On swallowing pills

I must confess that I have a handicap, dear reader - or is it more of a dirty secret - can it really be a secret if I'm writing about it in a weblog?

The thing is that I don't know how to swallow pills.

There! I've said it. I can see your head tilting already and a look of concern/bemusement forming: Can he really be serious? A full-grown 31-year old man can't swallow pills! Didn't everybody get over that as a child? What's wrong with him? etc.

Now this is the kind of thing that is difficult to admit. It's not quite like confessing an addiction or a social disease, but it's more like having a blind spot, a strange fetish or a peculiar deficiency of some sort (say like a penchant for wearing spiderman underpants). You feel like you want to stiffen the man up, slap or shake him, shouting "Just grow up, shape up etc.", as it were.

I certainly feel that way sometimes, but it's essentially just your garden variety phobia and/or eccentricity; something one lives with and gets on with. Like everyone I've had my fair share of illness (colds, flus etc), and occasionally with more serious and longer-term diseases, I've had to take daily regimes of pills so I have to deal with this problem regularly. I'm the kind of person the drug companies might point to when they claim that 'people in the third world don't know how to take drugs on a schedule' and decide not to supply AIDs drugs to poor countries.

Of course my problem is being able to take drugs at all, let alone taking them on a schedule.

Obviously I can, and do, swallow food - it's clearly not a problem with the mechanical act. In Ghana, we eat something called fufu - which is swallowed, not chewed - that's typically the child's gentle introduction to the ways of dealing with pills. Now I've always swallowed fufu so this difficiency was all too perplexing to all who raised me and noticed this aspect of me. Even today, the problem is psychological. It's the notion of knowingly ingesting potentially bitter medecine that is at issue - knowing that it will help you or provide relief is irrelevant. A couple of anecdotes are in order.:

I still remember the look of disappointment on my aunt's face: aged 6 or 7, with my mother out of town, I'd had a particularly bad asthma attack; the doctor prescribed something or other. First I couldn't/wouldn't take the pill, then she tried putting it amongst small balls of fufu - that didn't work; then she ground things up - I fought but eventually managed to take it down... Of course, since I hadn't swallowed, the pills had unsettled my stomach. Within 15 minutes, I had thrown up... so then the rigmarole continued: me being further weakened, now with an empty stomach and still sick and needing to take the medecine to get better. So it's a process of cook more soup and fufu, grind and try again, repeat as many times as necessary. Her's was a labour of love (and especially patience) but she essentially had to revert to treating me like a newborn baby. I can imagine her shaking her head and laughing as she would recount the events to my mother on her return: "That your son, he's a 'special' one."

On another occasion, after coming out of surgery (I believe I was 22 years old - as you'd note, not much progress in the intervening years, it was surgery with anaesthesia and all), I was given painkillers and some antibiotics; the nurse explained the prognosis: there would be pain, considerable pain, for the next week, but the painkillers would take off the edge. She left the recovery room and I started my excruciating pill-taking routine. The antibiotic went down well - well it took a few minutes, hemming, hawing. But when it came to the painkiller, it wouldn't work, I just couldn't swallow the pill, it was too big, wrong shaped etc. After 5-10 minutes, I tried chewing but it was awful, I tried, I tried...

So I did the next best thing, I spat it out and hid the pieces in my sling under my cast. Half an hour of increasing pain passed and the returning nurse ultimately discovered her patient in pain and then the culpatory material. I smiled weakly/apologetically etc... Again it was the same look - you're can't quite be manly in such circumstances... but then she was all business and professional (she must see this occasionally - maligerering or rather non-compliance), she got me another pill and waited to watch me take it... it took 10 minutes... Embarrasment is the least of it, not to mention the pinkish stain on my cast as a reminder for the next few weeks.

Now looking back it's funny, I was in severe pain, I'd just had surgery and yet this was my lot. Over the years I've trained myself to confront this failing and most times I've managed to deal with this... Here some of the number of coping mechanisms I've developed.

1. Avoidance

Simply don't get ill, healthy people don't take pills (unless it's vitamins). Or it's close cousin:

2. When ill, simply pretend that you're not ill.

This latter variant of course exacerbates things because one misses out on things like the benefits of prevention or early treatment.

3. Seek out chewables

This was more feasible when I was a child (see vitamins). But I don't see antibiotics like pennicillin in chewable format. More to the point, no amount of sugar or sweetener can ever make certain pills go down satisfactorily. Certainly this is true of quinine or choloroquin (which is sometimes given for malaria) as I know from painful experience - these are the worst tasting things imaginable, poisons essentially.

4.a Seek out powders, syrups or

4b. crush pills

I loved my Ventolin (such a sweet syrup, it tasted good, looked good (nice and reddish), and provided relief - it also had nasty side effects, French doctors were horrified to learn that I had been using it but that's another story). Similarly, the powdered, lemon-flavoured flu medications, Lemsip and TheraFlu, seem to do the trick, tried and true and decent stand-ins for Ibruprofen/Advil/Tylenol/Sudafed most of the time.

Grinding or crushing a pill is a last resort; it feels like cheating, unmanly somehow.

5. Seeking out the right shape and size pill

Some pill shapes give me more problems than others, I seem to have problems with rounded pills for some reason - it doesn't matter how small they are. The dreaded capsule is the worst offender. I can't do it, I'm half defeated already. It's coated, so its contents are clearly bitter and would upset your stomach if you chew. So its a struggle... I note: the smaller the pill, the better so oval 120-200mg tablets work best.

6. The long production

With practice, I've eventually 'learnt' how to take most medecines. I have my eccentric routines but by-and-large it's not an ordeal. Sometimes however, it's a case of the 'long production'. Even now, I can spend 10 minutes trying to swallow, pacing around the rooms, tilting head, standing up, sitting down, etc to no avail.

And that is where I'm at now, and why I'm writing this blog entry.

I've just now gone through most of these stages: I've been fighting a (now-diagnosed) sinus infection for the past week and the doctor has just prescribed some antibiotics and something to thin out the sinus channels. There was avoidance, denial for a few days, unfortunately chewables were not an option, and I had to settle on powders but even these haven't worked. So on to the current, forebidding prescription:

• The one is a huge 500 mg capsule
• The other is a 720mg tablet. A beast in other words - and the wrong shape too, more square than oval and bulging ominously.

I just took them:

• the first one went down ok - modulo a chew or two
• the other was a long production ™. 7 minutes too. I had been been through all the stages. I couldn't chew, it was a capsule, I know better than that. I did the pacing, the tilting etc.

With antibiotics these days, you have to take the full course. this is going to be an interesting few days.

With the internet being what it is, there are lots of resources about my ills, primers on 'pill swallowing' even educational videos. They all target children, emphasizing behavior modifcation, reinforcement, building confidence, performance anxiety etc and even the last resort, consulting bevioural psychiatrists (basically it's just like potty training). Hmmm... I wonder if I can be cured, I'm tempted to order off a video or something. Or I'm a more of a malade imaginaire?

There's a new film out this week, Maria, Full of Grace, which is about how a young, newly pregnant girl from Columbia becomes (or is forced into becoming) a 'drug mule'. It's supposed to be a heart-stopping drama and audiences are apparently gripping their seats when she swallows her cargo of 60 or so little pellets of heroine - wrapped in some plastic or other to ensure they don't dissove in her stomach and kill her. The tagline:

These pellets contain heroine. Each weighs 10 grams. Each is 4.2 cm long and 1.4 cm wide. And they're on their way to New York in the stomach of a 17-year-old girl.

I'll be watching that scene with more than professional interest: perhaps I can learn something about swallowing pills.

The drugs are kicking in now... It will be light blogging for the next few days.

File under: culture, health, whimsy, phobia, obsession, confession, memoir, swallowing, pills, eccentricity, toli