For some time now, Dorothy has been groggy a lot. At first I thought it was simply part of the post-stroke phase but as time wore on I began to suspect other causes, especially medication. Her rehab doctor has never taken the initiative to reduce or elminate any of her drugs though he has increased the dosage of one. I am not drug-phobic but I do think that drugs need to be reviewed periodically and if possible reduced or eliminated as conditions change. After all, prescription drugs are powerful. This week Dorothy met with our primary care doctor, who is one of those physicians who works hard to avoid medicating his patients unnecessarily. He has been her doctor (and mine) for more than 15 years, so he knows her well. With no prompting he took a look at the drugs her rehab doctor had prescribed. When Dorothy mentioned that she seems to be groggy a lot he asked her if she still has muscle spasms. She said that she doesn't so he suggested that we reduce her Baclofen from the current 30 mg. a day to 20 mg. He said Baclofen is really for muscle spasms and that if the spasms are no longer a problem there is no reason not to back off of that drug. So we did. And now, only four days later, the grogginess has vanished. Dorothy says she feels a lot more alert. I can see the difference too. It's clear to me that she had been in a bit of a drug-induced stupor before we backed off the Baclofen.
I am sharing this by way of reminding others that doctors tend to prescribe drugs without revisiting them from time to time. As a result, many people wind up being medicated long past the time when they need the medication. The other lesson we've learned is how important a patient's primary care doctor is even when other doctors are involved in that patient's treatment.
We had already taken it upon ourselves several months ago to lower Dorothy's Cymbalta dosage with the blessing and guidance of our primary care doctor. There have been no problems since. I'm convinced that she's doing just as well with the lower dosage as she was with the higher dosage. Our primary care doctor says we could reduce the dosage even more if we would like and we may yet do that. We just want to proceed with sensible, measured caution. Our primary care doc is an important guide as we decide how and when to lower the dosage. Better yet, his loyalty is to the patient, not a fellow physician, so he doesn't worry about ruffling feathers by second guessing from time to time. I'm beginning to think we may even eliminate Cymbalta altogether before much longer. Our primary care doctor says that could be worth a try down the road and that because her dosage is so low she wouldn't have to be weaned off gradually.
I firmly believe in the value of the right medication at the right time. But I also believe that no one should take medication without a very good reason to do so, especially for an extended time. Our primary care doctor thankfully subscribes to the same philosophy. I realize my limitations as a layman so I don't attempt to practice medicine without a license. But I also believe that even good doctors too often go on auto-pilot once they establish a treatment protocol for a patient. That's why it is good to have another set of trained eyes on the patient. And that's also why it is critical to always keep watching and thinking when you or your loved one are being treated. So be sure to use your primary care doctor even when under the care of a specialist. He or she is important as an advisor and as an advocate.