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Staying Healthy: What about the side effects?!

Work with your doctor to manage medications and unwanted byproducts

All medicines have side effects, said Mustafa Kazemi, a physician who deals in primary and pulmonary medicine as well as pulmonary intensive care at San Ramon Regional Medical Center.

Usually side effects from medications are mild, although occasionally they can be serious, even life-threatening, which is why people must work with their doctors to determine the best option.

"There's a big fat book called the Physicians' Desk Reference; it's a huge book, and it lists all the possible side effects on every medication," Kazemi said.

He continually refers to it as he treats his patients.

"Dizziness and nausea are the most common side effects with medications because they get processed in the liver; 95% of drugs are processed with the liver, so I have to worry about what other drugs a patient is taking," Kazemi explained.

"Side effects could go away, but you don't want to be suffering for more than a couple of days," he added. "The body is an incredible machine. If the body adapts, you've met your goals."

A doctor must take many factors into consideration when prescribing drugs, Kazemi said, including age and medical condition.

"We are dealing with chemicals being introduced into a patient's body," he pointed out.

But generally, side effects are not a problem.

"For 95% of the prescriptions I write, I don't get any complaints," Kazemi said. "And usually things show up in the first few days, or they know within a week or two if a medication is causing a difference in their life."

Over-the-counter vitamin supplements can also have side effects, Kazemi noted.

"It depends on how much you take and how much your body needs," he said. "All of them can have side effects, which could affect the kidneys, the liver. Most tend not to, but you have to be aware of it."

Television commercials that tout a miracle drug then -- as required by federal law -- rattle off a long list of complications are a boon for comedians but they often irritate everyone else. And doctors may feel even more strongly.

"They are the most annoying thing you see on TV," Kazemi said. "I think it crosses the line about what a physician feels is safe and comfortable for the person."

For instance, he recently prescribed an inhaler to a patient, knowing that one listed side effect was a possible increased heart rate.

"But in 20 years, my patients have never had that," Kazemi said. "But then a commercial says if you have heart disease, don't take the medication -- so my patient gets upset with me."

He said physicians and pharmacists tell patients what side effects they need to watch for, so the dangers are under control. And he wishes drug companies did not advertise directly to the consumers anyway.

"They are pushing the drugs -- I wish they were off the TV," he said.

Most medications do in some cases, or with long use, cause liver or kidney problems, he said, which is why doctors monitor patients.

"As a physician, I follow my patients' blood work to make sure medicines are not affecting them," Kazemi said. "Most of the time, we see these patients frequently, every three or four months, and usually there is a blood test involved."

With patients' records now being kept electronically, each doctor can see what medications have been prescribed for each person and what allergies they have or side effects they have experienced, Kazemi said.

"The main problem in the past has been too many doctors prescribing medications," he said. "I always have a list of what they are taking and am updating it. That's one of the major issues of good care."

"The patients themselves have to bring a list of medications so I can look and constantly be looking at side effects," he added. "That's the No. 1 thing I look at."

"We are all trying to cure things, to discover new drugs to make people feel better," Kazemi remarked. "The listing of side effects is relevant in less than 1% or 2% of the time."

Although pharmaceutical companies will give him new drugs to try, Kazemi said he educates himself before prescribing anything.

"What I do is stick with medications that have been around for a long time," he said.

Medicine has come a long way since the 17th century. And although modern drugs may have side effects, your doctor can help you manage them or find another medicine or treatment that is a better option for you.

When you get a new prescription

* Read the side effects that are listed and watch for them as you begin to take the medication.

* Follow the directions. If they don't sound right, ask your doctor or pharmacist.

* Check all medicines with your doctor, making sure they're aware of all of your prescription drugs, over-the-counter medicines, supplements and herbal remedies so you can be sure the combination is safe.

If you experience side effects

* Discuss symptoms with your doctor or pharmacist. Sometimes simple changes can be made to manage or prevent side effects. Or what you think may be a side effect may actually be caused by something else.

* Ask your doctor before you stop taking a medicine unless your reaction is life-threatening. Suddenly stopping a medication can be harmful.

* Side effects may lessen or go away as your body adjusts to a new medicine. For a long-term medicine, there may be a difference in one to two weeks.

* Do not take a medicine that was prescribed for someone else. Medications and dosages are chosen according to an individual's age, weight, gender and health.

Dealing with side effects

* Nausea: Take medicine with meals. If instructions are to take on an empty stomach, take the medicine at bedtime.

* Upset stomach/diarrhea: Ask your doctor what other medicine you can take to treat these symptoms.

* Constipation: Try eating foods that are high in fiber, drinking more water or taking a stool softener.

* Drowsiness: Take at bedtime.

* Sleeplessness: Take in the morning.

* Dry mouth or persistent dry cough: It might help to drink more water, to chew sugar-free gum, or to suck on sugar-free hard candy or a cough drop.

* Sexual problems: Ask your doctor about another medicine to help with these side effects.

* Mild depression: Exercising and a healthy diet can help boost a person's mood. Consult your physician.

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