A Service of Dr. Val Karan - 558 Anderson Avenue - Cliffside Park, New Jersey 07010 - (201) 943-2726 - Karan4U@aol.
com - January 2003
KARAN 4U NEWSLETTER
My Drug Dreads and Dream Team
Dear Clients, friends and relatives,
I never thought I’d have to admit what I’m about to
confess, but say “Hello” to a sufferer of drug abuse.
Before you get the wrong idea, let me make one
point perfectly clear: I didn’t abuse drugs, my
prescription drugs abused me!
To explain how this happened, permit me to
backtrack to my last two newsletters. In the last issue, I
explained that, because of atrial fibrillation and high
blood pressure, my doctors have given me a
smorgasbord of medications, including a blood thinner.
I also have written about my son’s wedding plans.
In preparation for the marriage which took place
November 7, I had some minor nuisance health
problems that had to be taken care of first. One
concerned an aching wisdom tooth that had to be
removed. The other involved a bothersome bruise that
mysteriously appeared on my right shin and that caused
some pain and limping. My doctor at the time reckoned
that I was suffering from cellulitis; he also knew that I
desperately needed to be steady on my feet so that I
could dance at Edward and Nancy’s wedding. So just as
the oral surgeon had prescribed an antibiotic for me
which ran its course, so, too, the physician put me on
another antibiotic as well.
Here’s where the story turns dicey. In the weeks
leading up to the wedding, I took the new antibiotic
faithfully and my leg kept getting stronger. When the
day of the wedding arrived, I was able to join in some,
if not all, of the dancing. What was bothering me more,
however, was a nagging diarrhea. The food at the
wedding was delicious, but it didn’t stay inside me very
long. So, too, for the next few weeks, despite various
home remedies, nothing seemed to stem the tide of the
diarrhea. Even some medicine which the doctor
prescribed only made the situation worse.
Finally, on November 18, I went to the physician’s
office again. If I say so myself, I looked and felt
miserable. This time I saw my gastroenterologist, and
she ordered an ambulance to take me to Holy Name
Hospital for more intensive treatment.
The condition I had was an antibiotic induced
diarrhea that is technically called Clostridium
Difficile (or just C Difficile). Antibiotics do not just
attack the infection they are prescribed for. They can
also kill useful bacteria that help you digest food and
normally protect you against other infections.
Antibiotic-induced changes in intestinal bacteria
allow overgrowth of Clostridium Difficile, a bacteria
that causes serious diarrhea. I was warned that about
10% to 20% of patients will experience relapse -
regardless of what treatment is given. For almost a
week, I remained in the hospital being rehydrated
constantly and being treated, ironically, with another
antibiotic that counteracted the C Difficile.
Although my stomach must have shrunk
throughout this ordeal, by the time I was released
from the hospital (where, incidentally, the atmosphere
and staff were pleasant and professional), I was
b l o a t e d f r o m
the medication and water retention and looked as if I
had gained weight. I stayed home from work for
another week to recover and to prepare for a visit
from my grandsons for Chanukah.
On November 24, when my daughter and son-in-
law and their three sons came by, I was feeling better
than I had in many weeks. I went to bed that night
thinking that the worst was over and I would be back
to my regular schedule shortly.
During that night, I was assaulted with intense
diarrhea. I could barely make it back to bed, and I
knew I had had some sort of a setback. I somehow
managed to get back to the doctor’s office early the
next morning. Once again she admitted me to the
hospital for what turned out to be severe gastritis and
bleeding, a reaction of my body to the blood thinners
and combination of other medicines. This time my
hospital stay was not so long, but it included blood
transfusions, rehydration, and new medicines. I was
A Service of Dr. Val Karan - 558 Anderson Avenue - Cliffside Park, New Jersey 07010 - (201) 943-2726 - January 2003 -
home before the weekend where I needed another
week of rest and recuperation before I could return
to my practice and my school psychology job.
So what can we laymen do to forestall any
possible abuse by the prescription drugs? I am
indebted to my friend Robert Zweiman, Past
National Commander of the Jewish War Veterans,
who recently wrote an incisive article, that is both
serious and tongue in cheek, about the potential
harmful interactions between common drugs we
take. Bob passed out as he was about to deliver a
eulogy, and he woke up later in a hospital
emergency room. After extensive tests, the doctors
concluded that he blacked out from the inherent
nature of and conflict between some of the
medicines which he had been taking. Bob warns us
that we should all become more aware of our
prescription drugs and their effects and should have
answers to the following questions:
 Do you know what drugs you are taking?
(always keep a list handy with proper
dosages)
 Do you know what condition those drugs are
for?
 Do you know the impact of one drug on
another?
 Do you know whether they are to be taken
on an empty stomach or with food?
 Do you know whether they can all be taken
together at the same time or how the taking
should be timed?
 Do you know whether there are alternatives
to medications which you should consider?
 Do you know the effect of the drugs on your
body?
Just as little or no information can be dangerous,
so, too, too much informed consent can be
confusing. I don’t know about you, but I get sick
just reading the warnings and contraindications in
small print on the back of prescription drug ads in
magazines or a Physician’s Desk Reference (PDR).
That is why choosing trusted primary care doctors is
one of the most important health care decisions you
will make. I say “doctors” because I've come to
the conclusion that is it is not only in matters of
law and sports that one should have a dream
team. The human constitution, it seems to me, is
too complex to be entrusted to just one medical
specialist. Choosing the optimal persons from
whom to receive health care requires knowing more
than just the qualifications of the providers. Also to
be considered are perceived traits such as
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availability, "style" or communication patterns
(informal, warm vs. formal, detached), philosophy
of care (disease-oriented vs. wellness-oriented),
therapeutic approaches (conservative vs.
aggressive), competency, and degree of inviting
patient involvement.
As one medical expert has written, "You can
have a doctor who is the most intelligent person in
the world, but without a lot of compassion, they
probably aren’t going to go the extra mile to take
care of you."
Sometimes, even after a careful selection
process, it turns out that your personality just
doesn’t mix with your doctor’s personality. When
that happens, don’t be afraid to find a new doctor.
That’s what I did.
Luckily for me, I had four physicians who were
communicating with me and with each other during
my health crisis. Whenever I had a question about
my condition, medicine or treatment, I could always
count on a settling answer from one or more of my
dream team members who were in frequent contact
with one another. The gastroenterologist who
admitted me to the hospital is a rising star, certainly
in my galaxy. Dr. Susan Fishbein oversaw every
aspect of my care with such skill and reassurance
that from now on I will rely on her as my primary
care physician since she is an internist as well as a
specialist. I also have a great cardiologist by the
name of Dr. Jose Meller of Mount Sinai hospital. I
would guess that Dr. Meller has to be one of the
busiest cardiologist in New York City whose offices
are always teeming with patients and who invariably
has emergency calls while he is in the examining
room. Yet not matter how many cases he is juggling,
he always has a calm and assuring demeanor; and
when he is talking to you, he is totally focused on
you and your condition. Joining All-Stars Meller
and Fishbein on my dream team was Dr. Robert
Lesser, my wife’s cousin and a rheumatologist who
has made New York Magazine’s list of top doctors,
and our own daughter Dr. Suzanne Karan, my
favorite anesthesiologist.
Our health is a thing we all take for granted,
Until diarrhea hits that can’t be Mylanta-ed.
So my Dream Team is set for the staying well game,
As when drug skull-duggery brought me to Holy
Name.
May your health stock rise in 2003,
And let’s all enjoy peace and security.