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Maureen, Volunteer Mentor
@alpaca

Posts: 208
Joined: Nov 17, 2016

Overmedication with cancer and other conditions

Posted by @alpaca, Apr 17, 2018

This could possibly be on another Mayo thread but this is my home base so I’ll start (I hope) a discussion here. A lot of us with cancer are getting older and have comorbidities (new word I have acquired on this journey), so a danger is that we need a lot of medications to control not only pain but blood pressure, thyroid etc. We can be caught up in a tangle of medications all with their side-effects and possibly interactions. Do you have any tips about how to manage this?

REPLY

@cindylb

Indiana Scott – you bring up another interesting point regarding medications. When you have multiple doctors involved in the care of one patient meds can get confusing. Each doctor is 'tasked' with certain duties for a patient. In the case of cancer, it's curing cancer and sometimes that seems to be at the exclusion of other concerns (sometimes). It's their job and 'ego' to cure or get cancer in remission. At times that can be at the cost of side effects from drugs or other conditions that send you off to another type of doctor. Of course, not all doctors think so singularly………some do consider the side effects and long term effects of treatments and medications. But I do believe any patient either needs a caretaker or support person in their corner or if they're on their own…..a group like this that gives them multiple perspectives. I liked your "Kramer v. Kramer" analogy. I've hit that point a couple of times myself!

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Individualized treatment……..that is so correct. It is wonderful that Mayo is trending toward that direction. Not sure it is easy to find with medical care everywhere.

@gaybinator

@jaler I keep my husband's drug list on the computer (sample attached). Anytime he adds/subtracts a med I can easily change the list. I print a few copies to keep with us and present it to the receptionist at every doctor's appt. While the Mayo Pharmacy would have safeguards for drug interactions for the prescriptions they fill, I wouldn't expect them to keep up with prescriptions filled elsewhere.

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I do the same thing, as I did when my mother was alive, for her. It keeps it simple and accurate.

@lisakuehl

Is there any consensus that the effects of medications vary as persons lose weight, or are unable to normally metabolize medications as a person's health status declines?

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It certainly does change with animals in veterinary medicine, so I would expect it to in humans. I am often amazed at medication dosages being the same for my 125# as they are for my 210# husband! In the vet world weight is always a factor in dosing. In chemotherapy in humans and animals dosage is by body mass, but I don't find that to be true with all human medications.

Wonderful topic. I also think that the media has a lot to do with over medication and the pressure form pharmaceutical companies. And have you noticed, no more samples!! Pharmacists are a fantastic resource to make sure that you are getting enough or less or more of what you need. In this world we need to be our own warriors and not trust everyone who is a "professional"! I hate having to feel this, but the government is not looking out for us anymore.

Each time I go to an appointment at Mayo, I take a list of my medications and receive a list of medications that the Pharmacy has on file. I have to compare them to determine whether they are the same and if not, make the changes and give them to the doctor with whom I have an appointment. What happens to the list after that? Does a pharmacist go over the list? Does a pharmacist compare the meds to determine whether they are compatible? Does anyone know the answer to that question?

Hi, Maureen. I also have comorbidities and take tons of meds. My diagnosis are Non Hogkins Lymphoma, stable Bipolar, Hypothrydroism, chronic nausea for 5 years, post chemo peripheral neuopathy, and arthritis. I am definitely polypharmasized. Can't really stop any of my meds, but I have worked carefully with my doctor to take only as much as I really need. I also don't read up too much on side effects unless I think I have one or need to watch for asymtomatic side effects. And when I am in hospital I take advantage of the in-house pharmacist to review everything. Thanks for your comments.

@IndianaScott

Very interesting and useful thread there! Thanks @alpaca aka Maureen 🙂 In my wife's case she was on a constantly changing stream of medications as they struggled with the constantly altering effects of her tumor. Initially it was a tough balancing act between her neuro-oncologist at Mayo, her GP at home, and our pharmacist. Early on our pharmacist was a huge help until our local pharmacy was sold to a chain and it was never the same pharmacist twice. I cringe when I think back to how much time I wasted re-educating pharmacist after pharmacist on who my wife was, what her condition was, and why she was on the cocktail she was on at that specific time. Grr!

Then there was the issue of doctor vs doctor, which put Kramer vs. Kramer to shame! Finally after a grueling 'duel', where I felt as if I were some bizarre type of Second, the neuro-oncologist finally convenience our GP to get out of the mediations loop (other than to be informed of any changes in meds or dosages). One professional ego took a hit and the relationship never recovered, but it was for the good of my wife so I was happy to give up the relationship I had with the same GP.

My wife was on a medicinal cocktail of 32 doses a day. Keeping them straight required a spreadsheet to keep track of the time of day and doses. Luckily, once my wife went into home hospice, her nurse transferred all her meds to another smaller pharmacy with a more stable staff and who delivered. They worked together hand-in-glove. At this point her meds were often changing daily so it was crucial for there to be solid, knowledgeable communications between all the medical pros! This was also critical when we had to go from pill-tablet-capsule form to all liquids for her meds since the liquid form often caused them to act differently, on a different timeline, absorption rate, etc. Unfortunately for future patients in our area, this pharmacy was also swallowed by a national chain and no longer offers the same level of service.

With all the progress in technology I would think information sharing would be simpler regarding patients, their medications, and the providers involved. Hopefully this will improve quickly, but give the conflicting forces of the profit motive, I have my doubts.

Strength, courage, and peace to all.

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@IndianaScott I have a small family owned pharmacy that I love to use. The pharmacist guess to our church, so we've known her for years. My husband uses a pharmacy in a chain grocery store, but thankfully has had the same pharmacists for several years. (Odd I know, but it works for us. Lol) Sadly, our insurance forces us to use a mail order for certain prescriptions. I hate using a pharmacy that doesn't know us, but financially we have no choice. I like that Mayo has a list of all his medications and updates them every time he has an appointment.

@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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@jaler maybe you could request an appointment with a pharmacist to ask about interactions next time you are at Mayo?

@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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I have had the pleasure of having an appointment with a pharmacist at Mayo. The test results were remarkable and very enlightening.
We discovered why I was having medication reactions, and also why my body simply was not accepting or absorbing a certain medication.The doctor was fantastic and when we met, his explanations helped me and my understand how I could have a better quality of life.

@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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How did you get this appointment?  I thought the purpose of reviewing my medications each time I go to Mayo was so that the pharmacist could coordinate them, but apparently that isn't the case.  Do you have to get a referral to the pharmacist or can you just make your own appointment?  Of course, I'm sure Mayo will bill for that.

Thanks,

Judy Long

@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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@jaler you can request it and yes I'm sure you'll be billed, but it is well worth it if you have concerns. An appointment was part of my husband's pre-transplant work-up.

@lisakuehl Dialysis is one reason for drug doses to be adjusted. My husband was taking a multi-vitamin when he first started dialysis, and his first labs were waaaaaay off. He now takes a low dose of B & C after dialysis. Those are water-solvable vitamins, therefore they are removed by dialysis. I imagine there are many other reasons for adjusting doses of both Rx and OTC drugs.

@IndianaScott

Very interesting and useful thread there! Thanks @alpaca aka Maureen 🙂 In my wife's case she was on a constantly changing stream of medications as they struggled with the constantly altering effects of her tumor. Initially it was a tough balancing act between her neuro-oncologist at Mayo, her GP at home, and our pharmacist. Early on our pharmacist was a huge help until our local pharmacy was sold to a chain and it was never the same pharmacist twice. I cringe when I think back to how much time I wasted re-educating pharmacist after pharmacist on who my wife was, what her condition was, and why she was on the cocktail she was on at that specific time. Grr!

Then there was the issue of doctor vs doctor, which put Kramer vs. Kramer to shame! Finally after a grueling 'duel', where I felt as if I were some bizarre type of Second, the neuro-oncologist finally convenience our GP to get out of the mediations loop (other than to be informed of any changes in meds or dosages). One professional ego took a hit and the relationship never recovered, but it was for the good of my wife so I was happy to give up the relationship I had with the same GP.

My wife was on a medicinal cocktail of 32 doses a day. Keeping them straight required a spreadsheet to keep track of the time of day and doses. Luckily, once my wife went into home hospice, her nurse transferred all her meds to another smaller pharmacy with a more stable staff and who delivered. They worked together hand-in-glove. At this point her meds were often changing daily so it was crucial for there to be solid, knowledgeable communications between all the medical pros! This was also critical when we had to go from pill-tablet-capsule form to all liquids for her meds since the liquid form often caused them to act differently, on a different timeline, absorption rate, etc. Unfortunately for future patients in our area, this pharmacy was also swallowed by a national chain and no longer offers the same level of service.

With all the progress in technology I would think information sharing would be simpler regarding patients, their medications, and the providers involved. Hopefully this will improve quickly, but give the conflicting forces of the profit motive, I have my doubts.

Strength, courage, and peace to all.

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@jodeej How lucky you have consistency with your pharmacies! That is so nice! Big or small, knowing the person behind the counter knows a bit about your history is comforting for sure! I spoke with one of the pharmacists at our chain and she explained the chain moves the pharmacists around their various shops, keeps them under a certain number of hours and thereby keeps them on the books as part-time and not fulltime employees. All part of the games they play these days I guess! Perhaps one day the pendulum will swing back!

Strength, courage, and peace!

@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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Hi Judy,
I did some digging and found out a bit more about medication reviews and associated costs. At Mayo, we refer to this as Medication therapy management (MTM).

MTM does carry a cost. MTM is sometimes covered under a patients prescription benefit. Patients can contact their insurance to find out if MTM services would be covered under their plan. Many patients do pay out of pocket for this service. Sometimes medications can be eliminated or changed to less expensive alternatives which reduces overall cost resulting in a net financial benefit even considering the cost of the MTM service. Of course, this is not always the case. You can read more about what services may be covered by Medicare plans at https://www.medicare.gov/part-d/coverage/medication-therapy-management/medication-therapy-programs.html.

@jaler

Mayo requires that you update your list of prescriptions they have on file each time you go to your doctor there. I have several different doctors at Mayo in addition to my hematologist who prescribed various drugs for the side effects of chemo therapy. I would hope that a Mayo pharmacist would go over these drugs periodically to alleviate any problems. In addition to the cancer drugs, I also have medications for blood pressure, hypothyroidism, GERD, COPD, asthma, cholesterol, pain from torn rotator cuff, etc. I have no idea if there are adverse interactions from any of these medications. Does anyone know whether the Mayo Pharmacy Department reviews these lists of medications?

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Thanks.  I checked the Medicare site and don’t think they pay.   I’m surprised Mayo doesn’t check since I provide them with my medications printed each time I go there.  What do they charge for this service?  And why do they need the medications list at each visit if no one looks at it?JudyLong 

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