DEAR DR. GOTT: I am a 76-year-old female. My meds are Benicar, hydroclorothiazide, atenolol for hypertension, Zantac for GERD, potassium chloride, simvastatin for high cholesterol, Levemir for diabetes, an 81 mg aspirin most days, and a nitroglycerin patch for angina. I still have a lot of chest pain, even with the patch.
I am allergic to molds, most fragrances, smoke, many medications – (especially narcotics for pain). Twenty-five years ago I had a distal pancreatectomy and now have developed a small tumor in the remaining head of the pancreas. My father died at 83 from pancreatic cancer, my mother at 96 from multiple myeloma. My father had CAD which I now have. My doctor prescribed Plavix that causes extreme itching but no rash, so I discontinued its use. I tried Effient. Same itching. Discontinued use. My doctor says a stent is indicated but because I cannot tolerate Plavix or Effient, I am not a good candidate. I am frustrated that there are no medications I can tolerate. I have spent a lot of money for meds I cannot use. Any suggestions? Thank you.
Dear Reader: Let’s see if we can sort some of this out in a reasonable manner. You have hypertension, gastroesophageal reflux disease, diabetes, angina, hypokalemia (low blood levels of potassium), coronary artery disease, and possibly high cholesterol levels. I say “possibly”, because your cardiologist may be playing it safe in wanting your levels to be lower than normal due to your heart problems.
The Plavix you were taking is known to cause extreme itching, rash, difficulty breathing, weight loss, and a host of other unwanted side effects. Your reaction to that drug is understandable. Effient isn’t reported to cause an itch, yet has its own set of unpleasant side effects for some individuals. It is prescribed to prevent blood clots in those with acute coronary syndrome who are undergoing a procedure following stroke or an attack, and for those with disorders of the heart. Again, I can understand why your physician put you on it to replace the Plavix.
I’m not making light of the fact you are allergic to fragrances, smoke, numerous medications and more but to a slight degree, you can control your exposure to them. You have much more pressing issues to be concerned about.
Other than your family history, your coronary artery disease (CAD) may have been caused by such things as your diabetes, high blood pressure, and high cholesterol levels. You may be (and understandably so) under a great deal of stress, suffer from sleep apnea, don’t get sufficient exercise that could lead to extra pounds, and while I doubt it, you may be a smoker. All these things and others can exacerbate the symptoms of your CAD.
I suggest you speak with your cardiologist to determine if you have any prescription options other than the two you have tried with less than satisfactory results. Then discuss a program of rehabilitation until you can work out those pre-surgery medication issues. If he or she deems it appropriate, you will work with physical and occupational therapists, a cardiologist and a host of other specialists who can monitor your exercise, nutrition and diet. The overall program must be considered long-term maintenance. Ask your physician about the possibility. You may learn to cope with your condition and improve your quality of life.
Readers who would like related information can order my Health Reports “Consumer Tips on Medicine” and “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and $2 (for each report) in a U.S. Check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
