new medical discoveries–not all equal

06/27/2009 at 5:20 AM Leave a comment

Something is always changing, in life as well as in medicine. It adds to the fun and challenge of medicine. At one level it means that the medicine we tried a few months ago which caused problems, may no longer cause those problems. Or that the disease we have been fighting for a long time might have changed and is not susceptible to it.

The body is never static, it tries to heal . It also changes with time and will adjust to different environments. A medicine will interact with the current status of the body, and as that changes, so will the effect ( or non effect) of the medicine. 

On the one extreme, we have allergic reactions to antibiotics. These are common and although in general fairly benign, we find them scary( see my next post). But because there are so many great antibiotics there is generally little reason to try one more than once. Even though in many cases the reaction had nothing to do with the antibiotic, it was an “innocent bystander”

On the other extreme, a drug may not show any promise for the problem, but it turns out that the patient had so many things going on at the beginning that it was impossible to tell that the medicine could help and it takes some time to simplify the situation by dealing with some of the other issues and then retrying the medication. An example is someone who comes in with an anxious depresion under a tremendous amount of stress ( not uncommon in this day and age). They may also have body symptoms ( we call those somatic complaints), such as back ache or fast heart beat or shaking, insomnia, etc. Treating some of these things before treating the anxiety and depresion can be frustrating and  pointless. Furthermore,  treating these two first somethimes makes all the other complaints either go away or become so minor as to not need much.

 By the time they come in they are desperate and the last thing they want to hear is that we need to address things in order instead of all at once.  So in many cases the challenge is getting the trust of the patient to try a few things in varying order. I can usually do the follow up by phone and made adjustments on the fly. But remember it is amazing how a bad mood (depresion and /or anxiety can multiply the discomfort of something minor like back pain, or your kids/spouses behaviour).

I never got to the new medical discoveries. Will post that soon.

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Entry filed under: How things work.

newly heard ditty Allergic reactions- rules to live by

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