Today we’re going to consider some questions that our patients have recently posed.
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“Doc, I’ve got bad indigestion – reflux they call it – and have been on stomach medicine for years. My sister-in-law tells me it can cause problems if I take that stuff for too long? Is she goofy? Wait, let me rephrase that. Does she know what she’s talking about?”
I couldn’t address the part about her being goofy, but she was on to something regarding the long-term use of “stomach medicines”, including histamine type 2 blockers (Tagamet) as well as the proton pump inhibitors (Prevacid). Long-term use (greater than two years) can be associated with the development of B12 deficiency. That makes sense, since these drugs alter the acid content in our stomachs, reducing the absorption of this important vitamin. A recent study in JAMA indicates this can increase our odds of developing this problem by as much as 25-50%. And it’s important because of the consequences of this deficiency. Not only does it cause an anemia, but it can also lead to neurologic and peripheral nerve problems. But many of us need these medicines long-term. Just be sure to talk with your physician and make sure she’s keeping an eye on things.
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“What’s the big deal about vitamin D? Is that stuff really good for you?”
This is another instance where “knowing your numbers” is important. I’ve shared with you before that as many as 75% of the patients we test in our clinic have low levels of this vitamin, with many being significantly deficient. We’ve talked about the importance of this nutrient and by now you should know of its importance. But here’s something else – hot off the press – about some new findings. First, how common is osteoarthritis, especially of the knees? We’re talking about the wear-and-tear of normal living and the pain associated with deteriorating joints – and it’s very common. This problem causes a lot of pain, loss of mobility, and decreased enjoyment of daily living. Anything that can lessen these age-related changes would be helpful and welcomed. This may be where vitamin D comes in, or at least according to some authors in a recent orthopedic trial. They determined that in patients with known osteoarthritis (OA) of the knees and low vitamin D levels, supplementation and correction of this deficiency was associated with an improvement in the amount of pain these patients were experiencing. This was a pilot study and more research needs to be done, but here are a couple of points: If you have OA, get your vitamin D level checked and if low, start taking some. In this particular study, the time span to see improvement was 12 months, so be patient. The good news is that vitamin D is seldom toxic and can be safely taken. Again, talk with your health-care provider.
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“Dr. Lesslie, I want you to have a seat in that chair. We’re going to get a few things straight.”
Elsie Miller, all eighty-nine years of her, sat on the exam table and pointed a long, slender finger at my nose. She reminded me uncomfortably of my fifth-grade teacher.
I sat down.
“Now, let me explain myself.” She folded her hands in her lap and studied me over her bifocals. “I’ve just moved here from New Hampshire – came to help take care of my daughter.”
For the first time, I noticed the middle-aged woman sitting in the corner of the room. She looked up at me, smiled, and shook her head.
“I hope you doctors are not all the same,” Elsie continued. “My family doctor back in Manchester was all about testing this and studying that. He wanted to get blood work every time I went to his office. You can check my record – I’m in excellent health and don’t take any medication. Don’t intend to.”
She leaned closer and I couldn’t help backing into the wall behind me.
“You’ve noticed, I’m sure. I’m eighty-nine. On my last visit – my son who still lives in New Hampshire insisted I go – the doctor tried to schedule me for a colonoscopy. A colonoscopy! And I asked him what he intended to do if he found anything. Well he just sat there, and was about as helpful as last year’s almanac. That was it – I never went back. I’m eighty-nine – did I say that? – and I’m not interested in being poked, prodded, or preached to. And if I decide that you should be my doctor, all I want is your help with whatever comes along. And if you can make some suggestions that make sense to me – something simple – I might consider it. Otherwise…Well, you get the gist of it. What say you?”
It took me a while to say anything. I glanced at her daughter, who was now studying the light fixture on the ceiling.
Elsie made a lot of sense, and I told her so. And I told her I would be honored to help her with anything I could.
“Just no colonoscopy.”
“Deal,” I said, and we shook hands.
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So thanks for your questions, and keep them coming. And thanks Elsie, for helping me consider what we should be about. For most of us, especially physicians, that “reset button” needs to be more than occasionally pushed.
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