Garth Rattray | Save yourself, take your prescribed meds

Being a primary care physician is extremely challenging. The constant burden of responsibility weighs heavily and increases as the years roll by. We are not perfect, and this world is not perfect. No matter what we do, no matter how perspicacious, no matter how much of a diagnostician, and a clinical ‘genius’ some of us may be, people will become sick and eventually die. Part of our job is to try to avoid suffering and prevent premature deaths.

The major problem with reducing health risks, and perhaps intervening in disease processes, lies in trying to convince some patients to take their prescribed medications in order to save themselves. We used to refer to patient participation in their own care as ‘compliance’. However, compliance is blind obedience. We would like patient cooperation through adherence. We need patients to understand why they require medication(s) and therefore willingly participate in their treatment. But this is often a monumental, time-consuming, and frustrating undertaking.

The two most common non-communicable ‘diseases’ (NCDs) are hypertension and diabetes meletus. They are often asymptomatic and painless at the outset. By the time people become aware that something is going wrong, the damage is usually significant, and perhaps irreversible. Consequently, when an asymptomatic NCD is discovered, it is usually found out on a routine investigation, or on a medical exam for migration, school, or employment purposes.

BLOOD PRESSURE CAN CREEP UP

I have seen totally asymptomatic individuals with resting blood pressures of 250/120 mm/Hg. The blood pressure can creep up so slowly that the body accommodates to the incremental changes, and nothing is noticed. The abovementioned patients had no headaches, palpitations, shortness of breath, dizziness, blurred vision, or light-headedness; they had no inkling that they had one foot in the grave.

High blood sugar tends to be more symptomatic when elevated. However, I have also seen fasting blood glucose levels of 25 mM/L in people who did not complain of excessive thirst, dry mouth, excessive urination, unusual hunger, lethargy, blurred vision, or weight loss…and their minor wounds healed quickly. They felt fine but were in significant danger of major systemic malfunction.

If and when an NCD is discovered, lifestyle changes are always necessary. These usually include modifications to the diet, moderate exercise, adequate sleep/rest, and stress reduction. If the lifestyle changes are known to be, or are found to be inadequate to control the problem(s), medication is indicated. The choice of medication and dosing will be decided on, and a prescription written.

When it comes to making lifestyle changes, our bodies appear to have several pesky problems. They easily fall into bad habits, and they find it very difficult to break out of those bad habits to form new, healthy ones. Our bodies possess a lot of inertia, they will remain sedentary ad infinitum, if allowed to do so. And they require baby steps towards sustainable wellness goals. They do not like or tolerate sudden changes; however, they do very well with moderation and slow but steady progress.

It takes two to eight months to form a new habit. The great news is that when a good habit is formed, it eventually becomes automatic, and we find it easy to maintain the momentum towards health and fitness. The trouble that physicians encounter is the tremendous effort that it takes to get most patients over the first hurdle of inertia. If the first hurdle is exceptionally high, because of rumours and misinformation, we have a huge task on our hands.

HATE TAKING TABLETS

Most patients confess that they absolutely hate taking tablets; in fact, they hate taking medications on a whole. The realisation that most medications are manufactured in a (chemistry) lab is a huge turn-off. Because of this, an indeterminate number of patients will try ‘natural’ products to treat their NCD(s). In my experience, once an NCD is established, and especially if it is moderate or severe, natural products alone are never potent enough to properly treat the condition.

Nonetheless, some turn to various bushes and herbs for help. The problem is this, aside from the fact that instructions to boil this or that tea, and blend this or that plant do not come with any accurate dosing guidelines, no one has established the safety and efficacy of those products through detailed and rigorous animal and human studies. For those reasons, it is far better and safer to take well-researched medications for your NCD(s) and avoid putting yourself at significant risk for organ damage, organ failure, or a premature death.

People complain of fearing addiction to medications; but an addiction is “a compulsive, chronic, physiological or psychological need for a habit-forming substance”. The term is therefore irrelevant when it comes to describing the need to take life-saving medications. Some patients research or listen to others talk about any and all possible side effects of medication(s). However, drug companies are compelled to document and list any side effect(s) that may occur, even if the possibility of those side effects is remote.

Many men fear blood pressure meds because they think that they cause erectile dysfunction (ED). But ED is extremely rare with the new blood pressure meds, and the NCDs are extremely good at causing ED.

Hypertension and/or diabetes will cause major health problems, including crippling strokes, heart failure, kidney failure, heart attacks, blindness, amputations, dementia, and premature death. Simply taking medications regularly will significantly reduce the risk of those problems.

Garth A. Rattray is a medical doctor with a family practice. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.