Still Life with Robin: Rx Effects

by Peggy Robin

Last week’s column was about the glories of springtime in Washington. This week’s is about the price some of us pay for enjoying the blossoming and the greening of our city: hay fever caused by pollen counts that have hit stratospheric new highs.

At the same time as I rhapsodize about the liveliness and loveliness of the season, I’m a wheezing mess. I’m not used to it, either. For the past decade, I’ve held my own in the war against season airborne irritants. You see, I have been armed with a weapon that had always rendered me invincible: a Water Pik. Not just any Water Pik, but one fitted with a special nozzle to shoot a spray of salt-water through the nostrils to wash out any pollens before they could get into my lungs. I perform this nasal ablution twice a day, and I have always been able to weather even the highest of the pollen-count spikes. Until this year.

Not only did I have complete confidence in the efficacy of this weapon, but I became something of an evangelist for it. Whenever I heard people complaining about the sneezing, redness, and other allergic miseries caused by our floral and arboreal bounty, I would take them aside and say in my most empathetic voice, “You know, I used to be just like you. But let me tell you what changed all that for me.” And then I would describe the miracle of this twice-daily ritual and how it freed me from my former fear of the pollens of spring. I don’t know if I made many converts, but I had no doubt that I was pointing them toward the one true path to a cure.

Now I have my doubts. Though as observant as ever about my practice of nasal rinsing, I have to confess, it is no longer keeping me free from the symptoms of hay fever as it did before. So I went back to what I used to do in the bad old pre-Water Pik days. I am back on drugs. I started with Zyrtec. It’s small, cheap, and available in any drugstore. I took it for a few weeks but felt nothing. Then I caught the word on the street that Allegra was the way to go. People were saying it was stronger, packed a bigger punch. So I moved up to that. It was definitely more expensive than the Zyrtec. CVS sells a 24-tablet package of Allegra for $25, or $1.04 a pill, while Zyrtec in the 70-count bottle goes for $40, which comes out to 57 cents per pill.) After a couple of weeks on Allegra, though, I have to say I wasn’t feeling any better than I’d felt while on Zyrtec.

I was pondering what do to next when a commercial for Zyrtec came on TV. Usually I tune out TV commercials for medications, because they always feature some annoyingly chipper old people playing golf or bicycling while a friendly-sounding off-screen narrator reels off a phenomenally long list of potentially lethal side-effects at breakneck speed. If I ever do stop to listen, I have to wonder why anyone would ever risk taking anything with even a single one of the known hazards cited. So I’ve stopped paying attention.

The Zyrtec ad, however, does not follow the clicheed pattern. It starts off with a young couple, both in business attire, walking toward a park bench, where they both sit down with their brown-bag lunches. The man, who's been sneezing, brings out a bottle of orange juice and is just about to use it to swallow an Allegra when his female companion stops him. “You know you can’t take Allegra with fruit juice,” she warns. He does a double-take and says “Huh?” to which she responds: “Yeah—it’s on the label. Labels are meant to be read.”

So I jumped up and went right to the medicine cabinet to check the Allegra label. Sure enough, there on the back of the bottle, in that teensy-weensy type, small enough to require me to adjust my reading glasses and squint at the same time, it says “do not take with fruit juices.” That means for all those weeks that I’ve been taking Allegra in the morning, the glass of orange juice used to wash it down has been silently sabotaging any beneficial effect. Not only that, but I now see that Allegra users are also forbidden to take any aluminum or magnesium antacids, so that even if I move my Allegra dose to the evening, I’ll need to forgo my usual treatment for the occasional bout of reflux before bedtime. This isn’t a frequent problem (excuse me if this is TMI for anyone) but it happens just often enough for me to want to keep open the option of a post-dessert antacid.

Okay, so Allegra is out. I’m not going back to Zyrtec, either. And that old standby Claritin has never done much for me. What else is there? It looks as if I need a doctor to advise me. So I looked up the number of the doctor who, over a decade ago, turned me on to the non-drug nasal rinsing routine. Guess what? He’s now semi-retired and is seeing patients just one day a week, and is completely booked up for the next three months. I was offered an appointment with one of his young colleagues, instead. I took it and will meet this new M.D. next week. But I already know how it will go. I will meet this young man, who will look to me as if he’s just graduated from middle school (when in reality, he’s several years out of some extremely prestigious med school) and he will prescribe some newly reformulated antihistamine, which my insurance will inevitably decline to cover on the grounds that I could be taking the over-the-counter generic form of Claritin for about two dollars a month. I will grit my teeth and pay the two hundred dollars for the new drug out-of-pocket. And then I will faithfully follow the directions to take it, which no doubt will advise giving it two weeks to let it build up in my system in order to get the full benefit. By the time I start feeling better it will be mid-May, when the tree pollens are starting to fade and the grass pollens are surging to new highs.

The thing is, I’m fine with grass pollens -- it’s just the tree pollens I can’t handle. So I would probably be okay, with or without a new drug, if I can just hang on until a week or two past Mother’s Day. Assuming I decide not to wait it out, I have to figure on the odds that this new drug will have some other little kicker hidden in plain view amid all the verbiage in the patient package insert. Somewhere in all those long columns of fine print, I’ll miss the line that tells me I need to give up eating potatoes on Sundays, or that I have to take the pill at 2:45 in the morning on days with a full moon, unless it’s an alternate Monday in a month without an R. Or that one of the “rare but serious side effects” is that my tongue could swell to the size of a football.

Lest you think all this might make me nostalgic for an earlier, simpler time in the history of medical practice, let me close with my version of the dialog that transpired between my grandmother and her doctor, probably about one hundred years ago. My grandmother had been suffering from a serious breathing disorder, for which the doctor gave this advice: "The best cure would be a long stay at a spa in Arizona.” My grandmother: “I see. So I should quit my job in the garment factory where I sit at a machine and sew all day long and go off to a resort in the desert. Fine. Write me a prescription that includes a train ticket and the cost of the stay, and I’ll be sure to follow your orders to the letter.”