Organizing medications

Bengt Bostrom, 71, organizes his medications on July 3 at his home in Coppell. Bostrom suffered from a bleeding ulcer after being treated for exhaustion without internist Dr. Bradley Jones knowing Bostrom was already being treated for prostate cancer, and a specialist had prescribed naproxen to help reduce swelling. If Jones had known that, he’d have added a medicine to protect Bostrom’s stomach.

Dallas Morning News/Louis DeLuca

DALLAS — A failure of communication proved to be life-threatening for Bengt Bostrom.

Bostrom, 71, of Coppell, went to his internist, Dr. Bradley Jones, to figure out why he was so exhausted. Bostrom was already being treated for prostate cancer, and a specialist had prescribed naproxen to help reduce swelling.

If Jones had known that, he’d have added a medicine to protect Bostrom’s stomach. Instead, Jones didn’t find out until he noted how unnaturally pale Bostrom was, ran tests and sent him to the hospital, where he required four units of blood to stabilize a bleeding ulcer.

“I didn’t suspect the medication,” Bostrom said, noting that the naproxen, which Jones identified as the culprit, was an over-the-counter pill he’d only taken four or five days.

Jones, an internist on staff at Baylor Medical Center at Irving, said the incident points out the importance of having one doctor monitor all of a patient’s medications — prescription, over-the-counter and herbal.

“The internist is the quarterback of a patient’s care,” Jones said. “The internist needs to make the referrals, and if you self-refer, the specialist should send a report back so the internist can say this medicine is fine or there’s a reason why we can’t do this medicine.”

Armon Neel Jr., a fifth-generation pharmacist and author of “Are Your Prescriptions Killing You?” (Atria Books, $25), might add that a board-certified pharmacist, working with that doctor, can play a key role as well.

About 46 million people in the United States have multiple chronic health conditions that require multiple medications and rely on multiple health care providers for their care, according to the Alliance for Integrated Medication Management, an organization created in June with the goal of integrating pharmacists into primary care services with the help of the Health Resources and Services Administration of the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services.

Medication-related problems are common, costly and hurt people, according to a 2012 report from the American Geriatrics Society. Problems can occur when medications are taken incorrectly or conflict with one another or with certain foods and alcohol.

Fatal prescription interactions can occur at any age, as witnessed by the case of actor Heath Ledger, who died in 2008 from an accidental overdose of six prescription drugs, including painkillers, sleeping pills and anti-anxiety medication.

However, Dr. Paul E. Carns, an anesthesiologist and assistant professor of anesthesiology at the Mayo Clinic in Rochester, Minn., said that the most vulnerable are the elderly, who use an average of 16 medications apiece, often prescribed by different specialists and acquired at different pharmacies as patients shop for the best prices.

“As we get older, we have more chronic conditions that require multiple medications that are more powerful than ever before,” he said. “Many work specifically on certain places in our body, and many times there’s an interaction.”

The problem extends to over-the-counter medications taken in excess, from fever reducers such as Tylenol, which can damage the liver, and anti-inflammatory medications such as Advil, which can affect the kidneys, he said.

Additional interactions to watch for: certain beta blockers can have an adverse effect on blood sugar; anti-inflammatory medicines can raise blood pressure; some antibiotics and high doses of grapefruit can inhibit the metabolism or breakdown of statins in cholesterol medications; coumadin, a blood thinner, can be blocked by too much vitamin K, which comes from eating green vegetables.

Neel offers a long list of potentially adverse reactions in his book, pointing out how patients taking blood pressure drugs should be monitored for muscle pain, migraines, blackouts, diabetes and kidney failure.

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