Which First, Crow or Egg?

The cardiologist's voice was solicitous: "I know you're worried about Dad, honey..."

Me, he honeyed. My mother, he darlinged. My brother, the airline captain, who has been gathering Papa-san's medical records assiduously, was spared the endearments.

The cardiologist did tell me that now he had figured out why the Crestor he prescribed had attacked my father's muscles and put him in the hospital: "Dad's" heart failure was advancing so quickly that "Dad" was unable to metabolize the Crestor, which built up in his system!

The cardiologist was immensely relieved to have discovered that he was off the hook for this one. He reminded me again that he considered my father a friend, his favorite patient, and he wanted the best for him.

I, wits dulled by stress, did not say, well, when he first,started complaining of weakness to you, why did you not even consider it might be Crestor? You checked his pacemaker, you sent him for a CAT scan, and you didn't do a blood test for this known side effect? And don't you think his current level of heart failure might have something to do with being on his back for a month with rhabdomyolysis and hospital-acquired infection?

So. The drug didn't cause the sickness, the sickness caused the reaction to the drug.

That's the cardiologist's story.

The Sock Eater

This blog was intended to be a little bit useful and a little bit amusing, but since my father's illness, that's not the way it has gone.
He was brought down by the mistakes of his doctors, whom he trusted. They prescribed powerful drugs, too powerful, more powerful than an eighty-two year old could handle. They didn't warn him of side effects, passed the buck about how he landed in the hospital, and now won't return our phone calls.
So add anger to the normal grief I feel at seeing Papa-san, world traveler, laid up in the plastic pink sterility of a nursing home bed.
Yes, he's eighty-two. Yes, he's had multiple cardiac problems for thirty years. But he was up and working and shopping and cooking, zipping around town in his little white Suzuki (nickname: "the ice cream truck"), buying duck eggs and smoked salmon and stuffed olives and heirloom tomatoes from the same people every Saturday, and turning out reams of copy on his industry, reviewing unreleased prototypes, going out to dinner with Mama-san. Only a couple of months ago. But all the time, he was being overdosed with Crestor, growing weaker and weaker without knowing why.
At his age, with his heart, it was a tightrope act. It's a tightrope act with us all, of course. As you near the end, the rope is narrower, your balance more delicate. But it's possible to keep going for quite a while, all the way to the end, unless something knocks you off the tightrope.
That's what these doctors did: they knocked him off his tightrope, early. Maybe it's greedy or unrealistic of me to want more for him, of him. But I want it. This is not how his life should finish. The hospital and nursing home rounds of fear, humiliation, fear, humiliation. And his internist of more than 20 years, who is the same age as my father,and who retires at the end of this week, was supposed to see him; Papa-san has been having some problems. The internist's office called the nursing home and cancelled the appointment. They didn't suggest one of the other doctors in the practice; they merely said that Dr. Ch----- was no longer seeing patients.














When I was a little girl, I could not hang on to a pair of socks. Neither could my brother or father. Mama-san, obsessively methodical as she was, could not understand why we never removed both socks in the same place. She said she never thought she would marry into a family of one-legged people, but the evidence was clear that she had.
Really, of course, it was the Sock Eater who lived in the deep recesses of Papa-san's closet, beyond the shoe trees. At night it would make the rounds, camouflaged among the dust bunnies, incorporating one of every pair of socks into itself, and retiring to its lair to digest all that cotton, wool and nylon during the day. I don't know what it excreted---buttons, maybe.
We children didn't worry about the Sock Eater. Mama-san sighed over it but she had to accept it and its voracious appetite. It was our only under-bed monster--there wasn't room for anything larger or more sinister, what with the extra cot and all the Woman's Day magazines.

We didn't fear monsters. We didn't fear the dark. We didn't fear spiders, or bats, or fire or floods. We lived in a stone house in the woods, up on a hill where floods or tornados never came. It seemed impregnable, a fortress. And none of these things ever hurt us.

It wasn't impregnable, of course; time crept in. That was to be expected, but we didn't expect it. More than that, though, a tiny oval marauder was brought in, disguised as a friend.

elephantasy

A Card for my Father

He really did see the Hindenberg. He was at Admiral Farragut Military Academy in New Jersey. I suppose they were all watching for it, and it floated right over on the way to its historic immolation.

I wonder if that image was transmuted into the dream he told us about years ago, when we were all sitting around the kitchen table at breakfast. Here it is:

It is a holiday in a small New England town. People are standing around, waiting, as for a parade. A shadow forms in the distance. Slowly, it takes over the sky, darkens the sun. Looking up, my father realizes it is the underside of a giant elephant. The shadow passes, and as it goes, the crowd breaks into applause, and cheers, "Elizabeth's done it again!"

This is the best dream I ever heard. Most people are more entranced with their own dreams than with each others', but all my friends have to admit that this is one really great dream.

He is in the rehab center, which looks awfully like a nursing home. I've come down with a cold and can't see him, so I'm sending him this.

Action Figure

Just to let you know what they're messing with, this is Papa-san. This is his action figure. My brother had it made for Papa-san's 80th birthday. It is true-to-life down to the belt buckle. He is accessorized with a safari hat, giant single-lens reflex camera, and a pocketful of leaky green pens.

Thanks to his doctors' near-fatal enthusiasm for a powerful statin drug (see 'Crestorfallen' in November), he is in a rehab center now. Today was his 2nd day of physical therapy. I won't tell you his exact progress; that's his story. We don't know how far he'll go, or how long it will take to get there. But nobody has put a limit on his possibilities, and so we go on.

Terminal Detail

For over 47 years, he strode through Grand Central Terminal, past this little brass panel on the way to his job on The Magazine. He and my mother had lived in the Village but after I was born, they moved up the Hudson to a stone house in the woods, and Papa-san car-pooled with other commuting Daddies. Many children in my town thought this was actually their fathers' job: commuting. In winter, in the dark, while children were still asleep, all over the little town Daddies were getting into cars to take them to the station, to board their usual car on their usual train to sit in their usual seats for the ride down the Hudson to New York, not to return until six-thirty or seven, well into the winter evening. I wouldn't call it an easy existence.
For the last two weeks, I have walked past this little brass panel on my way to my father's hospital. It's part of the ticket window. It's a little grace note from 1913, when Grand Central was constructed to uplift the spirits of the throngs passing through.

Disasters Lighter Than Air

My father has always loved dirigibles; when they are not bursting into flames over Lakehurst New Jersey, dirigibles are easy to love. They are cuddly, yet purposeful, nosing around the sky like big seacows (O the manatee). The Empire State Building was supposed to have a mooring mast for them, but the winds were not favorable.
Every Christmas I try to find dirigibilia for my father: postcards, tin zeppelins, and, thanks to Ebay, a silver captain's pin, though the airship in question turned out to be a mere blimp. (Blimps lack the discipline of a rigid frame. And they aren't filled with such volatile gases.)
One New Years', my parents went to a costume party. Papa-san went as Dr. Hugo Eckener, the father of the Zeppelin. Unsurprisingly, the other guests were unaware of Dr. Eckener's importance, so my father printed up the above card to distribute. His Dr. Eckener costume was further enhanced by false beard, mustache and pince-nez. He won a prize for most original costume.
I don't remember what Mom wore. Besides a rather miffed expression.
Now he is in a hospital bed, trying to survive his cardiologist's love for "cutting edge" drugs like Crestor. It looks like he will be there for a while--he's not in pain, but recovery is slow, and interrupted by fevers from hospital-acquired infections. The cardiologist comes in and sings hymns to the wonders of Crestor, very safe, this is totally anomalous, and other forms of ass-covering.
Some days Papa-san doesn't care for reading, or TV, and just lies there, alternately dozing and worrying. There is a contraption above the bed for lifting patients into wheelchairs. It is at the right height, just the right height, I believe it could serve as a mooring mast for a very small dirigible.

CRESTORFALLEN

• Four months ago, Papa-san, my 82 year old father, was striding through Grand Central Station, green cloth briefcase over his shoulder.
• Three months ago, his cardiologist started him on a new cholesterol-lowering drug, Crestor. It worked like a dream; his cholesterol numbers dropped where they should drop, instantly.
• Two months ago, my husband said, "Your father seems much frailer than the last time we saw him." I didn't want to admit it, but it was obvious; he had trouble lifting his feet up the steps to my brother's house, and he needed to nap frequently.
• One month ago, my father fell off the bus to the station, hitting his head on the sidewalk. He was rushed to St. Vincent's, where they MRI'd his head and Krazy-glued the wound closed.
• Three weeks ago, he stayed home from work.
• Two weeks ago, he had trouble getting up the stairs to bed.
• A week ago, I finally found all this out and called his internist, who said, "What can I do at my office? Tell him to go to the emergency room."
  He had to be carried to the car. He's been in the hospital ever since.

His doctors were mystified. They ran blood tests, cat scans, MRIs. The blood tests showed elevated levels of muscle enzymes.
It was Crestor. Crestor attacks muscle fiber even better than it attacks cholesterol. The cardiologist finally admitted that my father was "overmedicated."
Doing a search on Crestor turns up warning after warning that it can cause rhabdomyolysis, a terrible assault on skeletal muscle tissue, if given in high doses, or to Asian patients, or to people over 65. There are multiple law firms looking for Crestor victims' business. Consumer Reports, Public Citizen, and Health Canada all have advisories against the use of Crestor.
My neighbor, a 63 year old, had to be taken off it and is now in rehab.
My friend Dr. Dan, an ER doctor, said, "We had a woman in last week in her 50's who had myopathy and it was Crestor. Her doctor said, 'But she's taken it for years, and she never had a problem!' I said, 'Well she's got one now.'"

"Overmedicated"? Or should he ever have been on this medication at all?

I have found, buried in some literature about Crestor, information which the cardiologist said was outdated Internet stuff. "The problem with the Internet is that old information just sits out there."

The "outdated" information warned that Crestor could cause muscle weakness, inflammation and kidney damage, particularly in the elderly. Papa-san is lying in bed doing an amazing simulacrum of an old man with muscle weakness, inflammation and kidney damage. The "outdated" information also noted that while Crestor does amazing magic tricks with cholesterol numbers, no link has been established between taking Crestor and actual incidence of heart attack. It's like a carnival barker's trick.

The Crestor website proudly boasts that the link between Crestor and reduction of atheroschlerosis (or as Crestor calls it, "athero") has just been established. Fabulous. But it has yet to be proven that Crestor will prevent anyone from actually dying, (morbidity and mortality) and it also confirms that Crestor spent a considerable time on the market before there was any proof that it even worked against "athero."

The cardiologist evinces all the signs of being in love with this medication. "I'm on it, and so is my wife," he told me. He seems a nice man, seems to care about my father ("I live vicariously through Dad's travels"--when he talks to me of my father, he says 'So you're worried about Dad?'), but sees only the magic of the numbers game that Crestor pulls. He might very well have almost killed his own father with it, he loves it so.

The internist has implied that my father was so advanced in years and illness (he is a Cheney-level cardiac patient), that this whopping medical mistake could hardly make much of a difference. He said to my brother, "Oh, by the way, you might want to consider a DNR, just for the future." That's a Do Not Resuscitate order.

The patient was at that moment sitting up in bed reading the New Yorker.

The Crestor website says doctors should warn patients to watch out for any sign of muscle weakness or pain, and report it to the doctor. But my father's doctors didn't warn him. And he, being 82, assumed the weakness was old age at last, and didn't want to let on. He struggled through Grand Central Station as long as he could. He struggled heroically.

We don't know what the future will bring. Papa-san is slowly improving, but when you're knocked to the ground at his age, it takes a long time to get up.