DEAR DR. DONOHUE: I am a 54-year-old female who was on anti-inflammatory medicines, including Aleve and Advil, for approximately three years for back and knee pain. I went to an orthopedist, who was concerned about the length of time I took these medicines, and he told me to get off them. I could function only when I took them, and I continued. Early this year, I had an endoscopy that showed stomach bleeding. I got off the anti-inflammatory medicines immediately. It's been six months, and I can barely move. I feel 90. What can I do? -- M.G.
A: NSAIDs -- nonsteroidal anti-inflammatory medicines such as Aleve, Advil, Motrin, Indocin, Voltaren and others -- are widely used by people with joint pains, especially arthritis joint pain. They're widely used because they bring relief. Nothing comes without a price. The price of NSAIDs is the possibility of stomach bleeding and ulcers. They also can raise blood pressure. Some of them might be implicated in an increased risk for heart trouble.
What to do when they can't be taken is an issue that many people have to deal with. One answer is Tylenol (acetaminophen). It often works. It doesn't bother the stomach.
Physical therapy is another option. Hot soaks, warm compresses -- heat in any form -- can ease joint pain and swelling. A whirlpool bath is another solution.
If life becomes unbearable and if nonmedicine therapy isn't working, your doctor might let you try NSAIDs again, but this time with protection from them. Taking the medicines with meals affords some protection. Drugs that decrease stomach-acid production counter NSAIDs' irritation. Prilosec and Nexium are two examples. Cytotec reinforces the stomach's protective layer and can lessen the chances of stomach bleeding from NSAIDs.
DEAR DR. DONOHUE: What tests are needed to diagnose rhabdomyolysis? I've been on six different statin drugs for cholesterol for eight years and have had leg pain for the last year and a half. Is a specialist needed to diagnose this syndrome? Is it permanent? -- D.T.
A: You don't need a specialist to diagnose rhabdomyolysis (RAB-doe-my-OWL-uh-siss). It's a destruction of muscles. Blood levels of the muscle enzyme creatine kinase -- CK -- indicate muscle destruction, as do high blood levels of myoglobin, a muscle protein that transports oxygen to different sites within the muscle cell.
Rhabdomyolysis usually isn't permanent. When muscle breakdown is extreme, the condition can be dangerous and threatens kidney shutdown.
Muscle pain is common. Muscle pain from statin drugs isn't all that common. Rhabdomyolysis from statin drugs is very rare. Statin drugs are cholesterol-lowering medicines -- Mevacor, Zocor, Crestor, Pravachol, Lipitor and Lescol.
c. North America Syndicate
