May is Mental Health Awareness Month, and we take this time to look at the plight of patients with Chronic diseases.
It must be such a lonely road sometimes. Likened to combat, no one ever prepares you for the tragedies and uncertainties that being diagnosed with a chronic disease can bring. The extent the disruption can bring to the daily routine of your life is not something anyone can say that they understand without the risk of belittling one’s pain.
Patients with chronic conditions often have to adjust their aspirations, lifestyle, and even work arrangements around their disease. Many grieve about their predicament before adjusting to it. I recently came across an interesting study that had the following conclusions drawn…
“Patients with hypertension manifested symptoms of anxiety, depression and stress. This implies that the patient’s hypertensive state and perhaps the need for adherence to the anti-hypertensive medications placed psychological demands on their health.”
Study link: #https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4077111/
The management of Hypertension comes with uncertainties of the future, like, “Will I respond to the treatment? Will I ever be okay? Will this resounding headache ever go away? What about this awareness of heartbeat that I’m feeling? What if my colleagues see me taking my medicines every time? Will my life at the workplace ever be the same? Can I lead a normal life again?”
These are just but a few of the string of questions that one may mull over, ask themselves or would want an assurance on.
In my line of duty as a pharmacist, the other day, I had a patient who came in with a prescription for two anti-hypertensive drug regimens that had only been prescribed for 5 days. Like the proverbial curious cat, I needed to make some inquiries into my patient’s history to know if the patient has ever had a diagnosis of Hypertension and if they were compliant with their medication. If the prescription was a refill or for a newly diagnosed hypertensive case and if yes, I was more than willing to take it up with the prescriber as to why the patient was given a combination of two anti-hypertensives.
Suffice it to say, my prodding bore some fruits. The patient disclosed that they had been diagnosed with hypertension about two years back and were on meds for the same. Further on went on to say that she usually takes her medication consistently until she feels okay, and then she stops them. When a very severe headache kicks in, she rushes to the hospital and gets a refill as she then knows her blood pressure has sky rocketed.
My main concern was this though ‘Why feel the need to go off meds when you feel okay and go back to them when you think the blood pressure is high?’ To which she responded by saying, “My doctor never told me when to stop taking this medication, and I’ve watched my mother go through the agony of taking these drugs every day, and I just don’t think I’d want that kind of life for myself”. I don’t want a life resigned to fate, the fate of taking drugs in oblivion. I never wanted to feel trapped by drugs, and also, I have been in denial about other people’s reaction towards our family, considering I am young, hypertensive, and my mum too is.”
Owing to all that the patient had disclosed, I knew that I would not let my patient go with these meds just like that without saying something. I decided to tell my patient the following:
1) A diagnosis of Hypertension is not a death sentence, it just means that it takes more work to get the blood pumped through the entire body system, and sometimes the blood is pumped at a faster rate. The drugs that are given are to help ease that burden on the heart and reduce the speed.
2) Hypertension does not imply that her future is doomed. It means she has to just be watchful of her diet, exercise routine and also some of the other blood pressure triggers like stress.
3)Adherence to medication is mandatory, whether or not she is feeling well, and we reviewed the analogy of a pipe bursting due to high pressure from the tap and translated this to some of the things that high blood pressure can result in in the body.
4)I assured & reassured the patient that the lifetime medication is to bring the blood pressure under control so that she is able to live a long, quality and productive life and not just to bother her with peace & tranquillity. I reminded the patient that she was lucky, that such a diagnosis was made in time, and the complications of the same are preventable. Denial of the same will not only worsen her health but also predispose her to issues like depression.
5) Getting a blood pressure machine would be a good idea so as to be able to monitor their blood pressure from home daily and even record it, so that come their next visit, we can monitor the trend of the Blood pressure so that we can even discuss what is happening together.
My patient told me that no medical personnel had ever spoken to her like that…
Such is the situation that many people who are diabetic, with hypertension, cancer, HIV or any other lifelong illness. One could be overwhelmed or just downtrodden by the fact that they are unwell. Making sense of the entire disease could also just be really hard for them on some days, on most days or every day.
I believe that it is the responsibility of the Healthcare practitioners to constantly reassure the patients as part of the medicine adherence.
Self-autonomy is a very important aspect of treatment. Bringing the patient on board and just involving them in the process of care is beneficial as it also gives them room to share their concerns and insecurities.
Cognitive behavioural therapy is really important and shouldn’t be overlooked. Let us encourage them, check up on them and find out how they are fairing while on the meds. If possible, let us accompany them on their hospital visits if they are comfortable with that.
These times we are in are dire; please let’s check on our loved ones and patients and ensure we are there for them. Just to encourage them but also ensure they get their medicines refilled.
Love, Light and Hugs
#Let’s keep the conversations going.
#MentalHealthAwareness
#Let’s break the stigma.
PHARMACISTS CARE. I CARE. – DR. RASBURICASE