Sjogren's Strong

Introduction

PDR

This week on Sjogren’s Strong Lupe & Brian talk about a PDR. What is it and how do they use it? Learn to ask your Doctor better questions

PDR

Lupe & Brian talk about a PDR. What is it and how do they use it?

Lupe & Brian: [00:00:00] Welcome to another episode of Sjogren’s strong.

[00:00:03] Brian: [00:00:03] This is Brian.

[00:00:04] Lupe: [00:00:04] And this is.

[00:00:05]Brian: [00:00:05] And this is your podcast discussing how to live an active and healthy lifestyle,  despite a diagnosis of Sjogren’s.

[00:00:11] And today, today, we want to talk about something that’s come up time and time again, and that is prescription drugs.

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[00:00:21] So many people will hit us up in comments or private messages asking about drug information.

[00:00:29] Lupe: [00:00:29] And honestly, I don’t feel too comfortable talking about drugs because I’m not doctor, I’m not an expert, in drugs. Um, I mean, I could only talk about the medication that I take. That’s what I feel comfortable talking about.

[00:00:45] I’m not going to say giving advice, but you know, the side effects and what it does to me.

[00:00:49] Brian: [00:00:49] Yes. How, drugs affect you.

[00:00:51] Lupe: [00:00:51] Yes.

[00:00:52]Brian: [00:00:52] Because they’re going to affect people differently.

[00:00:56] Lupe: [00:00:56] Because even the drugs that I’m on, they affect other people differently.

[00:00:59] Brian: [00:00:59] Right.

[00:01:00] Lupe: [00:01:00] So, I mean, it’s hard to say. And to talk about other drugs that I’m not familiar with, they’ve never been prescribed to me, it’s tough.

[00:01:10] Brian: [00:01:10] And pharmacology is a really complex subject. The way compounds and drugs react in a body doesn’t mean they act like that in everybody. So, we want to share with you a tool. And some of you may have heard of it, use it, have it. And some of you might not.

[00:01:33] When I ran rescue ambulance, we all had what we call the PDR, Physician’s Desk Reference in our back.

[00:01:41] Lupe: [00:01:41] Is that the one that the doctors, when you ask them something, they pull out this little book out of their pocket.

[00:01:46] Brian: [00:01:46] That little book, and it’s all the drug information and they’re updated annually. So last year’s model, isn’t going to answer this year’s questions because there’s new drugs on the market or new research done, um, that changes the description of that drug in this PDR.

[00:02:07] So we use an online version of that. And one that I go to is pdr.net. So that is PDR.net. Now pdr.net, it actually reads prescriber’s digital reference. However, if you Google PDR, you’re going to get the Physician’s Desk Reference. And whether you buy a hard copy, use an online version, pdr.net actually has an app that you can download to your phone, as well.

[00:02:39] Lupe: [00:02:39] You know what? I didn’t even know that this tool existed online. Because I always go to Dr. Google, right? And when you Google in any medication, it brings different websites up, like Web MD. S, I, myself, wasn’t familiar with this. So probably a lot of people out there aren’t either.

[00:03:01] Brian: [00:03:01] Yeah. And this is big time tech talk. I am getting ready to attempt to pronounce words that I’m going to have a hard time with, because this is well above my head. I am not a doctor.

[00:03:13] Lupe: [00:03:13] It’s funny that you say that because, right now that we’re talking about it and I went onto this website and I was like, mmm, I ain’t even going to try. It’s way above my head my head.

[00:03:23] Brian: [00:03:23] Yeah. It’s kind of crazy. However, there’s enough layman term in here to help you formulate awesome questions for your doctor. So, if you understand, or have a basic understanding of what a tool like this is telling you, you’re going to be able to say, well, hey, I read this, talk to me. And they are going to be able to better educate you, then Lupe or me.

[00:03:53] Lupe: [00:03:53] Hey, that reminds me, remember  several, several years ago, I was looking for a new rheumatologist because. insurance changed. I didn’t have the same doctor. And I went into this new doctor, he was young, and I said, hey, you know, I’m looking for a new rheumatologist. I’ve been diagnosed with Sjogren’s and he’s like, oh, deer the headlights.

[00:04:15] Walks out of his office for about 15, 20 minutes. And, uh, I swear that he Googled Sjogren’s.

[00:04:23] Brian: [00:04:23] Probably. Probably. Um, so let’s dive into this PDR.  And again, the tool I’m using, right now, is pdr.net. However, the drug manufacturer website will have this information.

[00:04:37] A lot of this information is on the packaging or in that long pamphlet the pharmacist gives you,  when you pick the drug up. But it’s going to give you some basic.

[00:04:50] So what I would like to do is reference Dolobid. And that’s a drug that Lupe is on.

[00:04:57] Lupe: [00:04:57] I’ve been on Dolobid for a long time. And the, the generic name Diflunisal.

[00:05:05] Brian: [00:05:05] That one. So, when you search, it says PDR search, I typed in Dolobid and I clicked g. And Diflunisal is what comes up. Diflunisal?

[00:05:15] Lupe: [00:05:15] Diflunisal. Now that you say that that’s how the doctors say it. Diflunisal

[00:05:19] Brian: [00:05:19] Cool. So, one of the first things I do is I like to scroll down and there is a section that says common brand names and Dolobid is listed there. So now in my mind, I understand we are talking about the same drug. How supplied. Right underneath it. It says Diflunisal/ Dolobid, oral tablet, 500 milligrams.

[00:05:44] So again, I’m confident that I’m reading about Dolobid. So, all the way up at the top, there’s a classes section. So, this is a nonsteroidal anti-inflammatory drug or  NSAID, and you’ve heard  NSAID on this show, all the way back to Dr. Wong.

[00:06:03]Lupe: [00:06:03] Right.

[00:06:04] Brian: [00:06:04] And that’s what NSAID means nonsteroidal anti-inflammatory drug.

[00:06:11] Then the next section is boxed warning, and this is everything that’s on the box. And this is all the terminology that they would print on the packaging, which is fairly easy to understand. And it covers some of the side effects. For example. What can happen if you have a heart attack with this drug, which we refer to as contra-indications. Which I kind of want to get into in a bit.  It gives you the description of the drug, back to common brand names, which we discussed earlier.

[00:06:45] Then there’s a section called dosages and indications. So basically, if you take this much, this is what you can expect. If you take this much, these are the things that need to be considered, from adult, to elderly, adolescent down to children.

[00:07:02] And again, what we want to do is get information in our heads, so we can better ask our doctor questions.

[00:07:09] Lupe: [00:07:09] You know, um, when I’m prescribed a new med, your first instinct is to Google it, right. But I sometimes don’t want to Google it because  I go directly to the side effects. And then if you read those side effects, oh yeah, you know, it makes me dizzy and I can’t breathe and this and that and the other. I’ve learned not to do that.

[00:07:31] Brian: [00:07:31] Because she gets every single side effect she reads.

[00:07:33] Lupe: [00:07:33] I force myself not to do that anymore because then I start feeling that. But if I don’t read the side effects, I don’t get them.

[00:07:41] Brian: [00:07:41] And when it comes to side effects, when the FDA is reviewing drugs, and  they’re looking at all the studies that were done, if one person out of a thousand gets diarrhea, partaking in that study, diarrhea is a side effect.

[00:07:56] It doesn’t mean you’re going to get it. I don’t even read the side effects unless I take a med and I feel funny. And then I’m like, hmm, this is different. Let me read the side effects and see if this is different normal because of this drug. And can I tolerate this new, different normal, or do I need to find a new drug?

[00:08:16] Lupe: [00:08:16] What if the guy that got diarrhea, got diarrhea, nothing to do with the drug?

[00:08:20] Brian: [00:08:20] That very well could be a possibility.

[00:08:22] Lupe: [00:08:22] They still have to?

[00:08:23] Brian: [00:08:23] They still have to list it. And that’s why side effects are pretty comical nowadays. You know, everyone sees drug commercials on TV and it’s like, the side effects I giggle. And I don’t know. That’s my sixth sense of humor, I guess.

[00:08:39] Lupe: [00:08:39] Do you fall asleep at night and wake up in the morning? If so.

[00:08:43]Brian: [00:08:43] That’s a possible side effect.

[00:08:44] Lupe: [00:08:44] You take this drug.

[00:08:48] Brian: [00:08:48] Moving on down this list. One important thing is storage. For example, Dolobid needs to be stored between 68- and 77-degrees Fahrenheit.

[00:08:57] Lupe: [00:08:57] What happens if it’s cooler or hotter? What happens to the drug?

[00:08:59] Brian: [00:08:59] Well, technically you can lose potency. Obviously 68 to 77,  if you live in the desert, I mean, what are you going to do, if you live in a very cold climate, you know, So these are ideal conditions.

[00:09:14] Now this is my next favorite part, contraindications and precautions. And this is what concerned me when I was running an ambulance. We would pick up patients from time to time and they might have a laundry list of meds. And we would have to chart all of that down. Nine times out of 10,  it’s like, I’ve never heard of this drug, when the call’s over, I would research it. I’d open up my PDR just to learn about this drug. I’ve never heard of.

[00:09:41] However, contra indications in a night shell are, if you take this drug, you can no longer take this drug  because it reacts with it. And those are the big problems. And remember that the doctor’s going to write a script, the nurses going to go, hey doc, you can’t give them this drug because of this drug. And the nurse will correct the doctor and the doctor might change the script.

[00:10:03] Number one, number two, the pharmacist is going to look at your history and go, hmm, we might have a problem here, call the doc. And the doc might change the script.

[00:10:14] So there’s really three levels of care when it comes to contraindications before that drug is even handed to you. But it might be good to know.

[00:10:26] You might go to a rheumatologist that doesn’t have access to your internal medicine doctor’s records. Your internal medicine doctor might’ve given you a drug that your RA doesn’t know about. That’s why every time you go to the doctor, they ask you for that list of drugs.

[00:10:44] Lupe: [00:10:44] Oh! They’re just not being nosy.

[00:10:45] Brian: [00:10:45] They’re  just not being nosy.

[00:10:47] Lupe: [00:10:47] You know what? Sometimes I feel like, seriously, because I was here six months ago, and I gave you the list. I mean, nothing has changed.

[00:10:53] Brian: [00:10:53] And if nothing has changed, it’s easy to give them that list. I encourage everybody take a piece of paper, whatever size you’re comfortable with three by five card, write your drugs down with a date. And that way you can’t mix up.

[00:11:09] If you’re  given a new drug, update the card. If a drug is removed from your regime, update the card. And carry that card with you and just ask him, can you make a photocopy of this and put in my chart.

[00:11:20] Lupe: [00:11:20] I like keeping, in my Google docs. I like keeping my drugs because there’s a list right there. But I’ve seen a lot of people put all their drugs in their purse and they just go to the doctor. What drugs are you on? These, Boop. Don’t do that.

[00:11:37] Brian: [00:11:37] Which is a waste of their time. I mean, I’ve literally gone into a house and have had to open a medicine cabinet and jot down 30 meds and it’s time consuming and it’s taking away from transporting you to definitive care.

[00:11:56] And this brings up another really good point. The drugs you have in your cabinet, if you’re off of it, get rid of it. If it’s expired, get rid of it. If you’ve got hundred years’ worth of eyedrops,

[00:12:10] Lupe: [00:12:10] He’s giving me this look like I have a hundred years’ worth of eye drops.

[00:12:14] Brian: [00:12:14] Make sure that they’re clearly marked. So, they’re not looking through 42 boxes to make sure it’s the same drug, same dose.

[00:12:25] Lupe: [00:12:25] Okay. I’m guilty of that one, not eyedrops.  Because you know what? What if in six months or a year,  I don’t have insurance. I would like to have a little bit of backup, W

[00:12:35] Brian: [00:12:35] Which is cool. Don’t keep them with your main drugs. Because once they find your stash, that’s what they’re going to list. They’re not going to go looking throughout the house to see if you have a secondary stash.

[00:12:46] Lupe: [00:12:46] Hey! And that reminds me, if you ever go to the doctor or an ambulance comes or something, be sure to tell him all the drugs that you’re on. Even the ones you’re embarrassed to mention,

[00:12:56] Brian: [00:12:56] Never, ever, ever lie to a doctor about the meds you’re on. Because they might give you a drug that can kill you because you’re on a drug that you did not disclose.

[00:13:10] For example, nitro glycerin is a drug that we used to use in the field for chest pain, suspected heart attack. And we would have to ask three different ways, three different times, are you on any sexual enhancing drugs? Because if you’re on the little blue pill and we give you nitro, you’re going to die.

[00:13:30] Lupe: [00:13:30] And they’re like, oh ok.

[00:13:31]Brian: [00:13:31] It’s that simple. And it’s like family members around. So, we’d try to occupy the family and really, you need to be honest, do not be embarrassed because it’s your life. It really is.

[00:13:42] So, contraindications are a section I really like to dive into. And if you have questions, please  write them down, call your doctor, send them a fax, write them a letter.

[00:13:57] Next appointment, do whatever you need to do to get the answers to the questions you might have, based off this new information you just found utilizing a PDR.

[00:14:07] Lupe: [00:14:07] Right? So, for me, if I have a question, just any question that pops up randomly, right? Cause sometimes that happens. Write it down. Keep a notebook with all your questions.

[00:14:18] I have a little notebook and that’s the only one that I use when I go to the doctor. So, I could have my questions that I had, you know, a year ago when I saw him or, you know, maybe yesterday or two weeks ago, I thought of something.

[00:14:30] Because you know what happens? When you go to the doctor and you want to ask all these questions and they’re kind of just rushing you through it and you forget. And you’re going to forget because they’re rushing you through it.

[00:14:40] And you know, maybe you’re having a brain fog day or something. And that’s the only way, because you’ll forget. My point is you’ll forget, just please write it down.

[00:14:50] Brian: [00:14:50] And then you can also write the response down to it. And let me run through a few of the subsections underneath contra indications, acute Bronco spasms. And again, this is for Dolobid,  asthma and said, hypersensitivity. This is a section that rates of paragraph. If you’re going to take Dolobid and you have any of these issues, these are some concerns.

[00:15:14] Alcoholism, there’s a section there. GI bleed is included in that same section with alcoholism. Dehydration, diabetes has a section. There’s a section for. Labor obstetric delivery pregnancies. This drug’s going to affect your labor and delivery in this manner.

[00:15:34] If you’re going to be breastfed, is this drug safe? Influenza, coronary artery bypass. How this drug is going to affect geriatrics versus pediatrics. So not to beat a dead horse, tons of great information here.

[00:15:52] And this is another tool that can arm you with enough knowledge to be harmful or enough knowledge to ask better questions and not be harmful.

[00:16:02] Lupe: [00:16:02] Correct.

[00:16:03] Brian: [00:16:03] And listening to this episode will not cause diarrhea.

[00:16:07] Lupe: [00:16:07] Let’s hope not.

[00:16:10] Brian: [00:16:10] So. pdr.net is a tool that I use. I do not have the app.  You know, and there’s been times where a family member has been put on a drug and I’m like, hmm, I’ve never heard of that. let me just check it out. And not that I’m being nosy. It’s just that, you know, I like to know what and why.

[00:16:28] Lupe: [00:16:28] It’s funny cause my family, they know that you used to run an ambulance and they’ll call, Lupe, can you ask behind this? Cause you know, this and that and the other and they put him on this drug. I’m like, Oh, okay.

[00:16:39]Brian: [00:16:39] And I answer very generically because I’m not taking a full medical history. I’m not a doctor. I’m not a professional in the field of medicine any longer.

[00:16:48] Lupe: [00:16:48] You  don’t know the history.

[00:16:49] Brian: [00:16:49] Right. And like Lupe,  I’m sure they’re lying to me .

[00:16:54] Lupe: [00:16:54] What?

[00:16:55] Brian: [00:16:55] About your medical history.

[00:16:56] Lupe: [00:16:56] I am not lying to you.

[00:16:57] Brian: [00:16:57] No, but you’re a bad patient we’ve talked about.

[00:17:00] Lupe: [00:17:00] I don’t know why he keeps saying that.

[00:17:01] Brian: [00:17:01] Because you’ll go to the doctor and be like, doc, I feel like this. And you expect them to know everything.

[00:17:06]Lupe: [00:17:06] But they’re a doctor.

[00:17:07] Brian: [00:17:07] But they don’t know everything.

[00:17:09] Lupe: [00:17:09] They should. Then don’t pretend to.

[00:17:11] Brian: [00:17:11] But  you give them a good history and a good list of drugs you’re on. And then they’ve got all the information they need to make a treatment path for you.

[00:17:20] Lupe: [00:17:20] I’ve  really good patient lately.  I tell them what they ask, but more importantly, I don’t take you because then you put me on the spot. Really? You do that.

[00:17:30] Brian: [00:17:30] No, I wouldn’t call her out. I’m like, and? And? Dr. Ryba would ask her a question and when she was done answering he  would look at me like, is that it? Cause even he knew.

[00:17:45] Lupe: [00:17:45] Oh my goodness.

[00:17:46] Brian: [00:17:46] So again, to wrap this episode up, the PDR is an awesome tool. Play with it. Look up your drugs. Again,  don’t let the information scare you. Please, please don’t do that. But better understand what medications you’re on and how they’re going to affect you. And ask your doctor better questions. So, you have a great understanding of your condition, this drug, and how it’s going to help.

[00:18:13] Lupe: [00:18:13] I have a funny story.

[00:18:14]Brian: [00:18:14] Please share.

[00:18:15] Lupe: [00:18:15] Not too long ago, maybe a couple of weeks ago, a family member called and they’re like, can you tell me what this drug is? Me? And I looked it up and they’re like, can you tell me what the side effects are?

[00:18:30] So I’m waiting this drug and it has a lot of side effects. And I’m like whoa. Do you have any side effects? Yes. What are the side effects? What, what do you feel? What side affects you have that, you know, that you feel that this drug is causing? Well, I have this and that .Is that it? Yes. Those are the only side effects.

[00:18:49] No, there were like 20 side effects, you know. But I didn’t say that because then it gets in your head.

[00:18:54] Brian: [00:18:54] Right.

[00:18:54] Lupe: [00:18:54] So, I try not to read  side effects for that reason.

[00:18:58]Brian: [00:18:58] Again, for example, I was placed on a medication by a doc and it made. me feel very strange. Nothing, heart palpitations, just funny in the head. And I’m like, okay. So, let me look up these side effects. I’m like, okay, now I know why I’m feeling this way. But the benefits aren’t outweighing the way I’m feeling right now, I was not feeling right. So, I called the doc and she’s like, stop taking it and we’ll explore something else. And I’ll give you a call in about an hour.

[00:19:35] And they called me back and they said, we’re going to put you on this instead. And again, yeah, let us know how it’s working. And that’s what happened, and everything was fine. But that’s the only time I read side effects, is if I’m feeling something that’s not normal. And I would encourage you to do the same thing.

[00:19:53] Lupe: [00:19:53] Uh, let me ask you something, Brian. Um, since you know about this PDR stuff. Um, is PDR the only website? Do you prefer this over other?

[00:20:04]Brian: [00:20:04] I do prefer this over other. I’m not a paid member. I there’s some sort of thing you can sign up for. If, for whatever reason. I’m not happy with the information I get. I’ll go to the manufacturer’s website. You can go to the FDA website and get drug information.

[00:20:25] You can get the information they gave you when you got the drug. You know, they give you 82 booklets and it’s just all this paperwork that stacks up next to the microwave in the kitchen.

[00:20:35] Lupe: [00:20:35] Aha. That’s where I put it. It’s like, uh, this CVS receipt, right? When you go buy a pack of gum or something, it goes on and on forever. You’re like, chuck it.

[00:20:43] Brian: [00:20:43] Yeah. All this information is there. And I think that it’s easier for somebody to say, hey, tell me about this drug then it is to read the information about the drug that you’re given when you’re given to it.

[00:20:57] Now, mind you, it isn’t like number negative 92 font, and you need 10 pair of glasses, four magnifying glasses, and a lot to read, but information’s there. And again, it’s your body and you’re in a partnership with your doctor to create a course of treatment or a treatment plan for you. You need to be on board. You can always say no to a med. If the benefits aren’t outweighing any adverse reactions.

[00:21:27] Lupe: [00:21:27] I think a lot of people don’t know that, that you could say, no. You could say no to your doctor. Or you could say no to a med. You could say no to the treatment who wants to give you. A lot of people don’t feel that. A lot of people don’t know that, but you have to remember that you’re, the patient. You have to be your biggest advocate.

[00:21:44] Brian: [00:21:44] And they’re going to ask you to sign this little disclaimer, it’s called an AMA against medical advice. And the last sentence is going to be, up to and including death. And that’s just the standard AMA. We would have to collect AMA signatures in the field. If somebody didn’t want to go to the hospital, we would have to tell him, well, if you don’t, you might die. And that was just part of the legal aspects of medicine in America.

[00:22:10] Lupe: [00:22:10] I went to a rheumatologist and she wanted to take me off of Dolobid and put me on something else. And I said, no, I’ve been on it a little bit for many years and it’s working for me. So no, I don’t want to change. Okay. No problem. So, she gave me a script for my Dolobid. If it’s not broken, don’t fix it. This has been working for me.

[00:22:29] Brian: [00:22:29] Definitely.

[00:22:30] Lupe: [00:22:30] So, we just kind of wanted to share this tidbit of information with you. Um, there’s resources out there.

[00:22:38] Brian: [00:22:38] Yeah, and you need to educate and arm yourself with the best information possible. And these are a few resources that we use and the manner in which we use them, and we hope they help you.

[00:22:50]Lupe: [00:22:50] Until next time, sip constantly and stay hydrated.

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