Is it safe to take heartburn medication on a long-term basis?

Posted May 31, 2013, 2:00 am

I’ve been taking Prilosec for years to prevent heartburn. My wife doesn’t think it’s safe to take any drug for that long. What do you think?

I’ve said it before, but I think it bears repeating: No drug is 100 percent safe. That doesn’t mean that you shouldn’t take one if you need it. But you should continually weigh the risks and benefits.

Prilosec is a proton pump inhibitor (PPI), a drug that reduces stomach acid. We need stomach acid to help digest food, but in excess or in the wrong place, it’s a menace. It can inflame and irritate the esophagus, causing heartburn. (Recurring heartburn is called gastroesophageal reflux disease, or GERD.) It can also contribute to ulcers in the stomach and small intestine.

PPIs are the most commonly prescribed drugs for acid reflux and heartburn. PPIs include lansoprazole (Prevacid), omeprazole (Prilosec) and esomeprazole (Nexium).

Like you, people often take PPIs every day for years. This makes sense if you have a chronic problem with stomach acid, but the occasional case of mild heartburn does not need to be treated with a PPI. For that kind of spot duty, antacid medicines such as Tums, Rolaids and Maalox will likely do the trick. They directly counteract acid in your stomach. So will drugs like cimetidine (Tagamet), famotidine (Pepcid) and ranitidine (Zantac). Like the PPIs, these drugs cause your stomach to make less acid, but they work faster than PPIs.

You can also tackle your heartburn with changes that don’t involve taking anything. Eat smaller meals and cut back on alcohol. If you’re heavy, lose weight. Raising the head of your bed should also help.

As a long-term PPI user, you should also consider the possible drug interactions and side effects of PPIs. They may decrease the effectiveness of clopidogrel (Plavix, others), a medication that helps prevent artery-clogging blood clots. (This is controversial, and irrelevant if you’re not taking clopidogrel.)

In addition, people taking PPIs seem to be more likely to get pneumonia than those who aren’t. Why would a medicine that reduces stomach acid make you vulnerable to pneumonia — a lung infection usually caused by bacteria? Because some cases of pneumonia come from regurgitating stomach contents up into the throat and having some of these contents drop down into the lungs. Since acid kills bacteria, stomach contents that are low in acid are more likely to contain bacteria.

Stomach acid also helps you absorb calcium in your diet. Theoretically, that might mean that long-term use of PPIs would make you vulnerable to thin bones (osteopenia or osteoporosis). However, the evidence for that is weak. Experts do not recommend, for example, that people taking long-term PPIs get bone density tests, or take calcium pills.

Even if you have a prescription for a PPI, you and your doctor should review the reasons for it periodically to make sure they’re still valid. If you do need that prescription — and many people do — it should be for the lowest effective dose.

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False-Positive Mammograms Can Trigger Long-Term Distress

For some, anxiety persisted up to 3 years after being declared cancer-free, study finds

By Kathleen Doheny

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Women who have a false-positive mammogram result -- when breast cancer is first suspected but then dispelled with further testing -- can have lingering anxiety and distress up to three years after the misdiagnosis, a new study finds.

The emotional fallout is probably so long-lasting, "because the abnormal screening result is seen as a threat to your own mortality," said study author Dr. John Brodersen, a researcher at the University of Copenhagen in Denmark.

The report is published in the March-April issue of the Annals of Family Medicine.

False-positive mammograms are often cited by public health experts as a downside to mammography screening that needs to be considered when making recommendations about who should be screened, at what age and how frequently. They aren't uncommon: the risk of a false positive for every 10 rounds of screening ranges from 20 percent to 60 percent in the United States, Brodersen said.

After an abnormal mammogram, doctors typically order additional mammograms and, depending on those results, more tests such as an ultrasound or MRI, and finally a biopsy.

Studies about the short-term and long-term consequences of false-positive mammogram results have produced mixed findings, which Brodersen said spurred him to conduct his study. He evaluated more than 1,300 women, including 454 who had abnormal findings on a screening mammogram and others who received normal results.

Of those 454 who first had abnormal results, 174 later found they had breast cancer. Another 272 learned the result was a false positive. (Eight others were excluded from the study due to unknown conclusions or a diagnosis of cancer other than breast cancer.)

The women answered a questionnaire about their psychological state, such as their sense of calmness, being anxious or not about breast cancer and feeling optimistic or not about the future. They repeated the questionnaire at 1, 6, 18 and 36 months after the final diagnosis.

Six months after the final diagnosis, those with false positives had negative changes in inner calmness and in other measures as great as the women with breast cancer. Even at the three-year mark, women with false-positives had more negative psychological consequences compared with women with normal findings.

The differences among those with normal, false-positive and breast cancer findings only began to fade at the three-year mark, the study found.

Brodersen can't say if women who were more anxious about health or life in general to begin with were more likely to have long-term distress. "I have not investigated this aspect," he said.

Even without this information, the study is a good one, said Matthew Loscalzo, the Liliane Elkins Professor in Supportive Care Programs at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

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False-Positive Mammograms Can Trigger Long-Term Distress

Title: False-Positive Mammograms Can Trigger Long-Term Distress
Category: Health News
Created: 3/19/2013 10:35:00 AM
Last Editorial Review: 3/19/2013 12:00:00 AM

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Erectile Dysfunction Tied to Long-Term Narcotic Use in Men

In study, more men on impotence meds were taking opioids for chronic back pain

By Serena Gordon

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- If you're a man, the pain-killing medications known as opioids may do more than relieve pain -- they may also put a damper on your sex life.

A new study found that men who were prescribed medications for erectile dysfunction or low testosterone levels were more likely to be taking opioid (narcotic) medications for chronic back pain.

"People who have persistent pain problems need to know that a potential side effect of long-term opioid use may be erectile dysfunction," said lead study author Dr. Richard Deyo, a clinical investigator for the Kaiser Permanente Center for Health Research in Portland, Ore. "This is not a well-known potential side effect among patients, and it should be considered when thinking about treatment."

Deyo also noted, however, that "the nature of this study as an observational study limits our ability to make a causal [cause-and-effect] inference. Opioid use and erectile dysfunction seem to go together, but we have to be cautious about saying one causes the other."

Results of the study were published in the May issue of the journal Spine.

More than 4 million people use opioids on a regular basis, Deyo said. Commonly prescribed opioids include hydrocodone, oxycodone and morphine. In this study, use of opioids was considered long-term if patients used them for more than 120 days, or more than 90 days if more than 10 prescriptions were filled for the drugs.

The study included data on about 11,000 men who had back pain. In that group, more than 900 received medications for erectile dysfunction or testosterone replacement. Those who were given prescriptions for erectile dysfunction medications or testosterone were older than those who didn't get such prescriptions. They also were more likely to have depression and other health conditions.

And those who were taking erectile dysfunction medications or testosterone tended to be smokers or users of sedative medications, according to the study.

Erectile dysfunction drug prescriptions were for sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

Age was the most significant factor in getting a prescription for erectile dysfunction, according to the study. Men between the ages of 60 and 69 were 14 times more likely to receive a prescription for an erectile dysfunction medication than men who were between 18 and 29.

After adjusting the data to account for other possible factors, including age, the researchers found that men who took opioid pain medications for long periods were about 50 percent more likely to take erectile dysfunction medications or testosterone replacement therapy.

Dr. Daniel Shoskes, a professor of urology at the Cleveland Clinic's Glickman Urological and Kidney Institute, said the study doesn't prove that the pain medications cause the erectile dysfunction.

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Few plan for long-term care though most will need it

Posted May 06, 2013, 2:09 pm

Two of every three Americans who reach age 65 will at some point need long-term care for up to three years. Yet the majority of those age 40 and older have done “little or no planning” for how they might pay for long-term care when they get older.

That’s a key finding from a new survey of 1,019 Americans over age 40 on the topic of long-term care. The survey was done by the Associated Press and NORC at the University of Chicago. Other interesting results:

Most people underestimate the cost of nursing home care (it averages $6,700 a month) and overestimate what Medicare will cover.Few people are setting aside money for long-term care even as most worry about key issues of aging such as memory loss or being a burden to family members.Many people support public policy options for financing long-term care, either through tax incentives to encourage saving for long-term care or a government-administered plan.

As a primary care doctor, I see my patients struggle with how the cost of age-related care affects their lives and their financial realities. Long-term care costs are huge. We can’t afford not to think about them.

The U.S. Census Bureau estimates that $217 billion will be spent in 2015 on nursing home and residential care. This includes assisted living facilities and board and care homes. Currently, about 25% of these costs are paid out-of-pocket by older adults and their families. Almost two-thirds of the cost is paid by Medicaid and Medicare combined.

Medicare only pays for short-term care—20 days in a nursing home—when illness causes disability. After that, patients or their families must meet these costs out-of-pocket. Most older adults with chronic needs then “spend down” their funds to pay for long-term care until the money runs out. At that point, at poverty level, Medicaid support may be available.

Without a crystal ball, it’s tricky to plan for the future. It’s easy to convince yourself that you or a partner won’t need long-term care. But the statistics suggest you should start planning now, even if your plan isn’t perfect.

1. Talk with your family. Nearly 60% of older people who need long-term nursing or personal care rely fully on unpaid caregivers, usually their children or spouses. Sometimes this is an obvious arrangement. But your family must be flexible and committed. If a caregiver must stay at home, some family income will be lost. This is rarely a comfortable situation if everyone did not agree ahead of time.

2. Consider long-term-care insurance. Fewer than 3% of American adults have purchased a long-term care insurance policy. The average cost is high. A typical plan might cost $3,300 a year for a healthy 60-year-old couple. And it might pay only a $150 a day for up to 3 years. For a person who buys this insurance at age 65, there is a 45% chance of making a claim. If you never need long-term care, the payments you made to the plan are lost.

3. An “age in place” retirement arrangement might be right for you. Some campus-like retirement communities are designed to permit an older adult to “age in place.” This means you can go from a relatively independent life to a more dependent life while staying in the same community. Services often include recreation for the active elderly and 24-hour skilled nursing or rehabilitation services for the frail elderly. These organizations are called continuing care retirement communities. They are always expensive. Usually, they charge an up-front fee of $25,000 to $500,000. Then you pay a membership fee or rent each month.

4. Build up your savings. Making ends meet is a challenge. But in your working years, don’t underestimate how much you need to save. Many of us think, “After we no longer have our mortgage, we should be able to live on our savings.” It’s a good idea to factor long-term care into your savings plan. If disability strikes, you will need it.

5. Write an advance directive (“living will”). Some people receive intensive medical care after they become profoundly disabled. By then, some people who are in this situation are no longer able to communicate their wishes to family members and doctors. If you know that you would not want life-sustaining treatments in this condition, it is wise to record your wishes in a legal “advance directive.”

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Breast Cancer Radiation Has Long-Term Heart Effects: Study

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Lap-Band Shown Effective for Long-Term Weight Loss

Jan. 18, 2013 -- More than 200,000 weight loss surgeries are performed each year in the U.S.

Several recent studies have questioned the effectiveness and safety of one type, gastric banding, which has led to a decline in its use as patients choose other surgical options.

But the largest and longest study yet of the procedure found that patients followed for up to 15 years maintained significant weight loss -- an average of about 60 pounds.

About half the patients in the study needed additional surgeries to adjust the bands or deal with other complications, but only about 1 in 20 patients opted to have the bands removed.

Researcher Paul O’Brien, MD, of Melbourne, Australia’s Monash University, was a pioneer of the Lap-Band procedure, and his latest study was supported by Allergan Inc., which markets the gastric band system.

He says gastric banding offers an effective, reversible, long-term solution for weight loss as long as patients get good follow-up care and are willing to carefully control the way they eat.

The study is published in the January issue of the Annals of Surgery.

“Placing the band is just the first step in the process,” he says. “Compliance and follow-up are critically important. There are plenty of people out there doing this surgery without a follow-up program for their patients, and they are setting them up for failure.”

The Lap-Band procedure is one of several weight loss surgeries performed in the U.S. and the only one that is easily reversible.

The band is an inflatable silicone ring that is wrapped around the upper part of the stomach to create a pouch the size of a golf ball, which limits the amount of food that can be eaten. The band can be tightened or loosened to increase or decrease the size of the opening to the lower stomach.

The most commonly performed type of gastric bypass surgery also reduces the size of the stomach to that of a golf ball. The surgery also bypasses a section of the small intestine, which limits calorie absorption.

The gastric sleeve procedure involves the surgical removal of a portion of the stomach to create a "sleeve" that connects to the small intestine.

Just a few years ago, gastric banding was widely seen as less risky, less costly, and less invasive than either of the other surgical options, and about half of weight loss procedures in the U.S. involved banding.

But that has changed as the long-term data comparing weight loss surgeries has come in, says Ronald H. Clements, MD, who directs the bariatric surgery program at Vanderbilt University Medical Center in Nashville.

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