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Originally published Sunday, July 20, 2014 at 6:16 AM

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Doctor’s dirty hands drive patient away

People’s Pharmacy on doctors who don’t wash their hands, the EMSAM skin patch for depression, and internal bleeding from Xarelto for atrial fibrillation.


Syndicated columnists

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Q: I am a retired dental hygienist with years of infection-control experience. There is evidence that health care workers must wash their hands between patients to prevent the spread of infection. I am dismayed when doctors fail to do this.

My husband asked his doctor to please wash his hands before examining him. The doctor’s reply was “What for?” He washed his hands (poorly) and threw the towel into the sink.

At a follow-up appointment, he was talking to me about my treatment. He came up behind me and put his unwashed hands on my face.

I now go to another town for treatment. What can be done about doctors who don’t believe they should wash their hands?

A: Infectious-disease experts are adamant that washing hands (and cleaning stethoscopes) before each examination is essential (Mayo Clinic Proceedings, March 2014). Asking a provider to do this can be intimidating for many patients, however.

One caller to our radio show said she takes hand sanitizer to her appointments and cleans her hands as soon as the doctor enters the room to serve as a good example. She says this action usually encourages the health professional to follow suit.

Q: I cannot tolerate oral antidepressant medications because of unacceptable side effects. My doctor has prescribed EMSAM, a skin patch, but it is very expensive.

Does this medicine work for depression, and can I buy it safely from Canada?

A: EMSAM (selegiline transdermal system) is a unique antidepressant medication. It works differently from medicines such as bupropion (Wellbutrin), fluoxetine (Prozac), sertraline (Zoloft) and venlafaxine (Effexor).

We were shocked to discover that the price for a month’s supply runs as much as $1,400. The manufacturer offers a $500/month rebate coupon on its website, which may help somewhat. Canadian discount pharmacies sell EMSAM for roughly $1,200 per month, so there isn’t a huge savings.

Studies have found that this skin patch is safe and effective in treating depression and less likely than other antidepressants to cause weight gain or sexual side effects (Journal of Affective Disorders, November 2013).

Q: My husband was on Xarelto for about a year and a half because he had atrial fibrillation. When he had a hernia operation, he stopped taking it for three days, but had major internal bleeding afterward.

Despite this, his heart specialist continued the prescription. One day he had some stomach pain and felt faint. We rushed him to the hospital, where he was diagnosed with a ruptured spleen. He had not fallen or bumped himself, and there were no bruises on his body. The spleen was removed, but the loss of blood could not be stopped because of the Xarelto. He died one day later. Could the Xarelto have caused the spleen to rupture?

A: We are so sorry for your loss. The prescribing information for rivaroxaban (Xarelto) does not specifically mention the spleen, but bleeding into critical organs was reported during clinical trials.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them c/o King Features Syndicate, 300 W. 57th St., 15th floor, New York, NY 10019, or via their website:www.peoplespharmacy.org



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