Wednesday, February 17, 2016

Proton pump inhibitors and me

a visit from Maya yesterday

In the news recently, new evidence that proton pump inhibitors can cause more harm than good. Apparently among the elderly (defined as 75+ years), the incidence of Alzheimer's Disease is higher amongst those who take proton pump inhibitors (PPIs) than those who do not. I am not sure if a causal relationship was proven. Maybe it is similar to the observation that breast fed babies do better in school ignoring the class differences in the incidence of breast feeding.

PPIs inhibit the formation of hydrochloric acid in the stomach and thus reduce the incidence of heartburn and gastric reflux. There are several on the market including Prilosec and Nexium. Both Steve and I take the generic form of Prilosec.

The current recommendation, not necessarily coming from physicians but from medical writers, is to take PPIs for the least amount of time necessarily and to treat one's condition 'naturally'. How would one treat this condition naturally? Lose weight and stop all consumption of alcohol and caffeine. Residual heartburn should be treated on as needed basis with antacids such as calcium carbonate. And if that does not work, perhaps take a less effective agent such as the histamine-2 blockers (generics: cimetidine and ranitidine) which have been on the market longer and so far do not have the  same side effect profile.

Steve has severe GERD (Gastroesophageal Reflux Disease). It has eroded his throat so much that he has a constant dry cough and a hoarse voice. He is not overweight (rather the opposite) and does not drink alcohol. He drinks one cup of coffee a day. He is fond of hot sauce as over the years, he has lost his sense of smell and taste. When he tries to cut back on his PPI to once every other day, he gets severe heartburn. Eroded esophagi can lead to gastric cancers. His father died of stomach cancer so he is paranoid that this can happen to him though his father was a smoker and had quite a different diet.

My case is less severe. I never had heartburn until I was in my last months of pregnancy. And it went away as soon as the babies were out. Then 8.5 years ago, I broke my arm (running!!!!). They could not set it as the fracture was right under my shoulder blade. I tried to keep it immobile but the least movement would result in severe pain which was treated with opiates until it was decided that I should be cut off though the pain remained. This will not happen again as I have squirrelled them away after every surgery and other pain causing instances. I took high does of ibuprofen, which only dulled the pain but eroded my stomach lining resulting in heartburn. I was taking large amounts of antacids which interfered with my thyroid medication resulting in hypothyroidism. The inactivity (even walking resulted in pain) and hypothyroidism led to obesity. Finally the pain abated, the hypothyroidism dealt with (slow process) and I was able to move again. Off to Italy! Maybe I drank more there or changed my diet but I ate up my 2 month supply of Rolaids in the first 2 weeks.

On our first visit to a town that had a pharmacy (Raino, cherry capital) and armed with 2 weeks of Italian and my roommate who knew a bit of Italian, we went in to see what the pharmacist would give me. They have much more power to prescribe medications there. Come se dice 'heartburn?'
He knew no inglese. My roommate thought the word was 'agita' which I had heard of from watching the Sopranos and thought it meant 'aggravation'. Indeed, agita is the Italian-American word for heartburn (and aggravation) but it is not the medical term, which is brucore di stomaco. I started off rattling off tradenames of acid blockers. I didn't know the generic ones. He eventually gave me some generic Zantac which was very expensive but worked for the duration of my stay. I was fine without it once I got home. Shortly thereafter, I entered Cancerland and said I would need Prilosec to deal with the Adriamycin shredding my stomach lining. I have been unable to wean myself from it even though it has been 7 years. I do take it every other day but get breakthrough heartburn occasionally on the second day. Last year, I cut down my alcohol consumption for a month or so in order to lose weight.. Still needed the stuff. Maybe it is addicting.
Next step, see if I can get away with Zantac.

Other alleged evils, loss of bone density, anemia, kidney disease, C. diff infections. None of this do I have any signs of.

Still ***ing winter here. My running path is covered with wet, slippery snow that I hope a few hours of sun might melt. I am tired of walking in circles in the basement.

Day 17 of my recovery. The mouthful of fishing line seemed to disappear overnight. I must have swallowed it. My nose is almost normal sized. My lip is less swollen but is hard as a rock and numb. The sutures have healed over leaving a large scar. The seristrips have come off but as things seemed to have healed, Have not replaced them.

Senior day at the resale shops.Shall I go out? Going stir crazy here.


Lisa said...

The study concluded that more research is needed to examine the connection between Alzheimer's and proton pump inhibitors. There is a strong link between esophageal cancer and Barrett's esophagitis caused by GERD. Talk to your doctor before taking any action.

Sue in Italia/In the Land Of Cancer said...

My husband will not give up his Prilosec because of the Barrett's esophagitis. He has had the problem for years. Mine is not so severe and I might be able to be weaned but I will check with my doctor.

Elephant's Child said...

My partner relies on his Nexium. I will have to talk to him.


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