Case in point. A chiropractor recently referred an elderly gentleman (73 years old) to me for low back pain following a spinal fusion in the lumbar spine.
Come to find out, the chiropractor had done a multiple number of therapies, several times a week, for several weeks without any success: spinal adjustments, cold laser therapy, ultrasound. All he was able to do was successfully run through the patients insurance money. At what point does a doctor with integrity tell a patient that there is nothing else they can do for them? Granted, every patient is different. They all respond differently to each therapeutic modality. Each patient has their own unique history that can inhibit their body's healing processes. Some of a patients history is due to their own lack of attention to proper diet, lifestyle, exercise, etc. The other problem with a patients history is due to poor or incorrect treatment strategies by their doctors. I believe in doing all I can to help educate patients so that they will have the necessary tools to make good choices in order to enhance their health and well being. Unfortunately, most medical professionals are so over-worked, just to keep their doors open, that they don't make time to empower patients to help themselves. The end result is that it becomes easier, not better, to simply prescribe more medications or perform more surgeries.
Getting back to my new patient, he brought in his list of medications and significant medical procedures.
And people wonder why they're not feeling well or not getting better.
Significant medical procedures or events from 1987 to 2009:
3 heart attacks
Triple by-pass heart surgery
Polyps removed during colonoscopy, 3 times
Gallbladder removed
Double knee replacement
Congestive heart failure, 3 times
Prostate Cancer surgery
Spinal fusion in lumbar spine
Heart catheterization
Defibrillator/Pacemaker installed
Current list of medications:
* carvedilol
* Celebrex
* Diovan
* dipyridamole
* furosemide
* Klor-Con M
* Levoxyl
* Lovaza
* metformin
* Niaspan
* Novolin 70/ 30
* pantoprazole
Whenever a patient is taking more than 2 or 3 medications, I like to run a report of any possible interactions to see if there is anything to be concerned about. The report for this patient is listed below:
Avoid/Use Alternative
1. carvedilol <-> Celebrex
monitor BP, use alternative: combo may cause sodium/water retention, decreased antihypertensive efficacy (antagonistic effects)
2. carvedilol <-> Novolin 70/ 30
use alternative: combo may alter glucose metababolism, prolong hypoglycemia, mask hypoglycemic sx (adrenergic antagonism)
Monitor/Modify Tx
3. carvedilol <-> metformin
monitor glucose: combo may alter glucose metab., prolong hypoglycemia, mask hypoglycemic sx (adrenergic antagonism)
4. Celebrex <-> Diovan
monitor BP, renal fxn: combo may decr. antihypertensive efficacy, incr. risk of nephrotoxicity (antagonistic effects, additive effects)
5. Diovan <-> furosemide
monitor BP, use for therapeutic advantage: combo may incr. risk of hypotension (synergistic effects)
6. Diovan <-> Klor-Con M
monitor potassium, check potassium content of supplement: combo may incr. risk of hyperkalemia (additive effects)
7. furosemide <-> metformin
monitor glucose: combo may decr. hypoglycemic agent efficacy; loop diuretics may cause hyperglycemia (antagonistic effects)
8. furosemide <-> Novolin 70/ 30
monitor glucose: combo may incr. insulin requirement, loop diuretics may cause hyperglycemia (antagonistic effects)
9. Levoxyl <-> metformin
monitor glucose: combo may decr. hypoglycemic agent efficacy; high dose thyroid hormone may cause hyperglycemia (antagonistic effects)
10. Levoxyl <-> Novolin 70/ 30
monitor glucose: combo may incr. insulin requirement, high dose thyroid hormone may cause hyperglycemia (antagonistic effects)
11. metformin <-> Niaspan
monitor glucose: combo may decr. hypoglycemic agent efficacy; niacin may cause hyperglycemia (antagonistic effects)
12. metformin <-> Novolin 70/ 30
monitor glucose, use for therapeutic advantage: combo may incr. risk of hypoglycemia (synergistic effects)
13. Niaspan <-> Novolin 70/ 30
monitor glucose: combo may incr. insulin requirement, niacin may cause hyperglycemia (antagonistic effects)
Caution Advised
14. carvedilol <-> Lovaza
caution advised: combo may antagonize antihyperlipidemic effect of omega-3-acid (antagonistic effects)
15. carvedilol <-> Niaspan
caution advised: combo may incr. risk of orthostatic hypotension (additive effects)
16. Celebrex <-> furosemide
caution advised: combo may decr. diuretic, natriuretic, antihypertensive effects of loop diuretics, incr. risk of nephrotoxicity (antagonistic effects, additive effects)
17. dipyridamole <-> Lovaza
caution advised: combo may incr. risk of bleeding (additive antiplatelet effects)
Really?! I'm positive this patient was never informed of the interactions or the side affects of all these medications. It's very sad to see what is happening to our "senior citizens". They were raised in an age where you could put all your trust in the medical profession. That trust has failed this patient and I'm sure it has failed many others.
I can't help but think that western medicine has, somehow, gotten off-track. Whatever happened to "doing no harm"? There seems to be a real lack of connection of medical doctors with their patients. Actually, I hear complaints about this, quite often, from my own patients. Unfortunately, most of the population in Western society are convinced that western medicine has all the answers. This case illustrates how off-base this system has become. Just the other day, another one of my patients asked me how to file a complaint with my state's medical board. I asked her why, was she going to file a complaint about me? She assured me that she wasn't but related her own horror story and experience with "one" of her many other physicians. It seems to be a rampant problem in main-stream medicine.
The medical profession, in general, is broken. The focus needs to be put back on the patient, not the bottom line.
