Photo by Towfiqu barbhuiya on Unsplash
If you have not had the pleasure of visiting an Emergency Room lately, let me assure you that it is nothing like the televised medical dramas. On television, heroic doctors and nurses are the stars, and the patients are minor characters. But when you are the patient, you might think you are the center of the story, and you would be wrong. You’re still a bit player. Forget the suspenseful drama and fast-paced action – you will appear only in brief cameos, which break up long, monotonous stretches of fruitless waiting. This is not a formula for thrilling Entertainment.
I was in the ER last week because I awoke one day unable to maintain my balance and sporting a pounding headache that would not quit. After another day of headache and unsteadiness and two nights with minimal Sleep, my wife drove me to our primary care physician, who asked a few questions and then referred us directly to the nearest ER. During our 12-hour sojourn there, I went through a CT scan (negative), an MRI scan (negative), and a neurology workup (negative). These tests confirmed that I wasn’t having a Stroke, a brain bleed, or anything else life-threatening. I received a pain medication for the headache that eventually worked. Those actions took about two hours total. The other 10 hours were spent waiting. For most of that time, I was shivering under a blanket because the ER temperature is permanently set at “Meat Locker” to minimize the spread of nasty little organisms, and I had come dressed for a warm summer’s day.
I was finally released, my balance still a bit wobbly, but the next day my hands were trembling violently. Eating was an Exercise in frustration and futility, For the only time in recent memory, my wife finished her meals long before I did. To drink liquids, I had to place them in a cup with a lid and a straw – essentially, my very own sippy cup. Writing was impossible: It took me 10 minutes to get my quivering fingers to type a one-line message on the computer or the phone – when I could manage to unlock the phone with the correct password.
On the fourth day after my discharge from the ER, we scored a follow-up appointment with the primary care practice. A nurse practitioner studied the charts from the ER docs, asked a lot of questions, and finally said, “I think I know what’s going on.”
Huzzah!
Her diagnosis: The hand tremors occurred because the pain medication delivered in ER caused an adverse interaction with a prescription I was taking regularly. Eventually the drug would wear off. There was nothing to do but wait it out. (The original balance problem and headache might have been a drug reaction set off by dehydration.)
Just as she predicted, the tremors gradually receded, as did the balance issues. Three days after that visit, I was back to normal. One frightening medical mystery solved.
My experience, I have since learned, is not unique among older adults. The more medicines you take, the greater your risk of having an adverse drug interaction. Most of us, by age 60, are taking prescription drugs for one or more Chronic Conditions such as high blood pressure, high cholesterol, or inflammation. Studies have shown that patients taking more than five medications (a condition called polypharmacy) are up to four times more likely to be hospitalized from an adverse drug event.
The number of drugs is not the only issue. Our bodies change over the years, and a drug we’ve been prescribed for years may not work as effectively as it did. Even vitamins and supplements can trigger dangerous drug interactions. A spike in glucose or lack of fluids can set off a chain of events that can lead to scary symptoms.
Here’s another little surprise: Elderly patients are rarely, if ever, included in drug trials. So doctors know what to expect when prescribing for young and middle-aged adults but have little to guide them on how the drugs perform in older bodies, or what constitutes a safe dosage. There is more guesswork and playing hunches than we would like to think.
I am definitely in the polypharmacy demographic: I have taken seven prescription medicines and an over-the-counter nasal spray for decades. But after two tremulous experiences in six months, I will be insisting that my physicians take a fresh look at my medications, with an eye toward deprescribing some or finding newer, safer alternatives.
I’m too young to abandon my writing career because of trembling hands!
