Tuesday, January 17, 2017

#6: Pills, Pills, and More Pills!

Dear Dr. Tumorific, 

I can't remember the name of the medication I take, it's round and white. Do you know the one I'm talking about?


Dear D,

Take this to heart:

One pill makes you larger, and one pill makes you small,
And the ones that mother gives you don't do anything at all.

--Jefferson Airplane

Pills, pills, and more pills. A round, white pill has the blandest of all shapes and colors. I need more information.

Is it a big pill, or a little pill? Is it tasty, or gross? What happens if you give your husband five or six of them? If they're sildenafil (Viagra), you should know right away. If it's a water pill, like furosemide (Lasix), that should be pretty easy to identify this way, too. Still don't know? Give him more! Of course, he may end up in the emergency room getting his stomach pumped, but, sometimes, that is the price of knowledge.

Okay, okay, just kidding. Do not, under any circumstances, take a whole bunch of pills you can't identify, or give them to someone else!*

The sad truth is that most of the time, we doctors have no idea what the pills we prescribe look like.** It's not our fault. Even for a single type of medicine, different manufacturers make pills that don't resemble each other at all. Sometimes, different doses from the same manufacturer don't look similar and may be nearly identical to entirely different medicines.

This can lead to dangerous or amusing situations. For instance, one friend of mine was on vacation and mistook his sleeping pills for his blood pressure pills. He then went to after-dinner cocktails and had a couple of very delicious margaritas. Even though they were small and did not taste strong, he quickly found himself quite soused.

Manufacturers could, theoretically, have some uniform standards for pill appearance (antidepressants could be blue, water pills could be yellow, and so on), but they don't. So I have no clue what your pills look like. But I do get asked questions like yours quite frequently. It happened last week. Especially as they get older and have more medical conditions, patients often don't know what it is they are taking. The complexity of the names of the drugs makes it harder. ***

A couple of weeks ago, I stayed at work quite late, taking 45 minutes to explain a patient's asthma meds to him over and over again. I then called his daughter and explained them again, because the patient seemed a little demented. The patient then came in last week and complained that I didn't bother to explain his medications. There's no pleasing some people. Another patient had been taking a medication I meant for him to stop, but actually stopped taking a medication I only wanted to change the dose on. I think I explained it pretty well, but it didn't sink in.

Try to remember what it is you are taking and why. If you can't remember the names of all of your medicines, bring the bottles in whenever you go to the doctor. Better yet, bring someone you trust with you to write them down and make a master list of the names, doses, and what they are for, including vitamins and supplements. And if you have a family member who has complicated medical problems, maybe you should volunteer to go with them to the doctor.

Digression: This is part of a larger point I plan to repeat a lot. Try NEVER go to a doctor for a complicated problem without a helper you trust. This is true if you are 93 and having memory problems, or if you are young and have a great memory. It has been true for me during my various Tumoriffic adventures. My wife is always at my side, writing things down and coming up with questions or remembering ones I forget to ask. It can be disorienting and scary to be a patient no matter who you are or how much you know. Here endeth the lesson.

So don't pay too much attention to whether your pills are red, white, or blue. Learn their names, and try to remember what they do. Yes, it is my responsibility to do my best in the limited time I am given to explain them to you. But ultimately, no one can pay as much attention to your own health as you and your family can. Know your pills.

Be well,

Dr. Tumoriffic

* Strangely enough, there is a thing called a pill party. People will come to the party and drop a bunch of pills in a jar and mix them up. Then, party-goers will just take random pills. I'm sure I could break such a party up pretty quickly if I brought a bunch of laxatives.

In other crazy pill lore, there was a rock star in the 70s who would accept random pills from his adoring fans and take them immediately. I don't think it was a member of the Grateful Dead, but it could have been. Please tell me in the comments if you know.

** A major exception would be the occasional generic Adderall pill one might find around the call room during residency.

*** The names of generic drugs are often purposely difficult to pronounce and remember. That way, the doctors and patients will have a comparatively easy time remembering the brand name when the patent runs out, so they are more likely to prescribe the brand rather than the less expensive generics.

Ginny says, "know your pills!"

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