RM-10: an anecdotal story - Health Risks and Environmental Issues

Townsend Letter for Doctors and Patients,  June, 2003  by Rose Marie Williams

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This story begins July 2001 when an otherwise healthy 83 year-old woman, Mrs. M, had glaucoma surgery to reduce pressure on her right eye. Following the surgery, Pred Fort, anti-inflammatory eye drops were prescribed to be used for a period of eight to 12 weeks at a dosage of 15ml 4x p/day.

On the second day of using Pred Forte Mrs. M began to feel weak and dizzy with a burning stinging sensation all over her body. On the third day Mrs. M called the eye surgery clinic to complain about side effects from using this drug. She was sharply rebuffed by the surgeon, who claimed her symptoms had nothing to do with the medication and that she needed to see her primary care physician instead. (This surgeon will herein be referred to as "Dr. Rebuff.") Mrs. M felt certain the burning, tingling, and weakness were related to the Pred Forte eye drops and was exceedingly dissatisfied with "Dr. Rebuff's" uncaring handling of the matter.

Mrs. M endured the drops a few more days while the burning, stinging, and weakness persisted. Desperate after one week, she called the clinic for an emergency visit and was seen by a different eye specialist who listened attentively to the problem and reduced the dosage of Pred Forte from 15m1 to 10ml 4-x p/day. This reduction made a very slight improvement. The burning persisted, and Mrs. M was forced to take cool showers for relief.

After a full two weeks on Pred Forte Mrs. M was still feeling weak with a loss of appetite, persistent stinging in her right eye, and burning all over her body. She called the eye clinic for another emergency visit and this time was seen by a very gentle, sensitive eye surgeon, "Dr. Gentle," who further reduced the Pred Forte from 10ml to 5m1 which brought very slight relief.

Pred Forte

In a profile taken from the internet, the side effects for Pred Forte (generic name, Prednisolone acetate) may include: allergic reactions, blurred vision, burning/stinging, cataract formation (my emphasis), delayed wound healing, dilated pupils, drooping eyelid, increased pressure inside the eyeball, inflamed eyes, perforation of the eyeball, secondary infection, ulcers of the cornea. Occasionally, long-term use of Pred Forte eye drops may cause bodywide side effects due to an overload of steroid hormone.'

It is most unfortunate that "Dr. Rebuff," a highly respected eye surgeon, failed to acquaint himself with the manufacturer's profile on Pred Forte. He would have known instantly that his patient's complaints were indeed valid. He could have shown some compassion, substituted a medication that was better tolerated, and perhaps helped Mrs. M avoid some of complications that developed over the following year.

There was mounting frustration that vision in her right eye was worse instead of better after the surgery. Mrs. M had been told it might take several weeks, even months, for any vision improvement to be detected. Meanwhile she began complaining about an irritation in the right eye that felt like a grain of sand.

November 2001

On the third follow-up visit with "Dr. Rebuff," Mrs. M was bluntly informed that she also needed glaucoma surgery on her left eye, and cataract surgery on both eyes. In response to complaints about the irritation, she was told this was the result of a bleb, a slight bump on the eye resulting from a tiny bit of tissue being folded back to improve drainage and relieve pressure. It could be felt each time the eyelid opened and closed. "Dr. Rebuff" told Mrs. M that most people get used to it and she would have to get used to it also.

Angry at the callous treatment by "Dr. Rebuff," disappointed with a lack of vision improvement, and frustration with the on-going side effects associated with using Pred Forte, proved to be enormous stressors for Mrs. M. Her stress load was further burdened upon being told she needed additional eye surgery, while she was still having such a difficult time dealing with the original surgery.

December 2001

Mrs. M began to complain of abdominal pain and constipation for which an attending physician at her HMO prescribed an antibiotic that did not agree with her. Feeling worse, she made an appointment to see her primary care physician, a wonderful, caring woman, "Dr. Wonderful," who suspected diverticulitis or an intestinal blockage. "Dr. Wonderful" stopped the previous antibiotic and prescribed Cipro instead, which also did not agree with Mrs. M. Two days later she was advised to stop taking the Cipro as well. Concerned about Mrs. M's new health problems, "Dr. Wonderful" recommended a consultation with a gastroenterologist, "Dr. G.E."

February 2002

During the first appointment with "Dr. G.E." a simple approach was suggested such as introducing more fiber in the diet. This helped a little, but not enough. A colonoscopy was the next recommendation. This procedure showed a blockage and a pathology report of "cancer in situ" was noted. A consultation with a surgeon was arranged. It was no surprise to have the surgeon and "Dr. G.E." both recommend surgery to remove the blockage. Still dealing with eye problems, Mrs. M was not immediately ready to deal with this surgery.