Overmedication with cancer and other conditions

I give the list a name associated with the date, i.e. 04182018, so that the revisions are in order. This allows you to go back through them and see when a drug was stopped/started.

The list is very helpful in filling the little pill organizer every week, and a copy of the list stays on the counter with the pill organizer for reference. Some of the pills are very similar in size and shape, so it is easy to get confused about what is being taken at a given time.

A trick I use when I'm creating files using dates and saving them in a folder or on a specific drive is to name the file using YYMMMDD, like 18Apr18-xxxxxxxx.ext That way you can easily sort and find specific dates quickly if you have a lot of files to look through.

Judy, I also take a list of meds, not quite as many as you, but more than I'd like. When I go to an oncology appointment, or see my primary physician, the nurse or aide will ask me if there are any changes to my meds. That is the only person who ever reviews my meds. Wouldn't you think they should know this?! Does make me a little nervous sometimes. I've discovered some interactions by doing my own research. When I mentioned it to them, they take full credit for discovering it. Hmmm. Unfortunately, I'm required to order my meds through an online pharmacy (Express Scripts), and I truly doubt they check for interactions. However, they do send volumes of paperwork with each prescription. I've learned the hard way to be my own advocate, even though I have very little medical knowledge.

I think if they want us to review our medications each time we have an appointment at Mayo, then a pharmacist should be reviewing them for drug interactions or why bother to review them.   I wonder if anyone reviews them.

Many of you mentioned the role of the pharmacist as part of your care team and had specific questions. Well, I showed this thread to a Mayo Clinic pharmacist and she was glad to have the opportunity to weigh in. Here what she offered:

"Having a list of current medications, conditions and significant medical history and keeping that list updated and with you especially at medical appointments is such a helpful habit. You never know when it could literally save your life. Many smart phones also offer a medical alert app or function where this information can be stored and even accessed by paramedics in case of emergency. There are pros and cons to storing a list electronically vs. on paper. Ultimately it is a personal preference. MyMedSchedule (http://www.mymedschedule.com/) is one example of an app that allows you to enter and modify medications.

Important tips
1. When making your medication list make sure you know why you’re taking each medication. For example, if you’re taking a stool softener to prevent constipation with opioids and are no longer taking opioids, you can probably stop the stool softener. Sometimes this can be apparent to the healthcare providers, but missed by patients who don’t understand what their medications are for.

2. It’s important to clarify with your provider when new medications are started if they will be replacing older medications or taken in addition. Some patients require multiple medications to manage the same condition and that’s okay. Sometimes medications are started with the intent to reduce or eliminate existing medications but for a variety of reasons this doesn’t happen.

3. Filling all of your medications at one pharmacy can help reduce risks. A pharmacist may notice duplications, omissions or interactions that care providers aren’t aware of. This can happen when there are multiple providers involved in your care or when medication changes are limited in acute care situations.

Pharmacists know when to look more closely at a medication regimen to ensure optimal therapy. Pharmacists can help weigh the importance of drug interactions against the benefit of the medication in collaboration with other patient care providers.

In many cases there is quite a bit of room for variation which is why many dosage forms are in set strengths like 20 mg, 40 mg. That being said we are entering the age of individualized medicine where precision medicine, especially for cancer, transplant and other specialties, is becoming more and more accessible. In the age of cellular medicine and CAR-T it doesn’t seem too far of a stretch that we will someday have much less trial and error and more personalized preventative medicine that optimally treat or cure diseases even before we experience symptoms.

Patients with very complicated medication regimens may qualify for medication therapy management which is a service offered by Pharmacists at Mayo Clinic. You can hear more about this service by listening to a podcast here https://newsnetwork.mayoclinic.org/discussion/medication-management/

@lisakuehl The Mayo Clinic pharmacist also added:

"Dosing recommendations can vary based on the medication.
- Weight: Some medications are more significantly weight based like heparins whereas many others are currently one-size-fits-all or titrated to effect by the clinician.

- Genetics: As we learn more about how our genes play a role in our response to different medications, having pharmacogenetics testing can help to reduce trial and error with dosing and suggest a more appropriate starting dose or perhaps dictate that a different medication or therapy is warranted all together.

- Age and Organ Function: As we age our bodies eliminate drugs differently as end-organ function declines. Often drugs are needed in smaller doses as we age because kidney and other organ function decreases. We begin to eliminate many drugs much less efficiently than a younger person with healthier organs. This is more important in certain drugs where precision dosing is indicated.

- Other Factors: Remember that there are often other factors that determine the dose our bodies actually receive including what we have to eat or drink with the medication and the pH associated with drug absorption.

Drugs.com has a tool you can list all your medications and it will check for interactions and tell you what side effects are possible

@colleenyoung Maybe you will want to cross post this to other groups.

My husband has fought Squamous Cell Carcinoma since summer 2015. He has had many surgeries, many rounds of radiation, Erbitux from September 2016 to June 2017 when a pet scan showed that while the Erbitux had worked on the cutaneous lesions, the cancer had metastasized to his liver, diaphragm and neck.

He was started on Keytruda in June 2017 and PET scans in October 2017 and February 2018 were clear. He continued having profound fatigue and it was always blamed on "chemo" and radiation. Sometimes he would fall asleep in mid sentence. The Keytruda took his transplanted kidney - that is why we waited so long to try it. Of course, hindsight is 20/20. We now do home hemo-dialysis four times a week. When we do the dialysis, we have to keep a record of his blood pressure and pulse every 30 minutes.

Last Friday we had an appointment with his Nephrologist, who also acts as his primary doctor. One of the nurses from the dialysis center was there. I had the records from our prior month's dialysis sessions, so I gave them to her. She leafed through them and said, "Why is his blood pressure falling into the 40's?" She brought it to the doctor's attention. Turns out that a legacy blood pressure medicine called Atenolol was the reason. My husband had been taking it for years. He stopped that day, and the change has been nothing short of miraculous. Today he got out in the yard and worked for the first time in a couple of years.

The reason I telling this is that you should question everything. The pharmacist is so right about knowing WHY you are taking what you are taking. That nurse gave my husband a chance to live again, instead of just existing. QUESTION EVERYTHING!!!

Thanks I’ll check it.

@gaybinator, this discussion along with your message has been cross-posted to other groups as it is relevant to everyone.

Wow! Thank you for sharing that first-hand story underlining the importance of knowing why you are taking the medications prescribed. Thank goodness that you are keeping track and providing reports and that the dialysis nurse flagged the issue. It really does take a team.

Incredible that this "simple" change has resulted in such a huge turn-around for your husband. I agree: Question everything.