Eight-point Side Effects without end

After reading yesterday's Red Electric post, one near and dear to me asked to see the package insert for my Istalol, the beta blocker I’ve been prescribed to ward off glaucoma. If unchecked, the condition leads to blindness.

She was concerned about my brooding over the doctor’s warning that the eye drops had, on occasion, caused depression. I had written in this space that, ironically, his very words were depressing.

Istalol’s insert, printed on both sides of a flimsy half-sheet, is not designed for those who going blind. You are reading this in 12-point type. The insert is written in what seems to be eight-point.

That looks like this.

Obviously the government or the drug companies, or both, don’t care enough to make side effects perfectly clear, even for those with 20/20 vision.

Once you get out the magnifying glass, you must scan, Holmes-like, through verbal pharmaceutical sludge.

“The precise mechanism of intraocular hypertensive action of Istalol is not clearly established at this time. Tonography and fluorophotometry studies in man suggest that its predominant action may be related to reduced aqueous formation. However, in some studies a slight increase in outflow facility was also observed.”

Perhaps the author of this rhetorical “outflow” of “predominant” verbal “action” was the same person who ordered it written in 8-point type. It’s not just hard to see, it’s nearly impossible to understand.

No wonder my doctor asked directly “Are you prone to depression?” and “Do you have heart problems?” As frightening and depressing as the questions were, at least I understood them.

Interestingly, the word “depression” is listed twice in the insert, but it is only one of dozens of “adverse reactions” reported, however rarely, by users of Istalol. Hallucination, confusion, anxiety, disorientation, memory loss. The list goes on and on: “nausea, diarrhea, dyspepsia, anorexia, dry mouth .... "

In fact the possible side effects are so numerous that I’m having trouble taking the warnings seriously. Then again, after two days of dropping this stuff into my eyes, I could be hallucinating, confused, anxious, depressed and suffering from memory loss.

My Depressing Sight

My eyes still dilated after two hours of testing, I sat and watched the white-jacketed doctor pore over my chart. He intently flipped back and forth between 18 months’ worth of graphs and notations that tracked change in my vision. He peered down at photos of my optic nerve taken a year ago and compared them with those taken just 15 minutes earlier.

For 10 minutes, like a student cramming for an exam, he had his nose in my recent ocular past. At one point, without looking up, he said, “Sorry this is taking so long.”

All I could think to say was, “Uh huh.”

Finally he swung around in his chair and pronounced that he didn’t like the “trend” in my left eye. My field vision tests showed that my vision is still slowly deteriorating.

Let me be the first to say that I hadn’t noticed it. After all, I don’t go around one-eyed looking for little scattered lights blinking on the wall of a dimly lit dome in a doctor’s office.

I’m into sunsets at the beach, and evening of reading, a morning of writing and looking for signs of spring. My sight is still serving me quite well, thank you.

But the dome test showed I had this problem caused by early-stage glaucoma.

“I’d like to put you on beta blockers,” he said. “Do you have any problem with depression?” he asked, slowly introducing possible side effects from the medication.

“No” I said hesitatingly, feeling slightly depressed at the thought of drug-induced depression.

“How about heart problems. Palpitations, that sort of thing?”

“No problem,” I responded without skipping a beat.

“Occasionally, not often, but occasionally, patients experience these problems with the eye drops I’m recommending.”

For the past year I’d been using another type of drop to lower pressure in my eye. Less pressure could stop, or at least markedly slow, my loss of vision to glaucoma.

The right eye was fine, presumably thanks to the drops. But then the left….

The word “depression” hung in the air. I don’t think I’ve ever been depressed. Sure, some January mornings the warmth of bed has kept me from facing the day. The room beyond the covers has been depressingly cold.

No, when I come up short, my response is, sadly, anger at myself, but not depression.

Now the doctor was possibly, just possibly, presenting a Hobson’s choice. He never said it in so many words, but he was really probing whether I would prefer blindness to possible depression.

Does life at my stage come down to such choices?

As I say, the very thought of depression was depressing, and I hadn’t even started to squeeze the little bottle that would release a single drop of the drug into each eye once a day.

Is this the way it will be? You have a choice, “cancerous death or chemotherapy and radiation,” “deafness or hearing aids,” “blindness or depression.”

In each case, the choice is clear even though the obvious alternative is diminishes life.

Not quite take-it-or-leave-it Hobson's choices. Call them half Hobson’s. You accept them because, like full Hobson’s, you have no choice, not really.

• • • •

After reading this over, I should note that many people have no choice at all. There is no bad and less bad. It’s just plain bad.

I also know that some who read this will suggest that I have other choices besides the ones posed by the doctor. Indeed, the doctor may decide there is a better course if the new drug too doesn’t work or if the side effects, including depression, appear.

What I do find strange is the paradox that warnings of possible depression are themselves depressing. It's a bit like being intolerant of intolerance. Those are snares to avoid.