Managing My Health

That medication that was supposed to help my brain could kill me if I need a pain killer.

Friends of mine have been following the saga of a mysterious particle that appeared in my right knee between the bone and the skin on the right side a few months ago. Fifteen years ago I had a double knee replacement that utterly changed my life. I had been unaware of the fact that my patellas were out of alignment in my knees for most of my life but in my early 60s, I found that I could barely walk a block without breaking down in pain. There are times when being a stoic is a terrible life choice. Having a double knee replacement is no walk in the park and it was accompanied by a fair chunk of postoperative pain, but the hospital was generous with postoperative drugs for a few days, and by the time I got back home for my recuperation and rehab, I was in less pain than I’d had for years. I love my steel knees except when for some reason I might have to kneel on them, but I’ve gotten good at avoiding that.

So when this mysterious particle appeared and began making odd clicking feelings/sounds in my knee I hied myself to my orthopedic surgeon. Going to any doctor is a chore for me because I live on the farm outside the city, I get up and I sleep early, and orthopedic surgeons tend to be doing surgery in the morning and having clinic hours in the evening. I don’t drive at night any more so I have to round up a driver (Uber and the like don’t come out to the boonies at night) and stay up later than usual. But I did it and we arranged a bunch of scans, xrays, a CT scan, and all to see what this was and where it was. It seemed to be about the size of a small M&M peanut and it was hanging out next to my knee but not in it. As long as no one pushed directly on it, it didn’t hurt. So we began trying to arrange surgery to relieve me of my hitchhiker. That took us about a month, it being summer and all, and with a communications glitch we ended up missing one appointment and finally setting another for a few days ago.

Both my doctor and I showed up at a nice private hospital in Maadi at the appointed hour, I had all the blood and heart work with me to save time, and I was rolled into the operating theater trailed by a couple of nice young residents who asked me about sensitivities to medications, allergies, and the usual suspects, all of which I answered with good humour while dressed in my backless paper garment that is so confidence inspiring. When the senior anaethesiologist arrived we went through the same song and dance, but then he threw me for loop by asking if I was taking anything for platelets. Hmm. When I had my TIA in November, I had boxes of medications tossed at me by neurologists, some of which were no problem and others of which were highly problematical. Most doctors just write things done and tell me to go buy it without much explanation. Most patients are okay with that, but I read pharmacology to know what I am doing to myself, and I am not okay with it. As it turned out, I missed the lesson on Pletaal, and this was counterindicated in a surgical situation.

So surgery didn't happen because one of the fashionable new platelet medicines was prescribed for me after my TIA last fall, but no one bothered to mention to me that I'd have to discontinue it at least 2 weeks prior to any surgery that might require something more than novacaine. I was taking Pletaal twice a day...Now I am taking aspirin 100 mg once a day, which is safe for surgery. I thanked the anaesthesiologist profusely when he caught this and we canceled surgery from the operating room. As a bonus, having stopped taking the Pletaal, I find that a lot of brain fog has cleared and I am remembering my words. I was blaming this all on the TIA, but perhaps it was aggravated by the medication. I will likely never go back to taking it again.

In Egypt, MANY doctors do not record visits, consultations, or prescriptions. When we get a prescription, we drive all over town looking for an open pharmacy that just might carry what we are looking for. This search can take forever, as we are currently considering surgery for a dog with a gall bladder problem since the medications that she needs are simply not available in the pharmacies. If/when we do find the medication, the issue of how much it costs these days is another story, and after all of that that pharmacy keeps no records of who bought what.

This IS IMPORTANT!!! Unless you keep a record (on your phone like I do now, maybe) of what medications you are taking, no one else is going to. Interactions of medications can kill. I went to the hospital with a small zipper bag of my medications for some reason that afternoon. I haven't made a practice of this, but it is going to be standard operating procedure from here on in. When asked if I was taking a medication for platelates a blank expression appeared on my face, but I suggested that they check the bag in my room, and this is where a possible disaster was averted.

My surgeon and I had planned the surgery a number of times when it simply didn't happen for whatever reason, and by the time I saw him in the operating theater, medications were not on our minds. But the anaesthesiologist has to worry about how anything you have put into your body is going to react with the drugs that he needs to use in surgery, so he has to take EVERYTHING into account. An neurologist might feel that Pletaal is going to help your brain, or a cardiologist will feel that your heart needs it, and they are thinking of ONE body part. Your anaesthesiologist has to think of them all. And the only thing connecting the different places where a medication is needed is the patient...so as patients we must be incredibly aware.

I have noticed that quite a few of my older friends are taking these platelet medications. Taking pills is one of the new sports that you learn as you age. Hopefully all of them will mention to any one wanting to do surgery that they are taking them. Because these medications are felt to help people with heart issues like my driver, or people with brain and cognition issues like myself, they seem to have become quite fashionable. But surgery can be needed quite suddenly, and perhaps there isn’t time to quit taking them before anaethsesia must be administered..

If you live in a highly regulated country, pharmacies keep track of prescriptions and doctors keep records, but this isn’t true everywhere. In Egypt we have no General Practioners or Family Doctors, who are seen before a specialist. We simply have a gazillion specialists, many of whom are very good, but as indicated by their label…they are specialists and are therefore working in a narrow focus. Sadly it is often up to the patient to try to figure out what sort of specialist they need. My late husband had a world class gastroenterologist as an uncle, and if I ever mentioned that one of my kids had a cold or something, I was told to talk to Dr. Mustafa, which I almost never did. He might have been the king of the colon, but that didn’t mean that he knew about tonsils, and I knew that what he knew about children was less than nothing.

I moved to Egypt in 1988 with two children and it was clear to me from the start that doctors and pharmacists had to be supervised. I blessed my parents who never put a lid on my reading when I was growing up because I was not afraid to tackle some of the books and later articles on the net when I needed information about something in medicine and pharmacology. I didn’t self medication much at all beyond minor pain killers or cold medications, but I did check the homework of the doctors and pharmacists. A bit of mistrust might save your life.