Don’t Think Medicines are Hurtful
Everybody thinks medicines are going to hurt and are full of side effects. Let us talk about – Why do we need medicines and why should we take medicines? Why do we need medicines anyway?
Why do we take crocin or paracetamol when we are running fever? In fever our body temperature goes up to 100 to 102 degrees Fahrenheit, but our normal body temperature is 98.6 degrees. So, we take crocin to bring down the temperature. Actually, if a young child has 104 degrees temperature, then the fever by itself may kill him, forget about the reason for the fever. Body just cannot function at very high temperatures. Same way, body cannot function at a very low temperature. That is what happened at the tragedy of Titanic. When titanic was involved in an accident, people boarded on it caught into very freezing water and they simply froze to death.
What does it tells you? It tells you that your body to function at best needs body temperature of 98.6 degrees. Similarly, it needs pH of 7.4. It needs hemoglobin between 12 to 14 grams. It needs HbA1c of 6.0 or less. It needs blood sugar of 100. It needs blood pressure of upper limit around 120mmHg, when heart pumps the blood and when heart relaxes, blood pressure should come down to 80mmHg. So, the body is used to of blood pressure 120/80 mmHg.
On the other hand, if my blood sugar is high, I will not hesitate in taking 2 or 3 medications. If my blood pressure is high, I will not hesitate in 2 or 3 medicines. If my cholesterol is high, I will not hesitate in 2 or 3 medicines. Sometimes one medication is not enough, or you need too much of one medication and you may start having side effects. Different medications work by different means you can take ibuprofen or crocin (paracetamol) to bring your fever down, but they both work by different mechanisms just like antibiotics. Different antibiotics work in a different way. They all do the same thing, but they are still different. What are the most common conditions as a doctor I see, and my colleagues see. I have talked to so many of my colleagues about the most common conditions we see. These are basically:
- We develop fever
- We get an injury
- We have some joint pain
- Overweight, high blood pressure and may be high cholesterol
- High blood sugar
- Not able to sleep at night for whatever reasons
- We are having loose motions, nausea, vomiting, and infections.
So, what if we have infections, injuries, diabetes, blood pressure, arthritis, and in the later stages of life, cancer. They all cover pretty much all of the medications and rare conditions happens very rarely.
One day a husband came to see me with his wife. He was in a government service for several years. We evaluated his wife and put her on several medications, and eventually she happened to be on 12 different medications. Obviously, everyone in India (even in US) remembers their medicines by colors like yellow pill, green pill, white pill or by shapes like round pill, square pill etc. She was feeling much better and came to me after 2 or 3 weeks for follow ups two to three times. She pulled out all her pills and asked me, “Doctor, here are the 12 different pills I am taking. I want only 8 pills to take now. You decide and tell me which eight pills you want to give me”.
I will be honest with you that it is very true as number of people came to me with such situation. People think that 10 or 15 different medications can hurt us, but it is not true. The medical profession is very complex and becoming more complex, but at the same time human body is also very complex. If we have diabetes, we will need two to three medications for diabetes. If we have blood pressure, we will need two to three medications for blood pressure. If we have arthritis, we may need one or two medicines or pain pill.
Some other day, a couple came to me and wife had been running with high blood pressure. I started her treatment for couple of weeks. So, after couple of weeks she came back to me. Her blood pressure was running on the higher side but, I had put her on good medication. I was little confused. So, finally I talked with her and she said, “Doctor, my headache has been doing better. So, once I have headache, I take medication for two or three days till my headache goes away and then I stop medication. I do fine, but after three to four days, I again have headache and then I start taking medication again. This is how, I come to know when should I take my medications for blood pressure and when not to take.” I was totally taken aback by her statement. Suddenly, I realized this is actually very prevalent in our Indian culture. I do not face this kind of situation in USA but in India, if you are feeling better then you have a tendency to skip all your medications and when you start having symptoms again, you take medicines.
Now I would like to tell you about one of my patients, Mr. Gyan Prakash. He had diabetes and blood pressure for many years and blood pressure was mostly above 200 without any symptoms. He used to skip his medications. So, finally I convinced him to take medications for diabetes and blood pressure. He came back to me after a month or two after. So, after Diwali Mr. Gyan Prakash came to me and he was not taking his diabetes medicine anymore. I asked, “What happened?” Mr. Gyan Prakash said, “It was Diwali, and everybody was bringing mithai (sweets) and just for this short duration of time, I had stopped taking my medication because it is not going to control my blood sugar anyway.” Again, this was a very unique situation with Mr. Gyan Prakash. I could understand his concern but then my answer was, “You should actually take more medications rather than not taking medication at all. Nobody says that in diabetes you cannot have sweets. But we can help you with that. You do not have to finish a whole box of sweets instead you can taste sweets and enjoy them.
I would like mention that it is very damaging to our body, once we start taking medication, we stop it and again we start, and we stop it. It actually causes more damage because once we are having high blood sugar and high blood pressure, our body keeps adjusting (because it happens very slowly).
But once we start taking medicine, we are breaking this vicious cycle. When we have controlled blood pressure and stop taking medicine, blood pressure will actually shoots up and same thing with the blood sugar too. All of a sudden body faces huge fluctuations in blood pressure and blood sugar with medication and then off medications.
Occasional missing accidentally is a different story, but we got to understand that once we start a treatment, we should take medicine properly according to the advice of the doctors. If you do not to take it properly then you should definitely need to discuss with your doctor and understand the risks and benefits.
Decision will be yours, but you need to understand the risks and benefits.
For high blood pressure and diabetes, people have asked me again and again, “Do we have to take these medicines for rest of our life?”
Again, my answer is actually very simple, “Yes, you have to”.
First thing is 20 years ago scenario might be different, but today we have excellent medications. They can keep our blood pressure and blood sugar normal and they can keep us going. If we are not able to sleep, then medicines are there to help us sleep. We are having headache, then medicines are there to deal with our pain. Our knee joint hurts, medicines help us to take away that pain and misery from us. We have infection, medicines immediately take care of that. Issue is not that you have to take medication for rest of your life or not.
Today you can buy a BP apparatus and monitor your blood pressure at home. We will show you how to do it. Today, you can buy a blood sugar machine and check your blood sugar at home, and we will show you how to do it.
So, as long as you show blood pressure 120/80 when you wake up and well rested and the blood sugar as 100 in the morning as a fasting blood sugar for years and years, then you do not need any medications.
Why would I as a doctor or my colleagues give you diabetic medication, if your blood sugar is normal?
Why would we give you blood pressure medications if your blood pressure is normal?
Why would we give you a pain killer medicine, if you are not having a pain at all?
I mean it defies common sense that almost all middle-class families are educated and almost everyone has a doctor member in their families. People should question their doctors right and left for any unreasonable treatment or they can ask doctor to justify their treatment. Nothing is wrong with that.
Once again, I would say that, it is your health and it is your life. You make decisions. Our role is to support you, guide you, help you and to bring out the medical knowledge to you.