Friday, June 4, 2010

drug interactions

Over the course of this blog, as one might expect given the numbers, other people have developed cancer. People who had been following my blog. So now I have had a chance to see it all from the other side. ...... wondering on some days when I have not heard, if something really bad has happened and just a constant thought about these people.

About 5 years ago a group called the ROP organized a march between Salem and Portland that many of us from Bandon participated in. It was a 7 day event and though some of the people came for only a day or two, there were probrably about 50 of us that did the entire trip. We camped along the way, and though there were many messages of peace we marched for, I think most of our group marched to bring an end to war. (in particular the one in Iraq)

The rather disturbing thing about that march is that to my knowledge now 3 women have come down with advanced gynecological cancers, Mariem died a year ago of ovarian cancer, I was diagnosed with the endometrial cancer a year and a bit ago, and the main organizer of the march, Marcy Westerling, was recently diagnosed with

Stage 4 Ovarian cancer. She too is quite healthy, She has just recently started chemotherapy.

Not sure about you, but that seems like a lot for such a small group, it is just coincindence, or did we march through a nuclear wasteland??

One person who has followed my blog closely and whom was the source of support for me, is now in the situation of caring for her husband who is going through chemo and radiation right now.

He started off doing extremely poorly, and the thought is always.....perhaps the cancer has spread further and is affecting other body parts. He was unable to eat, the food just seemed to get stuck at his stomach and go no further.

So I did a review of his medications. He had been on some meds before all this began and then of course he was put on several new meds, and when I ran a comparison on them, there were many that were apparently interacting, and he improved partially by just stopping one of the meds.

I got to wondering how often this happens. You take one group of doctors, those who really know the chemo drugs and ALL of the side effects really well, but not so much about all the other meds a person brings to the table when they start something like this.

In the work I have done for many years in geriatrics, they teach you to think , when a person comes in with a new complaint, just think drugs, drugs, drugs, and once you have ruled them out as a cause, then move on the other possiblilities based on symptoms.

This extends way beyond geriatrics though, really anyone who is on two drugs. For instance, if you are on an ace inhibitor (bp drugs that usually have a “pril” on the end of the word), and also take an NSAID (aspirin like drugs, usually called antiinflamatories), there is a much increased risk of this combo doing damage to your kidneys, and if you throw in a diuretic (water pill) the chances go even higher.

Other examples are the antidepressants, SSRIs, such as Paxil, Zoloft, Celexa, Lexapro etc etc. While these drugs are fairly safe if taken alone, if combined with other certain drugs, they can cause seratonin syndrome, which actually can be life threatening.

Some of the “other” drugs can be herbs. One of the main symptoms of seratonin syndrome is fever and shakes, without other signs of infection.

Here is a listing of meds that interact

I had lunch yesterday with a few friends in Bandon and they sheepishly each had medical questions to ask me, I told them I was thrilled to have their questions, it made me still feel like a doctor. There is no greater feeling that to solve someone else’s problem.

I guess I was not clear on the “qualifications” part of my last blog.

Ken and I had pretty much the same medical training, exept that he graduated in 1980 and I graduated in 1990. In Canada at the time, most docs were GPs, general practitioners. Specialists did residency trainingm and GPs did rotating internships.

There came a time when they decided that GPs should also become specialists ...”family practitioner”.

They had a residency training and exams as well.

Ken was able to write the family practice exam because he was grandfathered in and even though he had not done a residency because he graduated in 1980 he could do that, and the US accepted his Family practice specialty on par.

To be licenced in Oregon, one only needs to be a GP, which is why we have been able to work all these years in Bandon.

Places like Eugene have policies against doctors who are not board certified, partly because it is a more desirable place to live....I guess and so they have no shortages.

I believe myself to be a very good doctor despite my lack of board certification, but there is really nothing I can do in Eugene. Ken and I do well when we work together, and so it is hard for me seeing him work and me not being able to.

In fact between the two of us, Ken would have gladly quit medicine years ago, it has always been me that still enjoyed it.

Because of my “qualifications” or lack of them, i was extremely fortunate to have been able to work as a hospitalist in Bandon, I loved the job more than any I have ever had. I will hold that time as a very special part of my “work life”. As one can easily imagine too being in a position like that the administration clearly has something “over you”. So I was in a very vulnerable position.

Society has been taught that board certification is essential, and I am sure that the administrator will be glad to advertize now that all the doctors at the hospital are board certified. (I am just like a dinasoar that has been caught between time)

Often in small communities doctors are called upon to take greater responsibilities, and I feel that Ken and I both did just that, and we did it well.

We also truly loved the staff at the hospital, we had the most awesome working relationship with the nurses. It was truly like a real team, complete with mutual respect.

I had to go back to sign some charts yesterday and stopped only briefly at nurses station, lest I break into tears.

I will continue to be the director of the coumadin clinic, (in Bandon) and I did hear that there was a lovely picture of me in the paper. (perhaps if anyone HAS the paper they could save me one)

Ken has a job filling in at the university, and is still going to be doing some ER shifts in Bandon. We are planning on getting Mushroom licences in the fall, and perhaps trying to make money at it (it is one “job” we can do together). We LOVE picking mushrooms, but can never eat them all when they are fresh. Some we cannot eat at all. So that should be fun, plus we get to take the dogs as well.

I am currently thinking of working a couple of days a month (geriatric days) at Gail McClaves office, OR seeing her patients at heritage place a few days a month.

I am starting to get quite nervous about my CT scans I will be having in early July, but I guess that is par for the course.

Bye for now


Janet Bates

jankenb @

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