Don't Forget Your Friendly Pharmacist!

When you think of a pharmacist, you probably picture the men and women in white coats who work at your local pharmacy, filling prescriptions and answering questions (and whatever else they do). That's always been my limited idea of who pharmacists are and what they do. One of the last times I went to Target to pick up prescriptions, I was waited on by one of the pharmacy employees I see all the time. We exchanged some brief, cheerful banter acknowledging that we loosely "know" each other, due to my frequent trips to her counter. I joked, "You should probably just put my picture up on the wall over here, since I must be one of your best customers." Ever since being diagnosed with RA 18 years ago, I've been forced to become well-acquainted with pharmacies and their staff. But it wasn't until last September that I discovered a different kind of pharmacist, and it's one that has proven to be an invaluable asset to my "RA team."

In September, I returned home to Minnesota from New York, suffering from a severe RA flare-up, additional ailments, and feeling like my entire body was falling apart. One of the reasons I decided to leave New York was to get my health back on track, which was much easier to do in Minnesota. Straight away I started making phone calls and setting up appointments over the following days and weeks with various doctors: rheumatologist, primary care physician, endocrinologist, gynecologist, psychologist, and pharmacist.

Pharmacist? Yes, pharmacist! I didn't know this type of care existed, but one of the physicians I saw at my primary care clinic recommended I see the pharmacist who also works in the clinic--which is all part of The University of Minnesota and Fairview Health Services in Minneapolis. My primary care doctor thought it would be good to meet with a pharmacist to go over my fairly long list of medications I was taking. I had been having very uncomfortable and troubling "mystery" symptoms basically all summer that nobody could quite solve, yet multiple doctors thought it might be a medication side effect. Desperate to figure it out and feel better, I agreed that talking with a pharmacist seemed like a wise idea. They're the people who really know the most about the medications you're taking and possible interactions, right?

The mystery symptoms I just vaguely mentioned refer to episodes of sudden extreme sweating and intense "hot flashes." Not yet knowing what menopause is like, I'm guessing that the episodes I had where my body would suddenly feel severely overheated, like I just stepped into a sauna, might be similar to menopausal hot flashes. I'm not sure though. Whatever I had was horrible and I wanted it to end immediately. The pharmacist felt like my last hope for getting answers after I had endured many different physical exams and tests that revealed nothing.

I went to my appointment with the pharmacist not knowing what to expect and hoping that she could help me. When I sat down at the table across from her in her small office, I noticed another person in the room attending the appointment as well--a resident pharmacy student. The pharmacist and the student patiently spent more than an hour with me, discussing my medications and the sweating/hot flash problem I had been experiencing since July. They were both extremely kind, knowledgeable, and helpful.

"I'm pretty sure I know what's causing your symptoms," the pharmacist told me. "I think you've developed a sensitivity to serotonin." She went on to explain that my anti-depressant, Celexa, was probably the culprit causing this serotonin sensitivity. She also didn't rule out the hydrocodone (Vicodin) I had been taking daily to have some part in the problem, especially when I described to her what I thought some of the triggers of the sweating episodes might be. By the time I had my appointment with the pharmacist, however, I had already been off of the painkillers, so it was hard to tell what role they had.

As the pharmacist continued to discuss with me this serotonin sensitivity condition as well as my RA and medication history, I felt a gigantic rush of relief wash over me. I could have cried right there sitting at that table; I was so thankful that someone finally seemed to know what was wrong with me and how to fix it. Her recommendation was to immediately start tapering off the Celexa while slowly tapering up in dosage a new anti-depressant/anti-anxiety medication, Cymbalta.

Fast-forward a few weeks after I started my new medication regimen: the sweating and hot flashes completely disappeared. OH, THE RELIEF AND HAPPINESS! Words couldn't describe how grateful I was for this change, and grateful to my primary care physicians for connecting me with the pharmacist. She helped to dramatically improve my quality of life.

My only complaint with this experience is I wonder; why didn't someone refer me to a pharmacist before now? I had no idea that a pharmacist could be a part of my health care team. For 18 years I've naively tried to juggle long lists of different medications basically on my own. I see now how important and necessary it is to have a pharmacist to talk to about your medications and your health. I urge everyone who lives with RA and chronic illness to meet with a pharmacist like mine. It could make a big difference in your health and in your life.

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