For many patients, pharma side effects are a rough ride

When I take my medications, I imagine that the little pills migrate down my esophagus to my stomach, split into two groups and rumble like the Jets and Sharks in West Side Story.

These little buggers stomp and kick and pound the body. At least that is what it feels like where I am sitting.

The pharmaceuticals I take to fight sarcoidosis have been getting to me of late. I was handling drug side effects well but then two things happened: The introduction of metformin at a high dose and a seasonal flu shot. The metformin is for type 2 diabetes, which was caused by high dosages of prednisone used to fight my case of lung and heart sarcoidosis. In all the docs and I are employing….well, many drugs. Let’s list them: prednisone; methotrexate; lisinopril, hydralazine and hydrochlorat (to reduce prednisone side effect of high blood pressure) folic acid (to stem the cell-destroying side effect of methotrexate); metformin; Advair disk and Combivent inhalers (to mitigate pulmonary sarcoidosis and symptoms of COPD); Zolpidem (Ambien) to counteract prednisone–induced insomnia; alendronate and calcium and vitamin D supplements (because prednisone can destroy bones).

Prednisone is a steriod that suppresses the sacroidosis symptoms but also alters mood, makes your joints hurt, ratchets up blood pressure. Methotrexate suppresses sarc problems, too, but, it makes you feel worn out and can destroy good cells, too, which is why folic acid is prescribed to the mix. The blood pressure meds make you drowsy. The inhalers make you sneeze. The Zolpidem knocks you out.



Metformin side effects, stomach upset and worse, are now thrown into mix. Fun. Forty-million Americans take metformin and most suffer no problems. I guess I am one of the lucky ones.

There are tens of millions of people out there among us taking multiple drugs to battle some sort of disease. I watched a documentary that told its tale through the story of a young man in his 20s taking 30 pills a day plus injections to deal with a serious kidney problem. I am amazed people on multiple meds function the way they do.

Sometimes, I take these 'scripes and I develop what I describe as a do-not-know-whether-I-am-coming-or-going feeling. I feel weak and edgy and ragged and raw. So I just sit and let it pass. Watch some TV. Good documentaries on PBS in the mid-afternoon, you know. Learned a lot at the history of so-called narcotics farms in America. Fascinating stuff.

I wait until the feeling passes and then get on to what I was trying to do in the first place. I remain greatful because as bad as I have it, I know there are people who are worse off than I.

And better times are ahead. I visited my pulmonologist Wednesday and he said my lungs sounded clearer than the last time he listened to them, which was about six weeks ago. Blood pressure was 127 over 80, which is great for me. The goal is 125 over 75. My oxygen saturation test reading was 94/95 percent. He says a reading of 97 is great so I am not far off. If it hits 87, well, you have problems. Have to make sure it does not dip. Weight-wise, I am at 304. Not exactly where I wanted to be, but it is lighter than 312 and the weight loss comes after quitting smoking and while still taking prednisone. "You have no idea the good you've done by quitting smoking and dropping a little weight. It's hard; just try to keep it up," my internist said recently. I will.

The next big thing – I guess the only big thing – is my heart. The left ventricle, which pumps oxygen-rich blood, is weak. The question is how weak. The heart, a muscle, gets stronger with exercise and I have been working out. Did the prednisone reduce the inflammation and scarring that appears to be interfering with normal heart function?

I find out on Tuesday…finally. I am hopeful. The affects of the seasonal flu shot? It makes you feel...fluey. I'm feeling better, though. Can't wait to take the swine flu vaccine shot in October. Fun.

Ultimately it is a trade off: Do the drugs benefits outweigh the side effects and can the side effects be managed and/or tolerated? Will challenging times now give way to something better in the future? I say yes to both.