Ann's Allergy Story
When you listen to your body and use your intuition, you are using skills that no one else can match. #intuition While regular doctor visits and screening are important, it’s also vital to know and listen to your body. Knowledge of what normal feels like to you is important reference information for when you are exposed to something infections, or when you begin taking a new or different formulation of a medication. I helped a business colleague with just such a situation that began with her astute identification of a problem with the formulation of the drug she was taking.
Ann (name changed for privacy) related that she had been on Levothyroxine for about 15 years and had been stable on the same dosage for year. She changed her Primary Care Physician (PCP), health system, everything within the past year. This new PCP did bloodwork testing and changed her dosage of medication.
Within days of starting this new prescription, Ann developed a rash on her arms, legs, and torso. There were multiple factors that she considered; it was the tail end of a heat wave, and she had also been eating a lot of strawberries over the course of the previous week. She got some over the counter meds to help with the itching, but the rash persisted. She messaged her new PCP, who deemed the issue “non-emergent”, and they would visit it a month later.
Ann visited her pharmacist, showing her the rash, and the pharmacist confirmed that she
was having an allergic reaction to something, and suggested Prednisone as a possible treatment. Ann was persistent and insisted on seeing her PCP and was prescribed prednisone. When she asked if the new Levothyroxine prescription could possibly be contributing to the rash, she was told by her PCP that the medication had nothing to do with her rash.
Ann took the prednisone, and the rash faded but never totally disappeared, and began getting worse again. There were no food correlations that could be causing an allergic response. Ann spoke with another pharmacist, asking if they thought that the new drug could be causing her rash. This pharmacist suggested that she look at the inactive ingredients in the drug, reasoning that Ann’s PCP would never look at or consider the inactive ingredients.
Ann had another appointment (8 weeks out from the medications change), and again brought up the rash. While her PCP agreed to refer her to an allergist, the PCP was dismissive when Ann related the information from the other pharmacist about inactive drug ingredients. At this point, the PCP said the most likely offender was a food item. Ann related that the only thing she consumed daily was coffee.
Ann did some research on her own on inactive ingredients, looking on the manufacturing company website, and found a chart from the manufacturing documenting coloring agent and inert ingredients for each drug dosage. It turned out the for the dosage that Ann was on contained the coloring agent carmine. She did research into carmine. It is a natural ingredient that is extracted from insects from South America…and is known in this country as Red Dye #4. Turned out that red dye # 4 and Yellow Dye #5 are the most common coloring agents that people are allergic to. Coloring agents are recognized in the pharmaceutical industry as being potentially problematic in regulated medications. There has been research done into the reactions caused by these “inert” substances, technically termed as excipients. 1
Ann sent the results of her research back to her doctor, and at this point they agreed to change her dosage to another pill that did not contain those dyes. She ended up taking a combination of pills to get the correct dosage. Her rash start fading. Three weeks after the drug change the rash on her arms was gone, and the rash on the front of her trunk was also gone, with minimal rash on her back. The rash on her legs was faded, but still there. She also discovered that the drug companies do not routinely test for allergies due to coloring agents.
There are several practical takeaways from this experience:
A careful survey of food and medications and exposures is critical when you develop new symptoms or side effects, especially when a new medication is introduced. It is quite common for people to be on a cascade of medications just because that had an adverse reaction to a medication they were given, then placed on a medication to treat that reaction.
Drug adverse reactions are COMMON, but usually mild. (2)
Awareness of your body is critical in figuring out if you are having an adverse or allergic reaction to a food or medication. Tune into your body, and ABSOLUTELY FOLLOW YOUR INTUITION, rather than accepting an opinion when you are convinced that something is wrong. #bodyawareness #followyourintuition
A valid question for your prescribing doctor is a detailed inquiry about THE SIDE EFFECTS OF MEDICATIONS THAT YOU ARE PLACED ON, so that you can be aware if you have those reactions
BE PERSISTENT about getting a dosage or even manufacturing company change in a medication if you suddenly develop a reaction or side effect to a medication that you previously tolerated well.
A CHANGE IN HEALTH CARE PLANS OR COMPANIES CAN LIKEWISE result in a change in the manufacturing company for medications that your routinely take.
BE ALERT FOR ANY CHANGES IN THE APPEARANCE OF THE MEDICATION or change in the manufacturing company for a given medication. Frequently, you will only know this if the color or shape of the pill changes, since most prescriptions are distributed in the amber pharmacy bottles
GET HELP! Ask your pharmacist for help if you discover that you are having a side effect or allergy issue. The pharmacist should be able to tell you exactly the company that supplies the medication in the pharmacy. Armed with that information, you can go directly to the company website as Ann did to get information about a particular drug or drug dosage.
BE PERSISTENT!!! It took weeks for Ann to get her PCP to change her medication.
ADVOCATE FOR YOURSELF. As a female doc, and patient, I will tell you absolutely that WOMEN ARE FREQUENTLY NOT HEARD OR SEEN BY THEIR PRIMARY CARE PROVIDERS. That goes for female as well as male Doctors, PA, and Nurse Practitioners. I well delve into that in a later blog and in my newsletter. Medicine is a very hierarchical profession. Just as recruits to the military are “broken down” and trained in appropriated responses to situations, so are Doctors and other primary health care providers enculturated into the “Proper” way to deal with patients and questions to their plan. Likewise, patients are shown graphically when their questions are not welcome or heard. I say it’s a sad and sorry situation when women are frequently not listened to by their physicians and people in the medical industry. Much more on this later.
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Especially when it comes to doctor’s appointments, CONSIDER TAKING SOMEONE ELSE WITH YOU TO HELP ADVOCATE ON YOUR BEHALF.
Personally, I always ask my anesthesia patients if they have anything else they wish to tell me after I have finished with their anesthesia informed consent and workup. You would be surprised at the information patients will give when they are ASKED ABOUT THEIR CONCERNS. A good open-ended question at the conclusion of an appointment is to ask for the process for evaluation of any new prescribed medications. There are far more options with telemedicine these days, but if you feel uncomfortable with the way a problem is being addressed, be persistent, and get the face time/in person appointment that you need.
ADVOCATE FOR YOURSELF. IT’S YOUR BODY; YOU KNOW IT BEST.
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