08 April 2013

Whichever Way You Swallow It - A New Medication Adherence Method

I bought a pill box.

It is a box — for pills.

It is not small, or trendy, or cute, or ironic. It's not some repurposed cigarette case in which I keep Midol and Band Aids. It's a giant, plastic, albiet somewhat colorful, rectangle. Forget pocket-sized. This is a portfolio of pills, a veritable Advent calendar of pharmacology.

Each morning, I snap open a color-coded translucent lid marked with a time and respective day of the week and turn the entire ratting contraption over to dole out a pre-selected handful of medicine. The morning brings lots of colorful ovals—purple, green and blue, white, among others. In the evening I repeat the process, distributing pink, beige, and aquamarine. Saturday brings the cobalt blue sheen of Vitamin D. Snap, shake, pop, swallow. In only a matter of days, my medication process has become a thoughtless process of repeated motions, and I think I like it that way.

I've resisted buying a bill pox for years. "They're for old people," I said. "They won't hold all my medications," I said. "I'll just have to refill it every week," I said. I spent hours — yes, HOURS — shopping online for the perfect bill box. I wanted something that didn't scream "geriatric." Many seemed too much like those automatic pet feeders with rotating lids such that only one dose at a time would be revealed. More sophisticated ones cost a small fortune and featured alarm bells for audible reminders. Quaint little pretty boxes in designer colors wouldn't hold a day's worth of pills, much less serve any truly useful purpose. No, the only option that featured compartments large enough to hold a daily vitamin and then some with enough capacity to store a week or more's pills were the dowdy plastic boxes with S M T W T F S in raised black lettering across the day's lids.

I refused to go there.

"I can remember to take my medications," I said. "I know what day it is," I said. "I never get yesterday mixed up with today," I said.

And as luck would have it, my health improved, or at least the pharmacological treatments for my conditions lessened. "Two pills. I can take two pills," I said. "I'll even add some supplements for good measure," I said. So I did. Sort of. A daily vitamin was easy enough. Pro-active, I tried the Vitamin E, the Flax Seed Oil, the Red Rice Yeast... there was aspirin that came and went. I never knew exactly how to answer the nurses as they updated my medications list. "Yes, no, maybe, sometimes," I said.

After enough time, the medications list began to grow again. When I packed for an overnight trip, my duffle bag doubled as an unwieldy maraca. Bottles of pills inevitably worked their way below the shirts and underwear to hide. In September, while souvenir shopping in San Francisco's Chinatown, I relented that perhaps a small bag would be useful in corralling my mobile medicine cabinet and purchase one in purple brocade.

The bag was charming enough. In addition to my pills, it could hold a toothbrush, travel-sized toothpaste, digital thermometer, and a few bags of tea. I was pleased. However by late winter, the little purple bag was a struggle to zip. There were the rounds of antibiotics for the bout of pneumonia and cough medicines to suit. A new diagnosis meant the addition of new tools with their own carrying case. Additional lab tests meant an old med once discontinued came back into the mix, and finally so did another old med. The bare minimum of what I was to take no longer fit in my pretty purple bag, much less the "just in case" drugs I carried, well, just in case.

So while standing in line at the drug store, the giant, plastic, albiet somewhat colorful, rectangle pill box caught my eye. It was on sale, and I was tired. I'd noticed that over the past few weeks it had become considerably more difficult to remember exactly what I had taken and when. Furthermore, managing side effects and possible interactions was trickier. I feared missing a dose less than the possibility of doubling a dose, which was a distinct concern given that my methodology of remembering what a pill looked like in my hand before I took it seemed not to be quite as accurate as it once had been before.

The giant, plastic, albiet somewhat colorful, rectangle box wasn't perfect. Technically it was designed for a patient taking medications four times a day; however, it was somewhat divided in the middle such that I could easily make the top half — morning and mid-morning — into a week's worth of day and night and the bottom half — afternoon and evening — into another week's worth of day and night. I wouldn't have to worry about reloading for two whole weeks, a factor that greatly appealed to the scatterbrain in me. The downside was that at any given time, I could be carrying around two whole weeks of pills with me, which would still be less than my habit of carrying entire bottles of pills, the loss of which would amount to well over $100 in co-pays much less the hassle of having refills authorized. With two weeks of pills on hand, I could reasonably leave the pill bottles of medication at home; however, without the pill bottles, no one would have access to the names and dosages of my medications in the event of an emergency.

Upon unwrapping the giant, plastic, albiet somewhat colorful, rectangle pill box at home, I found that the designers of it had considered of this identification problem. Included was a self-stick label to be filled in with just the sort of information as one would find on a pill bottle, which while woefully inadequate, was at least a step in the right direction.

And I too am headed in the right direction, as what I have labeled a personal defeat — buying a pill box — has, in fact, improved my medication adherence. When I failed to take my medication properly, it wasn't because I didn't want to take it properly, it was because I was too arrogant to admit that I might need help doing so. Such is a continually critical battle in being a patient — learning when to make use of the resources available rather than sticking out the old way of doing things simply out of resistance to change. Illness changes us whether we are accepting of it or not. It is up to us to face change in a manner such that it may be incorporated into our lives with the least amount of disturbance to the things that we want to actually want to do. Rather than spend five to ten minutes every morning and evening peering at pill bottle labels trying to remember what I have and haven't taken, I now only have to spend five to ten seconds swallowing my pride.


01 April 2013

What's The Point in Telling Stories?

Penny's eyes are disconcertingly blue. They're the kind of blue only seen in carnival glass. Penny looks directly at me when she speaks, her eyes ever so slightly wider and eyebrows just barely raised such that I know that her interest is honest. She's not much of one for fussy things, never pulling back her long blond hair that falls in casually disheveled waves just beyond her shoulders. She enjoys golf, and though I loathe the game I imagine it suiting both her frame and her style of competition—minor adjustments made to suit varying circumstances and always played with the goal of personal bests in mind.

Thomas is lean, wears slack with plaid shirts—cotton or flannel depending upon the season—and sometimes allows his mostly brown, but somewhat salt and pepper beard to get ahead of him, its growth seemingly less purposeful than opportunistic. He drives a reasonably-sized pick-up truck. His greetings are an equal mix of eagerness and caution, as he peers over the top of his gold-rimmed glasses like an inquisitive barn owl. He always carries a computer, which he grips too tightly in his right hand such that the screen splinters outwards from the impression of his thumb. He's planning a trip out to Yosemite with his college-sophomore-aged son this summer. He hugs me whenever we say goodbye.

Matthew is reserved. He crosses his long legs at the knee and places one slender hand over the other as he listens. His slacks, dress shirt, and tie are impecable but, on the whole, unremarkable in shades of khaki, grey, black, white, and blue. His dark brown hair is combed back. He speaks softly yet unwaveringly. Even his laugh is measured. He has twin sons born in mid-September. We shake hands hello and goodbye.

Christopher is tall and lean with dashing brown hair and meticulously trimmed beard. His fashion also tends more on the dapper side with striped shirts and slacks. He is direct, if not perhaps a tad perfunctory, but appreciates a sense of humor, even a caustic one. He is married and seems to rely on deductive reasoning supported by data.

Elizabeth is social. Her slight Southern accent comes out less in the pronunciation of words than in the slow manner in which she speaks. It's as though she spends most of her time talking to very old people. She smiles a lot, and wears her brunette hair pulled back. She married her college sweetheart—they both went to Carolina—and the two of them moved back to her hometown to work with her father. She does not yet have children.

Penny, Thomas, Matthew, Christopher, and Elizabeth are all doctors. They are my doctors. They are also human beings with stories of their own. Stories may seem to do little in terms of patient care; however, sharing stories creates a bond and with that bond comes trust. With trust comes the ability to listen reciprocally. I am the better patient, and they the better doctors, for it.