Med­i­ca­tion must be bal­ance of risk and re­ward

Cape Breton Post - - ADVICE / LIFESTYLES / BUSINESS - Keith Roach

DEAR DR. ROACH: Please tell me about Cele­brex. I am 86 years of age. I took it 15 years ago, and it helped me not to be so stiff. Now my present doc­tor will not pre­scribe it for me. I have tried sev­eral dif­fer­ent med­i­ca­tions, but I don’t get the re­sults I got with Cele­brex. It never both­ered my stom­ach, and I want to take it again. — D.A.

AN­SWER: Cele­coxib is a rel­a­tively new drug, hav­ing been re­leased in 1999. Its long-term safety is not as well-es­tab­lished as that of other med­i­ca­tions. Like sim­i­lar medicines, cele­coxib can cause acute kid­ney fail­ure in a small num­ber of peo­ple, es­pe­cially those with pre-ex­ist­ing kid­ney dis­ease. Al­ler­gic re­ac­tions are pos­si­ble with any med­i­ca­tion. Stom­ach prob­lems, es­pe­cially ul­cers, hap­pen at lower rates than with other med­i­ca­tions, such as aspirin, ibupro­fen or naproxen.

The most im­por­tant risk, and the one that prob­a­bly has caused your doc­tor to not want to pre­scribe it, is the in­creased risk in heart dis­ease. A re­lated med­i­ca­tion, ro­fe­coxib (Vioxx), was re­moved from the mar­ket when stud­ies showed an 80 to 130 per­cent in­crease in heart at­tack risk among ro­fe­coxib users, com­pared with other anti-in­flam­ma­tory drugs. Cele­coxib has an in­creased risk as well, but it is es­ti­mated to be about a 35 per­cent in­crease in risk, based on a 2011 study. This trans­lates to roughly 1.5 more heart at­tacks per thou­sand peo­ple per year.

The ma­jor ben­e­fit of cele­coxib you know al­ready: It helped with your pain and stiff­ness. You might not know that it may re­duce your risk of colon can­cer, or that it has lit­tle bleed­ing risk com­pared with other anti-in­flam­ma­tory medicines, es­pe­cially aspirin.

I had pa­tients who were bit­terly dis­ap­pointed when Vioxx was re­moved from the mar­ket and who were more than will­ing to ac­cept the in­creased risk of heart dis­ease be­cause it was the only med­i­ca­tion that helped their arthri­tis symp­toms. Although I don’t rec­om­mend cele­coxib as a first-line treat­ment, I would con­sider its use in peo­ple who haven’t had good re­sponse to other agents, who are at gen­er­ally low risk for heart dis­ease and who do not have kid­ney prob­lems, pro­vided they un­der­stand and ac­cept the in­creased risk for heart dis­ease.

Let me end with the re­minder that ex­er­cise may be the best treat­ment for arthri­tis, since it im­proves func­tion, re­duces pain and has in­nu­mer­able other ben­e­fits, with low risk.

DEAR DR. ROACH: I am a 58year-old male with well-con­trolled di­a­betes with­out med­i­ca­tions (my A1C was 7.3, and has been steady at 5.9 for eight years). A few years ago I tried a low-fat ve­gan diet. While on that diet, my energy level dra­mat­i­cally in­creased, but I was forced to quit be­cause of the in­testi­nal gas and di­ar­rhea, which could be only par­tially con­trolled with mas­sive doses of pro­bi­otics. Do you have any di­etary sug­ges- tions for the pos­i­tive ef­fects with­out the neg­a­tive? — T.P.V.

AN­SWER: It is likely that the high fiber in your ve­gan diet was re­spon­si­ble for the ab­dom­i­nal symp­toms. What I would rec­om­mend is to make only a grad­ual change in your diet, al­low­ing your sys­tem to ad­just to the new foods. Veg­e­tar­ian (but not ve­gan) di­ets, with an­i­mal pro­tein in amounts much smaller than the stan­dard North Amer­i­can diet, are gen­er­ally healthy, and you don’t need to go strictly ve­gan to get many health ben­e­fits. I would al­low weeks or even months to let your body adapt to the diet, if needed.

The book­let on Di­a­betes pro­vides in­sight on its di­ag­no­sis and treat­ment. Read­ers can or­der a copy by writ­ing: Dr. Roach — No. 402, Box 536475, Or­lando, FL 32853-6475. En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Al­low four weeks for de­liv­ery.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­ or re­quest an or­der form of avail­able health news­let­ters at P.O. Box 536475, Or­lando, FL 328536475. Health news­let­ters may be or­dered from www.rb­ma­ (c) 2015 North Amer­ica Syn­di­cate Inc. All Rights Re­served

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