Dear Dr. Roach: My wife was recently discharged from the hospital after a long hospital stay with multiple diagnoses. Most of her problems were treated medically, with six new medications from four different medical disciplines in addition to the other three medications prescribed before her admission.
It was fairly easy to find drug interactions online, and the hospital discharge papers listed the morning, noon, and night doses. However, some medications need to be taken several hours apart, and this was not explained in my wife’s discharge letter. I had to find out the interval myself.
Using an online spreadsheet, I was able to create a daily schedule to minimize drug interactions. My question is, is it common to discharge a patient without a clear understanding of when to take the medication? — EW
Answer: When a person is being treated by multiple health care providers, there is always a risk that no one is looking at the person’s entire medical history, and drug interactions are one of many problems that can occur. One. Having a primary care physician, such as a family doctor or internist, can help you avoid exactly the problems you identify.
However, the person’s primary care physician needs up-to-date information, which may be lacking. Very few people do what you do and I admire your dedication and thoroughness. However, online programs do not always make it clear whether a drug interaction is a high risk. Many interactions that my program warns about have little or no clinical significance. Interpreting these requires clinical judgment.
One person who is often overlooked, despite being trained to help, is the pharmacist. After making any major changes to your medical plan, such as six new medications that my wife started taking, I highly recommend getting all your prescriptions in one place and talking to your pharmacist. Although drug timing is both an art and a science, there are some interactions that cannot be overcome by changing timing alone. Therefore, you need a specialist, either a doctor or a pharmacist.
Dear Dr. Roach: I am a healthy 66-year-old woman with osteoporosis and osteoarthritis. I recently saw a rheumatologist because I was about to start Reclast IV for my osteoporosis. Blood tests revealed that I had Monoclonal Gammaglobulinemia of Undetermined Significance (MGUS). I had never heard of this. This is an atypical protein in the blood that can lead to multiple myeloma over time, and I was advised to have it monitored annually.
I’m still a little worried about this new diagnosis. What is your experience with MGUS? — MA
Answer: MGUS is very common (affecting at least 4% of people over the age of 50) and should be considered a precancerous condition. Although not a blood cancer per se, some patients with MGUS eventually develop multiple myeloma or other related blood cancers.
There are three types of MGUS: IgM, non-IgM, and light chain. The risk of progression can usually be estimated with blood tests. A specialist, such as a hematologist, will put you into one of four risk groups. The lowest-risk group has only a 5% risk of developing cancer over 20 years, but people with all risk factors have a 57% chance of developing cancer over this period.
The type and level of abnormal proteins are two of the main risk factors. You need to know what risk level you are at.
Dr. Roach regrets not being able to respond to individual letters, but will incorporate them into his columns whenever possible. Readers can email questions to [email protected] Or write to us at 628 Virginia Dr., Orlando, FL 32803.
(c) 2022 North America Syndicate Inc.
Unauthorized reproduction prohibited
