The pharmaceutical market offers us a very a large number of various medicines for the treatment of many and ailments. In addition to true medicines, which have an active substance that actually has a therapeutic effect, there are various other therapeutic agents on sale: homeopathic, medicinal herbs, biologically active food additives. All this can be freely purchased at the pharmacy in the amount limited only by your financial capabilities and taken at your discretion. However, is this correct?
The doctor should prescribe medication
This is an aximom that does not require proof. However, in our country, due to certain organizational issues, access to a doctor can be difficult, and sometimes impossible. In such cases, the patient independently tries to prescribe a medicine for himself or turns to the pharmacist for help with the phrases “Give me something from my head?”, “My legs are swelling. What should I drink? " And he gets a recommendation of 10 different medicines and other remedies. How this will affect him is unknown, because the pharmacist is not responsible for the result of treatment, but only for the storage conditions and sale of drugs.
Maximum number of medicines that can be taken at the same time
In the event that a patient gets an appointment with a doctor, he receives recommendations on drug therapy. Usually, on average, a doctor prescribes 3-5 drugs for a patient. It is your right for the doctor to explain and tell what each drug is for and what its side effects are. If the doctor, due to workload, does not have time, do not be lazy, read the instructions for medical use of each.
The moment of drug interaction is also very important. After all, getting into the human body, they can have mutual effects - weaken or strengthen each other's actions. Therefore, if the doctor prescribes more than 5 medications for you, ask him, is it really necessary to drink them all at the same time, maybe there is an opportunity to shorten the list or prescribe something more effective? In the hospital, a clinical pharmacologist monitors the amount of prescribed drugs. And in the clinic, the doctor gives recommendations to the patient personally, and he goes with them to the pharmacy. Of course, sometimes the patient is forced to take more than 5 drugs at the same time due to several serious illnesses, but, as a rule, such people are under the constant supervision of doctors.
Herbal remedies, homeopathy and dietary supplements: drug interactions
When the doctor is going to prescribe treatment for you, be sure to inform him that you are already taking something, even if it is not important in your opinion (for example, herbs or dietary supplements). And all the more, you shouldn't add something "from yourself" to the doctor's recommendations. This can have very negative effects. After all, it would never occur to anyone to apply 8 different creams to their face at once and dye their hair with 5 different colors at once. Everyone understands that this is unsafe. It's the same with medications, but complications. drug interactions not as obvious as the condition of the skin or hair, although much more serious.
Everything is good in moderation. This motto can be fully attributed to drug therapy.
Alexander Semeikin, Candidate of Medical Sciences.
The effectiveness of treatment largely depends on the way the drugs are delivered to the body. With the help of injections, the drug is delivered faster and in a more accurate amount. True, injections are painful, and most importantly, sterile ones are needed medicinal solutions, disposable syringes and droppers, and well trained staff. When a long, sometimes lifelong intake of several drugs is necessary, injections are not very convenient.
Most often, you have to use the oldest method of administering the drug - through the mouth: from resorption of the drug in the oral cavity to swallowing various tablets, pills, solutions and capsules.
Part of the drug is inevitably lost, dissolving in the contents of the gastrointestinal tract. The so-called effect of primary passage is known: the substance of the swallowed "pill", being absorbed, enters the liver with the bloodstream, where it is partially destroyed, without reaching the focus of the disease. Therefore, if swallowed, more medicine is needed. Food enzymes destroy some substances, for example, hormone proteins (insulin, etc.), they are administered mainly by injection.
Swallowed drugs usually do not work immediately - it takes time for the drug to dissolve and absorb.
The effect of the drugs that are absorbed in the oral cavity is manifested faster and in a lower dose - while the drug immediately enters the bloodstream, bypassing the liver. Unfortunately, very few drugs can be administered this way.
At home, "pills" are usually swallowed. But even this simple "event" is often a burden. According to statistics, almost everyone can easily use one tablet a day during the course of treatment. But three or four - without annoying reminders - less than a third of patients (which is why injections in a hospital setting are so popular and effective). To increase convenience, whenever possible, drugs are produced that are effective when taken once or twice a day. Oral solutions are made with a pleasant taste, especially for children (this attracts them, so keep the first-aid kit out of the reach).
A convenient way of administering drugs is external - application to the skin or mucous membranes, followed by absorption. Dosage forms for external use have gone through a long history of development - from the simplest fat-based ointments and compresses and patches to complex transdermal (percutaneous) systems.
Modern transdermal systems are plates glued to the skin containing a drug that gradually penetrates the skin through a special membrane that ensures a uniform flow of the substance into the body. Their advantage over injections and "pills" is a relatively long duration of action, up to several days. As for ointments and gels, transdermal systems are more comfortable for the patient and more accurately dose the drug. They are used either for substances that act locally (for example, plasters with lidocaine for neuralgia), or for highly active in low doses - painkillers, related to morphine, hormonal agents.
Systems of this kind are of vital importance for the continuous administration of nitroglycerin when ischemic disease hearts - from ointments with nitroglycerin to plates-"plasters" glued to the gums (the so-called subbuccal forms). For quick pain relief in emergency situations they also use special tablets with a medicine that is absorbed through the mucous membranes of the mouth (prosidol). When applied externally and absorbed in the oral cavity, the drug usually enters the bloodstream immediately, which accelerates the onset of the effect. The main disadvantage of such systems is that only a relatively small amount of a drug penetrates into the body at once, which does not allow the rapid introduction of a sufficient dose of most drugs.
Any drugs must be taken according to certain rules. Usually, the method of use is indicated in the instructions, and it should not be neglected. If we are talking about agents acting in the oral cavity, for example, antimicrobial lozenges, it is advisable to refrain from taking liquids or solid food for some time after resorption.
Medicines intended to be swallowed should always be consumed with sufficient liquid - at least half a regular cup (100-200 ml). Means that do not have a shell can be slightly chewed to accelerate dissolution.
If the medicine is not taken with a drink, the consequences can be very different, but always undesirable. The medicinal substance remaining in the esophagus is absorbed much worse than in the lower regions, that is, a significant part of the active substance is immediately lost and its effective concentration in the body cannot be achieved. Some medicines may have a local irritant effect (for example, acetylsalicylic acid). Therefore, they are released in a mixture with baking soda to neutralize and accelerate the disintegration of the tablet in the stomach, or in the form of effervescent tablets for solution preparation.
Drugs that are especially dangerous for the wall of the gastrointestinal tract (GIT) should be used strictly following the instructions. In some cases, it is useful to take them together with additional protective equipment. For example, with long-term treatment with high doses of powerful anti-inflammatory drugs (diclofenac, etc.), often causing damage to the walls of the stomach up to a drug ulcer, drugs are shown that reduce the secretion of hydrochloric acid in the stomach: omeprazole, ranitidine.
What to take with medicine is an important question. It is better to use the most ordinary warm water. Any additives to the drink can affect the rate of absorption and further metabolism of the active substance.
Carbon dioxide of carbonated drinks promotes vasodilation of the gastrointestinal mucosa and can increase the irritating effect of drugs. Weakly alkaline mineral water without gas is preferable when using anti-inflammatory drugs. Grapefruit juice contains substances that interact with the hepatic enzyme system (cytochrome P450), as a result, the breakdown of many drugs in the body slows down and there is a risk of overdose with serious consequences. Moreover, this effect also occurs when drinking fresh fruit juice simply against the background of taking medications, for example, cardiovascular, lipid-lowering (to reduce lipid fractions), psychotropic and many other drugs. This fact is well known and, as a rule, is mentioned in the full instructions for the drug.
It is categorically unacceptable to use even low-alcohol drinks. Alcohol has a strong toxic effect on many systems, especially the cardiovascular system, and on the brain. Against the background of taking cardiovascular or psychotropic drugs, life-threatening consequences can occur. Ethanol and alcohol surrogates are metabolized (destroyed) with the formation of toxic substances, which can increase the danger of many drugs, stimulate the formation of toxic decomposition products. For example, the most popular antipyretic drug paracetamol (which is part of, for example, drugs for headaches and colds) is deadly when combined with alcohol.
The effectiveness of drugs is associated with food intake. Usually, the instructions give instructions on when to take the drug - before or after a meal. Medicinal substances can bind with food in the lumen of the gastrointestinal tract, this slows down their absorption and reduces their effectiveness. Foods that irritate the wall of the gastrointestinal tract (spicy, fried, hard) increase the danger of the same anti-inflammatory drugs. Excess fat can affect the metabolic rate of drugs in the liver. Dairy products contain significant amounts of calcium, which reduces the activity of, for example, tetracycline antibiotics and some osteoporosis medications.
Modern medicines often have a complex composition and are produced with a protective coating or in the form of a capsule, which facilitates, for example, the release of the drug in strictly defined areas of the gastrointestinal tract; in the simplest case, the shell masks the unpleasant taste of the active principle. It is necessary to swallow such funds without chewing.
Of course, occasional drug abuse is relatively safe. But compliance with these rules significantly increases the effectiveness of drugs and speeds up recovery.
During illness, many people wonder if antibiotics and antivirals can be taken at the same time. What is the effectiveness of such a combination of drugs and whether official medicine allows the use of antibiotics and antiviral drugs together - find out more about this later.
Before proceeding directly to the question of what to choose - antibiotics or antivirals, one should find out the properties and characteristics of both types of drugs.
The name of this category of drugs speaks for itself - these are drugs directed against some kind of living microflora. Note that bacteria are living organisms, albeit microscopic. Viruses, in turn, show no signs of life outside the host cell. Scientists have not yet come to a consensus on whether to classify viruses as living or inanimate objects.
Therefore, antibiotics are definitely drugs designed to combat pathogenic microflora, namely bacteria. They are prescribed for diseases caused by bacterial agents.
Therefore, antibiotics will not be effective for viral diseases: influenza, ARVI, hepatitis, measles, rubella, herpes, and so on.
There are two types of antibiotics, based on their effect on bacterial cells:
- Bacteriostatic - pathogenic microorganisms lose their ability to reproduce, due to which the development of the disease stops and after a while the bacteria die.
- Bactericidal - the use of these funds is aimed at destroying pathogenic microflora. The antibiotic kills the bacteria and removes them from the body.
There is also a classification of types of antibiotics according to their origin, the mechanism of action on the cell.
Antibiotic drugs are prescribed for diseases such as:
- Pneumonia;
- Cystitis;
- Enteritis;
- Pyelonephritis;
- Colitis;
- Stomach ulcer;
- Acute sinusitis and other bacterial infections.
It is very important to be aware that antibiotics are serious drugs that can have a lot of side effects... Taking them outside the doctor's prescription at your own discretion, you run the risk of getting both complications and recurrence of the infection in a short time. Therefore, if you want to be treated effectively, you must follow the doctor's prescriptions.
In addition, only a specialist can determine the effective and safe dose of each drug for a particular patient and prescribe the duration of the course of antibiotic therapy.
Let's note one more important point. Antibiotic drugs cause resistance (addiction) in pathogens. Rough treatment with strong antibiotics can be effective, but shortsighted. In the future, if you catch the same pathogen again, it may be resistant to even very strong drugs and treatment will be difficult.
Antiviral drugs
Antiviral drugs are drugs aimed at combating viral pathogens. Antiviral drugs can be difficult to find, since viral particles go through a complex life cycle and it is necessary for the drug to act on them at a specific point in time. It can be difficult to guess whether an antiviral agent will help now - it is not always obvious to the doctor when the disease began and what path the viruses could take in their development.
Drugs of this type of action can have one of the following effects:
Antiviral drugs are prescribed for diseases such as:
- Flu;
- ARVI;
- Herpes;
- Measles;
- Cold;
- Chicken pox;
- Hepatitis B, C;
- Mononucleosis and so on.
You can buy antiviral drugs for the most common diseases at the pharmacy without any problems, so you can also get treatment for viral diseases at home. When taking this or that drug, it is imperative to take into account the peculiarities of its action, as well as the side effects that may occur.
Note that medicinal product that has no likely side effects does not exist. For example, Arbidol and can cause allergic reactions, Rimantadin - nausea, weight loss, dry mucous membranes, neurological symptoms, Zanamivir - allergic skin reactions, as well as respiratory problems.
Is it okay to drink antibiotics and antivirals?
Now that we have figured out the action of both types of drugs, we will answer the most important question: can you take antibiotics and take antivirals together?
Most doctors are inclined to believe that one should not use both drugs. This is due to the peculiarities of the action of antibiotics and antiviral drugs. Antibiotics "in a fit of passion" reduce human immunity, destroy even the normal microflora (which can cause dysbiosis after antibiotic therapy). Antiviral drugs, on the contrary, enhance the body's immune response, which makes it possible to defeat the virus.
It turns out that the simultaneous use of antibiotics and drugs for viral infections negates the results of antiviral therapy, and drugs for viruses neutralize advances in the fight against bacteria.
Also, antibiotics are quite toxic, affect the gastrointestinal tract, causing dysbiosis.
However, there are a small number of diseases for which doctors can prescribe both drugs. Combined products should be used only if prescribed by a doctor. There are also cases when a typically bacterial infection occurs due to viruses and then the treatment changes course.
- In the case of a viral nature of pneumonia, it will be treated with Arbidol or Anaferon, although it is expected that pneumonia will only be treated with antibiotics.
- With cytomegalo viral infection drugs Tsimeven and Cytotect will show high efficiency. Treatment should be started as soon as possible, since otherwise the pathogen can penetrate into the bloodstream, and from there into all organs and systems.
- Pyelonephritis in most cases occurs due to bacterial invasion, but in rare cases, viruses are also the cause of the latter.
- In some cases, after suffering an acute respiratory viral infection, a person develops viral cystitis. Such a clinical case is always accompanied by complex treatment.
- Colitis associated with the high activity of the human symbiont of the bacterium Helicobacter pylori can be treated in a complex manner.
- HIV-infected people need not only antiviral therapy aimed at inhibiting the development of the virus, but also antibacterial therapy, because due to the reduced body resistance, the normal microflora of their body can be dangerous and conditionally pathogenic.
- If you yourself decide to take both antiviral and antibiotics, keep in mind that it will be difficult for the doctor to determine what exactly will happen to the body.
Prescribing drugs of both types of action, the doctor must take into account the compatibility of different drugs and the possibility of combining them in one course of treatment. We will look at several drugs and present examples of their compatibility with others.
- Arbidol - shows high efficiency when combined with Suprax, Amoxiclav, if a viral infection turns into a bacterial one;
- - this drug does not interact with antibiotics, as proven by pharmaceutical studies;
- Acyclovir - it is undesirable to combine with antibiotics, it is possible only in the case of treatment of advanced genital herpes;
- Anaferon is a well-known homeopathic drug that combines well with antibiotics, thereby avoiding prolonged use of large doses of antipyretic drugs;
- Kagocel is a drug used for complex therapy with angina;
- Ingaverin - scientists do not have comprehensive research results in order to assess the compatibility of a drug with an antibiotic;
- Tsitovir - interacts well with Sumamed;
- Grippferon - if a bacterial infection has joined the viral infection, it “cooperates” well with antibiotics;
- Viferon - effectively treats bronchitis together with Macropen.
What are the benefits of combination therapy?
If combination therapy is indicated in your case, you should not be afraid. The doctor will select the most gentle and optimal option for you. Let's take a look at the benefits of this treatment:
- The immune system is stimulated.
- More antibodies, immunoglobulins and interferons are produced to protect the body from foreign agents.
- With an adequate selection of drugs for complex therapy, toxic effects on the body are practically excluded.
- It is possible to eliminate the infection quickly, while it is only in its initial state.
- The growth and reproduction of pathogenic factors stops.
- The activation of the immune system not only provides protection during illness, but also allows the body to develop an acquired active immunity to a specific pathogen.
How to help the body if antibiotic therapy is prescribed
As you understand, it is difficult for the body to cope with the load that the components of antibiotic drugs create on the organs. Therefore, you can refer to some folk recipes to help maintain strength and fight infection.
- Mix beetroot juice and honey in a 2: 1 ratio and drip into your nose 4 times a day. This will improve nasal breathing if it is difficult.
- Onion and garlic inhalation - a good option for people with diseases respiratory tract, since the juice of these vegetables contains many useful active ingredients.
- Natural fruit drink can be drunk by diluting it with water. This will help the body obtain vitamins and also eliminate toxins as quickly as possible.
- Vegetable salads. Try to maintain a stable amount of vitamins in your food so that the body can more easily cope with the disease.
Now you know if you can drink antibiotics and how to help the body with folk remedies.
How to help the body if antiviral therapy is prescribed
Antiviral drugs and folk remedies also compatible. How?
- The more you drink, the faster toxins are eliminated from the body. For this, blueberry compote, rosehip decoctions, raspberry, lingonberry, currant tea are suitable. Drinking plenty of fluids helps the body!
- There is one interesting recipe... For it, you will need about 100 grams of raisins. Peel it well, boil it in a little water for 30 minutes, and then grind it in a blender. This drink should be drunk in small portions several times a day.
Nutrition during illness
Whatever illness you have - viral or bacterial, you should follow an adequate diet. She excludes:
- Fried;
- Salty;
- Conservation;
- Spicy foods;
- Sauces, ketchups, adjiku, mayonnaise and so on;
- Flour products (try to eat them as little as possible);
- Smoked products.
In their place should come "light" food, which is well absorbed by the body even in a state of weakening. For example, it can be cereals, broths, dietary meat or fish in small quantities.
A leaflet is often included in the package with a medicinal product indicating the time of its administration, and the doctor must write in the prescription when and how to take this or that medicine... What do doctors base on when making their prescriptions?
One of the fundamental laws of pharmacology states that a medicine begins to act only when it accumulates in sufficient concentration in the tissues of the diseased organ. This is called the “threshold phenomenon”. If the concentration is below the threshold, then the drug will not have the desired effect. Required to obtain therapeutic effect the concentration of the drug in the blood, and therefore in the organ, is created when its optimal dose is introduced into the body.
The journey of the medicine to its destination is difficult, especially if it is taken by mouth. This method of drug administration has its advantages: the drug content in the blood is maintained at the maximum level longer. And what is the difficulty then?
The fact that drugs are not absorbed directly in the stomach. First, they must go into the intestine, dissolve in its contents and at the same time not be destroyed by the hydrochloric acid present in the stomach, enzymes, mucus, and food components.
If the medicine is taken on an empty stomach (3-4 hours after a meal or 30 minutes before it), when the stomach is almost empty, the pill simply has nothing to dissolve in. Therefore, it is better to grind or chew it first, and then drink it down with some liquid.However, if the tablet has a special coating, it is not recommended to grind it: the coating protects the medicine from the action of gastric hydrochloric acid or the gastric mucosa from the medicine. Most often, coated preparations are produced in the form of dragees. All such preparations, except for vitamins, cannot be crushed or bitten!
What to drink with? A glass of warm water. Tea, especially strong tea, is not suitable for this. The tannin contained in it forms insoluble and therefore non-absorbable compounds with many substances. Tannin especially actively binds papaverine, amidopyrine, cardiac glycosides, enzymes, active ingredients vegetable infusions and decoctions.
Most medicines can be taken with warm alkaline mineral waters: alkalizing the contents of the stomach accelerates the passage of the medicine into the intestines. And some drugs are more easily absorbed in an alkaline environment. These include, in particular, phenothiazine derivatives (propazine, ethaperazine and other drugs ending in "azine").
And, finally, there are drugs that are simply destroyed in an acidic environment. Erythromycin, for example, must be taken strictly on an empty stomach and must be washed down with alkaline mineral water. There is no mineral water, add baking soda to boiled water (half a teaspoon of soda in a glass of water) and wash down the medicine with it.
Neutralizes gastric acid and milk. They can be taken with fat-soluble drugs, in particular indomethacin. But with milk, however, you need to be careful: it contains calcium, which is able to combine with drugs, for example, with antibiotics of the tetracycline series. Therefore, it is preferable to drink them with sour juices, as well as barbiturates, theobromine, theophylline. But if you drink sour juice, say, amidopyrine, then the effect will be weak.
Therefore, in order not to be mistaken, drink the medicine with warm water. it is good for all occasions!
When the medicine is taken on an empty stomach, after 10-15 minutes it enters the intestines and is absorbed into the bloodstream - usually completely or almost completely. The concentration of the drug in the blood is usually sufficient.
And what to expect if a pill is swallowed with food? The tablet will not dissolve in food, and the secreted gastric juice gradually dilutes the contents of the stomach, and the hydrochloric acid can completely destroy the drug, for example, the already mentioned erythromycin. And the enzymes in the stomach begin to digest the drug. This is especially true of the now fashionable herbal remedies: they leave miserable fragments. Levomycetin is digested by pancreatic enzymes, and nothing remains of it. And, say, nystatin, polymyxin and neomycin form insoluble complex compounds with bile acids.
But the main thing is different. Food remains in the stomach for about 4 hours. And fatty or sweet or taken together with alcohol and some medications (papaverine, no-spa, belladonna alkaloids) and even longer - up to 7 hours! Accordingly, the transfer of the drug into the intestines is stretched for the same period. Absorption can be slowed down so much that the drug during this time will be partially destroyed in the liver and excreted by the kidneys. In a word, it will not be possible to create the required concentration in the blood.
However, I would not like the reader to get the impression that all medications should be taken on an empty stomach. Most are, but not all.
There are also those that must be taken directly with food. These are fat-soluble substances, primarily vitamins A, O, E, P, lipoic acid. Naturally, you should also take multivitamin preparations, which include the above vitamins.
If medications are taken with meals, the concentration of the drug in the blood will be almost constant. Experts take this feature into account when treating with potent drugs, for example, lowering blood pressure.
Patient adherence is not a new problem. Up to 80% of neurologist's patients confuse prescriptions, drink medications irregularly or do not drink them at all. “Well, a neurologist has a lot of patients with memory impairments, that's the reason,” you say. And you will be wrong.
Various cognitive impairments occupy only a small part of the admission, which means that these 80% for the most part are adequate people who, for some reason, choose to treat themselves at their own discretion or not to treat at all.
Happiness pills that no one wants to drink
The situation is not bad with those who are treated with antidepressants. More than half of patients do not dare to start taking prescription happiness pills. Another small percentage buys the drug, reads the instructions, decides that the doctor has gone mad and planned to kill him, and never touch the package with the medicine. Finally, there are certain losses of patients at the finish line: these are those who started taking the drug, felt its side effects in the form of drowsiness, distraction, dry mouth, decreased libido and decided to stop taking it.
But then, by the third week, the world blossoms for a patient on antidepressants with new colors. Mindful of the world without pills, which was a hopeless grayness, a kind of Orwellian reality, patients diligently take the entire prescribed dose for as many months as necessary. Because the difference between the mortal colorless world and the world of pink ponies, laughter and joy is colossal.
Roughly the same story with anti-anxiety therapy. It is very difficult to force a patient who is worried about any, even the least significant event in his life, to take some hostile pill. A person is used to living in a feeling of constant anxiety, it seems normal to him. In general, he complains to the doctor not about anxiety at all, but about insomnia, weight loss, constant heartbeats, from which cardiologists shrug their shoulders, some mysterious thing in his chest that constantly trembles, and so on.
For such people, due to their personal characteristics, to start taking new pills means to bring another reason for alarm into their full of worries life (“What if I sleep all the time? And if I turn into a vegetable? And if the doctor gets kickbacks from the pharmacy? And if they want to test me new drug? And if side effects begin? What if an allergy? But what about driving a car? " - and thousands more exciting questions). But if the doctor slowly answers this thousand questions, gives the patient time to think it over, the stars will converge in the right way and the first pill is taken, another life will begin. The patient will understand what it means not to worry every second. This means, very likely, will be motivated to continue treatment.
Although here it is not complete without tricks. I had one patient who suffered from chest pains. Cardiologists examined him inside and out, therapists threw up their hands, pulmonologists drove him out of their offices, reporting that he was absolutely healthy. Finally, he decided to visit a neurologist - good doctors suggested that the fault could be "chondrosis".
I twisted it this way and that, examined it a little, and did not find any hint of problems with the spine or back muscles. But after talking with him, it became clear that there is anxiety and a sub-depressive state. It was pointless to send him to a psychiatrist - the well-known song to every doctor began, "I'm not crazy." Bird neurologists are not proud, they themselves know how to prescribe antidepressants and tranquilizers. For about a month I persuaded this patient to start treatment. During this time, he became convinced that neither an orthopedic mattress, nor physiotherapy, nor mud, nor vitamins, nor painkillers help him. I continued to insist that antidepressants should be started because the cause of his troubling symptoms was different.
Finally, he made up his mind. By the third week, the face brightened as expected. A month later, he said that the pain had ceased, and that his sleep had also improved and, in general, life had become somehow more pleasant. After three months, I gradually canceled the happiness pills, and for six months we did not see each other.
Then the life of this man began to fade again. The lower back and lower abdomen ached. Again a string of doctors: therapist, gastroenterologist, proctologist, surgeon, urologist and even a rheumatologist. Everyone again shrugs their shoulders and nods towards the neurologist: they say, there is your doctor, go to him. Again I twist the patient this way and that, examine and find nothing new. I explain to him that sometimes the exchange of neurotransmitters in the brain is disturbed and depression arises, but it does not necessarily manifest itself with melancholy and sadness, but can disguise itself as incomprehensible pain wandering through the body and drive the patient crazy, because doctors do not find anything. He again begins the cycle of treatment with physiotherapy and vitamins. I am patiently waiting for him to be convinced of their ineffectiveness.
Two days ago, he came to see me again, and I again started talking about antidepressants. But the problem is that he completely managed to forget how it is to sleep normally, not to worry and not to listen to his feelings. Therefore, he continues to hope that mud and massage will help. But I know for sure that no later than in a month he will come for a recipe, and in two he will be fine.
Back pain is not a reason to trust the doctor
But all records of non-obligation and irresponsibility in relation to treatment are beaten by patients with back pain. Most are people with nonspecific lower back pain. Someone overworked in the garden, someone lifted too much weight for themselves in the rocking chair, someone carried a feverish child in their arms all night. In other words, most of these patients are seen by a neurologist for the first time. And we are sure that they know everything there is to know about their illness - tea, not idiots, they haven’t been banned from Google.
You assign them NSAIDs, and they buy Kuznetsov's applicator. You talk to them about physiotherapy exercises, and they begin to torture their butt with injections of B vitamins, and so on and so forth - until they infect themselves with the infection in the wounds torn apart by excessive enthusiasm when using the Lyapko applicator, or Quincke's edema from "Vitamins".
Why do patients fail to meet their doctor's orders? There are several reasons for this: this is distrust of the wearers of white coats, fueled by disgusting stories in the media about the triumph of murderers and horsemen. This is the confidence that in the age of the availability of any information, the doctor's functions are reduced to issuing sick leave, and all methods of treatment are perfectly described on the Internet. This is the excessive activity of pharmacy workers who need to fulfill the sales plan for fuflomycin, as well as the iron belief in their righteousness, which is often a companion of insufficient education. Sometimes these are curious cases when a patient meets his neighbor Aunt Klava and learns a fascinating story about “how she had pressure, and only Corvalol helped,” and also begins to be treated with Corvalol - after all, a positive example of a familiar person motivates much more than a bore in a white coat with their own standards for the treatment of arterial hypertension.
One way or another, it is helpful to remember that the effectiveness of your treatment is not only in the hands of the doctor. If you forget to take the prescribed pills or do not drink them at all, do not blame the doctor's unprofessionalism.