Carl has a Heart Attack and Gets on the Drug Treadmill

A fistful of pills leads to drug side effects, which leads to more drugs and side effects.

My 62-year-old friend Carl is a good example of someone who has become tangled in a sticky web of doctors and drugs and is suffering for it. He had a heart attack caused by plaque clogging an artery, had a stent put in, and then the runaround began.

Carl wanted to know why he had a heart attack. He is only slightly overweight, exercises regularly, has normal cholesterol levels and only slightly high blood pressure. Before the heart attack he didn’t eat particularly well, but then again annual checkups never revealed symptoms of heart disease. After visits to four different heart specialists he was told it was hereditary. Each doctor suggested a different combination of drugs for lowering cholesterol, lowering blood pressure and thinning the blood, and each doctor offered a variation on the theme of a healthy diet, all of which included very low fat. He was also encouraged to drastically lower his salt intake, even though there is no evidence that he is one of the 30 percent of people whose blood pressure is lowered by greatly reduced salt intake.

Carl finally got the drugs sorted out and began taking ezetimibe (Zetia) for lowering cholesterol, clopidogrel (Plavix) and aspirin for thinning his blood, losartan (e.g. Cozaar) and metoprolol (e.g. Lopressor, Toprol) for lowering his blood pressure, and levothyroxine for low thyroid.

Depression followed, which is common after heart surgery, not to mention the fact that both Carl and his wife work in real estate, and he could not return to his fallback job, which was construction. He was put on the antidepressant Wellbutrin.

A few months after his surgery, Carl began to have strange experiences with his sense of smell. Particularly as he was falling asleep, he would suddenly smell something intensely burning, or bitter, and then would have trouble drawing a breath. After another round of doctors and testing, it was determined that he was having “pre-seizures” at the site of an old head injury. His neurologist shrugged and offered him pregabalin (Lyrica). After two doses Carl decided not to take it because it made him feel so strange.

How does this mix of drugs fare for negative interactions? A quick check for drug interactions on drugdigest.org shows that:

• Levothyroxine levels may be increased or decreased by simvastatin.
• Levothyroxine may “impair” the effects of metoprolol as thyroid levels are normalized.
• Simvastatin may make clopidogrel less effective. A different statin is recommended.
• Aspirin and clopidogrel combined may increase the risk of severe bleeding.
• Aspirin may lessen the overall benefit of using metoprolol.

A  few of the side effects of Wellbutrin include: high blood pressure, palpitation, headache, seizures, tremor, restlessness, agitation, anxiety, insomnia, and concentration disturbance. And it’s hard on the liver. The physician information states, “There is no clinical experience establishing the safety of Wellbutrin XL Tablets in patients with a recent history of myocardial infarction or unstable heart disease. Therefore, care should be exercised if it is used in these groups.”

A few of the side effects of clopidogrel include: chest pain, palpitations, atrial fibrillation, cardiac failure, high blood pressure, high cholesterol, edema (water retention), headache, dizziness, accidental/inflicted injury, flu-like symptoms, pain, fatigue, indigestion, anxiety, insomnia.

A few of the side effects of simvastatin include: atrial fibrillation, edema/swelling, abdominal pain, constipation, stomach pain, muscle pain, headache, insomnia, dizziness.

A few of the side effects of losartan include: muscle pain and cramps, back pain, dizziness, nasal congestion, persistent cough, fatigue, flu-like symptoms, excessively low blood pressure, diarrhea, hypoglycemia (low blood sugar).

A few of the side effects of metoprolol include: high blood pressure, angina, shortness of breath, excessively slow heartbeat, arterial insufficiency, palpitations, congestive heart failure, swelling of the hands and feet, fainting, chest pain, excessively low blood pressure, wheezing, difficulty breathing, tiredness, dizziness, depression, headache, mental confusion, short-term memory loss, nightmares, insomnia, diarrhea, anxiety/nervousness, hallucinations, taste disturbances, impotence.

Common side effects of levothyroxine include: anxiety, diarrhea, flushing, mood swings, muscle weakness, partial temporary hair loss, sleeplessness, stomach cramps, tiredness, vomiting. Less common side effects can include: chest pain, difficulty breathing, fast heartbeat, hyperactivity, irregular heartbeat, irritability, nervousness, pounding in the chest, seizures, shortness of breath, tremors.

Aspirin: At least 10,000 people a year die from gastrointestinal bleeding caused by aspirin and other NSAIDs such as ibuprofen.

Adding Insult to Injury

The majority of side effects listed above are common. Note that all of the drugs can negatively affect the heart. All of the drugs but one cause insomnia. I’m surprised that Carl hasn’t been giving a sleeping pill.

But what bothered Carl the most was the smell disorder. Note that both Wellbutrin and levothyroxine can cause seizures. Note that metoprolol can cause taste disorders, which are closely related to smell disorders. None of his doctors mentioned this; they just offered him yet another drug.

Carl’s brain is also likely being deprived of cholesterol, which is essential for its proper function. Remember, his cholesterol levels were normal both before and after the heart attack, but he was put on a cholesterol-lowering drug anyway, because that’s the “standard of care” for someone who has any type of heart disease. He was also encouraged to seek out “sugar free” foods, such as those sweetened with aspartame, which is known for causing seizures.

What Carl’s doctors didn’t tell him is that plaque in the arteries is more closely linked to excessive sugar, refined carbohydrates (white bread, cookies etc) and trans fats than to cholesterol levels. Carl and I chatted on the phone about nutrition, and he proudly said, “I’m eating healthy—we just got some yogurt!” I sighed. “How much sugar is in it Carl?” He got the container and looked at the label, “Per serving, 28 grams of sugar.” Which is about nine teaspoons of sugar, the same as you would get if you drank a can of Coke or ate a large candy bar. I encouraged Carl to get plain yogurt and add fresh fruit or stir in a teaspoon or two of a low sugar fruit jam.

Carl is a smart, resourceful, well-educated person. If this is the kind of (mis)treatment he has to endure and try to negotiate on his own, what happens to those who are less able, such as the elderly, or those with poor reading skills or poor English? His doctors are just doing their jobs, but Carl needs more caring and informed guidance, as do the majority of Americans who have heart disease and diabetes.

Commonsense Articles about Heart Disease
What Your Dr. May Not Tell You about High Blood Pressure by John R. Lee, M.D.
What Your Dr. May Not Tell You about Cholesterol by John R. Lee, M.D.
Women and Heart Disease by Dr. John Lee
Dr. Julian Whitaker on Statins and Memory Loss