Medication

Over the years, I have been given a number of medications for preventive reasons. They fall in two categories: antibiotics and anti hypertensives. Neither actually cures anything, and neither causes me to feel any better. Of course, I can see how medication reduces blood pressure, but that's not a goal by itself. The question, rather, is how medications will keep me from getting more ill.

I have also witnessed, over these same years, major shifts in medical thinking about what should be done. This decade's conventional wisdom changes in the next. So I find myself dutifully following recommendations, to keep me well, which I are later considered to be wrong. Yet, despite the fact that the wrong thing was done, my overall health, with a few major exceptions, tends to stay stable. I don't get sick just because, for years, I did the wrong thing. This experience has impacted my perceptions of the world, my views on the medical field, and on my perspective in my field of psychology. I'll start with antibiotics.

It is generally understood that when one has a leaky heart valve, there are infective risks. It's been explained to me through a plumbing analogy. If you have new pipes, water flows freely. If you have some rust, the rust becomes a site on which things can accumulate. Similarly, a damaged valve is a site on which bacteria (or viruses, or fungi) can seed. Once settled in that site, they begin to multiply and grow. The condition is called endocarditis and it is quite dangerous. It can't be cured with simple oral antibiotics, but requires hospital treatment and weeks or more of intravenous medication. Hopefully, the organism is a bacteria, since the other possibilities are much harder to kill. Untreated, the condition can be fatal. Common illnesses do not lead to endocarditis, but blood born infections do. Consequently, it is considered important to prevent bacteria from entering the blood stream.

The American Heart Association publishes guidelines for protecting people like me, from endocarditis, with the most common concern being dental work. Evidently, we all have bacteria in our mouths. The gums give rapid access into the bloodstream. Common dental procedures, such as preventive teeth cleaning, can cause these bacteria enter. Although less likely, cuts in the gums from using dental floss, can do this, too.

Sometimes, the AHA publishes more stringent guidelines. Sometimes, they ease up. Recently, the guidelines have lessened considerably.

For me, it has been a bit surreal. When I was first diagnosed with an aortic insufficiency, they did not have these antibiotic recommendations. Dentists did not ask me if I needed prophylaxis, and I did not use it. So, I have a considerable experience of having my teeth cleaned, without this protection, without harm.

In my later 20s, I was suddenly told this was absolutely necessary. I would take medication for five days, two days before as well as two days after, when having dental work. Further, there were concerns that any infection in my mouth, even a common sore throat, could make me seriously ill. So, I had lots of antibiotics. Lots and lots of antibiotics. Every sore throat created fear, a trip to the doctor, and frequently, medication. In fact, one doctor wanted me to take an antibiotic pill, every day, for my entire life. As we now know, that practice can breed medication resistant germs. Fortunately, I never followed through on that suggestion.

In 1990, I was working at a hospital and was able to get medication from the hospital's formulary. With dental work planned, I got a supply. Something happened so that the procedure did not take place. I put the pills in my attache case, without further thought. In the fall when I did visit the dentist, I noticed I still had those pills. It did not hit me that, because I had carried them around through an entire hot summer, they were no longer potent. A few days after I saw the dentist, I developed fever. I saw my doctor. He gave me antibiotics. I felt better until I finished the prescription, and had a fever again. After repeating this routine with the same result, I had blood culture, which showed I had endocarditis.

After a three week hospital stay and four and a half weeks of IV treatment, I did get better and life went on. My new prophylaxis recommendation was IV antibiotics in preparation for dental work. For years, I had to arrange for a nurse to come hours before any dental procedure, to infuse the medication. More recently, my doctor has agreed to reduce the pre-treatment to an intramuscular injection. For this, I order the vial from my pharmacy, take it to my family doctor where the nurse gives the injection, and then mosey on over to my dentist's office. The routine is much better than the one before.

Here's the odd thing. Recently, the AHA has changed its recommendation to drastically reduce the use of pre-medication for people like me, with heart valve disease. If I were following today's recommendations in 1990, those antibiotics would not have been prescribed. Does that mean I would not have gotten sick? I didn't get sick in my 20s before they had these recommendations. Has the AHA, in an effort to not overuse antibiotics created a situation in which heart valve patients are now left unprotected? Is it still true that I, personally, need this aggressive approach to pretreatment for dental work?

I find the whole thing puzzling. These recommendations are not meant to cure an illness, but to keep some rogue bacteria from doing its dirty work. It may be like homeland security, overkilling on civil liberties, to block a terrorist cell. Anyway, I do what I'm told, and hope things works out.