I have always been amazed by the amount of medications Americans take. Sometimes it seems that drugs stick to a person’s medical history and are never questioned or reconsidered. Maybe it’s because we are afraid of what might happen if we stop taking them. Maybe we are afraid to question what another Practitioner has added and don’t want to offend.
All medical practitioners regardless of title, whether MD, DO, PA-C, ARNP, FDA, FBI, DEA (you get the idea), think our medicine is strongest. Similar to the Medicine Man and Shaman of long ago, that person would be prominent in the tribe and always sat with the chief and the counsel during important times and smoked the pipe.
Problem is; as the years go by adding all our “strong” medicine to try to cure and manage medical problems, some have effects as the body changes, the patient changes. The standard of care changes. We become aged.
Meet Mr. Smith. He is a big man, 6 foot and probably 230 pounds. You can tell that in his prime he could take names and kick ass. He arrives from out of town to live closer to family and I know little of him but yes, he has 4 pages of medications. He carries a diagnosis of Alzheimer’s Dementia. He is slow to respond to my questions, but is cooperative. He’s Confused. I ask him to demonstrate walking to his front door and back and he looks like a drunken sailor fresh of the boat and ready to fall over. I’ve seen enough.
Many of the medications he was taking were specifically for his dementia. I won’t mention the names here but they were marketed to slow the progress of dementia and have a long list of side effects. The other prominent medication was oxycodone for his knee and back pain. Very large dosages given every 4-6 hours. I need to know who this man is. Is he really a zombie? Or….Time to take away all of these questionable medications and see what lies beneath.
One week later I returned to find this gentleman sitting upright, smiling and pretty upset with me because I cut his opioid dose regimen to three times a day and lowered his oxycodone dose from a 15mg tablet (yes he was taking this as much as 6 times a day). He walked to his front door and back this day without wavering; only complaining about his knee pain.
I completed a series of mental status exams, pretty routine stuff to determine just how bad his Alzheimer’s Dementia was and he scored at a level consistent with mild cognitive impairment, mostly short term memory stuff. C’mon, how many of us can spell world backwards on a good day.
Polypharmacy; question medications you take, does it really help your condition? Is there actual proof it cures or alters the disease process at this point, or cloud changing thought processes that occur due to normal processes of aging. No fear of the walking dead, let’s see who is really in there.
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