On Bended Knee

[Guest guest]

On Bended Knee

 

" I've never been in this much pain. "

 

That's what I told my doctor when she examined my knee and suggested I

take a powerful and potentially addictive opioid drug called Oxycodone

(better known as OxyContin in its sustained-release form).

 

Apparently I may have torn a knee ligament (we're still waiting for

the results from my MRI). My concern is that if we mask the pain with

a very potent drug I'll use the leg in ways it shouldn't be used while

the knee is healing. I'm afraid that we'd interfere with the healing

process and possibly inflict permanent damage.

 

I also told my doctor I have no interest in taking drugs unless it's

absolutely necessary. Naturally, she wrote a prescription for

Oxycodone. And I'll admit I filled the scrip so that if the need did

become absolutely necessary, it would be there.

 

My doctor also wrote a prescription for an anti-inflammatory - an 800

mg dose of ibuprofen - to be taken three times each day. About this

she was adamant. She put it this way: " The anti-inflammatory is

non-negotiable. "

 

Non-negotiable! As if she had a way to hide it in my food like I do

for my dogs. But when the pain became so intense that my husband was

literally begging me to take it, I did try the ibuprofen. And it worked.

 

And here begins a simple tale of effects - and more importantly side

effects - that everyone should be aware of.

 

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Unintentional humor

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Having filled the prescription for Oxycodone I figured I might as well

read the attached information sheet. And as I suspected, I found some

entertainment there.

 

One of the first warnings I came across read: " Tell your doctor and

pharmacist if you are allergic to Oxycodone. " Incredible. And just HOW

am I supposed to know if I'm allergic to this drug? Is there a number

I can call? Or maybe there's a web site where I can check to see if my

name is on a list.

 

No. There's only one way to find out. But I wasn't willing to bite the

bullet (or swallow the pill) just to see if I was allergic.

 

Here's another statement from the info sheet that delivered some dry

comedy: " Many people who use this drug don't have serious side

effects. " MANY people! Now that's reassuring. Not " most " or the

" majority " - MANY people. So if a million people take the drug, and

50,000 don't experience serious side effects...well, 50,000 people

would qualify as " many. " You could fill a football stadium with that

many people.

 

But what did I expect, right? After all, this is a highly addictive

drug with side effects that include hallucinations, difficulty

breathing, yellowing of the skin or eyes, dizziness and vomiting. The

real surprises awaited in the ibuprofen.

 

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The java response

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Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that's

available over-the-counter in lower doses. As I've noted in many

e-Alerts, side effects range from liver and kidney impairment to an

increased risk of congestive heart failure. But how seriously should

we regard these " possible " side effects? Very seriously.

 

According to a commentary published in the journal Clinical

Cornerstone, well over 100,000 hospitalizations per year are

attributed to gastrointestinal events associated with long-term NSAIDs

use. About 15 percent of those patients die as a result of their

adverse reactions. That's more than 16,000 deaths every year.

 

The standard over-the-counter dose of ibuprofen is 200 mg. The

prescription dose my doctor gave me was FOUR TIMES that amount. So I

decided to take only one dose per day - not the three-per-day my

doctor prescribed.

 

As I mentioned above, the ibuprofen gave me relief. And I don't mind

admitting I was grateful for that.

 

But then I felt dizzy. And then I felt extremely tired. And then I

realized my mistake. I took the medication first and read the

information sheet second. And sure enough, my side effects were listed

there and on the warning sticker on the bottle. I had simply never

known that drowsiness could be a side effect on an NSAID. As I kept

reading I found other unsettling side effects, such as blurred vision

and swelling of the feet or ankles. And the most disturbing: " Vomiting

blood or vomit that looks like coffee grounds. " (No details on what

type of grind to look for; percolator, drip or espresso.)

 

Even more surprising was this instruction: " Do not lie down for 30

minutes after taking drug. " Don't lie down? I'm in pain that's intense

enough to require a mega-dose of a powerful drug, and buried in this

large sheet of instructions, printed in the smallest imaginable type,

is the advice to avoid lying down for half an hour. But there's not a

word about WHY I should not lie down.

 

Just, you know, trust us...you don't want to lie down.

 

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Take care

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The aspect of this experience that I found most daunting was the fact

that ibuprofen and other NSAIDs are so commonly used every day, but

the side effects of these higher doses are comparable to the side

effects of " serious " prescription drugs. Looking back, this makes

perfect sense. But I'm sure that many people get tripped up like this,

believing they know what to expect from a drug just because they're

comfortable using a lower dose.

 

I also believe that I was more susceptible to the effects of the drug

simply because I rarely take any prescription or over-the-counter

drugs at all. That's something that I probably have in common with

many HSI members.

 

The lesson here is simple but needs to be stated clearly: If your

doctor prescribes something much more powerful than you're used to

taking, be aware of the unique side effects that may come along with a

prescription dose. Oh, and read the instructions, warnings and list of

side effects before you're too drowsy to understand what they mean.

 

****************************************************

 

....and another thing

 

What happens in Vegas stays in Vegas. Unless you happen to be taking a

drug to address Parkinson's Disease (PD).

 

A new study from the Mayo Clinic reveals the most unusual drug side

effect I've ever encountered. While using a PD medication known as

dopamine agonists, some patients have developed serious gambling

addictions. In one case, a woman taking the medication gambled away

$100,000, prompting her husband and children to leave her. When she

later stopped taking the drug her compulsion to gamble simply

disappeared.

 

In other patients the compulsive behavior is expressed through

overeating, hypersexuality, or excessive shopping.

 

The Mayo Clinic study, which appeared in the Archives of Neurology

last month, examined 11 PD patients who had developed " pathological

gambling. " Each of the patients was taking therapeutic doses of a

dopamine agonist. Since concluding their study, clinic doctors have

identified more than a dozen additional cases.

 

In most of the cases, the dopamine agonist being taken was

pramipexole, better known by its commercial name, Mirapex. A

spokesperson for Boehringer-Ingelheim Pharmaceuticals (the maker of

Mirapex) told CBS News that the package insert for the medication was

revised earlier this year to note the rare reports about the unique

side effect. One study shows that about 1.5 percent of dopamine

agonist users may develop compulsive behavior.

 

Looking on the bright side, a press release from the Mayo Clinic

speculates that research into the way this drug affects the part of

the brain where behavior and rewards are processed could lead to

treatments for compulsive behavior.

 

Maybe then they'll be able to do something about doctors who

compulsively write prescriptions instead of first exploring non-drug

treatments.

 

To Your Good Health,

 

Jenny Thompson

 

Sources:

 

" Pathological Gambling Caused by Drugs Used to Treat Parkinson

Disease " Archives of Neurology, Early Release Article, 7/11/05,

archneur.ama-assn.org

 

" Parkinson's Drug Can Cause Compulsive Gambling " Mayo Clinic, 7/15/05,

mayoclinic.com

 

" Risky Rx for Parkinson's " CBS News, 7/11/05, cbsnews.com