Over-the-counter pain relievers and your heart
Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen are and have been the go-to “benign” pain medication for doctors and patients alike. Why? They aren’t addictive, and it’s not easy to overdose. Serious side effects like gastrointestinal ulcers and bleeding seemed to be limited to high doses taken for longer periods or time, or to people with significant medical problems. Even before the era of the opioid epidemic, it was raining NSAIDs, across the country. In 2004, the manufacturer of the NSAID Vioxx pulled it from the market because the drug was associated with serious cardiovascular problems like heart attacks and strokes. Soon thereafter, a related medication (Bextra) was also discontinued due to cardiovascular risks and potentially fatal skin reactions. Not all NSAIDs were caught up in that furor. Some prescription NSAIDs (including celecoxib (Celebrex) and some over-the-counter ones (ibuprofen, naproxen) were thought to be relatively safe. But multiple studies suggest a clear link between all NSAIDs and heart attacks, strokes, and heart failure. In 2015, the FDA strengthened the recommended warning on all NSAIDs: NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied. The latest on NSAIDs and r...
Atypical chest pain is of diverse origin. Typically, we initially consider cardiac etiology. When pain appears non-cardiac, there is a tendency to underestimate the illness, especially if the patient has neuropsychiatric illness. Our resident with dementia and anxiety disorder had chest pain; the diagnosis was unexpected.
We present a rare case of hemichorea associated with a hemorrhagic stroke in the contralateral striatum.
West Nile Virus (WNV) infection is the most common mosquito-borne illness in the United States. Most cases are asymptomatic or with mild symptoms. Older adults are more likely to have central nervous system (CNS) involvement, and a higher risk for mortality.
Chronic pain is common among older adults, as is the use of medications to treat these symptoms. Aging physiology, in combination with a higher likelihood of medication use and declining renal function, makes older adults more susceptible to adverse drug effects. As such, monitoring for side effects and changes in renal function is important to avoid drug toxicity, especially during acute illness when medication errors and acute changes in renal function are more likely to occur among older adults.
Many patients are discharged to post-acute care facilities (PACFs) following surgery. These patients have either had major surgery and require close monitoring and intensive rehabilitation, or have significant medical co-morbidities. Currently they are transported, sometimes at considerable cost, to the surgeon ’s office for post-surgery visits (PSVs). These trips can be painful and uncomfortable. A staff member from the PACF may need to accompany the patient. During PSVs surgeons observe the patient's incision(s), and assess potential complications following surgery, pain, and functional recovery.
Heart failure (HF) is a leading cause of mortality and hospital readmissions in the United States. A large proportion of these patients are readmitted from skilled nursing facilities (SNF). The implementation of quality initiatives, such as staff education, to recognize early measures of clinical instability could improve HF management at these facilities.
The geriatric population is at high risk of severe low blood glucose (LBG) events due to diminished homeostatic mechanisms, especially on hypoglycemic medications. Moderate to severe LBG events in these patients can contribute to behavior changes such as agitation, change in level of consciousness, disruption of sleep, instability and increased risk of myocardial infarction, stroke and falls. Rapid recognition and appropriate treatment and prevention of LBG and recurrences can reduce risk for hospitalization in the geriatric population.
Chronic pain is among the most common reasons for seeking medical attention. In the United States, 1 in 5 adults had chronic pain in 2016 and it is estimated to cost over $500 billion annually in direct medical costs and disability. It is a prevalent problem among residents in the nursing home. Non-pharmacologic therapies are the most preferred treatment for chronic pain as pharmacological therapies, such as opioids, have proven to be less effective and associated with numerous side effects among older adults.
I love my work as a post-acute and long-term care geriatrician, and as a hospice and palliative medicine specialist. I freely admit that. Yes, there are plenty of headaches, including administrative and regulatory burdens, and there ’s the unfortunate reality that lots of the patients I become fond of die. But I believe that most of Caring’s readers feel the same way. In fact, I believe most people who choose to devote their life’s work to providing care to the vulnerable, dependent, and ill patients we look after love th eir work and consider it a calling — including arguably the most important mem...
Publication date: Available online 25 February 2020Source: Mutation Research/Genetic Toxicology and Environmental MutagenesisAuthor(s): Yu Gao, Ping Wang, Yinping Su, Zhaonan Wang, Lin Han, Jie Li, Yinghua Fu, Fengling Zhao, Quanfu Sun, Yumin Lyu
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