HAVING A CHRONIC ILLNESS usually means taking one or more medications. It is therefore a very important management task to understand your medications and to use them appropriately. This chapter will help you do just that.
A Few General Words About Medications
Few products are more heavily advertised than medications. If we read a magazine, listen to the radio, or watch TV, we see a constant stream of ads. These are aimed at convincing us that if we just use this pill, our symptoms will be cured. “Recommended by 90% of the doctors asked,” they say. But be aware that they may have asked doctors working for the company or only a handful of doctors. And have you noticed that on TV, the ads present the benefits in a slow, upbeat voice, while the side effects are recited very rapidly? Almost as a backlash to this advertising, we have been taught to avoid excess medications. We have all heard about or experienced some of the bad effects of medications. It can be very confusing.
Your body is often its own healer, and given time, many common symptoms and disorders will improve. The prescriptions filled by the body’s own “internal pharmacy” are frequently the safest and most effective treatment. So patience, careful self-observation, and monitoring with your doctor are often excellent choices.
It is also true that medications can be a very important part of managing a chronic illness. These medications do not cure the disease. They generally have one or more of the following purposes:
To relieve symptoms. For example, an inhaler delivers medications that help expand the bronchial tubes and make it easier to breathe. A nitroglycerin tablet expands the blood vessels, allowing more blood to reach the heart, thus quieting angina. Acetaminophen (Tylenol) can relieve pain.
To prevent further problems. For example, medications that thin the blood help prevent blood clots, which cause strokes and heart and lung problems.
To improve or slow the progress of the disease. For example, nonsteroidal anti-inflammatory drugs can help arthritis by quieting the inflammatory process. Likewise, antihypertensive medications can lower blood pressure.
To replace substances that the body is no longer producing adequately. This is how insulin is used to manage diabetes and thyroid medication for underactive thyroid.
Thus the purpose of medication is to lessen the consequences of disease or to slow its course. You may not be aware that the medication is doing anything, such as slowing the course of your disease—keeping you from getting worse or helping you get worse more slowly. You may not feel anything, and this may make you think that the drug isn’t working. It is important to continue taking your medications, even if you cannot see how they are helping. If this concerns you, ask your doctor.
We pay a price for having such powerful tools. Besides being helpful, all medications have undesirable side effects. Some of these effects are predictable and minor, and some are unexpected and life-threatening. Some 5% to 10% of all hospital admissions are due to drug reactions. At the same time, not taking medications as prescribed is also a major cause of hospitalization.
Mind Power: Expect the Best
Medication affects your body in two ways. The first is determined by the chemical nature of the medication. The second is triggered by your beliefs and expectations. Your beliefs and confidence can change your body chemistry and your symptoms. This reaction is called the placebo effect. It is an example of how closely the mind and body are connected.
Many studies have shown the power of the placebo—the power of mind over body. When people are given a placebo (pill containing no medication), some of them improve anyway. Placebos can relieve back pain and chronic pain, fatigue, arthritis, headache, allergies, hypertension, insomnia, asthma, irritable bowel syndrome and chronic digestive disorders, depression, anxiety, and pain after surgery. The placebo effect clearly demonstrates that our positive beliefs and expectations can turn on our self-healing mechanisms. You can learn to take advantage of your powerful internal pharmacy.
Every time you take a medication, you are swallowing your expectations and beliefs as well as the pill. So expect the best!
Let’s look at some ways to do that.
Examine your beliefs about the treatment. If you tell yourself, “I’m not a pill taker” or “Medications always give me bad side effects,” how do you think your body is likely to respond? If you don’t think the prescribed treatment is likely to help your symptoms or condition, your negative beliefs will undermine the ability of the pill to help you. You can change these negative images into more positive ones. (Reviewing the discussion of positive thinking in Chapter 5 can help with this.)
Think of your medications the way you think of vitamins. Many people associate healthful images with vitamins—more so than with medications. Taking a vitamin makes you think that you are doing something positive to prevent disease and promote health. So if you regard your medications as health-restoring and health-promoting, like vitamins, you may obtain more powerful benefits.
Imagine how the medicine is helping you. Develop a mental image of how the medication is helping your body. For example, if you are taking thyroid hormone replacement medication, tell yourself it is filling a missing link in your body’s chemical chains to help balance and regulate your metabolism. For some people, forming a vivid mental image is helpful. An antibiotic, for example, might be seen as a broom sweeping germs out of the body. Don’t worry if your image of what’s happening chemically inside of you is not physiologically correct. It’s your belief in a clear, positive image that counts.
Keep in mind why you are taking the medication. You are not taking your medication just because your doctor told you to. You are taking your medication to help you live your life. It is therefore important to understand how the medicine is helping you. You can use this information to help the medicine do its job. Suppose a woman with cancer is given chemotherapy. She has been told that it will make her feel like she has the flu, she will vomit, and her hair will fall out. So of course, that is what she thinks about and that is what happens. But suppose she is also told that the symptoms will last only a few days, that hair falling out is a good sign because it means that cells that grow fast (cancer and hair) are being destroyed, and that her hair will grow back after chemo. In that case, she may regard her hair loss, flu-like symptoms, and vomiting as signs the drugs are working. She can then take actions to counter these effects and often have an easier time tolerating them. The presence of side effects can sometimes be your proof that the medicine is working.
Taking Multiple Medications
People with multiple problems often take many medications: a medication to lower blood pressure, anti-inflammatory drugs for arthritis, a pill for angina, a bronchodilator for asthma, antacids for heartburn, a tranquilizer for anxiety, plus a handful of over-the-counter (OTC) remedies and herbs. The more medications (including vitamins and OTC remedies) you are taking, the greater the risk of unpleasant reactions. Also, not all drugs like each other, and when they get together, they sometimes cause problems. Fortunately, it is often possible to take fewer medications and lower the risks. However, you should not do this without the help of your doctor. Most people would not change the ingredients in a complicated cooking recipe or throw out a few parts when fixing something in the car or home. It is not that these things can’t be done. It is just that if you want the best and safest results, you may need expert help.
How you respond to any one medication depends on age, metabolism, daily activity, the waxing and waning of symptoms, your chronic conditions, your genetics, and your frame of mind. To get the most from your medications, your doctor depends on you. Report what effect, if any, the drug has on your symptoms and any side effects. Based on this critical information, your medications may be continued, increased, discontinued, or otherwise changed. In a good doctor-patient partnership, there is a continuing flow of information in both directions.
Unfortunately, this vital interchange is often shortchanged. Studies indicate that fewer than 5% of patients getting new prescriptions asked any questions about them. Doctors tend to interpret patient silence as understanding and satisfaction. Problems often occur because patients do not receive enough information about medications or do not understand how to take them. In addition, all too often people do not follow instructions. Safe, effective drug use depends on your doctor’s expertise and equally on your understanding of when and how to take the drug, and the necessary precautions. You must ask questions. (Our discussion of communication in Chapter 9 can help.)
Some people are afraid to ask their doctor questions. They are afraid that they will seem foolish or stupid or that they might be perceived as challenging the doctor’s authority. But asking questions is a necessary part of a healthy doctor-patient relationship.
The goal of treatment is to maximize the benefits and minimize the risks. This means taking the fewest medications, in the lowest effective doses, for the shortest period of time. Whether the medications you take are helpful or harmful often depends on how much you know about your medications and how well you communicate with your doctor.
What You Need to Tell Your Doctor
Even if your doctor doesn’t ask, there is certain vital information about medications you should mention during every consultation.
Are you taking any other medications?
Report to your physician and your dentist all the prescription and nonprescription medications you are taking, including birth control pills, vitamins, aspirin, antacids, laxatives, alcohol, and herbal remedies. An easy way to do this is to carry a list of all medications along with the amount you take (dosage). Or bring all your medications to the doctor visit. Saying that you are taking “the little green pills” isn’t very helpful.
This is especially important if you are seeing more than one physician. Each one may not know what the others have prescribed. Knowing all your medications and supplements is essential for correct diagnosis and treatment. For example, if you have symptoms such as nausea or diarrhea, sleeplessness or drowsiness, dizziness or memory loss, impotence or fatigue, they may be caused by a drug side effect rather than a disease. If your doctor does not know all your medications, he or she cannot protect you from drug interactions.
Have you had allergic or unusual reactions to any medications?
Describe any symptoms or unusual reactions caused by medications. Be specific: which medication and exactly what type of reaction? A rash, fever, or wheezing that develops after taking a medication is often a true allergic reaction. If any of these develop, call your doctor at once. Nausea, diarrhea, ringing in the ears, light-headedness, sleeplessness, and frequent urination are likely to be side effects rather than true drug allergies.
What are your chronic diseases and other medical conditions?
Many diseases can interfere with the action of a drug or increase the risk of using certain medications. Diseases involving the kidneys or liver are especially important to mention because these diseases can slow the metabolism of many drugs and increase toxic effects. Your doctor may also avoid certain medications if you now or in the past have had such diseases as high blood pressure, peptic ulcer disease, asthma, heart disease, diabetes, or prostate problems. Be sure to let your doctor know if you are possibly pregnant or are breastfeeding. Many drugs cannot be safely used in those situations.
What medications were tried in the past to treat your disease?
It is a good idea to keep your own records. What medications were used in the past to manage your condition, and what were the effects? Knowing what has been tried and how you reacted will help guide the doctor’s recommendation of any new medications. However, the fact that a medication did not work in the past does not necessarily mean that it can’t be tried again. Diseases change, and the same medication may work the second time.
What to Ask Your Doctor or Pharmacist
There is also important information that you need to know about your medications. Be sure to ask the following questions.
Do I really need this medication?
Some doctors prescribe medications not because they are really necessary but because they think patients want and expect drugs. Doctors often feel pressure to do something for the patient, so they prescribe a new drug. Don’t pressure your doctor for medications. Many new medications are heavily advertised and promoted by their manufacturers. Quite a few medications that were heavily marketed were later found to be so hazardous that they were withdrawn. So be cautious about requesting the newest medications. If your doctor doesn’t prescribe a medication, consider that good news. Ask about nondrug alternatives. In some cases, lifestyle changes such as exercise, diet, and stress management should be considered. When any treatment is recommended, ask what is likely to happen if you postpone treatment. Sometimes the best medicine is none at all, and sometimes it is taking a powerful medication early to avoid permanent damage or complications.
What is the name of the medication, and what dosage do I take?
Keep a record of each medication you take, noting its brand name, if any; the generic (chemical) name; and the dosage your doctor has prescribed. If the medication you get from the pharmacy doesn’t match this information, ask the pharmacist to explain the difference. This is your best protection against medication mix-ups.
What is the medication supposed to do?
Your doctor should tell you why the medication is being prescribed and how it might help you. Is the medication intended to prolong your life, completely or partially relieve your symptoms, or improve your ability to function? For example, if you are given a medicine for high blood pressure, the medication is given primarily to prevent later complications (such as stroke or heart disease) rather than to stop a headache. On the other hand, if you are given a pain reliever such as ibuprofen (Motrin), the purpose is to help ease the headache. You should also know how soon you should expect results from the medication. Drugs that treat infections or inflammation may take several days to a week to show improvement, and antidepressant medications and some arthritis drugs typically take several weeks to start providing relief.
How and when do I take the medication, and for how long?
If medications are going to work you must take them when you are supposed to take them, in the amounts you are supposed to take them, and as long as you are supposed to take them. This is crucial to their safe and effective use. Does “every 6 hours” mean every 6 hours while awake or every 6 hours around the clock? Should the medication be taken before meals, with meals, or between meals? What should you do if you accidentally miss a dose? Should you skip it, take a double dose next time, or take it as soon as you remember? Should you refill and continue taking the medication until you have fewer symptoms or until you finish the current medication? Some medications are prescribed on an as-needed (“PRN”) basis, so you need to know when to begin and end treatment and how much medication to take. You need to work out a plan with your doctor to suit your individual needs.
Taking the medication properly is vital. Yet nearly 40% of people report that their doctors failed to tell them how to take the medication or how much to take. If you are not sure about your prescription, contact your doctor or pharmacist.
What foods, drinks, other medications, or activities should I avoid while taking this medication?
Food in the stomach may help protect the stomach from some medications but make other drugs ineffective. For example, milk products or antacids block the absorption of the antibiotic tetracycline. This drug is best taken on an empty stomach. Some medications may make you more sensitive to the sun, putting you at increased risk for sunburn. Ask whether the medication prescribed will interfere with driving safely. Other drugs you may be taking, even over-the-counter drugs and alcohol, can either amplify or lessen the effects of the prescribed medication. Taking aspirin along with an anticoagulant medication can result in possible bleeding. The more medications you are taking, the greater the chance of an undesirable drug interaction. So ask about possible drug-drug and drug-food interactions.
What are the most common side effects, and what should I do if they occur?
All medications have side effects. Your doctor may have to try several medications before hitting on the one that is best for you. You need to know what symptoms to be on the lookout for and what action to take if they develop. Should you seek immediate medical care, discontinue the medication, or call your doctor? While the doctor cannot be expected to tell you every possible adverse reaction, the most common and most important ones should be discussed. Unfortunately, a recent survey showed that 70% of people starting a new medication did not recall being told by their physicians or pharmacists about precautions and possible side effects. So it may be up to you to ask.
Are there any tests necessary to monitor the use of this medication?
Most medications are monitored by the improvement or worsening of symptoms. However, some medications can disrupt body chemistry before any symptoms develop. Sometimes these adverse reactions can be detected by laboratory tests such as blood counts or liver function tests. In addition, the levels of some medications in the blood need to be measured on a regular basis to make sure you are getting the right amounts. Ask your doctor if the medication being prescribed has any of these special requirements.
Can a less expensive alternative or generic medication be prescribed?
Every drug has at least two names, a generic name and a brand name. The generic name is the name used to refer to the medication in the scientific literature. The brand name is the unique name given to the drug by its developer. When a drug company develops a new drug in the United States, it is granted exclusive rights to produce that drug for 17 years. After this 17-year period, other companies may market chemical equivalents of that drug. These generic medications are generally considered as safe and effective as the original brand-name drug but often cost much less. In some cases, your physician may have a good reason for preferring a particular brand. Even so, if cost is a concern, ask your doctor if a less expensive but equally effective medication is available.
You may also be able to save money by knowing how to use your insurance advantageously. For example, your copayment may be less if you obtain your medications from a company designated by your insurer. Also, many national pharmacies have discount programs for seniors and individuals with low income. It pays to ask and then ask again. And it is wise to shop around. Even in the same town, different stores sell the same medication at different prices.
Is there any written information about the medication?
Your doctor may not have time to answer all of your questions. You many not remember everything you heard. Fortunately, there are many other good sources of information, including pharmacists, nurses, package inserts, pamphlets, books, and Web sites. Several useful sources are listed at the end of this chapter.
How to Read the Prescription Label
One great source of information is the prescription label. The following illustration will help you learn how to read the labels on your prescriptions.
A Special Word About Pharmacists
Pharmacists are an underutilized resource. They have gone to school for many years to learn about medications, how they act in your body, and how they interact with each other. Your pharmacist is an expert on medications and can readily answer questions face to face, over the phone, or even via e-mail. In addition, many hospitals, medical schools, and schools of pharmacy have medication information services that you can call to ask questions. As a self-manager, don’t forget pharmacists. They are important and helpful consultants.
Taking Your Medicine
No matter what the medication, it won’t do you any good if you don’t take it. Nearly half of all medicines are not taken as prescribed. This has been called “the other drug problem.” There are many reasons why people don’t take their prescribed medication: forgetfulness, lack of clear instructions, complicated dosing schedules, bothersome side effects, cost of the medications, and so on. Whatever the reason, if you are having trouble taking your medications as prescribed, discuss this with your doctor. Often simple adjustments can make it easier. For example, if you are taking many different medications, sometimes one or more can be eliminated. If you are taking one medication three times a day and another four times a day, your doctor may be able to simplify the regimen, perhaps even prescribing medications that you need to take only once or twice a day. Understanding more about your medications, including how they can help you, may also help motivate you to take them regularly.
If you are having trouble taking your medications, ask yourself the following questions and discuss the answers with your doctor or pharmacist.
Do you tend to be forgetful?
Are you confused about the instructions for how and when to use the medications?
Is the schedule for taking your medications too complicated?
Do your medications have bothersome side effects?
Is your medicine too expensive?
Do you feel that your disease is not serious or bothersome enough to need regular medications? (With some diseases such as high blood pressure, high cholesterol, or early diabetes, you may not have any symptoms.)
Do you feel that the treatment is unlikely to help?
Are you denying that you have a disease that needs treatment?
Have you had a bad experience with the medicine you are supposed to be taking or another medication?
Do you know someone who had a bad experience with the medication, and are you afraid that something similar will happen with you?
Are you afraid of becoming addicted to the medication?
Are you embarrassed about taking the medication, view it as a sign of weakness or failure, or fear you’ll be judged negatively if people know about it?
What are some of the benefits you might get if you take the medication as prescribed?
Remembering to Take Your Medicines
If forgetting to take your medications is a problem, here are some suggestions to help you remember:
Make it obvious. Place the medication or a reminder next to your toothbrush, on the breakfast table, in your lunch box, or in some other place where you’re likely to “stumble over” it. (But be careful where you put the medication if children are around.) Or you might put a reminder note on the bathroom mirror, the refrigerator door, the coffee maker, the television, or some other conspicuous place. If you link taking the medication with some well-established habit such as meal times or watching your favorite television program, you’ll be more likely to remember.
Use a checklist or an organizer. Make a medication chart listing each medication you are taking and the time when you take it, or check off each medication on a calendar as you take it. You might also buy a medication organizer at the drugstore. This container separates pills according to the time of day they should be taken. You can fill the organizer once a week so that all of your pills are ready to take at the proper time. A quick glance at the organizer lets you know if you have missed any doses and prevents double dosing. There are also Web sites that allow you to print out charts to help you track your medications; PictureRx (https://mypicturerx.com) is one, but it requires a subscription.
Use an electronic reminder. Get a watch or mobile phone that can be set to beep at pill-taking time. There are also “high-tech” medication containers that beep at a preset time to remind you to take your medication. If you have a smartphone, you can also download apps that can track and remind you to take your medication.
Have others remind you. Ask members of your household to remind you to take your medications at the appropriate times.
Don’t run out. Don’t let yourself run out of your medicines. When you get a new prescription, mark on your calendar the date a week before your medications will run out. This will serve as a reminder to order and get your next refill. Don’t wait until the last pill. Some mail-order pharmacies offer automatic refills, so your medications arrive when you need them.
Plan before you travel. If you plan to travel, put a note on your luggage reminding you to pack your pills. Also, take along an extra prescription in your carry-on bag in case you lose your pills or your checked luggage.
Self-Medication
You may take nonprescription or over-the-counter (OTC) medications or herbs. In every two-week period, nearly 70% of people will take a nonprescription drug. Many OTC drugs are highly effective and may even be recommended by your doctor. But if you self-medicate, you should know what you are taking, why you are taking it, how it works, and how to use the medication wisely.
More than 200,000 nonprescription drug products are offered for sale to the American public, representing about 500 active ingredients. Nearly 75% of the public receives its education on OTC drugs solely from TV, radio, newspaper, and magazine advertising. This advertising is aimed at you.
The main message of drug advertising is that for every symptom, every ache and pain, and every problem, there is a pharmaceutical solution. While many of the OTC products are effective, many are simply a waste of your money. They may also keep you from using better ways to manage your illness or may interfere or interact badly with your prescription medications.
Whether you are taking prescribed medications or using over-the-counter medications or herbs, here are some helpful suggestions:
If you are pregnant or nursing, have a chronic disease, or are already taking multiple medications, consult your doctor before self-medicating.
Always read drug labels and follow directions carefully. Reading of the label, including review of the individual ingredients, may help prevent you from taking medications that have caused problems for you in the past. If you don’t understand the information on the label, ask a pharmacist or doctor before buying it.
Do not exceed the recommended dosage or length of treatment unless you have discussed the change with your doctor.
Use caution if you are taking other medications. Over-the-counter and prescription drugs can interact, either canceling or exaggerating the effects of the medications. If you have questions about drug interactions, ask your doctor or pharmacist before mixing medicines.
Try to select medications with a single active ingredient rather than combination (“all-in-one”) products. In using a product with multiple ingredients, you are likely to get drugs for symptoms you don’t even have, so why risk the side effects of medications you don’t need? Single-ingredient products also allow you to adjust the dosage of each medication separately for optimal symptom relief with minimal side effects.
A Special Word About Alcohol and Recreational Drugs
The use of alcohol and recreational drugs (illegal or prescription medications used for nonmedicinal purposes) has been increasing in recent years, particularly among people over the age of 60. These drugs, whether legal or illegal, can cause problems. They can interact with prescription medications, making them less effective or even causing harm. They can fog judgment and cause problems with balance. This can in turn cause accidents and injure both you and others. In some cases, alcohol or recreational drugs can make existing long-term conditions worse. Alcohol use is associated with increased risk of hypertension, diabetes, gastrointestinal bleeding, sleep disorders, depression, erectile dysfunction, breast and other cancers, and injury. Limiting alcohol use to no more than two drinks per day is advised. “At risk” alcohol use for women is drinking more than seven drinks per week or more than three drinks per day and for men more than 14 drinks per week or more than four drinks in a day. This means that women of any age and anyone over age 65 should average no more than one drink per day and men under 65 should have no more than two drinks per day on average.
We are not here to judge but do have two pieces of advice:
If you are at the “at risk” level for alcohol or are regularly using recreational drugs, seriously consider cutting down or stopping their use.
Talk to your doctor about your use of these drugs. Doctors are often hesitant to raise the issue because they don’t want to embarrass you. So it is up to you to bring up the subject. Doctors will be very willing to talk about it. They have heard it all, and they will not think less of you. An honest conversation may save your life.
When choosing medications, learn the ingredient names and try to buy generic products. Generics contain the same active ingredient as the brand-name product, usually at a lower cost.
Never take or give a drug from an unlabeled container or a container whose label you cannot read. Keep your medications in their original labeled containers or transfer them to a labeled medication organizer or pill dispenser. Do not make the mistake of mixing different medications in the same bottle.
Do not take medications that were prescribed for someone else, even if you have similar symptoms.
Drink at least a half glass of liquid with your pills, and remain standing or sitting upright for a short while after swallowing. This can prevent the pills from getting stuck in the esophagus.
Store your medications where children or young adults cannot find them. Poisoning from medications is a common and preventable problem among the young, and the main sources of recreational drugs used by teens and young adults are the prescription medications of relatives or the relatives of friends. Despite its name, the bathroom medicine cabinet is not usually an appropriate place to store medications. A kitchen cabinet or tool box with a lock is far safer.
Medications can help or harm. What often makes the difference is the care you exercise and the partnership you develop with your doctor.
Suggested Further Reading
Castleman, Michael. The New Healing Herbs: The Essential Guide to More Than 125 of Nature’s Most Potent Herbal Remedies, 3rd ed. New York: Rodale, 2010.
Graedon, Joe, and Teresa Graedon. Best Choices from the People’s Pharmacy. New York: Rodale, 2006.
Griffith, H. Winter, and Stephen W. Moore. Complete Guide to Prescription and Nonprescription Drugs, 2012. New York: Perigee Books, 2011.
Physicians’ Desk Reference. The PDR Pocket Guide to Prescription Drugs, 9th ed. New York: Pocket Books, 2010.
Rybacki, James J. The Essential Guide to Prescription Drugs. New York: HarperCollins, 2006.
Shane-McWhorter, Laura. The American Diabetes Association Guide to Herbs and Nutritional Supplements. Alexandria, Va.: American Diabetes Association, 2009.
Silverman, Harold M. The Pill Book, 14th ed. New York: Bantam Books, 2010.
Other Resources
MedlinePlus: Drugs, Supplements, and Herbal Information, a service of the U.S. National Library of Medicine and National Institutes of Health:
http://www.nlm.nih.gov/medlineplus/druginformation.html
National Institutes of Health: Rethinking Drinking: Alcohol and Your Health: http://rethinkingdrinking.niaaa.nih.gov/
Natural Medicines Comprehensive Database: http://naturaldatabaseconsumer.therapeuticresearch.com/home.aspx
PictureRx: https://mypicturerx.com
The National Center for Complementary and Alternative Medicine (NCCAM): http://nccam.nih.gov/
WebMD: Drugs and Medications A–Z: http://www.webmd.com/drugs