A Curious Statistical Anomaly

Today when I opened my online news source, I was greeted with an article about the FDA wanting to pull many of the prescribed painkillers containing acetaminophen off the market. Philly.com has this article Painkillers at a crossroads as FDA decision looms. The Globe and Mail had this article, U.S. FDA recommends pulling some painkillers off the market. There was an article with an opposing view that was rather mild in my opinion.

In the Globe and Mail article, it said:

Despite years of educational campaigns and other federal actions, acetaminophen remains the leading cause of liver failure in the U.S., according to the FDA.

Panelists cited FDA data indicating 60 per cent of acetaminophen-related deaths are related to prescription products. Acetaminophen is also found in popular over-the-counter medications like Tylenol and Excedrin.

Those of you who read my blog know that I suffer from chronic pain. I found this bit about “years of educational campaigns and other federal actions” to be laughable. At one point, before my arthritis was diagnosed, the family practice doc I was seeing didn’t want to do anything about it because I was simply fat and needed to lose weight. The pain had gotten so bad that I was scaring myself with the number of Tylenol that I was taking just to manage to walk with a cane. I made an appointment and told her how much Tylenol I was taking and that I was concerned with liver damage. She laughed told me I could double or triple the dose and to just lose weight.

At the time, I was well below liver damage’s (LD 50) but that level has been lowered twice since and now I’d be just a bit below. I was so angry. I left the doctor’s office and went to see my chiropractor without an appointment. They took a look at my swollen knee and referred me to a specialist (at the time I couldn’t see another doctor without a referral). After seeing the specialist, I was diagnosed as having arthritis in both knees and later the added bonus of it was aggravating my fibromyalgia — a double whammy.

The point is that I knew more about the drugs I was taking than the malpractice-suit-waiting-to-happen doctor that I’d been seeing. Needless to say, I also changed doctors that day.

The second point is that most doctors, though they write the scripts, are not experts in drugs, drug interactions, and doses — most of the time they rely on the pharmacist to flag if something they prescribe is going to conflict with something you already have, or needs special information or training for the patient. Remember, there is a reason that so many pharmacies ask that you keep ALL you Rxs with them. It’s also the same reason they staple those informational notes to the Rx’s bag and ask if you have any questions.

If you take prescriptions be sure you understand how to take them and how often and whether you need to keep taking them if you feel better or should quit. Always ask questions if you don’t understand or feel confused. It’s your body and your life — you are the best person to take responsibility for keeping yourself healthy and safe.

Doctors have years of schooling, internship, and practice under their belts but, at heart, they are people. They know more about their fields that we ever will, but when you have a chronic condition, it’s worth your while to learn about it and ask questions, because no doctor can be an expert in every condition and disease that will walk through their office door. Mistakes and accidents happen.

My story about the doctor that suggested I take a near lethal dose of a Tylenol is a case in point. If I hadn’t read about the dangers of Tylenol/acetaminophen and liver damage, I just might have followed her suggestions. Luckily, I didn’t.

Do I think these painkillers with acetaminophen should be pulled from the market? NO. A resounding NO! Here in America many people live with pain — chronic, near crippling pain. Most people who deal with pain are under medicated and ignored. They need help. If these drugs are pulled, there are other that can be used, but we don’t have access to them in the US. Unless the FDA is going to allow alternatives they should consider leaving these on the market with strongly worded cautions and plainly worded Dosage Limits.

Even more important — the FDA should make sure that pharmacists, doctors, and the public have access to this education and training that they THINK they have done over the years. I’ve heard more stories similar to my “ignorant” doctor (used with the meaning that it can be cured) than I have of the other kind. I think information on drugs should be easier to find online, with easy to understand material explaining doses, uses, and contra-indications. Most dosage info online is convoluted or needs a chemical degree to figure out what’s too much and what’s safe — we need better resources for patients and doctors.

Mostly, we need better pain management. I have my good days and my bad.  And I do it mostly without painkillers.  But today, I slipped and fell, landing full force on my knee — it sure would be nice to take something, but I can’t, because I might need it more later on and I can’t waste the few painkillers I have. (I’m not the only chronic pain sufferer who has to balance need this way, and the sad part is none of us should have to.)

I was surprised to see an article on caffeine withdrawal the other day, “Beware the perils of caffeine withdrawal” on CNN.Health. I mean, I thought everyone already knew that coffee, or rather caffeine was addicting. But then I remembered that in this Just Say No society many people won’t admit they have a problem with drugs.

Yes, caffeine is a drug. And, yes, many people are addicted, including children. Caffeine is in many of the products that you ingest each day: coffee, tea, chocolate, some sodas/soft drinks, and many other food items. When you cut out all caffeine it can cause your body to react and fight to get its next fix. Not as bad a withdrawal from some of the hardcore drugs or cigarettes but painful nonetheless.

Personally, I love coffee. Those of you who read my blog know that I have often sung the praises of coffee; one of my favorite beverages. But, alas, I keep the intake down to one large mug a day and when I can (usually in summer when I prefer iced tea (decaf)) to one every other day.

We all have reason why we cut down on caffeine. Some people can’t have it because of health reasons. Me, I cut down because I have migraines. I find that if I keep my daily caffeine intact at a low level then when I have a real big whopper of a migraine upping the caffeine along with a smaller dose of pain meds, I can survive it without resorting to sitting in the dark closet with a pillow wrapped round my head, crying myself to sleep.

I picked up the caffeine trick when pain meds for migraines became difficult to get because, as I’ve been told so often by my health insurance, “It’s only a headache — take aspirin.” (I’m hoping all health insurance workers develop killer migraines and have to resort to aspirin for the pain.) Most of the heavy duty pills for migraines have caffeine in them so I thought why not experiment and see if I can find a balance that will work for me (other migraine sufferers will probably have their own strategies — but if I hear “go to your happy place” one more time, I may do damage…).

Anyway, I thought that just in case you found yourself shaky and unable to concentrate, maybe achy and tired — you might want to think about what you’ve cut out of your diet lately. It could be you’ve cut down on caffeine too quickly and need to rethink just how quickly you cut it out of your life. Slowly reducing intake is the best way to avoid the withdrawal symptoms. Check your food labels because you may have cut out caffeine you didn’t know you were getting.

Me. I’ll stick to my one cup a day or less until I really, really need this drug of choice. What about you?