Monthly Archives: May 2017

Are your prescription drugs making you sicker?

Drugs! It’s something I’m extremely passionate about for so many reasons.

Are your prescription drugs making you sicker?

We have a huge problem with legal prescription drugs in this country. Although drug addiction and alcoholism are always heavy on my heart – that’s not what I’m referring to. It’s a much different kind of drug problem. I’m referring to legally prescribed drugs that our people are taking as prescribed. They aren’t abusing. They aren’t doing anything illegal. But they are getting sicker and sicker and some are having to choose between the huge expense of the drugs or food. Ask a home health nurse. We are in the homes of our patients and we see how they are living and what they are sacrificing.

It’s a problem that is costing us millions and millions in lives and dollars. It’s affecting our Medicare, Medicaid, insurance and personal dollars. It’s affecting our quality of life. It’s affecting our loved ones especially as they grow older. For healthcare providers, it’s affecting our outcomes, profit, reimbursement and star ratings. It is affecting every aspect of our healthcare. The problem is HUGE and is negatively affecting lives and dollars.

I’m a Registered nurse and I’ve been in some form of healthcare since I was 16 years old – that’s 30 years. I come from a big family full of nurses. I’ve worked in many different areas of healthcare…from a certified nursing assistant, a Registered Nurse Case Manager to a Regulator – State Surveyor for home health. I have a pretty good understanding of the problem and know it is so much more than how it appears on the surface.

Here are some of the issues (please know…there are people who do everything right with their diet, exercise and health but they still get sick. Genetics play a part in our wellness. I’m not referring to them.) …

    1. We eat food that isn’t even food. It damages our cells/body and allows disease to form and grow.
    2. We put chemicals on our body and in our home, that are making us sick.
    3. We look for quick fixes that treat symptoms rather than root causes. Research the difference between modern medicine and functional medicine.
    4. We aren’t wellness advocates for ourselves or our loved ones especially the older generations. If a healthcare professional tells our elderly to do something they usually comply and don’t research and ask questions.
    5. In a world that is plagued with over prescribing, over seeking, over using and abusing medications – we have become a nation that is dependent on drugs. Legally prescribed drugs.

I’ve reviewed many medical records in my day. It has given me the ability to see things differently and from different perspectives that not everyone sees. A lot of times I work backwards. I first look to see – why the patient was hospitalized. Then I look to see…if there was information in the record that would have suggested the negative outcome was approaching. Was the physician notified of the concerns? Were appropriate interventions carried out? Was something missed? Was there something that could have been done differently to prevent the negative outcome? Most often, I find healthcare providers have done most everything well. Most of the issues I find are tied to the patient’s prescription medications.

Do some research. Most of our sick population is on 20-30 different medications. That is craziness. These people aren’t people who have had organ transplants and are required to take numerous medications for the rest of their lives to keep from rejecting an organ. These are normal people who had issues. Just like you and me. Medications were added. Their issues grew. More medications were added. Their issues grew. It is a continuous cycle. It’s sick care. For the most part, if we get real – we aren’t in healthcare. We are in sick care. As a nurse, that was a hard thing for me to swallow. I had always been told I was in healthcare and that’s what I believed. Until I learned more.

Have you seen the picture of the t-shirt on the internet that shows the craziness of how medications are ordered? Here’s what it says…

“I take aspirin for the headache caused by the Zyrtec I take for the hay fever I got from Relenza for the uneasy stomach from the Ritalin I take for the short attention span caused by the Scopederm Ts I take for the motion sickness I got from the lomotil I take for the diarrhea caused by the Zenikal (spelled wrong) for the uncontrolled weight gain from Paxil I take for the anxiety from Zocor…”

Remember the people who are on 20-30 different drugs? Think about it. How did they get to that point? Usually, we get a medicine for one thing and then the side effects of that medicine lead us to more medicine. Then the side effects of that medicine lead us to more. It’s never ending.

So here is an example of what we see. Remember – this is pretty much the norm for our industry. And while you are reading, think long and hard about where you are going because if you don’t have a plan to support wellness – you may soon find yourself on 20-30 different prescription drugs and feeling worse.

Who – person in their 70s with numerous hospitalizations/emergency room visits over the last couple of years.

Diagnoses – 13 different ones. These are typical diagnoses we see routinely for one person – COPD/pneumonia/oxygen dependent, gastrointestinal, Cardiac/Heart failure, Diabetes, Arthritis, Parkinson’s, muscle weakness, difficulty walking, history of falls

Drugs: thirty different ones. Did you catch that? 30 DIFFERENT drugs!!!!

Drug Interactions: 37 different drug interactions (29- level 3 interactions, 5- level 2 interactions, 3- level 1 interactions)

ranging from…

  • level 3 – Moderate interactions – assess the risk to the patient and take action as needed.
  • level 2 – Severe interactions – action is required to reduce the risk of severe adverse interaction.
  • level 1 – the most severe – Contraindicated drug combination: this drug combination is contraindicated and generally should not be dispensed or administered to the same patient.

As I looked up some of the interactions it was stuff like…

    • May result in life threatening arrhythmia. The patient had cardiac/heart issues.
    • Anorexia, nausea, vomiting, headache, fatigue, malaise, drowsiness, generalized muscle weakness, disorientation, hallucinations, visual disturbances and arrhythmias. Yes, the patient had most of these too.
  • Concurrent use of opioids and benzodiazepines may result in profound sedation, respiratory depression, coma, and/or death. There was recently a FDA Box warning added for opioids and benzodiazepines – I wonder how these interactions might be contributing to the patient’s pneumonia/COPD issues?
  • May increase the risk of acute phosphate nephropathy, which is an acute kidney injury associated with deposits of calcium phosphate crystal in the renal tubules that may result in permanent renal function impairment. Hmmm…I didn’t dig into this but I’d bet this patient has had kidney issue or urinary tract infections.
  • Could potentially result in gastrointestinal erosions, ulcers, stenosis and bleeding. Yep, the patient had a Gastro diagnosis as well.
  • Could increase the risk for serotonin syndrome. Symptoms of serotonin syndrome may include tremor, agitation, diaphoresis, hyperreflexia, clonus, tachycardia, hyperthermia and muscle rigidity. Hmmm…the person had a dx of Parkinson’s, muscle weakness, difficulty walking, history of falls.
  • May result in myopathy and rhabdomyolysis. Yep this too.
  • Which came first? So were the medications prescribed for the issues or were the issues caused by the medications?

Are you seeing any common threads? Insanity? Any reason for you to take charge of your wellness?

For our industry, we are required to notify the physician of drug interactions. We do.  However, it is so much more complicated than one physician just looking at the information and stopping the medications. And honestly, we can’t blame physicians. Some people over seek medication and aren’t willing to try other wellness approaches so physicians don’t have any other choice but prescribe. Most people don’t just see one physician. They see a specialist for each issue – diabetes (endocrinologist), cardiac (cardiologist), skin (dermatologist), urinary issues (urologist) arthritis (rheumatologist), ortho (orthopedic surgeons) and so many more. Each of those specialists are ordering different medications to treat the symptoms they are dealing with. It easily becomes one big nightmare. Not to mention, there is a huge nightmare with reimbursement and physicians are being limited on how many minutes they can spend with a patient. Insurance companies are directing physicians to discharge patients from the hospital even when the physician doesn’t feel the patient is ready. The patients are coming back to the hospital within 30 days and the hospitals are being penalized and money is being taken back. A Heart failure patient may go into the hospital with dehydration and their Lasix is stopped. The patient will be promptly discharged at the requirement of the insurance company and the Lasix doesn’t get restarted. Soon the patient ends up back in the hospital because of exacerbation of heart failure. The hospital is penalized for the readmission and so much more. It’s a mess and a perfect storm for so many bad outcomes. It isn’t something that can just be blamed on one person or one group. It’s a healthcare industry problem that requires a lot of focus and attention. Have you seen the movie Sicko? If not, I highly encourage you to watch it. It’s about 10 years old (2007) but still has so much great info about the failures of our healthcare system.

And if you must go on a medication, please consider the old ones that have been around for many years and have a history behind them. They are cheaper too. Remember Phen Phen? It was a miracle weight loss drug that took so many lives. Unless you have no other choice, don’t let your family be the guinea pigs.

Research side effects and drug interactions and discuss any concerns with your physician.

I’m not writing this to solve the drug problems of our Industry because that is enormous. And I’m not up for battling big pharma or insurance companies but I do want to shed some light and get people to pay attention, to research your drugs, side effects and learn how to manage your wellness and make informed decisions about drugs and how they may affect you.

Big Pharma’s drugs save lives. I’ve seen it. But they take lives too. I’ve seen that too.

Be an advocate for yourself and others. Be informed. Be intentional. Be mindful of your wellness.

Much love,

Kandy

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