Dr. Keith Roach

DEAR DR. ROACH: My wife was recently discharged after a lengthy hospital stay with multiple diagnoses. Most of her issues were treated medically and resulted in six new medications from four different medical disciplines, in addition to three other medications that were prescribed pre-hospitalization.
Finding drug interactions was fairly easy online, and the hospital’s discharge papers indicated dosing by morning, noon and night. However, some of the drugs need to be spaced out a few hours apart, and this wasn’t explained in my wife’s discharge papers. I had to research those intervals on my own.
Using an online spreadsheet, I was able to create a daily schedule to be sure that the drug interactions are held to a minimum. My question is: Is it common practice to discharge patients without a clearer idea of when their medications should be taken? — E.W.
ANSWER: When a person is taken care of by multiple providers, there is always the risk that nobody is looking at the whole person’s history, and medication interactions are among the many problems that can occur. Having a regular physician, such as a family physician or internist, can help avoid the exact problem you’ve identified.
However, the person’s regular doctor needs the up-to-date information, which is sometimes lacking. Very few people do what you do, and I admire your dedication and thoroughness. However, the online programs don’t always make it clear whether a drug interaction is high-risk. Many interactions that my program alerts me to have minimal or no clinical significance. It takes clinical judgment to be able to interpret these.
One person who has the training to help and is often overlooked is your pharmacist. I strongly recommend getting all your prescriptions in one place and speaking to the pharmacist after an enormous change in your medical regimen, such as the six new medicines your wife started. The timing of medicines consists of both art and science, but some interactions cannot be overcome by changing the timing. So, an expert, either her doctor or pharmacist, is needed.
DEAR DR. ROACH: I am a healthy 66-year-old female with osteoporosis and osteoarthritis. I recently saw a rheumatologist because I was about to start Reclast infusions for my osteoporosis. My blood work indicated that I have monoclonal gammopathy of undetermined significance (MGUS), which I had never heard of. I was told it is an atypical protein in the blood that can lead to multiple myeloma over time, and they have suggested yearly monitoring.
I’m still a bit worried about this new diagnosis. What is your experience with MGUS? — M.A.
ANSWER: MGUS is extremely common (at least 4% of people over 50 have it), and it should be considered a premalignant condition. It isn’t blood cancer in itself, but some people with MGUS will eventually develop multiple myeloma or other related blood cancers.
MGUS comes in three types: IgM, non-IgM, and light chain. The risk of progression can usually be estimated with blood testing. An expert, such as a hematologist, will put you into one of four risk groups. The lowest risk group only has a 5% risk of progression to cancer over 20 years, but people with all risk factors have a 57% chance of developing cancer in this time.
The abnormal protein type and level are two of the main risk factors; you need to know which risk level you are in.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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