Disaster Averted

“We have a situation with a guest…” explained the manager of the Georgian.

I love doing favors for hotel management, but this sort of announcement is not promising. Medical science cannot calm drunk, stoned, or disruptive guests, but hope springs eternal among hotel staff.

This turned out to be not so bad. A guest was taking an injectable medicine for rheumatoid arthritis. It required refrigeration, and the hotel had agreed to store it. Unfortunately, for unclear reasons, someone had left it on top of the refrigerator all night. What should he tell the guest? Could I call a pharmacy to replace it?

The medicine was Humira, a high-tech, genetically engineered monoclonal antibody. The internet pharmaceutical supplier that I patronize would sell me two doses for $7,000.

I did a Google search to find the manufacturer’s medication guide. While Humira should be kept in cold storage, leaving it at room temperature for a few days is OK. You can bet the manager was grateful for this news.

A Miracle Drug

Handing me a vial of an injectable medication, a guest explained that he needed a refill. Its label was in Spanish, but technical terms are recognizable in any language, so I had no trouble deciphering its mixture of vitamins and minerals. And cortisone.

That was disturbing. The guest’s wife’s rheumatoid arthritis occasionally flared up, and her doctor in Argentina wanted to make sure this didn’t spoil their vacation.

Discovered in the 1940s, cortisone seemed miraculous. Patients crippled with arthritis saw their pain melt away. Ugly psoriatic plaques disappeared. Hay fever vanished. Eczema victims who had been scratching for years stopped after a few doses of cortisone.

A cure for cancer could not have produced more excitement. The Nobel committee, which prefers to wait decades, rewarded cortisone in 1950 - just as doctors were realizing that symptoms return with a vengeance when the effect wears off, and repeated use produced disastrous side-effects.

Creams are fairly safe, and cortisone taken internally remains a life-saver for many serious diseases but a bad idea for ongoing symptoms (generalized pain, itching, inflammation). Large amounts for a short period are safe provided the problem is also short-lived. I give a huge dose for poison ivy but stop after two weeks. By that time the poison ivy has run its course.

A rare shot is probably OK for arthritis, but this family’s G.P. used it generously, a common tactic because the short-term effect is so good. There are no benign treatments for rheumatoid arthritis, but many are safer than cortisone. I prescribed enough for one shot.