Reflections on Mortality, Part 2: Medications (9/25/24)

(As I review this in July 2025, I broke this down into three segments to make it more digestible!  Since now being diagnosed with Parkinson’s disease, in retrospect, many things make more sense.) 

It is very easy to prescribe medications!  When learning about medications in medical school, generally we focus on the “indications” or reasons to use a specific drug.  But we tend to skim over at the overwhelming list of potential side effects or problems with a drug, especially when it only was reported in a small percentage of people.  However, with so many people on multiple medications, there are a lot of people with side effects and undetected interactions between drugs.  The patients often are not aware that what they are experiencing is related to their medication.  Unfortunately, many medical providers are equally unaware!

 

Often people take drugs for side effects of other drugs!  For example, the ubiquitous NSAIDs (nonsteroidal anti-inflammatory drugs) including ibuprofen, naproxen, diclofenac, and many others, can cause gastritis and ulcers, and even blood in the stool, that when detected leads to a rather expensive and uncomfortable series of evaluations.  Many people taking NSAIDs also take other medications for the associated heartburn and upper abdominal pain.  NSAIDs can also contribute to kidney failure, an increasingly common problem.

 

The most common medication for heartburn and gastritis (often caused by NSAIDS) are the PPIs (proton pump inhibitors) sold over the counter under various names, such as omeprazole…  These medications, which we have been taking like candy for decades, are now implicated in contributing to dementia, kidney disease and osteoporosis.

 

My own experience with NSAIDs is that I can take one dose, maybe two, of naproxen, before I get upper abdominal pain, heartburn, nausea, and often associated canker sores in my mouth.  It does help some to take it with food.  Even one dose of ibuprofen causes me abdominal discomfort.  For my osteoarthritis pain, I take acetaminophen and turmeric (with food).  

 

My mom always claimed to be “allergic” to codeine, which she was prescribed for arthritis pain.  I think I have inherited this intolerance, although it is not an allergic reaction.  Any narcotic that I have had prescribed leaves me extremely nauseated.  When given during surgery, it has prolonged my time in the recovery room due to the vomiting that follows.  When I have surgery, I negotiate with the anesthesia provider and surgeon, asking them to NOT use narcotics during the procedure or afterwards.  I would rather wake up in pain than with uncontrolled vomiting!  Once, after operating on my shoulder, the orthopedic surgeon, despite my request, injected long-acting morphine into my shoulder after the procedure.  I had three days of nausea and dry heaves!  I have no fears of becoming an opioid addict!

 

I also ask the anesthesia providers to not give me midazolam, the drug often used to make us forgetful, and to calm us down for surgery.  I have no fear of the operating room and would prefer to be awake until the last moment before surgery.  I also want to be alert as soon as possible after surgery so I can remember what the surgeon tells my wife!

 

Statins prescribed for high cholesterol also have side effects.  About 1 in 5 (20%) of people taking them get muscle aching.  A colleague of mine had quite an expensive evaluation, including MRI scans, for what turned out to be statin induced muscle pain.  When I started taking a statin for my elevated cholesterol, the onset of pain was insidious.  My wife and I took daily walks in the woods by our house with our dogs.  We lived on a ridge so had some hills to climb during the hike.  I began to notice an aching in my legs, as if I had worked out hard the prior day, except it never went away.  It actually seemed to be getting worse to the point I began avoiding the hills.  At work, I quit using the steps and took the elevator.  Then I remembered my colleague’s experience.  I stopped the statin, and the pain promptly went away.  I started the medication, and the discomfort returned.  Not being convinced, I stopped and started the medication one more cycle, and became convinced it was the medicine!

 

When I was diagnosed with prediabetes, I was started on metformin, which is known to cause loose stool.  I had done multiple colonoscopies on patients with diarrhea that turned out to be caused by metformin. (I also did many colonoscopies and upper endoscopies due to the effects of NSAIDs.) Patients told me that due to the diarrhea associated with Metformin, they quit going to restaurants, movies, church, and other events. I personally got to experience it myself!  I needed to know where the nearest bathroom was at all times!  My first stop at work after a 20-minute drive was the bathroom, to empty out.  One day, without warning, while in clinic seeing patients, I soiled my pants!

 

Fortunately, with my lifestyle changes, I no longer need to take a statin, a PPI or Metformin, and avoided other drugs with their side effects as well!

 

More recently, despite eating about 40 grams of fiber a day via a plant-based, whole food diet, I developed constipation, due to the side effects of a medication I was taking for bladder spasms.  I quit the medication, eat a few prunes a day, and am having no further problems. (Note from 7/10/25 perspective: Both the bladder spasms and constipation are common with Parkinson’s!)

 

Years ago, I was taking thyroid medication to suppress a thyroid nodule.  Despite my blood levels being in the normal range, when I added a couple cups of coffee to the mix, I found myself experiencing panic attacks.  These promptly resolved when I stopped the thyroid medication!

 

At another time, I began taking a medication named Bextra (no longer on the market, but similar to Celebrex), which was supposed to be easier on the stomach than NSAIDs.  I was taking it for arthritis in my big toe.  But, the medication caused a serum sickness response which actually increased the pain and swelling in all my joints!

 

How many doctors recognize or even ask their patients about these side effects?  I suspect most side effects go undetected, and maybe other medications are added to treat them instead!