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Jim Knipfel June 23, 2013

Rare Side Effects

An amiodarone case history.

My dad, George Knipfel, died on June 18 at age 79 and was buried with full military honors. The frustrating thing is that he wasn’t supposed to die. Not the way he did, anyway.

It’s rare to say this about one’s own father, but he was one of the most vibrant, youthful, energetic, and sharp-witted men I’ve ever known, with an unfaltering baritone voice and a goofy sense of humor. My mom commented more than once that he was just a 12-year-old in a 70-plus-year-old body. Over 20 years ago he had multiple bypass surgery, but he recovered fully and it didn’t slow him down in the least. At his last checkup just a few weeks ago, his cardiologist told him that his heart was strong and solid enough that he wouldn’t need to come back for another year. About a decade back he learned he had diabetes, but he kept a close eye on it, did everything he was supposed to, and it remained firmly under control. Well into his 70s he was as active as ever, walking several miles a day, going to ball games, traveling, working in the yard. By all accounts he was in extraordinary health.

Then four years ago he was prescribed amiodarone for a mild heart arrhythmia. Three years later he developed a cough that wouldn’t go away. Nobody thought anything of it at first (including his doctors), but it persisted. He began to grow short of breath and his energy level ebbed. When his primary-care doctor suggested an X-ray, it was discovered that scar tissue was growing on one of his lungs, and last November he was forced to start using oxygen. It was an incredibly frustrating turn for a man who was perpetually in motion. He never smoked in his life, never had the slightest hint of pulmonary trouble, but now had to carry an oxygen tank with him wherever he went. His doctors determined that the scar tissue was the result of what they called a “rare side effect” of the amiodarone. They immediately took him off the drug (he showed no signs of heart arrhythmia after that) and was put on another drug which, theoretically anyway, might clear up the damage.

It didn’t, and his breathing grew more difficult and labored until June 13, when my mom had to get him to the hospital. A few days later, the pulmonary specialist took another biopsy and put him on a ventilator, explaining that while most lungs have the consistency and flexibility of a Nerf ball, my dad’s were now more like a tire. The biopsy revealed that his lungs were now covered in scar tissue, and there was nothing more anyone could do. He also explained that amiodarone stays in the system three to eight months after it’s been discontinued and has a tendency to whip back around and do far more damage than it did on its first pass. Still, even the doctor was shocked at how quickly it all happened. My dad, as always had been his way, fought like a bastard to the end.

The official cause of death was cited as “pulmonary fibrosis secondary to medication.”

I don’t write this simply because I’m pissed that I’ve lost a man who meant so very much to me. Nothing I write will resurrect him or make me feel any better. But the stupid and pointless nature of his death does say something about the medical and pharmaceutical industries. Here was a man who, despite a couple well-monitored medical issues, was in extremely good health for someone of his age. Then a doctor he trusted threw a pill at him for a minor problem and that’s what killed him.

In the days following the funeral, every medical professional my mom, sister, or I encountered who heard the name amiodarone, or even just heard the symptoms, knew exactly what we were talking about and what had happened. If you do the slightest bit of research into the drug, untreatable pulmonary fibrosis is at the top of the list of side effects. It seems the only rare thing about it are those patients who don’t end up with the disease. It’s that common, and in many cases it starts to develop within a week after you begin taking the pill. Medical professionals and pharmaceutical companies know this, they know there are far safer alternatives available, yet amiodarone is still being prescribed to hundreds of thousands of people who are now unwittingly facing one hell of a trade-off.

Jim Knipfel / June 23, 2013


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