Re: Sue - COX-2s, ulcers, etc.

[Guest guest]

In a message dated 05/05/2004 12:59:18 Central Standard Time,

Matsumura_Clan@... writes:

> Sorry, this wasn't close to being brief.

>

>

>

>

Dearest

What you don't have in brevity you more than compensate for in being

thorough. I think I can " speak " for everyone in saying we are damned

grateful!!!

Cary

[Guest guest]

,

Thanks for the explanation and all of the articles you've sent. I have

had a prior GI bleed, and I am over 60. I have osteoarthritis along

with RA. Enbrel doesn't do anything for osteoarthritis, so that's

mainly why I take the Bextra. Tylenol doesn't have much effect on me. I

know what to look for on my labs that indicate bleeding, so I'll be on

the lookout for anything suspicious there. Also, if I have any stomach

discomfort, I'll be suspicious. It's funny, but I didn't have much pain

with the ulcer before, just a little stomach discomfort. I had a friend

who had ulcers, and she had a lot of pain, so I guess I was lucky.

Sue

On Wednesday, May 5, 2004, at 01:55 PM, wrote:

>

> In the meanwhile, a " poor girl " like you might inquire about adding a

> medication to protect your gut to your Bextra (pricey, but it may be

> safer). This is your doctor's call, but, if you've had a prior GI bleed

> and you are older than 60, there are recommendations by some that

> either

> a PPI or misoprostol be used in addition to whatever NSAID or

> COX-2 you're on. If you are worried about the cardiovascular risk of

> the coxibs, switching to a nonselective NSAID plus a gastroprotectant

> is

> another option. Depending on the nature and source of your pain,

> switching from an NSAID or coxib to acetaminophen also may be something

> to consider.

[Guest guest]

What a sweet thing to say. Thanks so much, Cary!

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

----- Original Message -----

From: <Birdijo@...>

> Dearest

> What you don't have in brevity you more than compensate for in being

> thorough. I think I can " speak " for everyone in saying we are damned

grateful!!!

> Cary

[Guest guest]

Sue, prevention, not monitoring, is the best defense. The problem with

GI adverse events is that they may, and very often do, occur without

warning. There may be no pain or other symptoms prior to big trouble.

Check out this passage:

" However, studies have demonstrated that a large percentage of patients

do not experience warning symptoms prior to serious GI complications. In

the majority of ulcer cases, the first symptom can be a serious GI

complication. One single-center study evaluated the incidence of NSAID

use in 235 patients who died or required surgery for a bleeding or

perforated ulcer during January 1983 to December 1985. NSAID use was

reported in 60% (141/235) of these patients. Among the patients

receiving NSAIDs, 58.2% of patients did not have a history of dyspepsia

before their event.[15] The lack of correlation between symptoms and

serious GI events also was confirmed in an ARAMIS study conducted among

1921 RA patients. Of the patients who required hospitalization for

NSAID-induced GI complications, 80% of patients did not experience prior

symptoms.[16] "

The above is an excerpt from " Clinical Considerations for Gastric

Protection in the Presence of NSAID Therapy " :

http://www.medscape.com/viewarticle/473972_16

Sometimes, too, when people try Tylenol or other OTC meds, they aren't

using enough. For OA, many physicians advise taking up to 4000 mg of

acetaminophen per day, circumstances allowing. Of course, I'm not

recommending that anyone use any amount of OTC analgesics without first

consulting a physician.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] Sue - COX-2s, ulcers, etc.

> ,

>

> Thanks for the explanation and all of the articles you've sent. I have

> had a prior GI bleed, and I am over 60. I have osteoarthritis along

> with RA. Enbrel doesn't do anything for osteoarthritis, so that's

> mainly why I take the Bextra. Tylenol doesn't have much effect on me.

I

> know what to look for on my labs that indicate bleeding, so I'll be on

> the lookout for anything suspicious there. Also, if I have any

stomach

> discomfort, I'll be suspicious. It's funny, but I didn't have much

pain

> with the ulcer before, just a little stomach discomfort. I had a

friend

> who had ulcers, and she had a lot of pain, so I guess I was lucky.

>

> Sue