Costochondritis

In the old days a chemist would dispense prescribed medicine in an anonymous container with the minimum of information--three times a day and no alcohol, or whatever. Now a pharmacist will probably provide tablets in the manufacturer's original package--complete with generic and company product names, with a comprehensive leaflet describing the indications, contraindications, advice on overdose, and an impressive list of potential side effects. In some instances relatively detailed information is provided on the drug's mode of action.

No doubt this is in keeping with the openness of the new NHS, and partly perhaps to meet health and safety requirements. Having worked in a medical school for 36 years I have some knowledge of my own subject and rather less of peripheral specialties. However, until recently I did not even know I had angiotensin-converting enzymes, let alone that they might need inhibiting. I find such product information leaflets interesting but also somewhat confusing and wonder what others with less medical knowledge, whether hypochondriac or not, make of them. Perhaps ignorance is bliss?

Another form of potentially blissful ignorance is traumatic amnesia. At present I am convalescing from what, by all accounts, was a rather spectacular heart attack. I have no recollection of the actual event, or the following week during which I was heavily sedated. In retrospect the second week indicated considerable distortion and fantasy. The intensive care unit was nothing like I remembered it, and I was convinced that I was in hospital in Jersey.

Now I am left to contemplate and take my medication. In addition to silver nitrate for an overgranulating tracheotomy wound and the glyceryl trinitrate spray (still not used), I take seven different tablets. Between them the drug leaflets list an alarming collection of potential side effects which I prefer to separate into three categories.

The first group are those unconnected with the underlying condition and relatively easy to interpret: impaired taste, hair loss, sexual dysfunction, etc. Interestingly, three (frusemide, ramipril, and especially amiodarone) may cause sensitivity to sunlight. This prompted purchase of a garden sunshade and sunhat, and the charitable disposal of short sleeved shirts.

The second group of side effects is less easy to interpret, though still unconnected to cardiac problems: diarrhoea or constipation and runny or stuffy nose--all offered by carvedilol and ramipril, and the former by' frusemide, pravastatin, and warfarin.

The third group are side effects which can mimic or are related to the underlying condition: slowed heart beat, (amiodarone, carvedilol), dizziness or low blood pressure (carvedilol, frusemide, ramipril), palpitations or chest pains (amiodarone, carvedilol, ramipril).

But how do I know I am having side effects? Some are obvious, others less so. I thought I had developed impressive flu-like symptoms (carvedilol again), until my wife and then our daughter obviously acquired the same virulent virus. And when do I use the spray given that the side effects of other medication may cause chest pain; I have arthritis in the left shoulder and bilateral costochondritis; the spray offers a 30-40% chance of reduced blood pressure; and my blood pressure is already being kept low?

How do I know which drugs cause any side effects? A quick count suggests my seven tablets offer a choice of at least 130 side effects though obviously there is considerable overlap. All may cause nausea and vomiting; five, rash or itching; five, diarrhoea or constipation; four, headache; four, chest pains or palpitations; and three, dizziness and low blood pressure. I will pass over the possibility that most may also cause kidney or liver problems or both, best assessed biochemically.

How are side effects measured? If one drug causes diarrhoea and another constipation are these two side effects or do they cancel each other out? Similarly, with stuffy or runny nose. In any case why are they all called side effects? Surely vomiting and diarrhoea should be top--and bottom--effects, and sexual problems horizontal effects.

Of course, most leaflets mention that side effects are usually rare or transitory or both and all emphasise the importance of seeking medical advice if there is concern. I am not suggesting a total return to the old days. However, perhaps less informative (alarmist?) leaflets and more time with admittedly overstretched doctors might in fact reduce their overall workload and lead to happier patients.

In retrospect, despite transitory nausea and vomiting and less transitory dizziness, possibly caused by an increased dosage (carvedilol--again), I do not think that I have had any serious side effects. So I will continue to hope that the enzymes that I did not know I had continue to be inhibited--and wonder what extras next week's influenza and pneumococcal vaccines might bring.

Derrick Baxby former medical microbiologist, Liverpool

COPYRIGHT 2001 British Medical Association
COPYRIGHT 2001 Gale Group