Paul Jason
Chapter 15: The Wonder Drugs
I guess it’s common knowledge that advances in medicine have managed to increase life expectancy in the United States over the past hundred years. In 1900, the average American lived to the age of 48 years . By 2000 , that life span had soared to over 70 years (80.0 for white females, less for others; 74.5 for white males, less for others). Of course, part of that increase is attributable to the manipulation of numbers.
Early in the last century, diseases like tuberculosis, pneumonia, dysentery, influenza and diphtheria stole many young lives, thereby skewing the statistics. Even then, men and women lucky enough to advance beyond their adolescence and ultimately reach the ripe age of 50 years had a fairly good chance of surviving to the age of 70. Now, thanks to major advances in immunization and child care in general, the number of infants who survive their twentieth birthdays has vastly improved. Thus, the average life expectancy has risen accordingly.
But, that is only part of the story. Modern medicine has also learned how to deal much more effectively with the ailments which accompany advancing age. Today, many people are alive who would have succumbed to their illnesses if we turned the clock back twenty or thirty years.
The critical issue has become, however, not whether modern medicine can keep us alive, but rather, what kind of quality of life can we expect from modern medicine if we are allowed to remain alive through the benefit of incredibly sophisticated surgical techniques and “illness-specific” drugs.
As I mentioned in the Preface, during the ten-year period prior to my bypass surgery, I used prescription medication to reduce my total serum cholesterol level, which in 1989 was discovered to be 254 mg/dl (milligrams per deciliter). In 1987, authorities in this field had announced that the maximum acceptable serum cholesterol level was 200 mg/dl, regardless of age or sex.
My Primary Care Physician at that time prescribed the medication Lopid to accomplish that goal. I also read Robert E. Kowalski=s New York Times bestseller “The 8-Week Cholesterol Cure”. Kowalski scared the hell out of me and had me baking my own low fat oat bran muffins and eating them by the gross which, at times, was “gross”. However, my own body was simply manufacturing too much cholesterol and Lopid and oat bran together could only bring my level down to around 220 mg/dl. And that, in spite of the fact that I walked, as I discussed previously, nine to twelve miles a week during approximately seven months out of the year.
To make matters worse, my “low-density lipoprotein cholesterol” (LDL, the so-called “bad” cholesterol) was always too high, and my “high-density lipoprotein cholesterol” (HDL, the so-called “good” cholesterol) was always too low. The end result was that the ratio between my total cholesterol and my HDL always exceeded the number that Kowalski said was critical:4.5.
Thus, when the newer medication Zocor came onto the market, I discussed with my physician changing to that medication. He advised me that there was, at the time, a dichotomy within the medical community as to whether or not Zocor should be taken together with Lopid, or whether it should be taken alone. His position was on the side of the dual medication; therefore, sometime in 1993, I began a regimen of both Lopid and Zocor. That combination brought my total cholesterol level down to around 200 mg/dl, the level deemed to be the absolutely maximum acceptable level. However, the ratio between my total cholesterol and my HDL remained unsatisfactory.
Of course both of these medications had side effects and I had to have my blood drawn and tested periodically to confirm that I was not experiencing any negative liver function disorders.
Also, somewhere along the way my doctor suggested that I commence ingesting a quarter aspirin (81 mg) every day as a heart attack preventive.
Then, in mid-1998 , I heard about the newest cholesterol drug, Lipitor. I questioned my new Primary Care Physician about it and he agreed that I should try it and see what positive (and possibly negative) effects it might have on me. Thus, in October, 1998, I ceased using Lopid and Zocor and began using Lipitor. The effects turned out to be all positive. My total cholesterol dropped to around 180 mg/dl and the ratio between my total cholesterol and my HDL improved as well.
Nevertheless, as you now know, all of the progress I made in my battle against Coronary Artery Disease as a result of these medications did not prevent the necessity of my having to undergo quadruple bypass surgery in April 2000.
In the years leading up to Y2K the only regular medications prescribed to me were Lopid/Zocor/Lipitor, which I took together with one-fourth dose of a regular non-prescriptive aspirin. Since the surgery, on the other hand, I have been on a regimen of six prescriptive medications, plus aspirin.
Let me give you the names of the drugs first and then I will describe them and their side effects in greater detail. I do not mean to imply that all post-coronary bypass patients take these same medications or even any of them; I only mean to tell you that my physicians, in whom I have confidence, have recommended this menu of drugs for my short and long term welfare.
The drugs, in alphabetical order, are: Altace , Atenolol , Colchicine , Folic Acid , Furosemide and Lipitor.
All of these drugs (including the aspirin) are “wonder drugs”: it’s a wonder that I can remember to take all of them every day (except for the Furosemide, which I take every second or third day); it’s also a wonder that I can keep track of when each prescription needs to be re-filled, since I seem never to be able to get all of the prescriptions to expire on the same day of the month.
My pharmacy encloses a computer-generated sheet entitled “Patient Prescription Information” every time I have a prescription filled. The sheet provides the common brand name(s) for the drug; how to use it; its side effects; precautions; drug interactions; and actions to take in the event of an overdose or missed dose. Using that information, and with the aid of some additional research, I thought I might attempt to give you some insight into some of the medications used by post-bypass patients.
Enzymes are a group of specialized protein molecules that control biochemical reactions in the body. Altace is a member of the class of drugs known as ACE inhibitors, which are designed to inhibit certain enzymes in the body from narrowing the blood vessels, thus helping to lower blood pressure. The good news is that it seems to work very efficiently to accomplish its stated mission. The bad news is that Altace seems also to have the ability to produce rather undesirable side effects like dizziness, headaches, diarrhea, constipation, nausea, fatigue and/or dry cough. The user may also develop chest pain, tingling of the hands or feet, yellowing of the eyes or skin, persistent sore throat and/or fever. In the event the user turns out to be allergic to the medication, reactions could include rash, itching, swelling, dizziness or trouble breathing. Sounds like fun, doesn’t it? I began with a dosage of 5 mg per day (one small capsule). After a year, that dosage was reduced to 2.5 mg a day.
Aspirin (acetylsalicylic acid) has been available commercially for over one hundred years. But it was not until the early 1970s that it was discovered that aspirin inhibits the body’s production of hormone-like substances called prostaglandins, which assist in the contraction of vascular smooth muscles and the dilation of blood vessels. Thus, aspirin can prevent blood clots by preventing platelets from releasing thromboxane, a member of the prostaglandin class, which causes the platelets to clump together in a blood clot; that is, aspirin serves as an anti-coagulant.
In 1985 the U.S. Food and Drug Administration approved the use of aspirin to prevent heart attacks in patients who had either suffered a previous heart attack or suffered from unstable angina. Aspirin may also serve to reduce inflammation in the blood vessels. Current research indicates that blood vessel inflammation can lead to hardened and narrow arteries, thereby precipitating heart attacks.
However, with long term use, aspirin can have some unintended side effects. Even at low doses, aspirin can cause gastric irritation, increased occult blood loss and, occasionally, serious gastric bleeding. There is even a relatively minor increased risk of cerebral hemorrhage from sustained use of aspirin and, at high doses, dizziness, ringing in the ears and vomiting has been known to occur. To counteract some of these side effects, it is recommended that the aspirin tablet used be of the coated variety, designed to eliminate stomach distress and/or damage. My cardiologist instructed me to take one 325 mg (full strength) Ecotrin tablet every day, indefinitely. Ecotrin is an enteric-coated aspirin.
Atenolol is part of a group of medications known as Beta Blockers. Beta Blockers can control angina (chest pain), high blood pressure and irregular heartbeats. Atenolol slows down the intensity of the heart=
s contractions and reduces its oxygen requirements and the volume of blood it has to pump. It also serves to increase the diameter of the blood vessels, thereby reducing the pressure needed to move blood through the vessels.
Atenolol can cause the user to experience dizziness, lightheadedness, drowsiness and/or blurred vision. Because it reduces blood circulation to the extremities, the patient’s hands and feet may become more susceptible to cold temperatures. In addition, the patient could experience easy bruising or bleeding, swollen hands or feet, confusion, depression or sore throat.
Allergic reactions to Atenolol may include rash, itching, swelling, dizziness and difficulty in breathing (difficulty in breathing!!). Women are cautioned that this drug should be used during pregnancy only after consultation with their physicians regarding the possible risks involved. I started with a dosage of 25 mg per day (one tablet). After one year, that dosage was reduced to 12.5 mg per day. The only problem is, there is no generic 12.5 mg tablet on the market. Therefore, every month I bring home thirty 25 mg tablets and diligently cut each of them in half.
Colchicine is used to prevent and/or treat gout, a condition characterized by the sudden onset of severe pain in the joint of the big toe, or, sometimes, in the ankle, wrist, knee or elbow. The pain intensifies and the joint becomes very sensitive to the slightest
external pressure. As I explained in Chapter 6, I experienced gout for the first time in my life during those few days I spent in the hospital prior to my surgery. I suspect it may have been precipitated by the introduction of thiazide or a thiazide-like diuretic into my IV as a blood pressure medication. Thiazide diuretics are recognized as a cause of hyperuricemia which, in 70 to 95 per cent of all cases, is the result of the underexcretion of uric acid rather that the overproduction of uric acid.
Colchicine has the ability to produce the following side effects: nausea, stomach pain, vomiting, diarrhea, yellowing of the eyes or skin, sore throat, easy bruising or bleeding, muscle aches, numbness or tingling of the arms or legs, fatigue, rash and/or itchy skin. Oh, and one more happy note: alcohol can decrease the effectiveness of Colchicine, so the patient should “limit” alcohol consumption while taking this medication. I take one 0.6 mg tablet every day.
Folic Acid is a vitamin. It is found naturally in leafy green or yellow vegetables, beans and orange juice. Folic Acid helps to regulate levels of homocysteine in the blood. A high level of homocysteine is an independent risk factor for arterial disease. A usual dosage of Folic Acid, contained in many non-prescription vitamin supplements for example, is 400 mcg (micrograms). I consume two 1 mg tablets a day. That’s 5 times the amount of Folic Acid contained in the vitamin supplement. At 1 mg (the standard therapeutic dosage), it requires a prescription. Fortunately, Folic Acid has minimal side effects; but some patients do suffer allergic reactions like rash, itching, swelling, dizziness or trouble breathing.
Furosemide is a member of that group of drugs known as “water pills” or diuretics. It is a potent diuretic , which means that it acts to decrease the amount of water retained in the body by increasing urination. Thus it counteracts edema (fluid retention and swelling of the hands and feet caused by heart failure or other diseases) and high blood pressure. Its side effects are interesting, if not familiar by now: dizziness, lightheadedness, increased sensitivity to sunlight, blurred vision, loss of appetite, itching, stomach upset, headaches and weakness, muscle cramps, pain, nausea, vomiting, dry mouth, thirst, unusual bleeding or bruising, rash, yellowing of the eyes or skin and/or ringing in the ears.
And whereas the effectiveness of Colchicine is decreased by the consumption of alcohol, the side effects of Furosemide may be intensified by the intake of alcohol. Women are cautioned that this drug should be used during pregnancy only after consultation with their physicians regarding the possible risks involved.
During the first year after my surgery I took one 40 mg tablet of Furosemide every other day. After one year, I reduced that intake to about every third day. During the first six hours or so after ingestion, the drug induces sudden, strong urges to urinate. This will occur repeatedly during that time frame. It is a highly unpredictable phenomenon. Needless to say, you will want to be sure that a toilet will be accessible and available to you at all times during that six hour period once the pill has slid down your throat. If you don’t follow this advice, then don’t say I didn’t warn you.
Finally, Lipitor is one of the statin group of drugs which are being used to help reduce cholesterol and triglycerides (fats) in the blood. It works by inhibiting cholesterol synthesis in the liver. Lipitor, too, can produce some of the nasty side effects I have alluded to above: headache, nausea, diarrhea, constipation, gas, stomach upset, joint pain, muscle pain, weakness, fever, unusual tiredness, chest pain, swelling in the arms or legs, dizziness, yellowing of the eyes or skin, dark urine, vision problems and black stools. As if that wasn’t enough, allergic reactions can include rash, itching, severe dizziness and/or trouble breathing. Frequent ingestion of alcohol may increase the possibility of serious side effects. Also, as with all statin drugs, liver function must be monitored periodically through blood tests to be sure the medication does not have a negative impact.
Lipitor does have one idiosyncracy, however: you cannot eat a grapefruit or drink grapefruit juice while using this medication. I don’t know why; you just can’t do it.
Finally, this drug cannot be taken during pregnancy since it may cause fetal harm.
There, that’s the whole of it. Based upon an orderly cataloging of the side effects I have described, you may have surmised that I walk around lightheaded; am unable to focus on the world around me; run to the bathroom at least once every hour; have yellowed eyeballs and rashes all over my body; appear slightly swollen; am prone to nausea, with ice cold hands and feet; given to scratching myself in the most intimate of places; chronically tired, slightly feverish, possessing no appetite and complaining constantly of muscle cramps.
If that’s your conclusion, I’m here to tell you that you are . . . wrong (. . .or at least I think you’re wrong!).
To be continued…
Ellen Bittner