Dealing With Side Effects

Every medicine has possible side effects.  Possible is not the same as probable, though.

The first tip on dealing with side effects is to remember that your doctor’s professional judgement was that the benefits from a specific medication outweigh the odds of significant difficulties from the medicine.  Most of those horrible things listed as a side effect only happen to a few people.  If two percent of people report a side effect, 98% of people don’t have that side effect.  Even if ten percent of people experience an unpleasant side effect, that means ninety percent didn’t.  The mind is powerful.  People even experience side effects with placebos.  If you think you’ll have trouble, you might just imagine your way into unpleasant side effects.  Think to yourself that you’ll be one of the people who tolerate your medications well.

It can be helpful to know that sometimes side effects are temporary.  Once your body adjusts, the side effects go away.

Another thing to remember is to follow directions.  If the instructions for a medication say to take it with food, then do it!  There’s a reason for those instructions.  If the med is supposed to be taken on an empty stomach, ask your doctor/pharmacist how long you must wait after eating.  With my mtx, I was told to wait at least two hours after eating – which really doesn’t seem very long.  I once took an antibiotic that had to be taken four hours after a meal – and then I couldn’t eat for at least an hour after taking it.  I wasn’t accustomed to going five hours without food!  Prilosec is something that I’ve heard many people say is ineffective – turns out that they take it with a meal.  The directions are pretty clear that this should be taken on an empty stomach.  Read the directions, and follow them.  It can make the medicine most effective, and minimize side effects.

Before beginning a new medication, ask your doctor if he knows any tricks for minimizing side effects.  Sulfasalazine is a DMARD that can be hard on the stomach.  However, if introduced gradually, people usually tolerate it well.

Sometimes side effects can be reduced by taking a medication at bedtime.  This allows you to sleep through any dizziness or nausea.

Sometimes little things can make a big difference.  If a medication says that constipation is a possible side effect, don’t try to live like a camel.  Drink plenty of water so that you don’t experience this side effect (or ask for another med to counteract this side effect).

Discuss your meds with your doctor.  Many people recommend splitting methotrexate – half the dose in the morning, and the other half in the evening.  This can be easier on your stomach.  Instead of listening to other patients, I asked my rheumy.  Although it’s easier on the stomach, it’s harder on the liver and isn’t considered a good idea – so it’s a good thing I asked.  Definitely discuss things with your doctor if you’re thinking of experimenting with your prescriptions.

Keep your appointments.  When a drug is potentially harmful to your liver or kidneys, your doctor will order bloodwork to keep an eye on things.  This allows potential problems to be caught early, when they’re easily reversible.  When a drug might affect your vision, make sure you see your eye doctor as frequently as recommended.

Know when to call your doctor.  Every prescription comes with the instructions, “phone your doctor immediately if any of these things occur…”  Don’t assume it’s safe to wait until your next routine appointment.  If you experience a side effect that is listed as a reason to call your doctor, pick up the phone.  This allows for immediate intervention instead of allowing the problem to progress.

Comments on a previous post discussed nausea.
Any other ideas on how to reduce unpleasant side effects from medications?

Raynauds

As winter approaches, I find myself wondering what the next few months will hold.  I’ve had Raynauds for over thirty years — lots more experience with it than with RA!

Dealing with it is second-nature.  In fact, I didn’t even think to mention to my PCP until a couple years ago.  Some people might find that odd, but I never mentioned to him that I breathe, either.

It’s always been there.  I’ve dealt with it for so long that it honestly never occurred to me that it might matter.

Known variously as Raynauds Syndrome, Raynauds Phenomenon, and even Raynauds Disease, (sometimes spelled Reynauds), this is a bizarre situation in which the blood stops circulating to extremities.  Typically it affects fingers and/or toes, but sometimes the nose, too.

As a kid, I thought it was kinda cool that my fingers and toes did something that nobody else’s did, but when my dad found out, he freaked!  He had seen cadavers, and didn’t at all like the way my hands looked.  I convinced him that it happened all the time when I got cold, and that all I had to do was soak my hands in warm water to get warmed up again.

My grandmother, however, was a different story.  I spent a week visiting her one summer, and it didn’t matter one bit to her that my dad knew about it, or that we’d come to see it as peculiar, but ordinary for me.  She had me in to see her doctor immediately.  (Even though it was so long ago, I remember the blood draw, because it was the first time anyone other than my mom had drawn my blood.  And the lady did a crummy job.  She poked and jabbed and couldn’t find a vein to save her life.  I was incredibly sore, starting to feel like a pin cushion, and finally sobbed, “My mom always uses the other arm.”  So she switched arms and succeeded on the very first try.  Grandma said that the lady felt awful about it. Not that any of that matters.)

So Grandma’s doctor diagnosed my ten-year-old self with Raynauds and said there wasn’t really anything that could be done.  I should stay warm and avoid situations that caused the blood to quit circulating.  I guess we never thought about the fact that there are new discoveries in medicine all the time, and that maybe someday there would be treatment options.

Anyhow, enough rambling.  I started out to give a few tips on how I cope.

Gloves.  You can never own too many gloves.  I have gloves in the pockets of every coat that I own – some coats have two pair.  I keep a couple pair of driving gloves in the coat closet.  I keep driving gloves in the car (okay, in both cars).  I keep a pair of gloves in the kitchen with my potholders – I can put them on before removing items from the freezer (on days that I’m really cold, I even wear the warm gloves with a pair of rubber gloves over the top to wash vegetables).  There are gloves in all of my purses, too, and I use them in the grocery store if I have to reach into the freezer.

Socks.  My login is WarmSocks.  Wool, llama, alpaca, mohair.  Good quality, natural fibers make top-quality warm socks.  Avoid cotton; it is not warm and it bunches up. Also avoid angora.  I have three pair of wool/silk blend that are almost as nice as alpaca.  Electric socks are available, but it seems like the battery pack would be too heavy and cause the socks to fall down, so I’ve never tried them.  Thinsulate is on my Christmas list.

Pay Attention.  I can feel when I’m getting so cold that my fingers and toes are about to lose circulation.  Being aware allows me to drop what I’m doing and head inside to soak my hands/feet in warm water.  My daughter has discovered that she, too, can tell at the very beginning of an attack.  By treating it urgently, we’re both able to nip it in the bud.

Medication.  There are a few medications that can be prescribed to prevent the problem.  It’s good to be aware, too, that some migraine medications can make Raynauds worse.  Make sure that the pills you take to prevent migraines aren’t exacerbating Raynauds.

For more information, check the Raynauds Association‘s website.