COMING NEXT: the doctor's next topic is about over-active and
under-active thyroids. Read his article, The
telltale loss of power and e-mail your question for answer online on
Wednesday or read other recent topics here
For some years now I have become more and more allergic to firstly asprin,
then NSAIDs, ibuprofen and anti-inflammatory drugs and have to, therefore,
avoid these drugs. I also react strongly to Immodium although I used to be
able to take it - my doctor thinks it is probably the blue colouring in the
capsule coating. However, I have arthritis, particularly in my feet and
back, and walking around and even doing everyday chores is becoming
increasingly painful and tiring. One of my great loves is gardening and I
can only do this in short bursts and am very stiff and in pain afterwards.
I read with interest your
article in the Times when you talked about Pycnogenol (Zinopin)
and wonder if this can be of any help to me as an anti-inflammatory I would
not react to. I shall also be taking a long-haul flight in September and,
again, can I take Pycnogenol? Any help and advise would be much appeciated. Pauline
Austin (Mrs)
It is important if you have any suggestion of an aspirin allergy that you
should avoid it and other drugs that have an allied hypersensitivity. I
don't understand why you should be sensitive to Immodium but your doctor's
suggestion that it is the blue colouring is a likely one. To confirm this
you would have to find out from the manufacturers what dye is used in the
production of the capsules. This knowledge could be useful to you as then
you would be able to avoid foodstuffs that have it or a similar dye. It is
known for example that patients who have a hypersensitivity to aspirin and
other anti-inflammatory non-steroidal drugs may also be sensitive to some
food dyes including, very often, those that are based on tartrazine.
In some people the hypersensitivity to aspirin and other NSAIDs (the
non-steroidal anti-inflammatory drugs) is dose-related but if somebody gets
a serious reaction then testing for it by using a challenging dose of
aspirin is considered by many doctors (including me) to be too dangerous
except under well-controlled situations. A classic sign of mild chronic
aspirin sensitivity is revealed by the association of aspirin-taking with
asthma and nasal polyps. This should be excluded always when this triad of
symptoms has been noted.
I should discuss with your doctor the possibility of using such natural
substances as rosehip extract. Two recent studies, one from Denmark and one
from Norway, have been published on the anti-inflammatory properties of
rosehip powder sold as a capsule known as LitoZin. It takes time for its
action to take effect, little or no change for around three weeks is to be
expected. By all means try pcynogenol (Zinopin), provided that your doctor
agrees.
Specially bred green lipped mussels from New Zealand are also helpful to some
patients with arthritis but their anti-inflammatory action is likely to be
through the same inhibition of the prostaglandin synthesis as exists after
taking aspirin and NSAIDs, and this will have to be taken into account by
your doctor.
Fish oil helps osteoarthritis, my mother swore by it. It might be worthwhile
trying any pleasant Omega 3 supplement, cod liver oil in which the vitamin A
content has been reduced or fish oil. This can be obtained in capsules or in
forms that no longer are necessarily nauseous.
Can you take anti-inflammatories if you are anaemic? Are there any forms of
NSAID that don't make you gain weight? Helen Lamb, Dagenham
Yes, provided that you can be quite certain the anaemia is not the result of a
slow, gradual bleed from the gastro intestinal tract. Many cases of anaemia
result from bleeding, usually from the stomach or small intestine but the
NSAIDs may also occasionally also cause bleeding from the colon.
A history of oesophageal reflux, chronic indigestion, or any form of peptic
ulceration whether in the stomach or the duodenum or even inflammation of
the stomach or duodenum (gastritis or duodenitis) is an absolute
contradiction to taking NSAIDS. Likewise if there is colonic bleeding from
the large bowel it would be unwise to take an NSAID.
The complication rate with NSAIDs is much greater in the over 65s.
Unfortunately these are the very people that need them most. It is a matter
of discussion with your doctor and together you will need to weigh up the
benefits you would receive from taking these very useful drugs, including
the ability to have a night sleep free of pain and to undertake such
pleasures as walking and gardening, against the dangers, however small, that
all NSAIDs pose. The likelihood of suffering gastrointestinal troubles from
NSAIDs does vary from one to another and some include an additional
substance that lessens the chance of causing gastro intestinal inflammation.
Unfortunately the additional constituent may, in occasional people, induce
mild degrees of diarrhoea.
The literature doesn't include any evidence that NSAIDs have a direct effect
on weight. This is of course very different to any steroid based
anti-inflammatory agent that does always cause weight problems. Many
patients with arthritis have weight problems because the pain in the joints
restricts their activity rather than from the NSAIDs they are taking.
Are there any NSAIDs which do not contain ibuprofen? I have been told that
ibuprofen may have triggered a chronic auto-immune skin problem so I have
stopped taking it, but paracetamol is not as effective for joint pain. W.
Hazel, Nuneaton
Yes. There are a legion of non-steroidal anti-inflammatory drugs (NSAIDS) that
don't cause chronic auto immune skin problems. Some forms of arthritis are
caused by an auto immune tendency that may be responsible for both the joint
pain and the skin manifestations. These could therefore be the results of an
auto immune response rather than an hypersensitivity caused by the NSAIDs. I
would suggest that you discuss this with your doctor and or rheumatologist.
I suffer from mild IBS and am flying to the US next month. Is it still all
right for me to take aspirin before the flight? Name and address
supplied
Yes. it will be perfectly safe for you to take a small dose of aspirin. There
is an association between gastritis and intestinal hurry, one of the
symptoms of IBS, so don't take so much aspirin that there is a danger of
developing gastritis. I would recommend that you take low dose aspirin
tablets and that you start taking them for ten days before you fly, and
after you reach your destination. Aspirin acts by reducing platelet
stickiness. As these small particles don't adhere together the traveller is
less likely to suffer from any thrombo-embolic troubles. The NSAIDs don't
have the same action on platelets, or if they do it is rapidly reversible.
The long action of aspirin is related to the ten day life of the normal
platelet particle.
