A Service of Dr.

Val Karan - 558 Anderson Avenue - Cliffside Park, New Jersey 07010 - (201) 943-2726 - Karan4U@aol.com - January 2003

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-inlaw 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 -

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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

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.