Aspirin a day may be doing you harm
‘A daily dose over 10 years increases by tenfold the risk of haemorrhage from the gut for over-75s’
Seven million people in Britain take an aspirin a day to keep the prospect of a heart attack or stroke at bay – though for most, the likelihood of it doing so are minuscule. Thus, 1,666 otherwise healthy people must take a daily aspirin for a year to prevent just one “cardiovascular event” – meaning that 1,665 will do so to no good purpose.
However, they will all be exposed to potential harm that, as reported last week, is considerably more serious than appreciated: some 20,000 patients a year are admitted to hospital with internal bleeding from the stomach, which, in 3,000 cases, proves fatal. The danger for those aged 75 and over can, without hyperbole, be described as alarming where an aspirin a day for 10 years increases by tenfold the risk of haemorrhage from the gut.
So the simple answer to the question “Doctor, should I carry on taking my aspirin?” should be: “No – and you should never have been prescribed it originally.”
The situation is rather different for those who have already had a heart attack, where to prevent one further event, just 66 people need to take a daily aspirin – though again, for the older person this is outweighed by the hazards and is thus similarly inadvisable.
Listen to dreams
The significance of nightmares of being asphyxiated, for example, beneath a sand dune, as indicative of sleep obstructive apnoea, recently mentioned in this column, has prompted family doctor Dick Soper to report the potentially serious consequences of misinterpreting the significance of his own dream-induced nocturnal symptoms.
He is prone to vivid, emotionally intense dreams from which he was woken one night by a brief episode of retrosternal pain that his doctor attributed to acid reflux from him lying horizontally. He did, however, arrange for him to have an electrocardiogram “just in case”, which thankfully proved to be normal. Soon after, when on holiday in Singapore, he had a similar pain climbing stairs and this time his forceful daughter insisted they book a return flight that evening.
Back in the UK, a coronary angiogram showed he had a 96 per cent obstruction of his main coronary artery, for which the cardiologists at Papworth inserted a stent. He has not had a twinge of vivid dream-induced angina since.
Mystery knee pain
This week’s medical query comes courtesy of Mr SD from Peterborough, who, after a sporting life (cricket, football, tennis, squash and badminton), developed at the age of 70 arthritis of the right knee sufficient to warrant replacement by “a top orthopaedic surgeon”. All went well, with no postoperative complications but, perplexingly, his symptoms persisted. “My knee feels as though it is in a clamp,” he writes, and is particularly painful getting in and out of his car or doing the stairs.
His surgeon suggested this might be referred pain from his (also arthritic) hip, which led in turn to a hip replacement that has not improved matters. He has had umpteen X-rays of the joints and lots of physio, but any sort of exertion, such as walking or gardening, remains severely limited. Can anyone with a similar experience, he wonders, provide some insight as to what might be amiss?
Dry-eye solution
Finally, the recent account in these pages by novelist Claire Kendal of the miseries of being afflicted by dry-eye syndrome – due to Sjögren’s syndrome, an auto-immune disorder – has prompted an Oxford reader to report her encouraging experience with the novel treatment of scleral lenses. These are saucer-shaped devices with a reservoir of saline solution that bathes the surface of the cornea throughout the day, keeping it “moist and comfortable”. They are not cheap but, through the Oxford Eye Hospital, she was able to obtain them on the NHS – a useful precedent that might, she hopes, allow others to do likewise.