To take or not to take, that is the question?

New drugs

It may surprise some staff to realise that not all patient interventions will be beneficial. Equally what works to the good for one does not necessarily work well or suit another.

A prime example of this is the use of drugs (medications of all types both prescribed and over the counter). We have been taught that some drugs can be both good and bad for you according to the scenario. Certain strong analgesics will relieve pain but are also muscle stimulants - therefore if for example, your pain was from a gall bladder problem, the pain will increase.

I want to share with you a recent event that I was certainly not prepared for. As those of you who read my articles regularly will know, I have a long standing cardiology problem complicated by diabetes and renal failure, and have been well controlled by the Heart Failure Team for some years. Occasionally, I need admission to hospital if fluid retention becomes excessive.

One such occasion was just before Christmas last year. I had to be admitted, and an opportunistic medical review of my management regimen was undertaken. As a result, a new drug was prescribed. After reading the accompanying data sheet, I noticed that as with many other drugs, this one was contra-indicated (or to be used with extreme caution) in patients with multiple pathology, such as myself. I checked with my cardiologist, who thought that its benefit outweighed the potential issues.

Some 10 days or so later, the side effects were growing both in number and severity.  I then had a most unpleasant event. I awoke at 6am took my morning pills and insulin, then readied myself for ‘part two’, of my routine - pop to the loo, get dressed and have breakfast.

It did not happen quite like that…

I felt dizzy and sick, cold but not clammy, but with no pain. I laid on the bed, assuming it was a blood pressure problem as my blood sugar was fine. I must have fallen sleep, as the next thing I recollect was hearing a loud crash; was it a car accident, had the roof fallen in, was I being burgled? I really had no idea. Upon opening my eyes I found that I was lying in a large heap on the floor at the side of the bed. I could not get up, I could not think clearly, and everything appeared at a distance and rather unreal.

Fortunately, a family member came into my room and tried to get me back in bed; in true slapstick style, I succeeded only in falling forward into a bedside cabinet, breaking it and cutting my scalp. As I watched my carpet turned red, I felt I had no arms nor legs, that nothing belonged to me, and that I was completely incapable of making a decision (not like me at all!). I lay on the floor until the ambulance arrived, an hour and twenty minutes later. The crew got to work in their efficient and capable way. Electrocardiograph was normal (ironic really, as normal is an abnormal state of affairs for me), blood sugar fine, but my blood pressure was 60/40mmHg. The culprit had been found!

I was admitted to the medical assessment area where in my 9 bed bay there were 21, (yes 21) admissions in the 12 hours that I spent there, yet the staff remained cheery. In due course I was seen by a Cardiologist, and two days three wards later, was admitted to the cardiology ward. One week later I left hospital a fitter person minus said new drug.

Reflection

Are new drugs safe? Well yes in general they are; they go through rigorous trials and validation processes before they get to ‘market. However, some drugs clearly cause significant reactions in certain people. Due to my polymorbidity, I have had the benefit of many new drugs, but on this occasion, I was unlucky. My heart attack was catastrophic, but did not frighten me like this reaction did.

Most community staff will know patients with multiple pathology and/or long term conditions that you regularly care for. My advice, which I'm sure that you do not need, is to listen and hear what your patients say to you about how any new drugs may be affecting them. Just because your other 99 patients haven’t had any side-effects, doesn’t mean that patient 100 won’t!

I'm better now and than goodness for that, that drug has a big black mark opposite it for me in the future.