Cancer Blog
By Brian Zimmerman
Begun on July 31, 2021
Email: dyingman1@yahoo.com
My Dying Words
Entry #7
August 7, 2021:
Some Principles of Mine for Recovery
I wanted to pick up where I left off in the last entry: a discussion of my cancer treatment. But, I decided instead (I’ll discuss symptoms more in a later entry. They change all the time) to use this continuation as a segue into what I’ll discuss in the next series of entries: what I call Brian’s dictums. These are just a series a sayings that I often repeated to patients in home health to help them understand or maybe remember some physical therapy or medical principle that they should know. Of course any one of Brian’s dictums is just a rule of thumb. I had professor who had saying about a rule of thumb: “It’s only good thumb of the time”. I used to tell the patients that dictum as well! They loved it.
I might well say it up front: these are sayings or principles that I have tried to live by in the course of my sickness as well. I believed them when I taught them to patients and I see their value even now as I go through this trial of cancer, so these are not ideas that are unrelated to my condition, but a part of my personal treatment regime.
Dictum #1: For You and To You
So, here’s the first dictum that I often repeated: “If a medication can do something for you, it can do something to you.” That meant if you are taking a medication regularly (I’m not talking so much about a limited course of a drug like an antibiotic for a sore throat or a course of steroid for some allergy you have), but rather a drug you’re taking day in and day out for months or years, then you need to know the side effects of that medication and watch out for them. Plus, a corollary to this dictum was: “If you’re taking a drug whose effects can be measured by you, then you should be measuring them”. So, if you’re on oxygen (which in the medical world is treated as a drug), then you should have pulse oximeter (which does exactly what it says – it measures your pulse and your oxygen saturation. Oxygen saturation is just a way of measuring the percent of hemoglobin that is carrying oxygen. Normal O2 saturation is between 90 and 100% with most people being 95% or above. MD’s get unhappy if your O2 saturation is below around 88% at rest. I’ve had people who had a reasonable O2 saturation (say 92%) that went down into the low 80’s or even lower (into the 70’s) when they exerted themselves, as for instance, by standing up and walking)). If your O2 saturation is consistently getting low, then the MD will likely want you on oxygen at home). You can buy a pulse oximeter on Amazon for around $20. If you’re on insulin or some other blood sugar lowering drug, you’ll need a glucometer to measure your blood sugar.
Blood Pressure Meds: A Double Edged Sword
But, the drugs I had the most trouble with in home health were blood pressure medications. I found that people took one or a number of these drugs regularly for years, but often rarely measured their effects. So, of course your body changes over time which means that the effect your blood pressure medication has on regulating your BP may change as well. And the problem is that when you go to your PCP, or whoever is prescribing your BP meds, they get usually only one BP reading. That is to say, your PCP gets a snapshot, and what he’d prefer is a movie of your BP. The one reading at the PCP is the snapshot, but you recording your BP reading daily at home and then taking those readings with you when you go to see the PCP is the movie. Those series of readings enable the PCP to see how your BP has varied over time, not just when you are at the MD office (and may be suffering from white coat syndrome}. I suggested that the patient take the BP at a consistent time each day, probably in the morning before taking the BP meds. Why would I suggest that? Well, for several reasons. First, if you take the BP before the meds one day, but an hour after taking them the next day, you’re comparing apples and oranges as you’ve introduced the effects of the BP in your readings in an inconsistent way. Second, and more important for me was the fact that I often received patient referrals for patients that were falling. I would do a history and find that the patient had problems with dizziness, being light headed. So, I did several things: first, I’d tell them that when they first stand that they should wait for a few seconds to be sure they didn’t immediately experience any dizziness. Then, I would have them walk with me. One lady experienced dizziness as we walked so I had her bend over and put her hands on her knees. Her dizziness disappeared. Which told me that it was likely her BP dropping. I’ve actually had patients whose BP I would take when arrived at their home and find it was something like 90/60 (normal is 120/80. Below 100 on the top is a red flag that the systolic BP (the top number) may start to cause symptoms, such as dizziness, especially when changing positions). I would ask, “Did you take your BP before taking your meds?” Invariably the answer was no. So, I’d give them Brian’s dictum and tell them that if their BP is anywhere near 100 for the top number, they needed to call their PCP to decide if they should take the BP medication. Something interesting I had a number of patients tell me earlier this year was that their PCP had changed pretty dramatically the way the patient’s BP was managed. In the past, MD’s pretty much had the rule that everyone’s BP, whether you were 20 years or 90, should be 120/80. But now patients have told me that that rule was no longer in effect. If the patient’s age was 80 or above, the patient was told that a systolic reading (top number) in their BP could 140, 150, or even 160. The MD didn’t explain why, but my guess is that the number of falls and serious injuries from those falls have reached a point where the falls are much more dangerous than the elevated BP. I could only say, “Finally!” I had a 90yo patient who was a retired engineer who said it made sense to increase blood pressure for elderly. Something to do with fluid mechanics, saying that if you wanted more blood to reach the brain when you stood and you couldn’t change the blood vessel diameter to increase flow, then you would have to increase pressure. Or, words to that effect. I walked out thinking maybe the blood pressure med people need to consult someone who understands fluid mechanics!
Monitor!
The point of this long example is that your meds are not completely benevolent. They may have benefits that you need, but I can just about guarantee you that they have side effects that you don’t want, and nowhere is that more true than with cancer meds, and the host of other meds that you take to fight the cancer meds side effects. But, there’s no escaping the need to constantly monitor and report your effects to your MD.