Why should I take these medications?
A hypothetical look at my future.
My one disappointment with Sensible Medicine, as we near the end of our second year, is that we don’t have more people writing from a patient perspective. I wrote one piece and Kristin Inciardi published a great one, but that is about it. Thus, I was thrilled to receive this one from John Horwitz. I am not sure what I should call it, a prose poem maybe? It doesn’t really matter; I do know it is great.
Adam Cifu
Many doctors tell me why I should take these medications. Some have told me that I will die if I do not take them.
They never want to know why I shouldn’t.
I had a heart attack and I now have moderate renal insufficiency. For my heart, they prescribe statins to lower cholesterol, beta blockers to slow my heart, anticoagulants to thin my blood, nitrates to dilate my coronary arteries, enalapril for hypertension, and prophylactic aspirin. Also on the list is duloxetine for my mood, esomeprazole for upper GI bleeding, and sildenafil for erectile dysfunction. For my kidneys there is empagliflozin, a selective mineralocorticoid antagonist, and an SGLT-2 inhibitor.
My primary, nephrologist, and cardiologist don’t communicate and soon I have side effects from every drug they have prescribed. Increased cholesterol, joint pain, loss of taste, headaches, too much potassium, irregular heartbeat, type 2 diabetes, and Fournier's gangrene.
The cardiologist orders a nuclear treadmill test, angiography, a dietary consult, and more medications to correct abnormal test results. Then there are more stents or open heart surgery. The nephrologist wants a kidney biopsy, a dietary consult, and orders more tests and medications. He is confused by unimproved test results, starts dialysis, and waitlists me for a transplant. The primary wants a social work consult and orders a norepinephrine dopamine reuptake inhibitor for mood enhancement before I have even been seen. The social worker thinks group cognitive-behavioral therapy is relevant because of my age.
After being shuffled from doctor to specialist to doctor to specialist, poked, prodded, medicated, analyzed, believed, doubted, examined, and cabbaged over a two year period — while spending a small fortune I could not afford and what remains of an ever dwindling life expectancy – I think I could have stayed with the healthy eating routine and daily exercise that used to work well for me.
Meanwhile I realized that the only reason for so many tests, surgeries, and medications was that there is no cure, no remediation, and no reversal of heart and kidney disease. All the medications did was muddy the test results and present conflicting evidence of relapsing or remitting symptoms. In the final analysis the test results were only a compilation of best guesses. Out of money, bedridden, disheartened by lack of progress, and greatly diminished, thoughts of suicide are welcomed.
So, what do I think?
I’m holding out for something better. Why don’t I skip the hundreds of thousands of dollars in medical bills, surgical procedures, tests, years of dashed hopes, over and under medication, group therapy, and just enjoy the time I have left.
If YOU have something better, bring it!
No one is sure what the future holds, and perhaps some medication would be helpful, but the rush to overanalyze and prescribe for the elderly without asking what WE want seems to be the standard.
Everyone alive today will die - what many of us want (but are unable to articulate) is a guide on that journey.
And, when our time comes, we want to leave with dignity.
John Horwitz is retired, and his life is hard to do justice to in a few sentences... He has been a longshoreman, an ironworker, a truck driver, and a professional photographer.
Photograph by Annie Spratt
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I am 66, and generally in good health for my age. Over the last 3-4 years I have had a gradual shift to more healthy habits. A few years ago my PCP Dr. sent me for a calcium scan of my heart. The score was very high, and he immediately prescribed 40mg of Rosuvastatin (sp). Never said one word about exercise and/or diet. After a couple of months I was feeling pretty weak but my Dr. was estatic over my lower cholesterol numbers. Still nothing about diet, exercise, or my lifestyle. Just take these pills.
I made a decision to stop taking the statins. I began to exercise and really started to lean heavily towards whole foods. My exercise routine is now about 2 hours a day, and includes light weights and cardio. My diet is foods that have one to very few ingredients- fresh fruit and some vegatables, and meat. In addition I usually walk my dogs a couple of miles a day. I do not sit in front of the tv until after dinner, and then only for 1-1.5 hours. I feel great. Just passed a stress test with flying colors. I am able go and do pretty much whatever I want.
I take no medications, and if a doctor ever tells me to take a pill again without asking about my diet and lifestyle they are fired. I have seen many that start down the road of pills and it never stops. They get weaker and quality of life is not so great. We are all going to die. To me what matters most is the quality of my life, not getting the most years while sacrificing my health for it.
My 80 year old aunt was just diagnosed with breast cancer. She will undergo chemo and radiation. Her quality of life will be severely affected. When I asked if her cancer was aggressive or indolent, when I asked how the “treatment” would affect her quality of life and if it would in fact cure her, I was called “insensitive.” As a society we need to start looking at these things and not just throw medicine at everything. Is she likely to die FROM the cancer or WITH the cancer. That’s the question.