Saturday, May 25, 2019

Comments by RMEgyed

Showing 4 of 4 comments.

  • This is a GREAT article and very easy to understand. Thank you… I will be sharing this with many, many people (both professionally and personally)!

    We just received results for my husband’s Pharmacogenetic (PGx) test this past week. 25 genes were tested. While he is not on any psychotropic medications, he does take cardiovascular medications (statin & high blood pressure). VKORC1 shows a “High Warfarin Sensitivity”. We will put that information in our back pocket should a physician (or hospital) want to prescribe that for him one day.

    The reason we got my husband tested is for an upcoming surgical procedure. Last February he had a similar procedure and came out of the anesthesia in an extreme amount of pain. The nurse did not understand as the pain medicine given during the procedure (Morphine) should have been strong enough “to last until he got home and was able to get his pain medicine prescription filled and the first dose taken”. That was not the case with him. They wouldn’t give him anything for the pain after the surgery (even though he was shaking and crying) so he suffered until we got the prescription filled. However, that medicine (Hydrocodone) didn’t work well either. While it seemed to work initially, it wore off quickly and he suffered quite a bit. I called the surgeon on a Saturday begging him to call in something stronger but he could not. He instructed my husband to take 2 Vicodin every 4 hours rather than only 1 every 4 hours. It was a horrible recovery. The increased dose caused him to sleep a lot and gave him horrible constipation which delayed his recovery greatly, causing him to take additional time off work.

    A year prior to this, in February of 2015, while consulting with an Alzheimer’s facility, the Director of Nursing told me about pharmacogenetic testing. A patient with Parkinson’s was having violent outbursts and the family was required to hire a 24 hour private duty caregiver, on top of the $6000 per month fee for the facility. The results came back identifying one of the drugs given to most Parkinson’s patients was not being metabolized normally in this gentleman. The patient was taken of that drug and his behavior improved. The 24 hour caregiver was no longer needed and the patient was able to stay in the facility. Not only did this save the family thousands of dollars, the patient’s quality of life greatly improved. At that time, only a psychiatrist was able to order a PGx test and most commercial insurance companies did not cover it. Later that year I attended a luncheon where the guest speaker was talking about pharmacogenetic testing and how it was going to change the way we practice medicine. While definitely intrigued by the science and implications, I still did not get involved.

    In July 2016, I came across pharmacogentic testing again and began doing a LOT of research. I had been in healthcare for over 25 years and worked as a geriatric care consultant for 13 years so initially I was interested in PGx because of the number of drugs many of my elderly clients took each day. The more I learned, I realized this test was beneficial to ANYONE taking a prescription medication and should actually be done BEFORE ANY medications are prescribed.

    As for my husband, after learning more about PGx, we suspected that the genes responsible for processing pain medications must have mutations and INSISTED his PCP do a test on him before his next surgical procedure. I found a lab (after much research) and even took the test and a lab representative with us on the appointment to collect the cheek swab sample. The results CONFIRMED our suspicions. According to his PGx/DNA test results, my husband has an “Altered Response” to Morphine (the drug used during surgery) and the report states “The patient may require higher doses of morphine for adequate pain control.” ALSO, “Altered Response to Hydrocodone” (the prescription for post surgery recovery) with the report stating “Acute postoperative and cancer pain: the patient’s genotype has been shown to be associated with reduced analgesia and increased opioid side effects at standard or high hydrocodone doses. If the patient fails to respond to increased hydrocodone doses, an alternative opioid may be considered.”

    There were many other drugs with cautions but these 2 were the ones we needed to know about right now. He can now take this report to his surgeon BEFORE his procedure this month and have PROOF that those pain medications do NOT work for him. Hopefully, we will avoid the horrible post surgical recovery experience we had last year. The lab we used also gives a list of medications that DO work for my husband so we can choose one of those from the list.

    Cautions were also given on several psychotropic medications including Zyprexa, Cloazril and Xenazine. While he does not currently take any of those, it is still good to know. Diabetes, Gastrointestinal, Infections and Urological drugs were also covered in the test (in addition to the Pain, Psychotropic and Cardiovascular drugs).

    For some reason there is still controversy around PGx testing but the science is REAL. Mayo Clinic has been using this science for years. St. Jude’s Children’s Hospital now tests ALL new patients upon admission. Many, many other well respected hospitals are using this test and more and more physicians are getting on board.

    If you are not convinced of the benefits of PGx testing, it is because you still do not understand it or you just don’t want to. As Mary Relling, Chair, Pharmaceutical Sciences Department, St. Jude’s Hospital stated, “If you knew about this genetic information and you did not act on it, you would not be practicing good medicine.”

    Do the research. Get tested.