“Polypharmacy” – A blessing and/or curse
By Tom Mathei
In the epic battle against cancer and other serious health conditions, researchers and clinicians developed what we have come to know as “drug cocktails”. They found that different drugs, used to treat different conditions, could work together to fight one, or more common enemies of the body. Many of the winning combinations of drugs were found to be effective through informed guesses and a bit of pure luck. Knowing that luck played a role reinforced the fact that there were two sides to the medical coin the researchers were tossing. One side of the coin might be a miraculous lifesaver, while the other could produce extremely serious side effects, or even death. In more informed circles these drug cocktails were referred to as “polypharmacy”.
According to Wikipedia.org:
“Pol-y-phar-ma-cy – Polypharmacy is the use of multiple medications by a patient, generally older adults [those over 65 years]. More specifically, it is often defined as the use of four or more regular medications. It sometimes alternatively refers to purportedly excessive or unnecessary prescriptions. The term polypharmacy lacks a consistent definition. Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes. About 21% of adults with intellectual disability are also exposed to polypharmacy.
Although polypharmacy can be appropriate, it is more often inappropriate. Concerns about polypharmacy include increased adverse drug reactions, drug-drug interactions, prescribing cascade and higher costs. Polypharmacy is often associated with a decreased quality of life, decreased mobility and cognition.”
So what about Elvis Presley? What killed him? When Elvis passed away back in 1977 his doctors were baffled. The idea of polypharmacy and the many ways it can present itself just wasn’t the first thing doctors considered. His personal physician was treating him for simple constipation for several months before his untimely death that August. In those days men didn’t talk about such things. Nowadays every other commercial on TV is about making something soft or hard. Many seniors, such as myself, still find such talk or commercials covering such topics to be embarrassing and definitely taboo. Regardless, as computer technology rapidly developed, it allowed millions of correlations, concerning a myriad of topics to be made with a few stokes on the keyboard. As a result, more research was being done at ever increasing speeds. Looking back into Mr. Presley’s medical history with newfound understanding, and access to the number and amounts of different drugs he was taking simultaneously, it is now conjectured that Elvis died of “paralysis of the colon” brought on by polypharmacy. More specifically, the side effects of drug-drug interactions and drug cascading (one drug causes a symptom that another drug is prescribed to address) caused the colon to shut down, making it impossible to move food through his system. Very sad to say, the King of Rock and Roll died a horrific, excruciatingly painful death on his bathroom floor.
It can happen to any of us. When I hit the age of 59 years the wheels came off my health bus. In the space of two years I had spinal surgery, four eye surgeries, heart surgery, a full craniotomy for a brain aneurysm and emergency surgery for a ruptured posterior nasal artery. I had different doctors for every procedure and was taking all the meds that each prescribed. Before the heart surgery I was taking meds to reduce my blood pressure. I was puzzled as to why I was still required to take them after seeing the “after pictures” of my Left Anterior Descending Artery (the widow maker] as wide open as a fire hose. However, I felt considerably worse than before the surgery. Against my wishes and whines I was released from the hospital feeling as weak as a mosquito with an empty tank. I was told to start moving around and I would feel better with each passing day. I did move around as instructed, but kept getting light headed, especially when I bent from the waist. I assumed, because of the severe headaches that intensified with each bend, it was an after affect of the brain surgery. I was wrong. It seemed to get worse with each passing day. It was an easy guess to blame the brain surgery for my headaches. I passed out and “face planted” off my deck, in the food store, at the gas station and all over my home for several years. I tried to avoid any bending as my quality of life lead me into clinical depression.
I finally went to the Mayo clinic in Rochester, MN for a post neurosurgical work up and evaluation. After four days and $18 bazillion dollars spent, I was told flatly, “Of course you have headaches and some dizziness. You had some very serious brain surgery, Tom. What were your expectations? You’re going to have to find ways to work around it.” When they first told me I was clinically depressed, I thought they were out of their minds. After the Mayo visit, I was positive they were correct.
A few months later I went to see our family doctor for my annual check-up. Before leaving his office he handed me my new prescriptions, which I promptly dropped to the floor. I bent down to pick them up. The next thing I remembered were the lights in the ceiling of the ambulance rushing me to the hospital. I couldn’t move, but I could hear everything they were saying to the ER over the radio. My blood pressure was so low I was off their charts and realized they were charging up the heart paddles just like on TV. I finally came back to consciousness surrounded by my wife and three daughters and my cardiologist. Four of them were crying and one of them seemed to be slightly upset with me. My cardiologist had my chart and asked me, “Why in the hell are you still taking the blood pressure meds?” Apparently, after my heart surgery, his order to take me off the BP meds had been missed. I had fallen victim to polypharmacy at the hands of a simple honest mistake.
Here is what I did to insure against making a similar mistake in the future:
- I took control of my own destiny. I started asking good questions and demanding credible answers.
- I thoroughly researched my medical team and validated my choices. I was pleased with all my doctors except my GP or Family Physician. I fired him and found a better one.
- I asked my newest doctor to be my Quarterback. I had all my records sent to him. I scheduled an hour-long appointment with him to make sure we were all on the same page. We reviewed each medication I was prescribed.
- I finally started reading all the small print descriptions of each medication.
- I asked each of my different specialists to copy my GP after every visit with the details.
Sometimes it seems like life just isn’t fair. I can’t help thinking of an old Johnny Carson line, “If life was really fair, Elvis would still be alive and all the Elvis impersonators would be dead.” Take care of yourself and let’s be careful out there.