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A Service of Dr. Val Karan - 558 Anderson Avenue - Cliffside Park, New Jersey 07010 - (201) 943-2726 - Karan4U@aol.

com - January 2003

My Drug Dreads and Dream Team
Dear Clients, friends and relatives, she ordered an ambulance to take me to Holy Name
Hospital for more intensive treatment.
I never thought I’d have to admit what I’m about to
confess, but say “Hello” to a sufferer of drug abuse. The condition I had was an antibiotic induced
diarrhea that is technically called Clostridium
Before you get the wrong idea, let me make one Difficile (or just C Difficile). Antibiotics do not just
point perfectly clear: I didn’t abuse drugs, my attack the infection they are prescribed for. They can
prescription drugs abused me! also kill useful bacteria that help you digest food and
normally protect you against other infections.
To explain how this happened, permit me to
backtrack to my last two newsletters. In the last issue, I Antibiotic-induced changes in intestinal bacteria
explained that, because of atrial fibrillation and high allow overgrowth of Clostridium Difficile, a bacteria
blood pressure, my doctors have given me a that causes serious diarrhea. I was warned that about
smorgasbord of medications, including a blood thinner. 10% to 20% of patients will experience relapse -
I also have written about my son’s wedding plans. regardless of what treatment is given. For almost a
week, I remained in the hospital being rehydrated
In preparation for the marriage which took place constantly and being treated, ironically, with another
November 7, I had some minor nuisance health antibiotic that counteracted the C Difficile.
problems that had to be taken care of first. One
concerned an aching wisdom tooth that had to be Although my stomach must have shrunk
removed. The other involved a bothersome bruise that throughout this ordeal, by the time I was released
mysteriously appeared on my right shin and that caused from the hospital (where, incidentally, the atmosphere
some pain and limping. My doctor at the time reckoned and staff were pleasant and professional), I was
that I was suffering from cellulitis; he also knew that I b l o a t e d f r o m
desperately needed to be steady on my feet so that I the medication and water retention and looked as if I
could dance at Edward and Nancy’s wedding. So just as had gained weight. I stayed home from work for
the oral surgeon had prescribed an antibiotic for me another week to recover and to prepare for a visit
which ran its course, so, too, the physician put me on from my grandsons for Chanukah.
another antibiotic as well.
On November 24, when my daughter and son-in-
Here’s where the story turns dicey. In the weeks law and their three sons came by, I was feeling better
leading up to the wedding, I took the new antibiotic than I had in many weeks. I went to bed that night
faithfully and my leg kept getting stronger. When the thinking that the worst was over and I would be back
day of the wedding arrived, I was able to join in some, to my regular schedule shortly.
if not all, of the dancing. What was bothering me more,
however, was a nagging diarrhea. The food at the During that night, I was assaulted with intense
wedding was delicious, but it didn’t stay inside me very diarrhea. I could barely make it back to bed, and I
long. So, too, for the next few weeks, despite various knew I had had some sort of a setback. I somehow
home remedies, nothing seemed to stem the tide of the managed to get back to the doctor’s office early the
diarrhea. Even some medicine which the doctor next morning. Once again she admitted me to the
prescribed only made the situation worse. hospital for what turned out to be severe gastritis and
bleeding, a reaction of my body to the blood thinners
Finally, on November 18, I went to the physician’s and combination of other medicines. This time my
office again. If I say so myself, I looked and felt hospital stay was not so long, but it included blood
miserable. This time I saw my gastroenterologist, and transfusions, rehydration, and new medicines. I was
A Service of Dr. Val Karan - 558 Anderson Avenue - Cliffside Park, New Jersey 07010 - (201) 943-2726 - January 2003 - Page 2

home before the weekend where I needed another availability, "style" or communication patterns
week of rest and recuperation before I could return (informal, warm vs. formal, detached), philosophy
to my practice and my school psychology job. of care (disease-oriented vs. wellness-oriented),
therapeutic approaches (conservative vs.
So what can we laymen do to forestall any aggressive), competency, and degree of inviting
possible abuse by the prescription drugs? I am patient involvement.
indebted to my friend Robert Zweiman, Past
National Commander of the Jewish War Veterans, As one medical expert has written, "You can
who recently wrote an incisive article, that is both have a doctor who is the most intelligent person in
serious and tongue in cheek, about the potential the world, but without a lot of compassion, they
harmful interactions between common drugs we probably aren’t going to go the extra mile to take
take. Bob passed out as he was about to deliver a care of you."
eulogy, and he woke up later in a hospital
emergency room. After extensive tests, the doctors Sometimes, even after a careful selection
concluded that he blacked out from the inherent process, it turns out that your personality just
nature of and conflict between some of the doesn’t mix with your doctor’s personality. When
medicines which he had been taking. Bob warns us that happens, don’t be afraid to find a new doctor.
that we should all become more aware of our That’s what I did.
prescription drugs and their effects and should have
answers to the following questions: Luckily for me, I had four physicians who were
 Do you know what drugs you are taking? communicating with me and with each other during
(always keep a list handy with proper my health crisis. Whenever I had a question about
dosages) my condition, medicine or treatment, I could always
 Do you know what condition those drugs are count on a settling answer from one or more of my
for? dream team members who were in frequent contact
 Do you know the impact of one drug on with one another. The gastroenterologist who
another? admitted me to the hospital is a rising star, certainly
 Do you know whether they are to be taken in my galaxy. Dr. Susan Fishbein oversaw every
on an empty stomach or with food? aspect of my care with such skill and reassurance
 Do you know whether they can all be taken that from now on I will rely on her as my primary
together at the same time or how the taking care physician since she is an internist as well as a
should be timed? specialist. I also have a great cardiologist by the
 Do you know whether there are alternatives name of Dr. Jose Meller of Mount Sinai hospital. I
to medications which you should consider? would guess that Dr. Meller has to be one of the
 Do you know the effect of the drugs on your busiest cardiologist in New York City whose offices
body? are always teeming with patients and who invariably
has emergency calls while he is in the examining
Just as little or no information can be dangerous, room. Yet not matter how many cases he is juggling,
so, too, too much informed consent can be he always has a calm and assuring demeanor; and
confusing. I don’t know about you, but I get sick when he is talking to you, he is totally focused on
just reading the warnings and contraindications in you and your condition. Joining All-Stars Meller
small print on the back of prescription drug ads in and Fishbein on my dream team was Dr. Robert
magazines or a Physician’s Desk Reference (PDR). Lesser, my wife’s cousin and a rheumatologist who
That is why choosing trusted primary care doctors is has made New York Magazine’s list of top doctors,
one of the most important health care decisions you and our own daughter Dr. Suzanne Karan, my
will make. I say “doctors” because I've come to favorite anesthesiologist.
the conclusion that is it is not only in matters of
law and sports that one should have a dream Our health is a thing we all take for granted,
team. The human constitution, it seems to me, is Until diarrhea hits that can’t be Mylanta-ed.
too complex to be entrusted to just one medical So my Dream Team is set for the staying well game,
specialist. Choosing the optimal persons from As when drug skull-duggery brought me to Holy
whom to receive health care requires knowing more Name.
than just the qualifications of the providers. Also to May your health stock rise in 2003,
be considered are perceived traits such as And let’s all enjoy peace and security.