Thursday, December 6, 2007

My Health

In February of this year, I was diagnosed with high Triglycerides and high Cholesterol. Mostly hereditary - have you seen the Vytorin ads? - and somewhat my diet. My doctor put me on Tricor, and I have been pretty adherent. In July, I stopped taking it for two weeks while I awaited a new script but otherwise everyday.

My new doctor (my old MD went back to research) didn't know if Tricor was the right drug, so he sent me for blood work.

He gave me the results today.

The good news is that all my levels went down: Total 247, LDL 149, HDL 38 and Triglycerides 301. The bad news is my HDL went down 10 points (very bad considering this is the "good" cholesterol and 40 or higher is recommended). The LDL went down 50 points (very good 130 is recommended), and my total is only 47 points out of the top part of the spectrum. So I am feeling pretty good about myself. I still need to eat better, lose more weight and exercise more effeciently - but who doesn't?

The point to all of this - other than letting you all know about my health, which is top of mind in your lives - is that within two minutes of questioning, my MD asked if I had been taking Tricor regularly. I said yes, except for that two week period, and he said "Everyday?" And I said, "Yes, everyday." I was going to tell him that I am the Director of Corporate Development for a healthcare technology company that focuses on enabling medication adherence and that a get daily text, voice and email reminders, but I didn't need to get into it.

It then occured to me that if I said I was taking the Tricor (see White Coat Adherence) and was not, that all of his diagnosees would be off. If he thought the Tricor wasn't working (technically it would not be working because I would not be taking it), and prescribed something else - it could really mess up my system. I never really thought about medication adherence this way, only that by not taking your meds, your condition gets worse.

My MD was happy to see my numbers and my weight go down and he gave me a choice: keep losing weight, eat better and exercise and see what happens in three months, or do all of that and take another medication in conjunction with the Tricor. He wanted to make sure I would stay adherent to another medication. Putting me on Niacin would increase my pills to 4 a day (I am on another med in the morning and bedtime). 32 million people are on 3 or more medications. Plus, he gave me an antibiotic to take for 10 days to knock a sinus infection out which I have had for two weeks.

So now, my total pill count is at 5 pills, 4 medications.

The better news is the rare blood disease he was worried about only needs to be checked every three months. So there is more time at the lab for me. If I stay adherent to the Tricor and the Niacin, and loose more weight (he said 10 lbs), and eat better (I do have the occational french fry, and ice cream) - I should have all my levels in the right range and not have to take any medications.

This would be optimal.

So, I will set up more reminders for myself, get into the routine of taking a new drug and everything should be right as rain.

As long as there are not any horrible side effects - he mentioned hot flashes - and the drugs fall into my formulary. By my son's 1st birthday, I will be a new man!


Allan Showalter, MD said...

I think your point that noncompliance has consequences more extensive, complex, and costly (in dollars and quality of life) than rendering the specific prescribed treatment ineffective is fundamental to understanding the nature of the catastrophe results of patient noncompliance. This is one of my basic contentions about compliance. At Noncompliance Costs, under the heading, "Complex, Cascading, Cumulative Costs," for example, I wrote, "Even calculations that take into account only such basics as the likelihood that noncompliance will result in treatment failure, the pervasiveness of noncompliance, and the expense of healthcare produce terrifying results. The total damage caused by patient noncompliance, however, is too complex, multivariate, intertwined, subjective, and extensive to quantify with a straightforward algebraic formula.

My contention, in fact, is that the central tragedy of patient noncompliance results from the fact that the effects of noncompliance rarely manifest in a straightforward If-A-Then-B algorithm; rather, they tend to cascade."

Hypothetical cases follow on that same web page to illustrate the idea.

The cascading effect of noncompliance has implications that are as mathematically terrifying as any problem that expands exponentially (e.g., viral epidemics, Ponzi schemes, or the "Trouble With Tribbles" episodes on Star Trek) but we haven't done a good job of conveying that to clinicians let alone the pubic. Perhaps we need a pithy slogan like "Oh what a tangled web we weave when we don't achieve adequate adherence to prescribed treatment."

Well, that needs some buffing but you get the idea.

SusanT1 said...

Excellent description of White Coat Adherence - I hadn't heard that term before, but it is a major issue, and one that makes it tough for doctors to prescribe properly.

I commend you for realizing the implications of NOT "ratting on yourself" about your adherence failures. More people should be aware of that cause and effect.

Regarding your setting up more reminders to improve your adherence, try the free email and phone reminders at:
They are very helpful for more than just medications.
I schedule a nag-call to remind myself to go workout at the "Y" and it says: "Don't wimp out. Go to the "Y" NOW! Let's hustle and build some muscle!" (I change the message weekly to keep it fresh and make myself chuckle!)

Good luck with your numbers...

Knight said...

Thanks Susan. I used oncellrx but did not get any voice reminders. I use Intelecare's reminder services, as that is my company.