the total effect of all these drugs will be." This is a question that cannot be answered easily, but will at least alert the doctor to the fact that patients are asking questions that go to the core.
Pharmacists: A pharmacist is an essential person in providing insight into potential adverse reactions. A good pharmacist will always track the sum total of medications being taken by an individual and be on guard for potential problems.
Paramedics: If paramedics are involved as they were in my mother's circumstances, then ask as many questions as possible. I found these individuals to be highly informed and knowledgable and one paramedic confirmed my suspicions about adverse drug reactions without reservation. This lead directly to the action I was soon to undertake.
Hospitals: I found the hospital we had my mother in to be under-staffed, which indicates it may also be under-funded if we assume it is operating with complete efficiency. To overcome this problem I became quite aggressive in pursuing doctors and nurses, that is, I did some research and asked questions that could not be easily side-stepped. This lead to more attention for my mother, yet it also left me wondering other patients that may not have this support. It also left me wondering why I would have to do this in the first place since there were clearly many talented doctors and nurses who were clearly dedicated to doing the best job they could. I suspect the problem is more systemic than I currently realize.
When Problems Occur: When proper care does not seem to be happening, then build a support network to get it. Mine included: a) Telehealth Ontario - a government organization that provides a toll-free number to registered nurses. I chose to document my mother's case with them; b) Patient Advocates - hospitals have a patient advocacy service that gives patients and family members a voice with the local hospital authorities; c) Hospital nursing staff - once my mother was admitted, I made it my business to become familiar with various members of the nursing staff in order to ensure they completely understood my mother's circumstances. This was very useful; d) Local media - although I considered it and made some contacts, sharing the story in motion with local media can be useful. The problem here is to ensure that the story does not breed opposition but is clearly focused on improvement. Unfortunately, media tend to prefer shock and opposition. I decided not to pursue this in the end.
Doctors: Most doctors will not question or criticize the work of another doctor. At the same time, making a variety of doctors aware of the problem, in this case the prescriptions given to my mother by her family doctor, does help. Since my mother's prescription medications were changed by hospital doctors and she is now clearly starting to feel better, the interaction with various doctors clearly had benefit. The fact that the list of prescription medications had changed so dramatically is a clear indication, at least to me, that the family doctor was in error.
Disclosure of the Cause: I found it quite challenging to get the doctors to state to me in clear and simple terms what the precise nature of my mother's problem was. While they frequently sought to release her prematurely from the hospital, all I needed to do was ask this question and whether or not it was appropriate to release a patient from the hospital without an understanding of what the problem is. The answer is so obvious that nothing more needed to be said.

Through these experiences is has become quite clear to me that we, as a society, do not understand the potential range of adverse reactions to prescription medication nearly well enough. We are simply playing a chemical version of russian-roulette. With an aging population, and therefore an increasing market for pharmaceutical companies, it is becoming more and more essential for all of us to take a much greater degree of personal responsibility and accountability in helping our families and friends deal with the potential downside of adverse reactions to prescription medications.

In Canada, the Adverse Reaction Drug Database needs to be positioned as an essential investigative tool to help reduce the problem, and regular reports to the Therapeutic Products Directorate. Family doctors should also be required to document and justify the range of medications they are prescribing to their patients. Education systems should be required to teach a curriculum that details the science, economics, social and personal knowledge surrounding the issue. This is clearly a lifeskill that has relevance and value, and would also help people to learn how to construct support systems.

Most importantly, each of us needs to make the issue of adverse reactions a personal responsibility and strive to build personal support networks whether it is about our own health, or the health of someone we care about.

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