Sock's Rheumatoid Arthritis Page 1:
Communication
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At the heart of an ideal doctor-patient relationship is mutual trust,but it may be diffficult to achieve without tearing down a few of the walls that traditionally separate the two, people with arthritis should be in the decision-making about therapy. It's their individual differences in pain,the disability,and their side effects they're experiencing that will decide whether a given drug is useful for them. It's not a straight-forward deal like some disease treatment where the treatment is more-or-less "standard".
 
A good doctor-patient relationship goes well beyond prescribing medications. If the've formed a broader kind of relationship,the doctor should be able to supply encouragement and express real empathy and understanding for what the patient is going through.
 
And where the results of treatment are not as immediate as what the patient wants,usually that's offset by the fact that the physician is still trying to help the patient at least come to grips with their own condition. The whole thing doesn't rest on whether the medication will make them better immediately. How the patient maintain faith or trust is a big part of it.
 
It's a two-way street,patients have to take an active role in the management of their disease,in joint protection, medications, exercise,and therapy. They need to know as much as they can about their condition and once they have a cleare understanding of what their condition entails,the have to learn about available medications in sufficient detail to ask the right questions.
 
Get as much reliable information as you can,then work with your physician to find out what part of that information applies to you. Incorporate that into your lifestyle. Exploit your strengths and learn to cope with your weaknesses. Comply with the limitations your condition imposes on you,seeking help when you feel you need it,and not trying to do too many things on your own when things don;t seem to going well. Don't worry about "bothering" the physician,professionals are there to help patients with their problems.
 
There are certain constraints on a physician's availability,which is a major reason for self-education. No matter how well-meaning the doctor and how attentive you maybe,a ten-minute interview,the standard GP's allotment for a patient visit,isn't enough for you to get a handle on all you need to know about your treatment regimen.
 
It helps if you can spell out your expectations ahead of time,so the doctor can address them,and eliminate dissapointments caused by unrealistic expectations. Blindly following a doctor's orders may work well in acute-care hospitals,but with a chronic disease,you have to take a more active role. Make sure you understand what the doctor is saying to you,communicate your complaints to your doctor,who is not a mind-reader. Two-way communication is of utmost importance,it may be the most important factor in therapy.
 
Medicine is often an inexact science,your doctor should know more about you,the the facts of your illness. You have the right to know your diagnosis,prognosis,alternate forms of treatment, recommend- ations of your doctor and why. If a diagnosis has not been reached, you should have a clear understanding and explanation of why not. Also,if further studies or follow-up is indicated,this should be explained.  It is your body the doctor is treating,and your health is in the balance.
 
With the rights come resposibilites;Plan your visits,ask questions. It's up to you to disclose all information relating to your illness to the physician. The doctor cannot be expected to make an accurate diagnosis and institute proper therapy if some information is withheld.
 
Withholding or misstating data requested by the physician may result in the use of improper,even potentialy dangerous therapies or risky tests.
 
Doctors have rights and resposibilities,too. They have to tell patients not merely of what the doctor feels,they need to know,but what patients want to know. Sometimes the doctor forget you need vital basic information,or feel you don't want a lot of information. Don't be afraid to ask.
 
You can't be timid about your care,it's your health at stake. If you feel your doctor has missed something,ask him. Don't assume everything has been done. Doctors are humans,they can miss doing things.
Make your questions accurate clear and specific. Volunteer facts,and be ready to conquer the fears of the unknown ( ignoring facts won't make them go away ). Don't be afraid to ask for clarification or repeat explanations.
 
Take mental notes ( later-write down some of the important points ), proceed in an organized way. Don't be overwhelmed or mislead by statistics,and don't ask questions a doctor can not reasonably be expected to answer.
 
Ultimately patients have to remember that their role is at the heart of their own health care. All their concerns,whether about medication, procedures,or surgery,must be addressed. Fear is taken away by true knowledge. Knowledge is power,it gives patients the power to go forward,to look ahead to a time when their illness won't be controlling them.

Your Doctor And You:
 
It seems like a reasonable assumption: Your doctor knows the cause of your arthritic symptoms. And the process is straightforward: You have a problem and the doctor then makes recommendations about how to treat it.
 
However,your doctor's notion of certainty and complete understanding of illness are probably overestimated. The best health providers recognize they are dealing with possibilities and probabilities and learn to accept uncertainty.
 
. In medical training,future physicians learn to create a differential diagnosis- a list of reasonable explanations for the problem at hand-and make some attempt to identify the most probable. The ability to promptly prune this list down to one diagnosis with confidence is more often the exception then the rule.
 
Interestingly,certain fields of medicine,such as arthritis,have more uncertainty than others,such as cancer. i.e.,A diagnosis of cancer based on the results of a biopsy is typically less open to debate than the cause of joint pain.
 
Even some exceedingly common problems within one field of medicine are poorly understood. Back pain,gout and shoulder disease are standouts in this regard.
 
If you are one of the millions of back pain sufferers,for example,you may see your doctor and learn you have back strain. However,another provider may tell your back pain is caused by arthritis,and yet another offers disk disease as a explanation. They may be all exceptional physicians,but the scary thing is they may all be wrong. The cold fact is,most  back pain cannot be definitively diagnosed.
 
There are risk factors,such as diabetes or  fracture of the upper arm,but the root cause of frozen shoulder-and in  many cases,the causes of the underlying triggers,such as bursitis or tendinitis-are unknown.
 
Risk factors associated with gout include being male,having hypertension or kidney disease,taking certain medications,such as diuretics and having a high uric acid level in the blood. But most people with these risk factors never develop gout.
 
Identifying the definite cause of symptoms may be impossible at times,making sure there is nothing dangerous or wrong can be done with relative certainty. There are many rheumatic diseases that can be diagnosed with certainty and readily treated. There is good reasons to see your doctor even if there's nothing wrong with you .
 
Checking your blood pressure,for example,is a well-established  way to identify a problem (hypertension) that may cause no symptoms for years. However,appropriate diagnosis and treatment of hypertension  (e.g.) is effective at preventing later problems. Preventive medicine is a life-saver and only your physician can provide it..
 
You may get a second opinion about back pain,gout or shoulder pain,but don't be surprized if the additional evaluation simply confirms the uncertainty of the situation in many cases.
 
For many years,since it is not directly lethal,rheumatoid arthritis was considered a relatively benign condition with the disease "burns out" in a relatively short space of time. With increased knowledge of rheumatic diseases this old "theory" has changed.
 
It is now a proven scientific fact that rheumatoid arthritis is a severe progressive disease that exacts a huge toll on patients,the economy, and on the health care system. Furthermore rheumatoid arthritis does not simply "burn out",and go away in a majority of cases.
 
Unfortunately,RA has the reputation that is incurable-that nothing can be done. Although RA is currently incureable,it is certainly treatable. Health care systems are changing. RA patients need to be proactive. People have to initiate contact with the physician and have the diagnosis made.
 
A rheumatoligist consultation is preferable. Patients must ensure they recieve appropiate treatment. It is most important that patients educate themselves about the disease. The most important thing in the management of rheumatoid arthritis is to get the disease under control..
 
If the inflammation associated with RA is controlled,most of the other problems that occur as a result of the devasting effects of inflammation will not occur or be minimized. Never accept that you have to live with it. Understand the treatment options,and never accept treatments just because they are readily available. They may not work.
 
Fortunately,patients have access to many rheumatoid arthritis information. The internet is one valuable source of information,but there is a maze of information, but some is untrue and can be harmful to the novice. Ask your physician for reference.
 
Start with nationally recognized associations that are associated with rheumatoid arthritis. The pharmaceutical industry offers patients and physicians education about the disease and is developing newer,more effective drugs .
 
Unfortunately the media often does not portray the true picture. The public librarys' have many information about rheumatoid arthritis and there are excellent material available,but be aware that some are outdated,and gives a shallow-broad description of "arthritis" under RA literature.
 
Communication is an important part of taking medications.Talk to the Rheumatoligist and Pharmacist about the medicines one is taking.They will give  vital information on when to take medicine,how,possible side effects, possible interactions and proper storage.These small steps will help the medicine  work best for the patient and help keep them safe.

If one can not talk to individual members of the health care team,they need to change. The patient's own description of his or her pain,stiffness,and joint function, and how these change over time is critical to the doctor's initial assessment of the disease and their assessment of how disease states  changes.
 
 Treatment is another key area for communication between patient and doctor .Talking to the doctor can help ensure that exercise and pain management programs are provided and changed as needed,and that drugs are prescribed appropriately.Talking can also help in making decisions about surgery if that becomes a option or necessity. Doctor's can only visulize your pain,or impairment we must tell them,in the most accurate possible manner that we can (where and the level).

Many patients with chronic diseases are on medicines for long periods of time.In order to achieve the best health possible,one needs to work with the members of the healthcare team to learn how to make the most of their therapy.
 
Health care systems are changing. The old system wherein physicians make all the decisions is gone. However,in the new system,patients,especially those with complex diseases can be misunderstood When doctors and patients work,communicate effectively,and take advantage of research-education there can be a difference.

Depending on the health care setting,the majority of the care with RA may be provided by a single physician ( primary care physician or rheumatologist who also provides primary care ) or the responsibility may be shared. The role of the primary care physician is to recognize and diagnose RA at its onset and to ensure that the patient receives timely treatment before permanent damage occurs.
 
The rheumatologist should provide support and consultation to the patient and his or her primary care physician in the diagnosis and treatment of the RA. In some areas,a rheumatologist may not be available. If the care of a patient with RA is to be shared,an explicit plan for monitoring disease activity and/or drug toxicity needs to be formulated.
 
Since the level of training and experience in diagnosing and managing RA varies among primary care physicians,the responsibility for accurate dianosis and monitoring of RA activity and/or drug toxicity may appropiately be assigned to a rheumatologist. The patient's preference may be the most important factor in deciding which physician(s) assume responsibility for care.
 
A general health maintenance strategy should be developed and responsibility for this strategy should be coordinated among the patient's health care providers. Routine prevention measures,such as screening for hypertension or cancer,should be recommended and risk factors modified.

RA has significant implications for the individual patients as well as for society. Individuals with RA have 3 times the direct medical costs,twice the hospitalization rate,and 10 times the work disability the work disability rate of an age,sex-matched population. A recent study estimates that costs for RA patients average $8,500.
 
Annual costs rise as the duration of disease increases and as function measured by the Health Assessment Questionnaire,declines. Indirect costs related to disability and work loss have been estimated to be 3 times higher than the direct costs associated with the disease.
 
For many years,relatively low-cost options have been available for the treatment of RA. However,the advent of Cox-2 inhibitors,newer DMARDs, ncluding biologic agents,and the incresing use of combination therapy have all brought cost considerations in treatment to the forefront.
 
Government health treasuries at both provincial and federal levels are cost conscious. They limit biological therapy use in most provinces and they are encouraging more primary care physician care in rheumatology to cut costs further.

 A ageing population and patient concerns:In the 50s, the population 65-and-over was less than eight percent; before another generation has passed, that proportion will have more than doubled. This greying phenomenon is at once the result of forces changing demographic patterns and relatively sudden advances inmedical science. The boom has not come without its price, however.
 
In the last century, we have learned to wage war with unsurpassed ferocity - and efficiency. The bitter irony is that war is fertile ground for the growth of scientific understanding - if only to staunch the ghastly wounds and block the pain of battlefield victims. Medical and technological advances made under the gun often find peace able and healing applications after the armistice.
 
Cortisone is one example of the vast arsenal of disease-fighting agents that has been developed since World War II - not to mention an extraordinary array of pharmaceuticals aimed at eliminating or at least dampening pain. We are living longer because medical science has more options to save us from disease and accident; on the other hand, these life-saving and pain-killing drugs area double-edged sword. There is always a potential for toxicity and unwanted effects, particularly when more than one medication is used in combination to treat different illnesses and ailments.
 
Because of the high incidence of such chronic diseases as rheumatoid arthritis,osteoarthritis, osteoporosis, cardiovascular disease, and liver and kidney dysfunction in their age group, people aged 75 and over are particularly vulnerable to the dangers of the medicine chest.
 
Drug depence among the elderly is a significant part of a growing financial and health problem across Canada: the soaring costs and use - many call it abuse - of prescription drugs at all levels of society. There have been clear danger signals,of drug abuse among the older population. Among them: a study by the drug quality and therapeutics committee of the Ontario health ministry in past years showed that of the geriatric patients admitted to hospital, as many as 20 per cent were treated for adverse drug reactions or for taking the wrong dosage.
 
Part of the problem is the growing phenomenon to the taking of multiple medications and with reference to their effects. Sometimes it's absolutely essential that a person be on all these drugs.
 
What it should do,is raise a flag in the doctor's mind when he sees someone on more than two or three drugs that polypharmacy puts them at risk of adverse drug reactions and drug interactions. Adverse drug reactions refers to the problems related to an individual drug, interactions to those between drugs - for example, a blood-thinner for highblood pressure, which inhibit blood coagulation, and one of the non-steroidal anti-inflammatory drugs, which could increase the chance of bleeding from the stomach.
 
Something to understand about any drug is that it is in one sense a poison. Too much of a good thing, in other words, and you harm the patient; too little, and he/she suffers needlessly. There's also a middle ground to consider, what physicians call the risk-to-benefit ratio: At what point do the potential side effects outweigh the potentially beneficial properties?
 
That's the relatively straight forward side of the story. Next, factor in all the drugs we've developed to combat ailments that we didn't even treat a generation or two ago (it wasn't so long ago, remember, that people with arthritis were told to accept their aches and pains as unalterable conditions of growing old), add in many physicians' decreased reluctance to prescribe drugs for every sort of complaint and many patients' demands for a pharmaceutical solution to their health problems.
 
Nearly 80 per cent of people 65 and over have at least one chronic illness (as against 40 per cent under 65), about one third have three or more chronic conditions, the majority take more than five different medications, and about 10 per cent take more than 12. The problem is that the chance of drug interaction - one drug cancelling out the efficacy of another, for example - rises with the number of drugs ingested.
 
A few years back a article appeared in the Lancet, a doctor wrote about a case he was asked to consult on: a 75-year-old woman who was apparently taking 12 different medications, amounting to 62 pills a day. After an initial assessment of her health problems, Clarfield wrote, 'she was admitted to hospital for a detoxification session involving the withholding of her medications, as well as simplification of the regimen. She returned home three weeks later on only three medications.
 
The doctor's patient exhibited what he called a typical final common pathway of the results of basic research, drug trials, pharmaceutical marketing, physician prescribing practices and pharmacist dispensing behaviour.
 
Another doctor who is in charge of a Acute Care Geriatrics Unit at  the San Diago Hospital and undergraduate co-ordinator for geriatrics at the state University,said. "I don't talk about the problems of too many drugs in the elderly,I'd rather call it the problem of inappropriate drugs for the elderly, because sometimes it's too few, sometimes too many, sometimes the wrong ones.
 
"It's simply arithmetic," he says. "the more medications you're on, the more likely you are to get side effects, adverse drug reactions and drug interactions. As a general rule, the more medications, the riskier - but, if they are required for an individual case, then it's appropriate to prescribe them."
 
One factor in this equation, is that some doctors don't always define why they're treating a person - that is, they don't define a specific goal and then see whether it has been fulfilled or not. Medications are started and continued, then not carefully reassessed and stopped if they're not doing the necessary good.
And the whole situation is complicated further, because people involved in clinical trials before a new drug gets federal approval are rarely aged 65 and over - both for ethical reasons and the high incidence of multiple disease, which would affect the validity of the research. This becomes especially significant when the pharmacokinetics of a drug are considered. Pharmacokinetics is a description of the distribution and excretion of medications.
 
 A research -scientist explains,every drug has its own pharmacokinetic profile. That means it' s absorbed in a certain way at a certain rate from the stomach; it's distributed around the body tissues in a certain percentage, and it's excreted by the kidneys at a certain rate or metabolised by the liver at a certain rate. All of these factors together give you what's called the pharmacokinetics of the drug.
 
The simple lesson,he adds,is that in older people, those pharmacokinetic effects will often result in a higher active drug level than the same dose in a younger person. Theoretically, the toxic effects are the same for both, but you're more likely to get a side effect at that dose in an older person than you would in a younger person.
 
What are some of the common side effects? Well, they can be as mild (though still distressing) as headaches and nausea, but, in the elderly especially, two more severe problems are gastric bleeding and hypertension. I recently attended a patient who was rushed in by her family doctor because her blood pressure was extremely high. I asked her what medications she was taking. She told me. And I said," Stop the medication." She came back in a couple of days, and her blood pressure was normal."
 
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed group of medications for mild to moderately severe arthritis, and, like all drugs, they carry with them the risks of certain side effects. The research-doctor-scientist adds,in high doses, these drugs can sometimes cause confusion in older people though they're unlikely to have that effect on younger people.
 
As essential as they may be for treating different types of arthritis, NSAIDs can be dangerous drugs. In the elderly, particularly, they can cause kidney damage and severe gastro-intestinal problems, as well as bleeding in the stomach. The question is to know when the risk is worth it. If a patient has rheumatoid arthritis, there's no doubt some sort of NSAID is required, whether it be some form of ASA or one of the others. The question comes when the physician is treating non-inflammatory arthritis, which is more typical of the older age group. Whether, for example, with osteoarthritis of the knee, the benefits of treating continuously with NSAIDs are worth it,in RA it is usually necessary.
 
The point is,continues the physician, "NSAIDs have both analgesic(pain-killing) and anti-inflammatory effects, and there is a tendency for some physicians to use them as analgesics when safer analgesics- acetaminophen products such as Tylenol(E) - would be more effective. Acetaminophen is of no use for inflammation, but it's a good, simple analgesic that's very safe. If a patient has a painful knee without inflammation, the physician might be better off treating that person with acetaminophen than an NSAID. When the knee flares up and gets a little inflammation and some fluid in it, at that time the physician can try a short course of NSAIDs.
 
It's a problem that, once again, is exacerbated by age. Since the populations drugs are tested on are people under 65 who have only one specific illness, the complications of multiple disease remain largely untested. Physicians have to wait for formal studies after a given medication has been approved by the federal Health Protection Branch - or else depend on 'anecdotal information, contiues the expert: "letters to the editor of scientific journals, small scale clinical studies and so on. But it's a real problem- nonsteroidals particularly. They seem safer when tested on the younger population, but when they get out on the market, they're prescribed to older people with OA and RA - sometimes,not the indication for which they were really tested. The more important thing is the pharmacokinetics; the way the body handles the drug is different.The kidneys don't excrete as well as they would when you're younger, and they distribute the drug in the body in a different way.
 
The kidneys, in fact, are extremely important players in all of this. For one thing, kidney function can decline as much as 50 per cent before we're 65, and other diseases, such as diabetes and hypertension, may reduce renal function even further. Consequently, the kidneys' ability to clear waste, particularly from medications present in the body, is considerably reduced; as a result, medications ingested to fight the effects of arthritis may linger in the body in a kind of toxic half life, setting the stage for potentially dangerous side effects.
 
Awareness of this sort of residual effect has led scientists to examine more closely how NSAIDs - which are designed to block the production of inflammatory substances called prostaglandins and leukotrienes - function in the elderly. In one such study, researchers are comparing the effects of an NSAID called ketoprophen, in people with and without impaired kidney function.
 
Ketoprophen is a member of the 'prophen' family, which in turn is a sub-set of different NSAIDs whose active ingredients are propionic acids. Ketoprophen is marketed in a 50/50 'racemate' mixture of 'left- and right-handed' - S (sinister)and R (rectus) - molecules called enantiomers. The left-handed(S) components are the active, anti-inflammatory half; the right-handed(R) side is practically inert. However, in elderly patients or patients with impaired kidney function, because renal clearance of the drug is slower than normal, the inactive R enantiomer can convert to the active S enantiomer, making the drug active longer. On a daily regimen of ketoprophen over a course of months, this unsuspected half-life could accumulate to toxic levels.
 
What the researchers are attempting to determine is the degree of anti-inflammatory activity of the R and S molecules - especially when the R to S conversion takes place. It's clear that the inactive R form has to be metabolically converted in the body to the Sform. The rate of that conversion may affect the therapeutic effects of the drug, but it may also influence the side effects of the drug.
 
Under these circumstances, it seems strange that ketoprophen should be made the way it is; but in fact, it's very difficult to separate the two structural components to produce the drug as a single structural entity. Whether they should be separated, however, is a question scientists are still wrestling with. If they goout on a limb on the basis of their current limited understanding and advocate the separation of these substances - and therefore the marketing of the 'superpure,' active component alone - they may be creating an unduly pessimistic or commercially impractical solution. A very strong case can be made that the cost involved is not justified and that patients are not at risk.
 
Profens as a group are very widely used, are very effective and are relatively safe, but researchers hope to improve that safety profile perhaps by having the S form alone. On the other hand, it may be an advantage to use the metabolic machinery that's responsible for converting the inactive drug to the active drug, because the inactive drug would be less likely to cause the side effects in the stomach and intestines one could get in the pure S form.
 
In the end, of course, this sort of research is intended simply to take relatively safe drugs and make them even safer, by better understanding their use, as well as - perhaps - by their reformulation.  In other words, the bottom line is the patient, and in treating his or her ills, the patient's safety should be uppermost in the physician's mind. It's not always easy, particularly with elderly patients who suffer from multiple illnesses. For example, says the physician-scientist ,"let's say you have someone with bad arthritis and hypertension. Anti-arthritis medications often - not always, but often - raise the blood pressure.
 
So, what are you going to do now, treat the arthritis or treat the high blood pressure?  "What if the physician is treating someone with arthritis and stomach problems? They've had a gastrointestinal bleed in the past, and the doctor is worried whether the treatment of the arthritis will make their condi tion worse. It's a very fine balancing act, but that's just part of the art of medicine: Which one needs to be treated most? Which is more dangerous? And the age of the patient is simply one more factor that you work into the equation.'
 
But at some point, patients have to be willing to take some responsibility for their own welfare. How? The physician contiues,don't change doctor after doctor. I tell patients not to go to specialists without going to their family doctors first, because that's one of the main reasons for polypharmacy. If you go to a heart doctor, a lung doctor and a kidney doctor, these three may or may not communicate with each other. I tell older patients particularly, whatever complaint they have, go to their family doctor first. And if he or she wants to send them on to the specialists, fine. But this way, the specialist will write a letter to the family doctor, and the family doctor will have the whole case and know what drugs are being prescribed to the patient.
 
"The second thing," says the expert,"is not to take drugs unless they're absolutely necessary. I warn patients about side effects, and I follow elderly patients more closely than I would younger people - bringing them back sooner. I start with a low drug dose and go slowly."
 
He also stresses the importance of patients' knowing about side effects, and what to look for, if there's any problem. Beyond that, he says, "they've got to be honest with their physicians - let them know everything they're taking. Some patients will borrow medication or will take a lot of non-prescription drugs and not let their physician know. That's extremely dangerous."
 
"I have a consulting practice, and when I see patients, I generally ask them to bring all their medications with them, so I can throw them out if they're not required, or ask the patient, "How are you taking this one? When are you taking it?" And see that they're taking it properly.'
 
Another preventative measure that elderly patients can take is to have their prescriptions filled out every time by the same pharmacist, preferably someone who is willing to dispense information along with the medication. The net result is, the pharmacist has a complete record of a given patient's prescription history and is far more likely to spot, for example, a dangerous combination of drugs or something else amiss. And as the prescription is being filled, it's also a good idea to ask the pharmacist to mark on the label in plain language what the medication is for- "for high blood pressure" or "for arthritis inflammation" and so on.
 
As far as he is concerned, elderly arthritis patients are no more prone to multiple problems " than any other group of elderly people that I see. Having RA is ubiquitous it's not a matter of if they have it, it's a matter of how it's affecting them. I think one of the big things in geriatrics, especially with RA and OA, is that the reason you're treating people - and you have to keep repeating it - is to maintain mobility. You're not going to make their joints go back to normal, and you're not going to relieve all the pain perfectly, but if they can maintain mobility, that's what's important. That kind of focuses your mind not on the arthritis and the joint pain, but rather on what you can accomplish. I use the medications to control joint pain - obviously you want to control the pain - but also to allow that person to remain active and get about."
 
He says "the most lethal thing you can do is be inactive, because the complications of being inactive are just horrendous. On the other hand, staying active is a prescription you can count on."
 

Have you ever felt frustrated after you have visited with your doctor or pharmacist? Did you feel that your doctor wasn't clear describing the disease or drug regimen? Have you ever felt that your doctor didn't have enough time to listen to you? Did you ever arrive back home feeling frustrated that you couldn't remember what your doctor told you or it didn't make sense?  Try to think back to the times when your doctor or pharmacist explained how to take your medicine and whether it might have helped if you would have asked more questions. Here is an example:
 
You get to the doctor's office. The doctor asks a few questions, and does a physical exam. The doctor explains the possible cause of your symptoms, may prescribe a medicine, and describes how to take it.
 
After the doctor's visit, you go to the pharmacy. The pharmacist asks if you have taken the medicine before. The pharmacist tells you how to take the medicine, potential side effects to look out for, and how to prevent or manage the side effects.
 
You get home and start taking the medicine. You get busy and forget to take your medicine - or even stop taking it. You might develop side effects and feel nauseated, drowsy, or light-headed, and you decide to stop taking the medicine.
 
Upon the next doctor visit, you are asked, "Have you been taking the drug?". Of course you say "Yes" because nobody wants to disappoint their doctor. Your doctor then asks, "Are you taking the medicine every day, three times a day, the way it was prescribed to you?" Once again, the answer is "Yes" to avoid feeling that you have let your doctor down.
 
Actually, you are hurting yourself because now the doctor can't understand why you are not getting better. Your doctor might decide that the medicine you are taking is not working and may prescribe another medicine. You go back to the pharmacy, are in a hurry, and tell the pharmacist that you know all about the medicine because the doctor has already told you how to take it. You get home, start the medicine, and for some reason you decide to stop taking it.
 
Study after study has shown that most patients are having problems taking their medicine correctly because they simply do not have enough information, misunderstand directions or forget what they have been told. It is normal for most people to forget much of the information after a few days. Unfortunately, this is not apparent to the doctor until one of your follow-up appointments.
 
 Unless patients are completely honest with their doctors, doctors will determine future treatment based on what you have told them. Lack of communication can have tragic consequences. Medication errors made by patients claim hundreds of thousands of lives every year simply because people do not take the prescribed medications properly or they skip them altogether.
 
The next time you receive a prescription from your doctor, make sure you clearly understand what your doctor and pharmacist are telling you. If you don't understand something, you need to ask questions. This is the only way to get the information you need to manage medicines at home and protect your health!
 
Don't be afraid to ask questions at every doctor visit. Be sure you know the answers to the following questions:
 
"What is the medicine for?" You need to know why the doctor prescribed the medicine for YOU. "How will the medicine help me get better?" You want to be able to recognize the signs that the medicine is working and that you are getting better.
 
"How do I take the medicine?" If you don't know how to take your medicine, you could make a serious mistake that could cause dangerous problems. If your doctor tells you to take a medicine three times a day, be sure you know whether this means to take all three pills at the same time or one every eight hours.
 
"What do I do if I miss a dose?" This depends on actual medicine you are taking. It is always best to call your doctor or pharmacist and ask them what to do if you miss doses.
 
"What are the side effects of the medicine?" Your doctor or pharmacist should inform you of all the potential side effects of the medicines you are taking. It is important to recognize the differences between the side effects of a drug and the symptoms of your medical problem. If you are aware of them, you can help avoid many of the side effects.
 
"What can I do to avoid the side effects?" There are certain side effects that can be avoided if you take medicines correctly. For example, some medicines are best to take on an empty stomach because more of the drug gets absorbed into the body, but this may cause some people to get nauseated. Other medicines must always be taken with food.
 
"What can I do to manage the side effects?" Every medication can cause some side effects. But not every person who takes the drug will experience every side effect. You should be aware of the possible side effects before you start taking the medicine so you know how to manage them.  For example, some people need medicine to lower their blood pressure. This medication could cause dizziness. When a person stands up too fast, they may get dizzy or lightheaded and could fall down and hurt themselves. To decrease the risk of falling, it may help to stand up slowly, and hold on to something that will help them keep their balance. Always ask your doctor or pharmacist how you can manage minor side effects from the medicine so you can keep taking it.
 
"Are there any drug-drug interactions?" There are medicines that should not be taken together because they can worsen your health. For example, Viagra should never be taken while also taking medicines that contain nitrates of any kind at any time. This includes nitroglycerin.  A serious drug interaction could occur and even lead to sudden death. It is important to tell all your doctors and pharmacists of all the medicines you take. It could save your life!
 
"Are there any foods that I should not eat while I am on this medicine? "There are some medicines that should not be taken with certain foods. For example, some medicines that lower high cholesterol should not be taken with grapefruit juice. Other medicines interact with different foods.
 
"Will my medicine interact with any herbal products or nonprescription medicines? "There are some herbal products and non-prescription medicines that should be avoided while on certain medicines or if you have certain health conditions. For example, if you have uncontrolled high blood pressure and a stuffy nose, you should not buy decongestant products that contain pseudophedrine because it can make your blood pressure go too high.
 
"How should the medicine be stored? "If medicines are not stored correctly many lose their effectiveness. For example some medicines are very sensitive to heat and must be stored in a refrigerator. Other medicines can be stored at room temperature but must not be kept in placesthat have high heat or humidity.  This is important for warm climate residents  who are traveling by car in the summer. They should not store any medicines in the glove compartment of the car because heat can reach extreme temperatures and destroy the drugs. Always ask your doctor or pharmacist how long and where to store your medicines.
 
If you don't understand what your doctor or pharmacist is trying to tell you ask them to explain it to you. It is always a good idea to keep a daily record so you can tell your doctor at your next visit when you started feeling better, any problems you had remembering to take each dose, minor side effects and how you managed them. The next time you go to the doctor, this record can help your doctor monitor your progress and provide better follow-up care.
 
Never leave your doctor's office or the pharmacy confused or uncertain. Also, be open and honest with your doctor and pharmacist. They don't expect anyone to be perfect. But in order to help you get better or manage your disease, they need to know what problems you are having and any concerns you may have about the treatment.
 
Your medicine can only be effective...if you know how to take it correctly!