Question: My doctor told me to stop taking baby aspirin daily to prevent heart disease. Years ago, I heard a recommendation to take aspirin while waiting for the ambulance if you felt you were having a heart attack or stroke. Is that still legitimate advice?
Answer: Anyone who suspects he or she is having a heart attack should call 911 immediately. Although there is controversy about aspirin as a daily preventive measure, the advice to chew an aspirin tablet while awaiting the ambulance still seems valid (Western Journal of Emergency Medicine, December 2015; Emergency Medicine Journal, November 2015).
Anyone who suspects a stroke, however, should avoid taking aspirin. In such a situation, it could make a bleeding stroke worse. Emergency physicians will determine the type of stroke before deciding on the appropriate treatment.
Question: I’ve accidentally found an amazing way to get off of acid-suppressing drugs without having rebound reflux. I’ve been taking heartburn medicines for decades, ever since cimetidine first came out. Later I started taking omeprazole or esomeprazole. Whenever I tried stopping these drugs, I got horrible heartburn.
This time, I discovered by accident how to get off them. I’ve been trying to lose weight, so I’ve gone low-carb. I eat just one meal a day because I’ve heard that intermittent fasting is helpful.
A week ago, I decided to try once again not taking daily medication to control my incessant heartburn. I stocked up on Tums and other antacids because I knew I would be in trouble once I stopped. Then I took my last omeprazole and waited for the flames to appear in my chest.
About 15 hours passed, and I started to feel a little heartburn coming. I took a Tums and waited for the next round. I’m still waiting. It’s now a week later, and I’ve not had any heartburn. I should be in agony, but I’m completely heartburn-free. I feel like singing!
I hope this helps others who were addicted to PPIs. The solution is: Eat one meal a day and fast for 23 hours before you eat again. Stick to low carbs and water. Good luck!
Answer: Research supports your accidental discovery. A very low-carbohydrate diet has been shown to help control symptoms of acid reflux (Alimentary Pharmacology and Therapeutics, November 2016; Digestive Diseases and Sciences August 2006).
We were not able to find research demonstrating that intermittent fasting is helpful for heartburn. We offer several other nondrug approaches for getting off strong acid-suppressing drugs in our Guide to Digestive Disorders. It is available at www.PeoplesPharmacy.com.
Question: As a doctor, I prescribe generic ketamine for my hard-to-treat depressed patients. A compounding pharmacy makes it into an affordable nasal spray. My patients have called it a game.
Answer: Ketamine (Ketalar) has been available since 1970 as an injectable anesthetic. Some doctors have prescribed it off-label for people with chronic pain or challenging depression. The generic form is relatively inexpensive.
The Food and Drug Administration approved a chemical cousin of ketamine, esketamine (Spravato), which is now available. A study published in the American Journal of Psychiatry (May 21, 2019) found that esketamine nasal spray worked better than placebo nasal spray to alleviate treatment-resistant depression.
Esketamine does have some side effects. They include dizziness, a bad taste in the mouth, dissociation and nausea. The dissociation could be described as a feeling of not being connected to the body.
The brand name, Spravato, has another drawback. It is expected to cost more than $4,000 a month.