Who Is Quarterbacking the Meds?

[Superbob]

I am 16 months post-op, feeling generally well and grateful for that, and have a six-month's echo and cardio visit this Friday.

One of my nagging concerns is the meds I am taking. Do I have to take all of these for the rest of my life, or can we dispense with some of them? Seven months after surgery, we moved from Northern Virginia (DC area) to Western Virginia (peaceful area) and so far none of my new docs has even hinted at changing my med regimen.

Three of my meds carry a caution: "May cause drowsiness or dizziness," and that doesn't even include the sleeping pill I take. Is it a wonder I sometimes feel groggy?

Here's what I still take 16 months post-op:

Metoprolol (lopressor), 25 mg, twice a day. A beta-blocker.

One 81 mg aspirin a day.

Metformin (glucophage), 1000 MG twice a day. This is for prediabetes, Type II. (My blood sugar readings have been below the danger level the past 6 months.)

Lisinopril, 10 mg, once a day. An ACE inhibitor.

Caduet 5/10 mg, once a day. This is a pill my former cardio highly recommended that is supposed to attack high blood pressure and high cholesterol in one swoop. (Never mind that I have never had high cholesterol.) Caduet combines two prescription meds: Norvasc and Lipitor.

Finally, like so many others on vr.com, I have had trouble sleeping, so I am currently taking one 15 mg Temazepam (Restoril) at bedtime. It works, but of course it "may cause drowsiness" -- duh).

Okay, I guess I should really press my new cardio for an evaluation of all these meds as a whole. When I first visited him last October, however, he didn't seem interested in being my med quarterback. And every time I ask my GP, she just laughs me off with the observation that many people take many more pills than I do (which is no doubt true, but do I need to keep taking the ones I take for the duration?)....

I know we're all different, but has anyone else had the sense of no one being in charge of the meds? (Different docs have added different meds to my regimen; no doc has subtracted any.) Or has anyone found a take-charge doc?

As for the echo, I assume I will get an explanation of the numbers, and I'll ask for a copy so I can compare here. I had been concerned that a couple of hard klutzy falls might have done damage to my Freestyle, so hopefully the echo will at least put those fears to rest.

This has turned into a ramble. Sorry, sometimes you just need to vent. If anyone has managed to read to the end and wants to offer thoughts, I'll welcome them.

 

[PJmomrunner]

I know what you mean about "nobody quarterbacking." I asked various cardiologists to have my dosages upped and one of my meds added. My primary care doc does pay attention though and asked me at a recent check-up when I went on the ace inhibitor and why, so that's good. If I were you I think I'd ask to go off some of the meds and see what he says--you may have to pick a couple to get a specific response. For me, the point of having the surgery is to resume a normal life and getting rid of the meds will, I hope, be part of that.

 

[Nancy]

Joe's Internist monitors his many medications very carefully. He is keenly aware of how many Joe takes and how they impact his health. Joe's on maybe 13-16 pills each day, plus an injection three times per week. He is on the least he's been on in a long while. I'm not sure it will be sustainable, but so far it is looking OK, not great, but OK.

There have been times when the hospital pharmacist was right in the room when the cardiologist was thinking about adding or subtracting something. That's how tricky it can be.

You ask a very important question.

 

[tommy]

My cardios have always been "take charge" guys. The surgeon had his standard regimen of heart meds including BP and cholesterol. The cardio yanked them when I was transferred to him from the surgeon.

 

[MikeHeim]

Rob-
You ask a very interesting question. It DOES sound like you are taking an excessive amount of medication. One month after surgery, I was down to Plavix and Atenolol (75mg twice daily). At my six-month appointment, I pressed my Cardiologist and got rid of the Plavix and reduce the Atenolol. He agreed (somewhat reluctantly), and I now only take 50mg of Atenolol twice daily. I'm hoping to drop that even further at my one-year appt.

Basically, all you can do is press the issue. Is it possible that your current Cardiologist is just doing a CYA job by being reluctant to change the prescriptions of prior Cardiologists?

Mike

 

[Marguerite53]

I came home JUST today from an appointment wondering the same thing. I swear they just pass you around in circles!!

The surgeon defers to the cardio. The cardio defers to the internist. I asked the cardio point blank today if she ever thought I would get off the BP meds. She thought not. And yet (I did not ask, I was determined to have a non-confrontational meeting with her -- too much to celebrate) I believe the reason they put me on them was the stenosis. My bp never was that high, and now the stenosis is gone........

I then asked if I could go back to the baby aspirin (from a 325 since surgery) and the cardio said sure. Then I mentioned my visual disturbances (since they resemble TMI's so much, thought I should just mention them)....she kind of misunderstood my intent, mentioned all the migraine triggers and hormone fluctuations and then said I should maybe stick with the 325 and talk it all over with my internist.

I do truly like and respect all 3 of these doctors. The cardio, today, said stick with the rehab, lose X amount of pounds and come see me in a year. All good to me. So I think I'll definitely use my internist for all the little pesky things like meds. After all, SHE (the internist) can call the cardio if she has any questions or concerns. She puts it all together in the package.....she's trained in a more whole person perspective. So I will use my internist in a few months, to draw some blood (can't handle the thought right now unless it's an emergency!!) have a look at all my levels, review my improved exercise program, look at my BP, and take it from there.

So, Rob, know that you're not alone!! Sounds like you are in a great place to have a review of some kind. Let the internist know what you are hoping for and see what he/she says! I would be leery of a doctor who poo-poo's you and says, oh, all people take lots of meds. Nope. Not a good enough response. Press on with that doctor, or find another one who will speak frankly and respectfully with you.

But do get a doctor's advice. No sense experimenting on your own....could be very dangerous.

Keep us posted.

Marguerite

 

[Der Biermeister]

I have BP issues (primary hypertension - which means no known reason) for which I've been taking Norvasc for years + Zestoretic, which is a combo of Lisinipril and a diuretic. About a year ago, they switched me to straight Lisinipril and Bumex (a more powerful diuretic) to try to control my AI. For some reason, I began having fairly painful muscle aches, which we attributed to the Lisinipril. So, they stopped the ACE and put me on Cozaar. They also have me on a beta-blocker (Toprol) now. I think they want me on the Beta-blocker for the long haul because of its benefits in helping the heart work less hard while also helping to lower bp. High bp is a real no-no for me anyway with my new valve because it was probably the cause of my real valve failing.

I've asked about the 325mg aspirin - if that was dangerous to take for long periods and was told -nope, won't hurt you a bit. So - I'm not worried about that -- I am just glad to be rid of the Plavix now. Since I have bypasses, they feel aspirin is all I need. One doc explained that Plavix is beneficial for things artificial -- like the stents I had put in 1 1/2 years ago. But for natural veins, aspirin is better.

So -- my challenge is to get my bp so much under control that maybe I can reduce things like Norvasc and Toprol and even the Cozaar. Immediate goal would be to get each reduced in half.

 

[joanne6]

I don't remember reading if you have any degree of heart failure. The ACE inhibitor is standard for anyone with diabetes. If you have heart failure, the Metformin would not be the best drug. Aspirin is generally a must. Beta blockers highly recommended unless you have asthma, or another chronic lung disease. How well controlled is your BP and could you maintain that off the calcium channel blocker. A statin drug would be pretty standard with your heart history. I think you need to look at each of these meds for the individual benefit they provide to you. That being said, maybe someone would help you get rid of one or two of these drugs. Let us know.

 

[Superbob]

These are great observations. (But what else do you expect on vr.com?) Thanks to you, all.

I think the main lesson I draw is that I need to be more aggressive in questioning the need for some of these medicines, and in asking for an overall med strategy. Like you, Marguerite, I don't question the competence of my doctors. I think part of the problem is that we've moved and I have a whole new set of doctors who didn't do the prescribing in the first place. And they make conclude that, well, if the numbers are good, why change anything? (If it ain't broke, why fix it?) But I need a rationale for each drug (something along the lines of what you outlined very well, Joanne). And I'd like to believe that as I get better, I can look forward to ending some of these meds....

Thanks again!

 

[Lynlw]

Justin's heart is different than yours, but he is not on any meds, hasn't been for years, except asprin for a while after he got his stents or valve, lyn

 

[OldManEmu]

The drug count

The drug count

I don?t know what?s meant by quarterbacking, other than it being a position in American football. The drugs however I totally agree it is all too easy to have no one actually looking at your drug regime as a whole. At 16 months post surgery I would want the doctors to go through each drug and explain why you should be on it for how long and what they would want to see before it could be discontinued. I was on 4 prescription drugs on leaving hospital 11/2004 I managed to get it down to 1 by 2/2006 an ACE inhibitor. I considered this my measure of success, most of these heart drugs as you say carry the warning "May cause drowsiness or dizziness", I didn't want the rest of my life turned into a prescription drug induced haze.

 

[Superbob]

Thanks, OldManEmu -- that's it, exactly. I resorted to the American football analogy simply because the quarterback is the one who calls the plays. That's what I need: someone to look at the whole picture and make the calls.

My frustration is that so far none of my doctors has shown an inclination to do that with regard to the medicines. My wife, who has some concerns of her own about meds (and takes even more than I do), is about to have a first appointment with an internist who was recommended by our pharmacist as a physician who looks very carefully at all medicines and their effects and is good at managing them. So, although I hate going to yet another doctor, I may wind up going to her for a "medicine checkup" if it goes well for my wife.

 

[terryj]

Five years after surgery my husband is still on Lopressor,Prinivil,Catepres Patch.Zocor,2 Fish Oil Pills a day and of course the Coumadin. His PCP monitors all this. His cardiologist agrees with the PCP. Every annual visit my husband asks if he can cut out some of these drugs and every visit he is told no, that he needs them all to keep his heart healthy and beating easier. I guess he may be right. He is doing great nearly 5 years years after surgery.

 

[MarkU]

I'm fortunate that both my PCP and my cardiologist are part of the same medical group and work well together. Of course I'm also lucky to only be on Coumadin (and my daily Centrum Silver).

I did have some problems when I had to act as medical surrogate for my father when he was going through his cancer treatment two years ago. He had a PCP, cardiologist, oncologist, and surgeon who weren't talking to each other. He had 20 some different meds going at one time. I finally had enough and told them all that the oncologist would be the "quarterback" as far as meds went. We ended up flushing most of the stuff in his medicine cabinet. The cardiologist was cool with it as he knew the cancer was the major issue at the time, not his cardiac problems.

I guess my point is that if no one is taking control, then you have to be your own advocate and assign the responsibility to someone. If nothing else, most pharmacies will give you a summary of possible interactions if you ask them - you can then take that info back to the docs to discuss.

 

[Georgia]

I always assumed that my pcp would be the drug guy; when my cholesterol shot up he worked with me. Then I went to my cardio for my annual check up and she acted kind of funny about his having taken the lead on that - seems that if it was anything cardiac-related she wanted to be calling the shots. Touchy touchy.

My pcp won't change cardiac drugs unless he confabs with the cardio.

 

[Marguerite53]

Well, that's it, Georgia. How many times have we all been in conference with a doctor and have them called out for a phone call from Dr so-and-so. Aren't they probably discussing a mutual patient? I would want to encourage the doctors to talk to each other....at least that's what I'm learning. I didn't, once, and paid for it with a double dose of an antibiotic I turned out to be allergic to....hives for months.....learned my lesson!

RobHol. I really like the idea of asking the pharmacist for a referral!! I think I've chosen my doctors well, mostly for their background, experience and associations, but to kind of check in with the pharmacist about them....what a great idea! I talk to pharmacists all the time, for particulars on medications because I am so sensitive to so many drugs. But to ask them about a doctor......very interesting! Let us know how that works out for your wife.

MarkU. You certainly do learn a lot when you start taking care of your parents, don't you. Been there.

Marguerite

 

[MadMac]

While I respect my PCP, my Rheumatologist, my Neurologist and my Cardiologist, I keep a close eye on the medications and do not completely depend on them to do so. I feel, as a reasonably well educated patient, that I can research things as they progress, find the pros and cons and have intelligent conversations with my care providers. And, they are all very open to this process. I also have a very competent Pharmacist that I have regular discussions with. I feel that the more information that is fed into the hopper, the better the decisions that are made will be. Taking multiple prescription drugs is a very delicate balancing act at best and at it's worst, it is a disaster.

 

[Superbob]

I can't take credit of thinking of asking my pharmacist for a physican recommendation. That was the work of my dear wife. She struck up a conversation with the pharmacist that went on and on while I impatiently puttered around the pharmacy (we live in a rural area, so that kind of conversation is more easily done than in a hectic urban setting). Anyway, the pharmacist wound up highly recommending for my wife a physician who is supposed to be really good at evaluating the effects of multiple medicines. (This internist also specializes in geriatrics, which I guess I must reluctantly accept includes old-timers like me). So impatient me may benefit from that neighborly advice as well. Maybe a doc like that would coordinate with my cardio.

I've always been the sort just to accept what the doctor says and it has never occurred to me to consult with a pharmacist. So several of you -- Marguerite, Mac, Mark -- have underscored this point: need to become more of a consumer activist/advocate (for lack of a better term).

 

[Superbob]

Follow-Up: Good Report

Follow-Up: Good Report

Since you guys were kind enough to listen to my whining and then make constructive suggestions, thought I'd follow up to report on my long-awaited cardiologist's visit today:

In short, the results were very positive. I will get a written report on the echo in about a week, but after looking at it today, the cardio said my valve/root device is working great, with no leakage at all. Gone is the murmur I'd had all my life. He said my Freestyle may well be the only replacement I'll ever need. (Of course there are no guarantees.) I have to see him again in 8 months but after then may just need an echo once every two years.

On the meds, he did give me a reassuring rationale for continuing to take those that I take. My BP was 100/80 and my cholesterol is 123 -- two indications that the meds are helping.

Some of you may remember that I fretted like crazy over a recent hard fall that left me with a big bruise under my heart. I have worried myself silly that I might have damaged the prosthetic. He reassured me that a fall like that is not going to do damage at this stage -- it's firmly seated and sealed and functioning well.

Nevertheless, it helped me greatly to express my worries here and to get your thoughts -- so again a big THANK YOU ALL!