Weekly View » Jane Pauley Community Health Center http://weeklyview.net Serving your community from Downtown East to Greenfield, North to Lawrence & Geist, and South to Beech Grove, New Pal & Southport Thu, 23 Apr 2026 05:11:02 +0000 en-US hourly 1 http://wordpress.org/?v=3.5 He said, NSAID http://weeklyview.net/2015/07/30/he-said-nsaid/ http://weeklyview.net/2015/07/30/he-said-nsaid/#comments Thu, 30 Jul 2015 05:09:01 +0000 Weekly View http://weeklyview.net/?p=8860 Continue reading →]]> You might have heard about some new warnings about NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These are a popular group of medications that many of us use to combat fever, headache, and various muscle and joint aches and pains. Included are the common over-the-counter (OTC) medications ibuprofen (Advil and Motrin) and naproxen (Aleve), as well as multiple prescription NSAIDs. Aspirin is also an NSAID, but aspirin is in a special category and excluded from the newest specific warnings. Acetaminophen (e.g. Tylenol) is also very useful for fever and aches and pains, but it is not an NSAID and is also excluded from the new warnings. The NSAIDs fight fever and pain whenever such are caused by inflammation, the process commonly involved when your body is fighting off an insult.
In 2005 the Federal Drug Administration (FDA) issued warnings that NSAIDs carry increased risks of heart attack and stroke, in addition to the known risks of severe stomach or other gastrointestinal bleeding. Now 10 years later, the FDA has strengthened the original warnings after studying additional data. A boxed warning (also called “black box warning”) is a special notice enclosed in a box on the medication label, on the package insert, and on advertisements. It’s the highest level warning that a medication can carry and remain on the market in the United States. One component of the boxed warnings is that the increased risk of heart attack and stroke exists even after only a short time of use (e.g. a few weeks), so there is significant risk even for the occasional user of these medications. People with known cardiovascular disease are at highest risk, but even those without known disease are also at risk. The risks are higher with higher doses and for longer treatment times. These medications should be completely avoided in the weeks following a heart attack.
NSAIDs and aspirin both affect the blood cells called platelets and affect their ability to form clots. (A clot in an artery feeding the heart or brain means a heart attack or stroke.) Although aspirin is an NSAID, the mechanism of action is different overall than that of the NSAIDs, and aspirin is actually protective against heart attack and certain kinds of strokes.
If this seems confusing or contradictory, it’s because it is a little complicated. Aspirin, NSAIDS, and acetaminophen are all common OTC medications used for fever and pain from a variety of causes. They each have several primary benefits and risks. A very limited summary is:
• “Non-Aspirin” NSAIDs (e.g. Aleve, Motrin, naproxen). Benefits – Fever and pain relief. Risks – Increased risk of peptic ulcer disease and bleeding, increased risks of heart attack and stroke, even during relatively short treatment periods.
• Aspirin (NSAID, e.g. Bayer Aspirin). Benefits – Fever and pain relief, protection against heart attacks and certain strokes. Risks – Increased risk of peptic ulcer disease, increased bleeding tendency.
• Acetaminophen (not an NSAID, not anti-inflammatory). Benefits – Fever and pain relief. Risks – Primarily liver damage, especially at doses exceeding the recommended daily maximum of 4,000 mg (8 maximum strength 500 mg tablets per day).
So what to do the next time you have a headache, muscle ache, or fever associated with a mild viral illness? As you can see from the above discussion, it depends on your particular medical history, and is best discussed with your primary care provider (PCP). For a couple of days, it might not matter which of the three groups you choose from, but if I had had a recent heart attack or a family history of heart attack or stroke, or I needed to take an NSAID for an extended period or often, I would pass on the NSAIDs and discuss it with my PCP.
Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at AskDrFleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).

]]> http://weeklyview.net/2015/07/30/he-said-nsaid/feed/ 0 New Year’s Resolutions http://weeklyview.net/2015/01/22/new-years-resolutions/ http://weeklyview.net/2015/01/22/new-years-resolutions/#comments Thu, 22 Jan 2015 06:09:08 +0000 Weekly View http://weeklyview.net/?p=7160 Continue reading →]]> Did you make New Year’s resolutions? Diet? Stop smoking? Good for you, but as we begin 2015, please consider adding a few more items to your “To Do” list for this year. We will mention recommendations first for all people in general, then those specifically for men, and finally recommendations for women. All:
1. Update your immunizations. For most adults, these would likely include immunizations for influenza, pneumonia (1 or 2 shots), tetanus and pertussis (whooping cough), and shingles.
2. Check and know your numbers. Know your blood pressure and know what’s normal (18-59, less than 140/90, age 60+, <150/90). These are the latest general recommendations, but there are many considerations depending on age, race, and specific conditions. Know your total cholesterol, as well as the breakdown of the good and bad cholesterol. If you have diabetes, know your sugar before breakfast (fasting) and supper, and know your A1C. A1C is the number that indicates diabetic control over a period of a month or so and doesn’t depend on the hour by hour fluctuations in sugar with meals and exercise.
3. Get a screen for colon cancer, which is largely preventable with meticulous adherence to screening recommendations. Get a check for hidden blood in the stool annually, and a colonoscopy every ten years if previous is normal.
4. If you’re a baby boomer, ask your provider for a blood test for hepatitis C, a liver virus common in this age group.
5. If you use tobacco in any form, make this the year to stop. Your primary care provider (PCP) can help. Limit alcohol intake, if at all. Men should drink no more than 2 drinks per day, and women should limit to one. Of course, if you are pregnant or think you might be, don’t drink alcohol at all. Do not use drugs — oral, inhaled, or intravenous. Seek help if you think you might have a problem with addictions.
6. Get a screen for depression and partner violence.
7. Consider a screening ultrasound for peripheral vascular disease and aneurysm. This will include checking the carotid arteries in the neck that could lead to stroke, the abdominal aorta for an aneurysm (dangerous bulge), and the arteries in the legs for blockages that could lead to non-healing ulcers and even the loss of a limb.
8. Get a screen for diabetes, especially if you have high blood pressure.
9. Practice safe sex and avoid serious to life-threatening sexually transmitted infections. Limit sexual partners.
10. Consider taking a daily 81 mg coated aspirin (“baby aspirin”) to help prevent stroke and heart attack.
Men:
1. Get an annual prostate check at your PCP office that includes a blood test for PSA (prostate specific antigen).
2. Erectile dysfunction is common after age 50, and it can be treated. But not if you don’t ask, so don’t be shy.
Women:
1. Get an annual mammogram and clinical breast exam at your PCP office.
2. Make sure your Pap test is current. Testing now begins at age 21, and should be done every 3 years through age 29. At ages 30-65, the testing interval can be extended to 5 years if “co-testing” is done and negative. Co-testing refers to doing both the Pap test and a test for HPV (human papilloma virus).
3. At age 65 and over, get a DEXA screen for osteoporosis (thinning bones that increase risk for fracture).
These are the latest general guidelines and recommendations. These should only be pursued in a team effort with your PCP. If these seem complicated or overwhelming, remember that you only need to remember to have at least an annual checkup with your PCP. You do have one, right? Wishing you all a happy and healthy 2015!

Dr. Fleming is the Medical Director of The Jane Pauley Community Health Center (closely affiliated with Community Health Network). Ideas for this column can be e-mailed to Dr. Fleming at AskDrFleming@gmail.com. Or you can write your medical questions to Dr, Fleming at Ask Dr. Fleming, 8931 E. 30th Street, Indianapolis, IN 46218. On written correspondence, please include your name and city (names will not be published).

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