Thursday, July 19, 2007

Polypharmacy, polydocs

One of my favorite eighty-somethings came in today to talk about simplification of her medical care. She was on six drugs, five supplements, and visited at least nine doctors including me.

The drugs were gold--two for hypertension, one for cholesterol, one to duck a second stroke, one for depression, and one for osteoporosis. She also took vitamins E and C. As I've mentioned before, the evidence in favor of these antioxidants is weak; in fact they may decrease the efficacy of the lovastatin she takes to lower cholesterol(1) and E may increase her risk of congestive heart failure(2).

The docs? A veritable medical village to support this senior! She had four(!) orthopedic specialists to hold up her skeleton alone--a podiatrist for the feet, a hand specialist for her trigger finger, a back-up man to prop up her spine, and slightly more general type orthopedist who graciously agreed to care for her knees as well as her hips.

No way to to pare this roster down to a pair o' docs. Now how ironic was this--after her visit to simplify her care, she hit her leg on her car door as she left and tore a huge flap of skin up off her leg. I would've sent her to a surgeon, but skin that fragile can't be sutured. We steri-stripped her leg and sent her home.

1. Cheung, MC et al. Arterioscler Thromb Vasc Biol. 2001 Aug;21(8):1320-6.
2. Marchioli, R et al. J Cardiovasc Med (Hagerstown). 2006 May;7(5):347-50.

1 comment:

Mauigirl said...

Thanks for commenting on my blog! The elderly woman you describe sounds like my aunt - 86, on several drugs for her heart/blood pressure - always has something wrong. And every drug, she swears, gives her side effects. My 88-year-old mom, on the other hand, who smokes a pack a day, is on no drugs whatsoever except for eyedrops for glaucoma, has no heart problems and is fine. Strange how different two sisters can be.

I love your blog, am going to add it to my link list. I'm a medical info junkie - and have another blog, Medicana, that talks about medical subjects! ;-)