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Friday, September 17, 2021

Why aspirin remains useful

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Dr. Sylvester Ikhisemojie

Aspirin is one of the oldest medicines known to mankind. Its original extract from the willow tree has been in the service of humans for more than two millennia.

The active agent in this medication is called acetylsalicylic acid and is, therefore, soluble in water. Up till in the mid-19th century, this medication was not formally made as a drug but it took the effort of the chemist, Charles Frederic Gerhardt to compound it in 1853.

It was in widespread usage in the years between that time up till towards the end of the 20th century when it generally fell into disrepute as a result of the increasing number of side-effects that were associated with its use.

One of those common adverse effects was stomach upset and later, stomach pain as well. Others were bleeding from the stomach, making ulcers worse and causing gastric erosion.

It was also blamed for gastric erosion, a severe problem that scrapes the wall of the stomach, scoops up the film of mucus that protects it and exposes the underlying layer which soon begins to bleed.

That increase in the tendency to bleed was found to be worse among the elderly, those people who take alcohol and among those who are already on other pain relievers known as non-steroidal anti-inflammatory drugs, NSAIDs.

Patients already on other blood-thinning drugs such as warfarin and coumarins, could also not take the medicine without the risk of severe consequences. It was seen to be deleterious to pregnant women especially in the last part of pregnancy, the third trimester when mothers tended to bleed excessively and fell into disrepute due to this and other reasons.

The newborns also bled abnormally. In children, it is not recommended for treating those who have an infection due to the risk of causing what is described as the Reye syndrome, a rare disorder in which severe brain and liver damage can occur in youngsters less than 20 years of age undergoing treatment for a viral infection such as chickenpox, measles or common cold.

As a result of this association, it is not a good idea to treat a child’s headache with aspirin. It often takes the blame also for significant abuse in its deployment in the treatment of a high number of conditions.

Nevertheless, Aspirin has again found important uses in the treatment of headaches, pain and fever. It is indispensable in the treatment of rheumatic fever and Kawasaki disease, an acute fever of sudden onset in children less than five years of age whose cause is unknown.

It is also useful in the treatment of pericarditis. It works in the body by acting against the various substances that promote inflammation in the cells and tissues and derives its effectiveness from the deployment of that unique capacity.

It is, therefore, sometimes used in the treatment or prevention of heart attack, stroke and angina. The latter is one of the most common causes of unexplained chest pain. But, when a person has a bleeding disorder, this drug is off-limits. The same is true for anyone who has got asthma or has had a history of suffering allergic reactions to the use of some of the other common NSAIDs such as Indomethacin, Feldene, Diclofenac and Ibuprofen.

The latter drug can make your aspirin less effective in preventing a stroke or heart attack. Aspirin remains one of the most widely used drugs in the world today and the ancient people who first began to use its extract from the willow tree knew of its wonderful therapeutic benefits. However, they did not understand the science behind its use and continued to utilise those benefits until the advent of modern science.

Recently, aspirin has found its niche again and is increasingly being recommended around the world for a host of problems. There are an estimated 50 to 120 billion tablets of this drug dispensed every year and it is available in different doses. It is produced as a 300mg tablet in the United Kingdom and as 325mg in the United States. The smaller dose generally called the Baby Aspirin is available as 75mg in much of the world and as 81mg in North America.

Baby aspirin is also known as low-dose aspirin and is in use today across the world as a necessary preventive medication against stroke, heart attack and angina. It is also found to have the potential to reduce the risk of cancer of the colon and of the oesophagus, while also taking a lot of credit for the reduction of the chances of dying from a heart attack when it is administered soon after such an attack.

Presently, it is being evaluated as potentially effective as well in the treatment of breast cancer. Therefore, baby aspirin is considered a valuable medication for people aged 50 years and above as a preventive medication against these conditions and is taken daily.

Furthermore, it has found good use in pregnant women at risk of pregnancy-induced hypertension and pre-eclampsia. It is agreed in much of the scientific community that when this medication is used in such women beginning from the end of the first trimester of pregnancy, the chances of suffering from pre-eclampsia are greatly diminished.

This potentially protects the unborn baby from severe brain injury and death within the uterus, while also preventing severe consequences of this condition in the mother. In a country like Nigeria where many pregnant women lack adequate access to the hospital for a variety of reasons, this intervention can be life-saving.

As a result of these newfound uses for an ancient medication, aspirin is available in different formats. It is most commonly available as a tablet. It is also available as a suppository. In certain conditions, it can be given as an intramuscular injection or an intravenous one. Aspirin is a white crystalline substance that is a weak acid and reaches boiling point at 140 degrees centigrade.

Overdosage problems can cause severe stomach pain, vomiting, diarrhoea, ringing in the ears, fast or slow breathing, or confusion. Hallucinations can also occur. In some more serious cases, the person may cough up blood or vomit something that looks like coffee grounds, an indication that he is bleeding inside the stomach.

The stools may then appear like tar but can be frankly bloody especially if the amount of internal bleeding is much. Others may experience convulsions and even go into a coma. As a result, the use of aspirin even in the low dose formulation is not for everybody. People who have pre-existing conditions such as hypertension and diabetes may well take it.

Some others with evidence of heart disease and previous strokes ought to be on it. Others who are obese but have no obvious similar condition to any of the above will probably not benefit that well from using it. When there is an identified risk, however, it should be used without hesitation.

For a drug that has been in use for so long, it is an oddity that its mechanism of action was not discovered until 1971, when the British pharmacologist, John Robert Vane, showed how aspirin worked by suppressing certain active proteins in the body. For this discovery, he won the Nobel Prize in Medicine in 1982.

The drug was named Aspirin by the pharmaceutical giant Bayer in 1899 and it has stuck since then, even though Hippocrates had referred to the art of reducing fevers using salicylate tea as far back as 400 BC. People who need to take aspirin must seek an audience with a doctor or pharmacist before starting its use.

It should be appreciated that people with certain conditions such as haemophilia must not even take this medicine. It can also cause anaemia from red blood cell destruction in people who suffer from Glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency), an inherited enzyme defect in which that factor is missing.

People with kidney disease, high uric acid levels, and gout should also not take this medication because it reduces the ability of the kidney to excrete uric acid and may thus exacerbate this condition. It is also not recommended for patients with retinal vein occlusion (RVO) even though this is essentially an accident involving abnormal blood clot formation in that vessel.

On the balance, aspirin is a beneficial medication that has been with us in various forms from ancient times. New uses have now been found for it and while new research continues to validate its usage for even more conditions, there can be no doubt about its continuing relevance to daily health care needs going forward.

It continues to save numerous lives and prevent tragedy in others. It looks set to find new uses in the near future including in the domain of cancer prevention and treatment.

Questions and answers

Dear doctor, I have a boil in my right armpit that keeps reappearing. It is sometimes painful and then it will just open up and start bringing out pus. I have been using different types of antibiotics but it has never fully healed. This has been going on now for about four months and it only happens on the right side. What do I do and what is the possible cause of this? I am a 43-year-old woman with four children. Thank you.0802xxxxxxx 

This may just be a carbuncle which is a hair-root infection like we discussed several weeks ago. The possibility here is that you have not seen a healthcare practitioner to advise you on the best medication or combination of medications to use. So the first thing you need to do is to go to the hospital nearest to you, see the doctors there and let them examine you properly.

Afterward, a swab of any discharge if you have any at present, will be obtained for culture and a good antibiotic can then be used to deal with this problem. If, however, this is not a carbuncle then it may need to be removed surgically under a local anaesthetic.

Dear doctor, thank you for taking an interest in my case. Kindly be specific to a layman like me what triple regimen therapy means to my ulcer and its cure within a month. I shall be immensely grateful to you for the information. 0912xxxxxxx

The problem, as I see it, is that you are reluctant to see a doctor for the necessary follow-up that you so much need. In the first instance, we are not at all certain that you even have an ulcer. It was not proven through any reliable investigation and we are just following your treatment as you take cimetidine over several years.

The effects of prolonged usage of that drug have been clearly stated before on this page. We said that long-term use of Cimetidine can cause reduced libido and eventually erectile dysfunction. It can also make you develop breasts if you are a man in a condition known as gynecomastia.

You need to stop this particular drug forthwith and see a doctor to determine if you could benefit from using Omeprazole with Clarithromycin and Amoxicillin (that is a triple regimen), but not the only combination. By imbibing their recommendations, this chronic problem of yours will be solved. So in a nutshell, a tiple regimen refers to the combination of a proton pump inhibitor with two antibiotics.

Dear doctor, the vertical surgical line on my tummy (from above the navel to the panty line) is still raised above the level of the skin about two years after surgery. Please what can I do to make the scar blend with the rest of my skin? Thanks.0811xxxxxxx

The best persons to treat this are the surgeons who operated on you. That way, being that they know your history and why this operation was conducted, they would be in the best position to determine if this scar you have described is an expected outcome.

That being said, however, it is important to let you know that certain peculiarities in the skin of different people make them heal differently than others. Creams such as Kenalog ointment are largely good enough for the kind of scar you have described. When it is more heaped up than yours is, when it is itchy and it is more deeply coloured than the surrounding skin, fortnightly kenalog injections placed inside the scar may be more reliable as a way to flatten and soften the scar.

Dear doctor, I have a 10-year-old son who I worry about because his penis is like half the size of his junior brother’s own and his younger brother is eight years old. What should we do about this, sir? 0803xxxxxxx

Well, there are several reasons why it may appear as though his penis is far smaller than that of his younger brother. One is to know how fat or plump he is. If he is big size relative to his brother, their penises will always look different. The fatter one will look as if his penis is smaller because it will be hidden to some extent by the belly fat overlapping into the groin. The other factor is the genes; the fact that they are brothers does not mean that they will have comparable organs in terms of size just as they will not grow up to have the same height. However, it is important to allay some of your fears and this can be achieved when you see a paediatrician. After their examination, which could include hormonal studies, the cause will be known.

Dear doctor, my mother is 78 years old and complaining of fever, body pain, cold and catarrh. What can she take? I understand that my sibling has taken her to a chemist in my village but I am not satisfied with that especially as she is not better. She was given Nectallin cough syrup, Metherine forte tablets, Bonadol, Bitoplex, B-complex, Clarinez and Glotol. Kindly help me. I cannot travel to my village now but any advice you give can be quickly communicated. Thank you, sir. (This dramatic event occurred during the last weekend and has been sorted as successfully). 0803xxxxxxx

The problem you are dealing with now is the danger of polypharmacy where the person treating your mother has no clue as to what may be wrong and has thrown his entire arsenal of drugs into the fight in the hope that one of them works.

Please stop all the medications above except the cough syrup and bonadol. Then get her any ACT-based antimalarial. (The sibling in charge of mama’s care had to travel to Esa-Oke, Osun State, before he was able to get Coartem). Needless to say, mama is better now and nursing only her toothache with bonadol and warm saline gargles three times a day.

 Dear doctor, thanks for the regular medical advice and suggestions you give on this page. You know that resident doctors are on strike in the country. I have been on dialysis for some weeks now and I don’t know what to do. Will I die if I miss it for a week or so? Kindly answer me urgently. God bless you. (This also happened early this week before MDCAN postponed its own strike action). 0808xxxxxxx

Thank you very much for your kind words. Dialysis is a treatment offered for a variety of reasons. You have not disclosed what the reason for your own dialysis is. However, since you have been on dialysis for several weeks, it means you have several sessions per week.

I would advise that you go to the hospital where you usually get this done and do it. The consultants are working and in the bigger hospitals, they have house officers to assist with the basic tasks. If you are not able to avail yourself of the opportunities there, you can visit some private hospitals which offer this service depending on where you live. I would not readily use the word die, but would merely caution that it is a possible outcome.

Dear doctor, my boy started having seizures some years ago after being treated for an infection. Recently it has come every three days. Since Friday it has happened every day, even in the night this week it has happened almost seven times and started this morning again. He keeps complaining of headaches. Please what do we do? [email protected]    

Well, unfortunately, the junior doctors are on strike around the country but you should still try to get him into a hospital for proper examination and treatment. Nothing else you do at home will be useful and nothing I prescribe here will work for him because the type of epilepsy he has must first be defined. Besides, you did not disclose his age.

Sometimes, certain medications are good or safe at a particular age range and not so safe or useful in another. Get him to a hospital as soon as tonight because every time he gets a seizure, there will be some brain damage. After that, proper advice can be offered and treatment should be effective which can control these distressing symptoms with some effectiveness. It is a bit odd that he has not been on any treatment or at least you did not indicate if he is on medications.

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