Overmedication and Illness

You just had that coronary heart bypass, and you have been prescribed several new medication pertaining to that and other conditions that popped up during your hospitalization for the surgery. You go to see specialists for these new diagnoses, and you get more medication. So you have over ten different medications to take now. You thought you would be getting along much better by now, but something is just not right. Are your conditions getting worse?

You may think that you are getting worse from the illness, but could it be the medicine? You decide to get out the Physician's Desk Reference (PDR) and research the medication you are taking. Upon discharge from the hospital you received information sheets about each medicine, but the information seems so scanty. Sure enough, you are right.

The PDR gives details about side effects and drug interactions you had no idea could occur. You wonder why the doctor didn't tell you one of the drugs could cause blindness, fatal lung disease, hepatitis, hyper- and hypothyroidism, loss of appetite, anorexia, constipation, worsening of the condition for which it has been given, etc., etc. As you read further you find this drug should not be used with two other medications you have been prescribed.

You no longer have to wonder why your recovery has been slower than expected, and why you feel so bad. You have been overmedicated! Here you were thinking you were getting sicker from your diagnoses and surgery.

Take the time to read about medicines you are prescribed. You may find that you are not as sick as you thought you were. Overmedication can easily mimic as well as bring on symptoms of many disease conditions, and make you feel worse than that for which you are being treated.

Patient Educate Thyself

You are a patient. You are the most important "link in the health care chain". You, patient, keep your health care chain strong. You are the strongest link. Stay up to date on your medical conditions through your health care providers, and through yourself.

Patient education is part of your job. It is up to you to seek out information and knowledge about staying well, preventing disease, and managing disease you currently live with daily. Make a list of your medical conditions, and all medicines you take. Make a list of medical conditions that run in the family. Study your lists.

Read about your medical conditions and those that run in the family. On your next doctor appointment ask your doctor for more information especially in writing. Talk with your doctor. Discuss any tests that you feel would help you in detecting and managing your conditions.

Know all you can know, patient, so you can "be all you can be".

Medical Preventive Tests

Today I read a column on health screening tests that made me go "hmmm". To do or not to do? This is quite a controversial issue for patients and doctors. Many doctors fail to recommend screenings even if you are at risk for certain things. Screenings commonly occur after something has happened. Just because your doctor does not recommend a screening test does not mean you may not need it.

Screening colonoscopy tests and mammograms are recommended routinely for those without risk factors as well as for those with risk factors. Knowing when to get these tests may save your life. Why wait for symptoms to occur or for something medically devastating to happen? This is when it is usually paid for by your insurance. If a preventive screening test is not covered, or if your doctor does not recommend it may not be a reliable indicator.

When I think about the lives I have saved by medical preventive screening, I can positively say it is worth it. Yes, false positives and incidentalomas do occur with necessary as well as preventive testing. Abnormal findings may also be followed without unnecessary, risky surgeries or procedures depending on what is found. I have heard too many doctors express the unnecessary risks (especially with new tests) as a reason for not doing a test versus the benefit of finding something that can be "cured" with preventive screening. There should be more concern about early disease prevention and detection. I assure you that your doctors would do this for themselves. You deserve the best, too.

Educate yourself about medical prevention screening tests. Waiting for your doctor to recommend them or for your insurance to cover them may be hazardous to your health. Sometimes you may have to pay. Your car insurance does not cover car maintenance, but you pay to have auto checkups and for insurance. Why not do the same for your body? Paying a little now may save you and your money in the long term. After all, true wealth is great health.

Incidentaloma Update

It has been over one month since my thyroid ultrasound was performed. After two weeks I was still waiting to hear from my primary care doctor. I called the diagnostic testing center and the results were faxed to me within five minutes. I faxed copies to the endocrinology specialist that same day. I am still waiting to hear from both doctors about my abnormal test which appears to be consistent with a goiter.

Again, I must emphasize that one must not assume tests are normal when your doctors do not contact you. It is best for you to follow up for yourself.

Thyroid Incidentaloma

Incidentalomas are more common than we would like to think. They can be found most anywhere incidentally. As medical scanning tests have become more sophisticated, they have been able to detect more things. These incidental findings are known as incidentalomas. What do you do when a test your doctor has ordered detects an incidentaloma or multiple incidentalomas?

A thyroid nodule was innocently detected on a stress thallium heart test I had done four years ago. When I discussed this with my cardiologist, I was told no further testing was needed. Fortunately my primary care doctor felt otherwise (like I did) and ordered more tests. The thyroid uptake scan detected a cold nodule which can be consistent with cancer. An ultrasound guided needle biopsy was negative for cancer. My thyroid blood tests have remained normal over the years. In addition, the nodule cannot be seen or felt. Yearly sonograms have been stable and unchanged until this year.

I am waiting for the official report from my doctor for this year's sonogram done this week. The technician that did the ultrasound of the thyroid confirmed what I saw as I lay on the table and watched the screen. There were changes showing up. After four years of following this incidental finding, it turns out it is not so incidental.

Many physicians feel that incidentalomas should be left alone. There is much controversy over what to do about them because it is feared that unnecessary procedures, surgeries, and treatments may lead to increase morbidity and mortality. They are becoming more frequent as tests get better. As you can see ignoring them is far from the answer. It gave me a "free" ticket for a thyroid biopsy then kept showing up normal for a few years.

At least yearly surveillance is warranted for incidental findings. Depending on what is found, medical invasive intervention such as biopsy or surgery may be necessary. Additional testing as it relates to the incidentaloma is also indicated. Each person's case must be individualized. The more you know about it helps you and your doctors decide what is best for you.

It turns out that I found out about my incidentaloma incidentally - when I requested a copy of my stress test report.


by J.L. Richardson, M.D., family medicine doctor and author of Patient Handbook to Medical Care: Your Personal Health Guide.

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