Category Archives: The Practice of Medicine

Commonly Used Medical Terms Made Clear


By Bob Aronson

cartoonTo most of us the abbreviations and phrases used in the medical world are another language from another planet.   Few understand what is written on the prescription they take to the pharmacy just as they don’t always understand the discharge instructions they get from a hospital or an emergency room.

To save time and clarify communication internally medical professionals have developed a very special system of codes, abbreviations and phrases that are quite exact in their meaning.  Unfortunately these same professionals often forget that the rest of us don’t have their training, education and expertise and use this “internal” language on patients who are often left dumbfounded because of a reluctance to ask for clarification.

The picture to the right is a real prescription and when you see it for the first time you probably are struck by the sameillegible prescription question most of us have, “How on earth does the pharmacist read that mess?”  Well,  the answer is that pharmacists understand the code words, phrases and abbreviations used by physicians but, they get stumped just like you do so they call and ask for clarification.   You should do that, too.   If you aren’t perfectly clear about what your medicine is and what it does you should seek clarification  first from your doctor and then from the pharmacist.

The list of common medical terms below was taken from several sources and I have tried to simplify it as best I could but should you be confronted with these terms or others not listed here that you still don’t understand don’t be afraid to ask and ask again until you have a perfectly clear explanation.  After all, it is your health, your body and your life and the medical people owe you a clear explanation of your condition, your diagnosis, prognosis and treatment plan including the medicine they have prescribed and what it does.

Miscommunication can be deadly.  You owe it to yourself to ask a lot of questions.  If you have done that and find that after processing what you heard you have more questions you should call your physician’s office for clarification. Do the same with your pharmacist or any other medical professional with whom you have contact.

Below is a list of the most common medical terms and abbreviations.  Note…you will see a mixture of upper and lower case entries.  These are not typos.   It is the way they are actually written.

Common prescription terms and abbreviations

AD: up to (defining a limit.)

BUSS: Inside the cheek

C: (With a straight line over the top ): With

cf: With food

h.s.: at bedtime

bid: twice a day

tid: three times a day

qd: daily

o.p.d.: once per day

q.a.d.: every other day

q.i.d: four times a day

sig: write on label

SL: sublingually, under the tongue

WF : with food

Terms and abbreviations used in prescriptions and elsewhere

a.c.: Before meals. As in taking a medicine before meals.

Ad lib At liberty. For example, a patient may be permitted to move out of bed freely and orders would, therefore, be for activities to be ad lib.

AKA: Above the knee amputation.

Anuric: Not producing urine.  That means the patient may need dialysis.

Bibasilar: At the bases of both lungs. For example, someone with pneumonia in both lungs might have abnormal  breath sounds.

BKA: Below the knee amputation.

BMP: Basic metabolic panel blood test.

BP: Blood pressure.. Blood pressure is one of several vital signs.

BSO: Bilateral salpingo-oophorectomy.  The removal of both of the ovaries and adjacent Fallopian tubes often part of a total abdominal hysterectomy.

C/O: Complaint of. The patient’s expressed concern.

cap: Capsule.

CBC: Complete blood count

CC: Chief complaint. The patient’s main concern.

cc: Cubic centimeters.

Chem panel: Chemistry panel. A comprehensive screening blood test to determine the status of the liver, kidneys and electrolytes.

COPD: Chronic obstructive pulmonary disease.

CVA: Cerebrovascular Accident (stroke)

D/C or DC: Discontinue or discharge. Adoctor will D/C a drug or DC a patient from the hospital.

DM: Diabetes Mellitus.

DNC, D&C, or D and C: Dilation and curettage.  Widening the cervix and scrapping with a curette for the purpose of removing tissue lining the inner surface of the uterus.

DNR: Do not resuscitate. This is a specific order not to revive a patient artificially if they succumb to illness. If a patient is given a DNR order, they are not resuscitated if they are near death and no code blue is called.  Usually requested by the patient or family.

DOE: Dyspnea on exertion. Shortness of breath with activity.

DTR: Deep tendon reflexes. These are reflexes that the doctor tests by banging on the tendons with a rubber hammer.

DVT: Deep venous thrombosis (blood clot I large vein).

FX: Fracture.

H&H: hemoglobin and hematocrit.  When the H & H is low, anemia is present.

H&P: History and physical examination.

h.s.: At bedtime. As in taking a medicine at bedtime.

H/O or h/o: History of. A past event that occurred.

HA: Headache.

HTN: Hypertension (high blood pressure)


I&D: incision and drainage.

IM: Intramuscular.. This is a typical notation when noting or ordering an injection (shot) given into muscle..

IMP: Impression. This is the summary conclusion of the patient’s condition by the healthcare practitioner at that particular date and time.

In vitro: In the laboratory.

In vivo: In the body.

IU: International unit

JT: Joint

K: Potassium. An essential electrolyte frequently monitored regularly in intensive care.

KCL: Potassium chloride.

LBP: Low back pain. LBP is one of most common medical complaints.

LLQ:: Left lower quadrant.

LUQ:: Left upper quadrant..

Lytes: Electrolytes (potassium, sodium, carbon dioxide, and chloride).

MCL: Medial collateral ligament.

mg: Milligrams.

ml: Milliliters.

MVP: Mitral valve prolapse.

N/V: Nausea or vomiting

Na: Sodium. An essential electrolyte frequently monitored regularly in intensive care.

npo: Nothing by mouth. Often ordered when a patient is about to undergo surgery requiring general anesthesia.  It means no food or drink.

O&P: Ova and parasites.  Stool O & P is tested in the laboratory to detect parasitic infection in persons with chronic diarrhea..

O.D.: Right eye.

O.S.: Left eye.

O.U.: Both eyes.

ORIF: Open reduction and internal fixation such as with the orthopedic repair of a hip.

P: Pulse. Pulse is recorded as part of the physical examination. It is one of the “vital signs.”

p.o.: By mouth. From the Latin terminology per os.

p.r.n.: As needed. Example a pain killer may be taken only when the patient has pain or “as needed.

PCL: Posterior cruciate ligament..

PERRLA: Pupils equal, round, and reactive to light and accommodation.

Plt: Platelets, one of the blood forming elements along with the white and red blood cells.

PMI: Point of maximum impulse of the heart when felt during examination, as in beats against the chest.

q2h: Every 2 hours. As in taking a medicine every 2 hours.

q3h: Every 3 hours. As in taking a medicine every 3 hours.

qAM: Each morning. As in taking a medicine each morning.

qhs: At each bedtime. As in taking a medicine each bedtime.

qod: Every other day. As in taking a medicine every other day.

qPM: Each evening. As in taking a medicine each evening.

R/O: Rule out. Doctors frequently will rule out various possible diagnoses when figuring out the correct diagnosis..

REB: Rebound, as in rebound tenderness of the abdomen when pushed in and then released.

RLQ: Right lower quadrant. The appendix is located in the RLQ of the abdomen.

ROS: Review of systems. An overall review concerns relating to the organ systems, such as the respiratory, cardiovascular, and neurologic systems.

RUQ: Right upper quadrant. The liver is located in the RUQ of the abdomen.

s/p: Status post. For example, a person who had a knee operation would be s/p a knee operation.

SOB: Shortness of breath.

SQ: Subcutaneous.. This is a typical notation when noting or ordering an injection (shot) given into the fatty tissue under the skin, such as with insulin for diabetes.

T: Temperature. Temperature is recorded as part of the physical examination. It is one of the “vital signs.”

T&A: Tonsillectomy and adenoidectomy.

tab: Tablet

TAH: Total abdominal hysterectomy..

THR: Total hip replacement.

TKR: Total knee replacement.

UA or u/a: Urinalysis.. A UA is a typical part of a comprehensive physical examination.

URI: Upper respiratory infection like sinusitis or the common cold

ut dict: As directed. As in taking a medicine according to the instructions that the healthcare practitioner gave in the office or in the past.

UTI: Urinary tract infection.

VSS: Vital signs are stable. This notation means that from the standpoint of the temperature, blood pressure, and pulse, the patient is doing well.

Wt: Weight. Body weight is often recorded as part of the physical examination.

Commonly used prefixes and suffixes

http://www.bubblews.com/news/2020191-what-did-the-doctor-just-say-some-common-medical-terms-prefixes-and-suffixes

Prefixes

1. “Angio…”
Related to the blood vessels
(Angioplasty, etc.)

2. “Lobo…”
Relating to either the brain or lungs.
(Lobotomy, etc.)

3. “Nephro…”
Relating to the kidneys.
(A Nephrologist is a doctor who specializes in medical conditions impacting the kidneys.)

4. “Hyster …”
Relating to the uterous.
(Hysterectomy, etc.)

5. “Gastro …”
Relating to the atomach
(Gastroenteritis, etc.)

6. “Myo…”
Related to muscle tissue.

6. “Arthr…”
Related to the joints.
(Arthritis, arthoscopic surgery, etc.)

7. “Encephal…”
Related to the brain
(Encephalitis, encephlitiform activity, i.e. seizures.)

Suffixes

1. Something or other… “itis”
Whatever the ‘something’ is is inflamed and possibly infected.
(Pancreatitis, appendicitis, tonsilitis, etc.)

2. “…ectomy”
The removal of whatever body part precedes it.
(Appendisectomy, tonsilectomy, hemorrhoidectomy, hysterectomyetc.)

3. “… otomy”
A surgical incision into whatever precedes it.

4. “… scentesis”
The surgical puncturing of something – deliberately
(Amnioscentesis to draw fluid from the uterine sac to check on the condition of a fetus.)

5. “…septic”
From a Greek word meaning putrefaction (rotting), as “spsis” it is used to refer to an infection of the entire system, particularly through the circulatory (blood) system and is considered quite seious.
The opposite, of course, is “Antiseptic”… the purification of something from germs and bacterial contamination.

6. “… ostomy”
The putting a hole in something in the hopes that it will help it function better.
(colonostomy)

7. “… plasty”
To modify or reshape.
(A “nose job” is a rhinoplasty, etc.)

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Bob informal 3Bob Aronson is a 2007 heart transplant recipient, the founder and primary author of the blogs on this site and the founder of Facebook’s over 3,000 member Organ Transplant Initiative group.

Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients.  He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy. 

Bob is a former journalist, Governor’s Communication Director and international communications consultant.

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Does Your Doctor Work for You or for the Drug Companies?


doctors prefer our drugs

Dr. Jon W. Draud, is the medical director of psychiatric and addiction medicine at two Tennessee hospitals.  It is likely that he is well paid for his administrative and medical expertise but according to ProPublica an investigative Journalism group the 47-year-old Draud has earned more than $1 million in the last four years for delivering promotional talks and consulting for seven drug companies and he’s not alone.  Hundreds, perhaps thousands of physicians all over the country are also on the payroll of drug companies.

Look at these headlines:

Colorado doctors take big speaking fees from drug companies, data show

http://www.denverpost.com/ci_22870273/colorado-doctors-take-big-speaking-fees-from-drugstethescope on mound of money

By Michael Booth and Jennifer Brown
The Denver Post

Posted:   03/26/2013 12:01:00 AM MDT

Colorado doctors who teach at major hospitals and universities continued to pocket hundreds of thousands of dollars in speaking fees from drug companies in 2012, sidestepping the institutions’ new restrictions on the lucrative payments.

Many private physicians also accepted speaking fees from pharmaceutical firms despite a spotlight on the practice, justifying their payouts as educational contacts with their peer

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I-Team: Nevada Doctors Accept Millions from Drug Companies

http://www.8newsnow.com/story/24001912/nevada-doctors-accept-millions-from-drug-companies

Posted: Nov 18, 2013 4:01 PM EST Updated: Nov 19, 2013 3:10 PM EST

By George Knapp, Chief Investigative Reporter –

By Matt Adams, Chief Photojournalist

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Does your doc get money from drug companies?

http://thechart.blogs.cnn.com/2010/10/19/does-your-doc-get-money-from-drug-companies/

There has long been mystery surrounding how much, and to whom, drug companies give money.

propublica logoNow, ProPublica has put together all of these disclosures that have been appearing recently on the Web. The resulting project, called Dollars for Docs reveals that about $258 million worth of compensation from seven companies went to health care providers in 2009 and 2010.

The team of investigative journalists found that 17,700 providers received such payments. Most of the money went to physicians, but nurses and pharmacists were also included, ProPublica said. The reasons for this money included speaking, consulting, business travel and meals.

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So, what’s wrong with a physician getting paid to give speeches?  Well, for the most part nothing unless the payment causes the physician to prescribe one drug or device over another because of it.  There is nothing illegal about the practice but, is it ethical?    What it boils down to is this.  Does the physician always do what’s best for the patient or what’s best for his or her benefactor?  An example:  If Bristol-Meyers Squibb makes a high blood pressure medication that costs $25 a tablet and Abbot Labs makes one that sells for $2 each and both medications do the same thing does the physician prescribe the $2 pill or the more expensive one from the company that pays him an extra $100,000 a year to speak on their behalf?  That’s the point of our blog today and we are going to return to it shortly but first some background.

Becoming a physician is expensive and that expense can force some into finding creative, albeit ethically questionable waysmedical  school debt cartoon in which to pay down their medical school debt.

According to MedPage Today http://tinyurl.com/n22k6dz The average debt facing graduating medical students is about $156,000.  The Wall Street Journal worst case scenario for med school tuition debt is a whopping $550,000 tab run up by a family practitioner http://tinyurl.com/m5gcov6  That huge debt is the result of her deferring loan payments while she completed her residency, default charges and relentlessly compounding interest rates. Among the charges: a single $53,870 fee for when her loan was turned over to a collection agency.

While the debt appears to be outrageous it is made a little easier to handle when you consider the earning power of physicians.  .A Time Magazine survey of 24, 216 physicians across 25 categories showed doctors’ earnings ranged from about $156,000 a year for pediatricians to about $315,000 for radiologists and orthopedic surgeons. The highest earners — orthopedic surgeons and radiologists — were followed by cardiologists who earned $314,000 and anesthesiologists who made $309,000 http://tinyurl.com/7jl8v6a. But remember, these are averages.  Some Orthopedic surgeons earn over $625,000 a year, some neurosurgeons earn nearly as much while many pediatricians earn over $200,000.  http://tinyurl.com/78lkdtg

The lowest earning doctors are family physicians and pediatricians and in both professions .there is a shortage that is getting worse.  Witness the increasing use of Physicians assistants and Nurse Practitioners who can now perform some of the functions traditionally handled only by licensed physicians.

It is bad enough that you begin a career a quarter of a million dollars in debt but now add on malpractice insurance and we are looking at some seriously large payments.

It is estimated that your physician spends 10 cents on malpractice insurance from every dollar you pay for health care, according to handfull of moneyDiana Furchtgott-Roth, a senior fellow at the Manhattan Institute. http://tinyurl.com/mhk6p3n Furchgott-Roth notes that premiums vary from $20,000 annually in low-cost states to $200,000 annually in high-cost states. According to a survey published November 2011 in “Modern Medicine,” family and general practitioners paid premiums of $12,100, and pediatricians’ premiums averaged $11,800. OB-GYNs paid an average of $46,400, and plastic surgeons reported median premiums averaging $30,000.

A 2010 survey by the “Medical Liability Monitor” compared premiums for three specialties in various areas of the country. Internists in Dade County, Fla., paid $48,245 annually in 2010, while general surgeons paid $192,982. In comparison, internists in the lowest-cost areas of California paid only $3,200 and general surgeons had the lowest premiums in Minnesota at $11,306 annually. OB-GYN premiums varied from a low of $13,400 in the lowest-cost areas of California to a high of $204,864 in the counties of Nassau and Suffolk in New York.

The new physician will not be able to earn much money during his five years of residency training either. The average salary for a surgical resident is about $56,000 per year, which will force him to defer paying the principal on his loans while the interest keeps on accruing that’s how the physician in the earlier Wall Street Journal story piled up over a half million dollars in debt.

So now that we’ve established that it costs a lot to become a physician we piled on and added the cost of malpractice insurance.  The combination of student loans and insurance payments becomes for some, an unbearable burden even with a good salary. That leaves us with the question, how do you pay all that debt and still have something left to live on?  Well, the answer is simple and physicians don’t have to look too far to find some extra income.

Enter center stage — Big Pharma.   This is where the huge pharmaceutical companies can be the answer to many young physicianbig pharmas’ prayers.  Once they have MD after their name and maybe a few other medical credentials their opinions become worth a lot of money. If Bob Aronson endorses a medication it is pretty meaningless but if Dr. Bob Aronson endorses it people take notice and if you add Dr. Bob Aronson from (name any famous clinic or hospital) the credibility is even higher.

Doctors are still among the most trusted people in America.  A December 2012 Gallup poll ranked Physicians third on the list just behind nurses and pharmacists http://tinyurl.com/cz7orar When Doctors speak, people listen and more importantly, they believe what they hear.  That believability, sincerity, and credibility, coupled with the Marcus Welby or Grey’s Anatomy image of super compassionate service makes doctors the ideal spokespersons for almost any company.

Most news stories today that address the issue focus on the big pharmaceutical  companies like Bristol-Meyers Squibb, Eli Lilly and Abbot Labs and they do spend a lot of physician endorsements but so do the little pharma companies, those with but one product for which they are trying to get FDA approval.  They spend hundreds of thousands of dollars of investor’s money to get physician endorsements.  I know because I worked as a communications consultant to many of them myself and travelled the country working with the docs on just how to phrase their endorsements.

Often a drug company will pay first class airfare to fly several physicians in from all over the country for a meeting.  Each doc gets a limo from the airport to the hotel, a very nice room, good meals a handsome stipend and professional help on how to endorse the company’s product.  If the issue is big enough and the physician is important enough the spouse might be invited as well and the trip could take three or four days and include several rounds of golf at exclusive clubs and perhaps a short meeting every day aboard a yacht .that is on a week-long cruise..

Often when a physician speaks to a gathering it is from a script prepared by the pharmaceutical company.  They get paid extremely well for doing nothing more than reading a speech prepared that was handed to them.  Physicians justify the practice by pointing out that the FDA and other agencies require specific language when speaking about specific drugs and being as the company has already fine-tuned the words and had them approved it makes sense to use their script.

dollars for docs keeperDollars for Docs is a site that keeps track of what Pharmaceutical companies pay to physicians, state by state.  You can look up your doc to find out if he or she is getting any money from the companies listed http://projects.propublica.org/docdollars/

Physician endorsements of pharmaceutical products are important because they can help:

  • Gain approval from a regulatory agency for the use or expanded use of their drug or product.
  • Ratchet back the noise when there is a crisis.  For example, if a journalist finds a study that suggests your drug is unsafe or someone files a law suit claiming extensive damages or death it is reassuring to the public and to juries to hear a well-known physician say we shouldn’t worry, the drug is safe.
  • It’s just good advertising to have a doc endorse you.  “3 out of 4 Doctors recommend brand X.. Here’s what Dr. Smith from the renowned xyz institute has to say about it, …….”.

The Pro Publica site has made quite a splash.  Journalists all over the country have used it to gain information about local physicians.  On March 10 of last year, Susan Abram, Staff Writer for the Los Angeles Daily news wrote a story based on research from Pro Publica that outlined the situation in California. http://tinyurl.com/kjwrebp

“Hundreds of physicians, psychiatrists, and medical school faculty members across California are on the payroll of major drug companies, earning tens of thousands of dollars for speaking to other medical professionals at events held by industry leaders that make drugs such as Advair, Cymbalta, Viagra and Zoloft.

From 2009 to 2012, California doctors who participated were paid $242 million – the highest in the nation – by major drug companies for research, speaking, consulting, trips and meals, according to a new database released Monday by ProPublica, an independent, nonprofit news organization.

The disclosures have been listed on the websites of some drug companies for several years, but a federal mandate will require it for companies by 2014.”

While the practice of speaking is not illegal, it raises the question of conflict of interest: Is the drug being given to you because you need it, or because the doctor writing out the prescription is paid by Big Pharma?  There really isn’t any way to tell.

So in the  final analysis, patients need to be far more vigilant and inquisitive about prescribed medications.  While clinical trials of drugs are usually quite thorough before the Food and Drug Administration (FDA) approves them, their full effect may not be known for years.  Even with large clinical trials with thousands of patients involved it is sometimes impossible to determine exactly what a drug will do to or for any given person because we are all very different from one another.

It is easy to understand that a physician who is deeply in debt wants to pay off the loans and live a more stress free life by endorsing certain medications.  I might do the same but they also have to exercise some caution with new high profile drugs that claim to perform miracles.  Let me name just three and you’ll then better understand that Big Pharma’s influence is real and it works for them but may not be in your best interest.

  1. Upon release everyone thought drugs like Fosamax the anti-osteoporosis drug (a biphosponate like Boniva and Actonel), fosamaxwas a Godsend but the FDA now says these drugs may in fact cause harm. In 2012 the FDA issued a report that said after years of use the drugs may in rare cases actually lead to weaker bones in certain women, contributing to “rare but serious adverse events,” including unusual femur fractures, esophageal cancer and osteonecrosis of the jaw, a painful and disfiguring crumbling of the jaw bone.”  The agency’s analysis, which found little if any benefit from the drugs after three to five years of use, may prompt doctors around the country to rethink how they prescribe them.

2. Then there’s Lipitor which was the best-selling drug in history.  Reports indicate that in 14 years the drug lipitorgenerated about 126 billion dollars for pharmaceutical giant Pfizer.  Lipitor is a statin a class of drugs developed to block the enzyme in your liver that is responsible for making cholesterol.  It has Since been found that statin users run the risk of experiencing severe muscle pain and damage which can lead to serious kidney problems.

The danger with Lipitor in particular is that the standard dosage is far stronger than many patients need.  One physician wrote, “The Lipitor dosage guidelines do not distinguish between patients with or without heart disease. They do not distinguish between patients requiring large reductions and those needing small reductions. The recommended initial dose of Lipitor, 10 mg, is so powerful that doctors can treat many patients with the same dose and not have to bother matching the dose to individual patients.”

  1. And finally, Paxil the SSRI antidepressant that was the preferred method of treating Post Traumatic Stress Syndrome paxil(PTSS) among Iraq war veterans.   In 2007 the BBC did a story about a study that showed adolescents were six times as likely to become suicidal on the drug.  In 2005, the FDA revealed birth defects associated with Paxil including heart problems, seizures, feeding problems, vomiting, low blood sugar and a host of other symptoms.  Then it was revealed that some patients had extreme difficulty when they tried to stop taking Paxil According to a report in the British Medical Journal, in case after case, patients coming off the drug experienced nightmares, dizziness, burning and itching of the skin, agitation, sweating and nausea. And for many of those patients, the only way to treat the side effects was to begin taking Paxil again! http://hsionline.com/2006/02/06/the-dangers-of-paxil/#sthash.B9BKt990.dpuf

All of these drugs seemed legitimate, effective and relatively safe at first. A good number of  physicians got on the Fosamax, Lipitor and Paxil bandwagons and were paid handsome sums for their endorsements.  In retrospect it is obvious that many of the claims were premature and that the drugs probably endangered the people who were taking them.

To be purposely repetitious I will again offer this admonition.  Patients have to become far more knowledgeable about medical treatments and prescription drugs and we have to ask more questions.  When a physician recommends drug X for arthritis we need to ask if there’s a generic.  We also need to question physicians about whether the drug or treatment is really necessary. And  remember — sometimes it is important to get a second opinion. A good, honest physician will support that decision.

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Bob Aronson is a 2007 heart transplant recipient, the founder and primary author of the blogs on this site and the founder of Facebook’s over 3,000 member Organ Transplant Initiative group.

Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients.  He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy. 

Bob is a former journalist, Governor’s Communication Director and international communications consultant.

Dr.

Why You Can’t Get Pain Meds


dea cartoonBy Bob Aronson

This is not my first post on this subject and it will no be the last because Americans with real pain are suffering needlessly.

Chronic pain is real.  I know, I have it and right now thousands of U.S. docs are refusing to prescribe narcotic pain killers not because people don’t need them but rather because federal agencies in their zeal to eliminate “Pill Mills” have frightened physicians.

They’ve told docs they run the risk of being investigated if they can’t prove an absolute need for every opioid prescription they write.  The result is that docs don’t want or need the hassle so many of them are saying, “No” to all requests for pain killers even when they know the requests are legitimate.  It happened to me and it is happening to thousands of others as well.

Federal agencies have gone over the edge on this one.  Their strong-arm tactics aimed at stopping a few unscrupulous physicians may result in some license revocation and brief incarceration while thousands if not millions of chronic pain sufferers are condemned to living with extreme discomfort and excruciating pain.  Have they spent any time thinking through the effect of their intimidation of doctors and pharmacies?   Do they really think that taking drugs away from people who need them will affect the trafficking of prescription meds?

While I understand physician’s reluctance to write prescriptions in the face of pressure from the feds I also think their behavior is as arrogant and irresponsible as the feds.  Physicians take an oath to treat the sick and to do no harm and by refusing to treat patients with with provable, legitimate pain they are violating both promises and risking the physical and mental health of their patients. 

Ever since I published my first blog on the subject I’ve received a constant stream of emails, tweets, Facebook messages and phone calls from people who have been cut off by their physicians.  Just this morning I got this email;

“bob, just read article on crackdown on narc . I have bladder cancer, replaced knee that was screwed up .  Other knee has to be replaced, have torn rotator cup right arm, bulging discs in c5 & c6. so yesterday my doc cut out my Lortabs because of letter from DEA.   Is this right & what do I do?”

What is most bothersome to me is that I don’t really have an answer other than to shop around for a doctor that will prescribe what he/she needs.  Certainly the oncologist should be sympathetic. This is a very serious problem but it is unlikely to be addressed because everyone is afraid…Afraid of being “Soft on narcotics enforcement,” afraid of being hassled, afraid of jail time.  It’s very sad and it is wrong.

Chronic pain is serious.  Millions suffer from it as the result of arthritis, accidents, broken bones, cancer and scores of other reasons.  I am one of them.  I have osteoarthritis and it hurts.  Without narcotic painkillers I would be immobilized.  With them I am functional and feel pretty good.  I don’t get high, I don’t’ abuse them I take them for their stated purpose – pain.

The Drug Enforcement Agency (DEA) has been hunting down “Pill Mill” doctors for years and they should.  It is an unfortunate truth that some real doctors will write prescriptions for almost anyone for an exorbitant fee.  Florida was the prescription drug capitol of the world until not long ago.

DEA is so obsessed with illegal narcotics that they don’t care who gets hurt along the way.  They have now persuaded the Food and Drug Administration to “Recommend” that physicians be more careful in their prescribing of hydrocodone (an opioid also known as Lortab or Vicodin).  The result of the DEA/FDA suggestions, warnings and recommendation is that physicians are just refusing to write prescriptions for narcotic painkillers or, in some cases any controlled substance including Valium. It’s not that docs are afraid of getting arrested, that’s quite unlikely.  They just don’t want the hassle of federal agents bugging them for detailed justification about the prescriptions they are writing for pain killers.

My primary care physician still provides me with the Oxycodone I need but I’m not so sure how long he’ll be able to hold out before he, too, will bend to the pressure from the feds. As the law stands now, a physician cannot call or fax a narcotic painkiller prescription to a pharmacy and those prescriptions are not refillable. To protect himself my primary care physician requires that I see him once a month for a pain evaluation before he writes new script.  Then with prescription in hand I must personally take it to a pharmacist.

I have written two blogs on the subject and there might be more coming.  You can find them at https://bobsnewheart.wordpress.com/2013/07/17/why-your-doc-wont-prescribe-narcotics-no-matter-how-bad-the-pain/     and at   https://bobsnewheart.wordpress.com/2013/12/10/suffering-from-chronic-pain-heres-what-you-need-to-know/

If you want to do something about this talk to your congressman or senator and get them to either deal with the issue legislatively or to put pressure on the FDA and DEA to back off legitimate claims for opioids.

Not Long ago the Boston Globe did a story on this issue.  It is well worth your time to read it.  http://tinyurl.com/l3ahgtc

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Bob Aronson is a 2007 heart transplant recipient, the founder and primary author of the blogs on this site and the founder of Facebook’s over 3,000 member Organ Transplant Initiative group.

Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients.  He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy. 

Bob is a former journalist, Governor’s Communication Director and international communications consultant.

Prescribing Abilify — Are Physicians Careful Enough?


By Bob Aronson

final cartoonThis blog is a wake-up call for those who take anti-depressants.  It is an attempt by Bob’s Newheart to draw attention to the drugs, the prescription process and some of the side effects they present.  We will focus in particular on the Bristol Meyers Squibb antipsychotic, Abilify.

This post does not pretend to offer a scientific evaluation of the drug.  We have neither the expertise nor the facilities to accomplish that.  Through research, though, we can offer readers some selected information upon which they can make their own judgments.  Specifically we looked into what the drug is intended to do, what it does, what unintended consequences have resulted and, of course, the profitability of the medication.

I was drawn to this subject because I have taken Abilify and suffered serious side effects.  I will detail them and offer other examples both scientific and personal later in this post.

Abilify is becoming a very commonly prescribed anti-depressant.  While there are many possible side effects this warning from the U.S. Food and Drug Administration (FDA) stands out.

FDA WARNINGS: INCREASED MORTALITY IN ELDERLY

PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS and

SUICIDALITY AND ANTIDEPRESSANT DRUGS

See full prescribing information for complete boxed warning.

Elderly patients with dementia-related psychosis treated with

Antipsychotic drugs are at an increased risk of death. ABILIFY is

not approved for the treatment of patients with dementia-related

psychosis. (5.1)

Children, adolescents, and young adults taking antidepressants for

Major Depressive Disorder (MDD) and other psychiatric disorders

are at increased risk of suicidal thinking and behavior. (5.2)

Not only does Abilify cause concern for elderly patients, it should be a cause of concern for all patients for many reasons including one that affected me, Tardive Dyskinesia.  Remember that term…we’ll be returning to it, but first I want to re-visit the subject of depression and what it is.

Many awaiting organ transplants and recipients as well suffer from serious bouts of depression.  They often will attribute their sunken feelings with being told that they have an end-stage disease.

Strangely, many patients who have received the “gift of life” also feel depressed and some even become suicidal.  Many believe they are depressed due to guilt.  Guilt caused by the belief that they received organs ahead of patients who were sicker and more deserving.

To the lay person the explanations given by pre and post-transplant patients make sense but medical science and research has told us for a very long time that the moods they describe may be the result of chemical imbalances.  Well, that may not be true.  Here’s what the Harvard Medical school has to say about depression and what it is.

cartoon...depression“Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, depression has many possible causes, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It’s believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

With this level of complexity, you can see how two people might have similar symptoms of depression, but the problem on the inside, and therefore what treatments will work best, may be entirely different.” You can read all the details of the Harvard explanation here http://www.health.harvard.edu/newsweek/what-causes-depression.htm

If you read between the lines of the Harvard explanation you can quickly come to the conclusion that physicians who treat depression are involved in educated guesswork as they try to find the right drugs to relieve depression symptoms.

I have been treated for depression for years and whether the treatment was offered by my family physician or by a licensed, board certified Psychiatrist the approach is the same.  They ask some key questions about lifestyle, what’s bothering you, how you feel and why and then say, “We’ll try a few things to see what works.  Let’s get you started on (drug).  It takes from 2 to 5 weeks for an effect to be felt but call me in a couple of weeks to let me know how you are doing.”

Obviously physicians have more knowledge about things medical than we do but when it comes to depression it can be a big guessing game.  There are scores of drugs that can be used depending on your symptoms but don’t be surprised if the most highly skilled psychiatrist armed with the best questions has difficulty deciding what’s best for you.  Even the famed Mayo Clinic says,

“Antidepressants are a popular treatment choice for those with moderate or severe depression. Although antidepressants may not cure depression, they can reduce your symptoms. The first antidepressant you try may work fine. But if it doesn’t relieve your symptoms, or it causes side effects that bother you, you may need to try another.

But don’t give up. A number of antidepressants are available, and chances are you’ll be able to find one that works well for you.”

So when you begin taking an anti- depressant you should not expect immediate positive results because you may get no relief at all — or worse yet, you could suffer some very negative side effects.

There are several different types of anti-depressants and they, like all drugs, bring with them side effects of which can be quite serious.  The problem is that because no two people have the same physical and mental make-up it is impossible to predict who will react negatively to a medication, who will react positively and who will have no reaction at all.  You can find more information about the types of drugs and their side effects here.  http://www.helpguide.org/mental/types_of_antidepressants.htm.

And that leads us to our reason for writing this blog.  Abilify and drugs like it can help a person feel wonderful abilifyor make you absolutely miserable and cause permanent damage…  I took Abilify and had a horrible reaction to it as did others I know.

Before I go on I feel compelled to point out that my case and other individual cases do not constitute medical evidence.  Individual cases are classified as anecdotal and while they may sound convincing are not considered medical proof so I will do my best to combine anecdotal and real medical evidence.

You should know, too, what anti-psychotic drugs like Abilify are and what they do.

According to Medicine Net dot com:

http://www.medicinenet.com/script/main/art.asp?articlekey=26299 The first antipsychotic medications were introduced in the 1950s. Antipsychotic medications have helped many patients with psychosis lead a more normal and fulfilling life by alleviating such symptoms as hallucinations, both visual and auditory, and paranoid thoughts. However, the early antipsychotic medications often have unpleasant side effects, such as muscle stiffness, tremor, and abnormal movements, leading researchers to continue their search for better drugs.

“The 1990s saw the development of several new drugs for schizophrenia, called “atypical antipsychotics.” Because they have fewer side effects than the older drugs, today they are often used as a first-line treatment. The first atypical antipsychotic, clozapine (Clozaril), was introduced in the United States in 1990. In clinical trials, this medication was found to be more effective than conventional or “typical” antipsychotic medications in individuals with treatment-resistant schizophrenia (schizophrenia that has not responded to other drugs), and the risk of tardive dyskinesia (a movement disorder) was lower. However, because of the potential side effect of a serious blood disorder–agranulocytosis (loss of the white blood cells that fight infection)-patients who are on clozapine must have a blood test every 1 or 2 weeks. The inconvenience and cost of blood tests and the medication itself have made maintenance on clozapine difficult for many people. Clozapine, however, continues to be the drug of choice for treatment-resistant schizophrenia patients.

Several other atypical antipsychotics have been developed since clozapine was introduced, they are risperidone (Risperdal), aripiprazole (Abilify),  olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). Each has a unique side effect profile, but in general, these medications are better tolerated than the earlier drugs. Click on the links above to each drug for more information about side effects.

All these medications have their place in the treatment of schizophrenia, and doctors will choose among them. They will consider the person’s symptoms, age, weight, and personal and family medication history”.

Now let’s get back to those side effects I alluded to earlier in this post.

Patients who take Abilify and some other prescription drugs can develop Tardive Dyskinesia which presents as involuntary, repetitive tic-like movements primarily in the facial muscles or (less commonly) the limbs, fingers and toes. The hips and torso may also be affected. 

Symptoms of tardive dyskinesia can develop and persist long after use of the medication causing the disorder has been discontinued. Tardive dyskinesia can appear similar to other types of disorders, most notably Tourette’s syndrome and can become a permanent medical condition.  

While taking Abilify I developed Tardive Dyskinesia and fortunately quit taking it in time to prevent the affliction from becoming permanent.  The above description does not do justice to it.  When it affected me it was accompanied by confusion, agitation and uncontrollable and very visible tremors around my lower jaw to the point where my teeth could be heard hitting each other despite major efforts on my part to prevent the occurrence.  Furthermore the drug caused tremors in my hands and hips which disappeared once I quit taking the medication.  I felt as though I was disassembling.

Not all patients are affected by dyskinesia.  Some have experienced other side effects.  One friend who we will call “Bill” wrote the following.

I started off on the lowest dose, 2 mg but I felt as though I was going to crawl out of my skin so I cut the dose in half on my own.

While I did not have the movement issues consistent with Tardive dyskinesia.  I did experience a terrible feeling of anxiety and depression unlike any I had experienced in the past.  I can describe the feeling in no other way than to say I felt like my mind was coming unglued.

My physician explained that he thought the dose was too low so we increased it again to 2mg which is a very lose dose but — things got much worse.   I could no longer handle the effects on my mind and body and stopped taking it.  The effects went away the next day.

Perhaps Abilify works for some but for me it was disastrous. Good thing I have a medical background and sense enough to stop taking it. Too often the docs give you something like this and say see me in 2 months, or longer.”

It is important to note here that the drug label clearly says that no one should just stop taking Abilify.  To discontinue use one should taper off slowly under a physician’s watchful eye.  Unfortunately as with Bill, he was unable to see a physician and the effects were so bad he felt compelled to take action himself.

Two stories do not constitute medical evidence but a CNN report says,

“The growing use of a popular drug in the long-term treatment of bipolar disorder is based largely on a single, flawed clinical trial that may be steering doctors and patients away from drugs with a more established track record.”

The CNN expert who studied the studies that got Abilify FDA approval said, “

“The medical research does not appear to justify the widespread use of Abilify for maintenance therapy,” says psychiatrist Alexander C. Tsai, M.D., one of the lead authors of the review and a visiting researcher at Harvard University.” We failed to find sufficient data to support its use.” http://www.cnn.com/2011/HEALTH/05/03/abilify.use.questions/

Bristol Meyers Squibb is the American manufacturer of the drug.  They spend a lot of money on advertising and it pays off.  Abilify was the second-biggest selling drug in their portfolio In 2011 when the antipsychotic generated nearly $2.8 billion in sales, or roughly 13 percent of net sales second only to the $7.1 Billion generated by Plavix.

According to Pharmalot http://www.pharmalive.com/feds-subpoena-bristol-myers-over-abilify-marketing

In September 2007, Bristol-Myers Squibb agreed to settle charges of giving kickbacks to docs and overcharging the government. Among the infractions alleged by the federal and state governments was off-label promotion of its Abilify antipsychotic, and the drugmaker subsequently paid $515 million and signed a five-year corporate integrity agreement.

At the time of the settlement, Bristol-Myers was charged with directing its sales force to call on child psychiatrists and other pediatric specialists, and reps then urged physicians and other health care providers to prescribe Abilify for children. The drug maker also was charged with creating a specialized long=term care sales force that called almost exclusively on nursing homes, where dementia-related psychosis is far more prevalent than schizophrenia or bipolar disorder (back story and the CIA).

The bottom line is this.  Abilify can help.  The problem is that medical science cannot say with certainty who it will help, what conditions it will alleviate and most importantly when and if the side effects will show up.  All they can say is Abilify MIGHT help some patients.

If your physician prescribes Abilify for you it is imperative that you have access to him/her while you are taking it so that if you are negatively affected you can be directed on how best to quit taking it without causing further damage.

One has to wonder about the impact of prescription drug advertising.  It is obviously done to get patients to put pressure on physicians to prescribe drugs that cannot be bought over the counter.  One also has to wonder about the practice of providing physicians with samples to pass out to patients and finally — one has to wonder what’s in it for the physician who prescribes the meds.  Lots of questions — not too many answers.

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scooter half size for wordpressBob Aronson is a 2007 heart transplant recipient, the founder and primary author of the blogs on this site and the founder of Facebook’s over 3,000 member Organ Transplant Initiative group.

Now retired and living in Jacksonville, Florida with his wife Robin he spends his time advocating for patients with end stage diseases and for organ recipients.  He is also active in helping his wife with her art business at art festivals and on her Rockin Robin Prints site on Etsy. 

Bob is a former journalist, Governor’s Communication Director and international communications consultant.

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