For problems that tend to persist
Take a look at what’s on the drug list
Symptoms varied and strange;
A small patch of the mange?
Find a drug we can stop, I insist.
I enjoy making people feel better. Finding the problem and improving the patient before they leave brings a wonderful feeling. Occasionally I get a doctor’s moment, when my strengths come together, I ask the right questions, and heal with words; it doesn’t happen often.
Every year or two I cure a man’s headache by moving the wallet to a front pocket. Once or twice a year I fix a woman’s headache by reducing the load in her purse; more often by getting her to either loosen her hairstyle or cut a couple of feet off her hair.
I really enjoy watching people get better when I stop drugs rather than starting them.
The three top drugs I love to hate are nicotine, alcohol, and caffeine, in that order. True, I get more than half my business from them, but I’m at a phase in my career when I want to slow down anyway.
The top prescription drugs I love to stop are the statins, like Lipitor, Crestor, and Pravachol and others. If a person comes in with otherwise inexplicable bone, joint, or muscle pain, I judiciously ask them to stop the statin (if they’re on one) and come back in a week or two. More than half the time the pain is gone and the patient is grinning. Then I start the hard process of getting the cholesterol under control either with a statin plus coenzyme Q 10, or by turning to other agents.
Many a patient came in with a dry, hacky cough and no other symptoms, and asks if it might be the lisinopril (or other angiotensin converting enzyme= ACE inhibitor) prescribed for high blood pressure. Of course it could be, I said. In fact, it probably is, so stop that drug (the entire class can give such a cough) and start this other drug, an angiotensin receptor blocker, or ARB. And come back in a week or two and we’ll see how you’re doing. The shift from an ACE to an ARB is pretty straightforward.
If a person takes a drug and the drug is distributed throughout the body, one would think that an allergic skin reaction would be throughout the body’s covering. Very difficult to diagnose is the fixed drug eruption, where a small part of the body, less than six square inches, reacts to a medication; it is well described in the medical literature.
There are at least two case reports of people who had a rash in reaction to tap water. Now if a person can have a rash in response to water, then any person can have any reaction to any drug.
Thus we get to one of my governing first principles, ABCD: Always Blame the Cottonpickin’ Drug.