Sticks in the Throat

Editorial Note: This post by John Scheel from Ontario brings out how medication and devices can lead to what we’ve lately been calling Drug Traffic Accidents. The concept seems a better fit to what happened here than either side effects or adverse reactions. John has a wider ranging book “Someone Gives a S**t” (see www.johnscheel.com) which gives a feel for the passions that drive him.

In November 2011 I experienced mild chest and arm tightness which my local hospital diagnosed as a blockage of the Left Anterior Descending Artery. Although not assessed as critical, 3 days later I was taken by ambulance to Trillium Hospital’s Heart (“Cath”) Lab for an angioplasty/stent insertion. I had not eaten or had liquids for at least 10 hours and so was somewhat dehydrated.

On arrival I was immediately greeted and told I was ‘batter up’. Within minutes a doctor met me, told me the downside risks, had me sign a waiver form and gave me many large ASA and Plavix pills according to the “standard procedure or protocol”. He provided perhaps 2 ounces of water and I swallowed the pills with difficulty while on my back. I never got to sit or stand up. Within 3 minutes I was wheeled into the OR for the stent procedure. After the procedure I had to lay motionless for another 6 hours. Finding the blockage and fixing it wasn’t a problem. On the surface everything went well. I was assured of a complete recovery.

Post ‘procedure’ problems

Immediately upon returning home, I experienced discomfort in my left mid/upper chest and arm. I presumed this was a normal consequence. After some days I visited my local ER with concerns. My heart was fine and I was discharged; I still had pain.

Over time, the pain slowly worsened and I presented myself at Trillium’s ER 6 times over 5 months. Each time I arrived with very high blood pressure, constant high pain and feelings of a heart attack (elephant on chest, numb left arm, etc.). Each visit, which sometimes led to 3 or 4 days in a ward, my heart was proven to be fine. It seems that a hospital’s protocols always address chest pain as heart attack based.

Once my heart was eliminated as a cause by cardiologists either in ER or on the Cardio ward, I was often given pain meds and discharged to follow up with my family practitioner. I was in a recursive process with no hope of a solution. I was pushed out the door when I was not healthy!

Problem identification

Quite by accident during an unrelated meeting with a gastroenterologist (who had cauterized my colon 6 times for radiation proctitis) the discussion focused on my “heart” issues. He described my complex symptoms exactly as I had been doing for months. He suggested a gastroscopy and said that he had seen quite a few cases like mine “often after heart procedures”.

He found severe esophagitis, ulcers and the beginning of Barrett’s Esophagus. I learned that esophagitis pain apes that of heart attacks because these body parts share nerve systems – cardiologists apparently do not know this. The pain that I was experiencing, he said, could be as bad as from kidney stones. I concurred.

I had not experienced problems with my esophagus in 69 years until the day after the stent procedure. Yet the medical community had been unable to link the pain to the stent. It is important to note that had it not been for a completely unrelated event, I may still not have a cause for my pain and declining health.

I surmised that the original pills never got to my stomach because I was not given sufficient water, was lying on my back and was rushed unnecessarily to the OR. The acidic pills sat in my esophagus and damaged it. This initial weakness was then exploited by the required daily doses of ASA and Plavix and normal stomach acid reflux. To prevent stent plug-ups, I had been put on these drugs to minimize platelet coagulation. That worked to aggravate the ulcers. Without coagulation, an ulcer would not heal. Nice Catch-22 to be in!

If you want to see how destructive a pill can be, place an aspirin tablet between your cheek and gum and let it dissolve in place. The flesh around the pill will turn white and start peeling off very quickly. Then imagine 12 ASA/Plavix pills like I was given sitting in my esophagus for almost 8 hours. And what kills me is that no highly trained and technical doctor, nurse or health care administrator would even consider the possibility of pill damage as I have described to them.

So my problems came indirectly – not from the actual stent itself. Myopic doctors abound! My condition worsened over time. There was no direct link between the stent and the pain.

It turns out (according to the hospital’s written procedure) that the pills were supposed to be given at least 2 hours prior to a stent procedure so that they could reduce the blood’s clotting ability. So they were not only improperly given, they had no effect when I was introduced to the stent. How dangerous was that?

A perspective of extra costs

What is the cost of mal-administered pills? Assume that I am just 1 in 100 (only 1%!) who has a bad pill experience. I estimate that a stent insertion process costs about $3000. The real cost came afterwards with the repeated ER visits, hospital stays and scores of tests, all magnified by the inability of specialists to identify a problem (from their error) outside their narrow field of expertise. Rigid protocols guaranteed failure.

I estimate that about $150,000 has been spent on me. In a sense I became the equivalent of 50 other stent insertion patients who required no follow-up. On a base of 100 patients, the one man-made mistake (in 1% of cases) with me cost $150,000 while doing a proper job with the other 99 patients cost $297,000. At a 2% error rate, it may cost more to handle 2 patients than the 98 done well. Imagine a 10% error rate!

My example is drawn specifically from heart stent insertions but it has broad applications elsewhere and everywhere. Consider all the aged ward or long term care (LTC) patients who have little control or say about their predicaments. All of them take pills and surely many of them end up taking them improperly. I shudder to think how these patients could handle, let alone understand, a problem like the one I suffered. No one will relate to their increasingly complex medical situations. Bad pill administration is a very broad problem.

Accepting responsibility

The gastroenterologist had stated that my condition was not all that infrequent and perhaps linked to heart-related procedures but he did not suggest or speculate that the pills had stuck in my esophagus. I broached the subject with my cardiologist and two other doctors and none accepted my conclusion.

For 3 months one doctor had attributed my problem to ‘anxiety’ until I showed him the gastroscopy results. One stated that only a little water is provided on purpose so that the patient does not regurgitate it in the OR. He said they were treating critical situations; I countered with “I was not critical”, having blown away a 15 minute stress test. I could see a “my bucket’s got a hole in it” type game coming. Blame does not stick within the circled wagons of the health care industry which relies on silence and preserves past momentum for self protection. It does not admit to failure very easily. Health care acts like a black hole; information flows in but never out. Think protection, protection, protection.

Conclusion

It is easy to take one’s own experience and build a mountain out of it. My situation has been difficult. I had and continue to experience heart attack like symptoms 24 hours a day. I knew that something arising from the stent procedure had caused my problem. All ER interest was directed by a heart attack protocol. I was unable to convince staff that it may be something else.

I was stuck and without the luck I had with my inquisitive gastroenterologist I would still be stuck and getting worse. Not many people have the inner strength to beat the cards I was dealt. Having had cancer and beaten it three times in my life helped a lot. So I do have respect for much of the medical community. But cancer was mild compared to the rigid medical terrorism that I was forced to endure. A simple glass of water may have prevented all of my post stent suffering.

If I am only partly right and credible, this problem must still be analyzed in detail by all participants. My big hope rests with the drug companies who should police how their drugs are administered, if only to get off the hook on class action lawsuits. Perhaps all pill packaging containers should have special labels which state in large letters – “TO BE TAKEN WITH 8 OUNCES OF WATER”. This would be analogous to cigarette packages having warning messages such as “CIGARETTES CAUSE LUNG CANCER”. Adding a ‘skull and crossbones’ wouldn’t hurt either. We all have to depend on the health care system which today seems not appreciative of why water is so important. A big education exercise is badly needed because drugs continue to become an ever bigger part of our health care solutions and costs.

See the follow up to this post – Sticks in the Throat: Boxology.