Figuring prominently in one's health history are
medications, especially those that may be ototoxic
(poison to the ears). In this case, Therapeutic Aspirin
can be a bane or boon, depending on dosage and
individual reactions.Reader inquiries may be directed to
digicare@aol.com.
Replies are for educational purposes only, and are not
to be construed as medical advice or opinion.
Aspirin Therapy: A Cautionary Experience
by
Max Stanley Chartrand, Director of Research
Health & Human Services/Research in Communicative
Disorders
Some years back, while guest consulting at a seaside
clinic in southeastern Texas an eighty-two year-old
female hearing aid patient was evaluated and brought in
to see me. I was to conduct a health history and video
otoscopy examination, and make a recommendation for
possible changes in her amplification and auditory
rehabilitation strategy.
“May I see your list of medications and list of
nutrition supplements?” I asked after a brief but
friendly introduction.
“You certainly may. I have it right here,” came her
courteous reply, as she reached deeply into a handbag
and produced a rather lengthy and detailed list. It
listed about a dozen medications, including dosages, for
conditions ranging from hypertension, diabetes mellitus
II, to arthritis, high LDLs and trigycerides, and
anxiety disorder. She also listed a few nutritional
items, all appearing to be within range for the
medications she was taking. However, I noted that among
the doctor-prescribed items was 325mg. of Aspirin daily.
“How long have you been taking the Aspirin, and is this
the amount your doctor recommended?” I inquired.
“I’ve been taking it for about a year now, and on the
amount, he just told me to take an Aspirin a day. He
didn’t say how much,” came the reply.
I noted to her that the Oxford study was on 75-150mg.
per day, and that there was a caution that unless the
patient exhibited active heart disease then the standard
325mg (300mg. in Europe) was just too much for most
patients. The risk of internal bleeding rose
dramatically when taking the full-strength over time.
During otoscopy, I noted the status of the right ear,
but when I inadvertently flashed the light coming from
the speculum into the left eye on the way to looking
into the left ear, I noticed a great deal of pupil
dilation without response to the bright light.
“How are you feeling right now?”
“Oh, I’ve been feeling a little woozy this morning, but
then I feel that a lot of times.”
“Have you had an accident recently, or possibly bumped
your head?”
“Oh yes, this morning while reaching across my kitchen
counter I raised up and hit my head against the
cabinets.”
From that bit of conversation I suggested that she check
into the emergency room of the hospital across the
complex, asking one of the office staff to help her. She
was confused about the concern, but complied with the
recommendation.
About 2 hours later we received a call from a nurse at
the hospital thanking us for sending her over. She
informed us that the patient had been diagnosed with
hemorrhaging of the right frontal lobe as a result of
concussion, and was being admitted into the hospital. It
later turned out that the underlying cause of the
bleeding was from thinned blood vessels resulting from
overuse of Aspirin.
Since that time, when I take case histories and 325mg.
of Aspirin is listed a red flag goes up. “Is that amount
prescribed by your doctor?” Whether or not the
recommended dosage comes from their doctor, I suggest
that be a talking point at their next examination.
During in-service training visits with physicians I’ve
long noted that the fine detail of Aspirin dosage has
not been adequately considered, but when pointed out to
them, the consensus usually gravitates toward
recommending the 81mg enterically-coated dosage over the
more convenient 325mg dosage. Indeed, when such
little-known conditions as cochlear stroke, stria
vasculari hemorrhage, and external otitis exposure due
to bleeding ear canals, physicians typically reduce or
eliminate Aspirin recommendations. In cases of tinnitus,
Aspirin is often eliminated to see if the condition
lessens or abates. Some cases of idiopathic vertigo may
be related to internal bleeding in the labyrinth. When
considered concomitant with other medications that also
present deleterious side-effects, such as bleeding,
tinnitus, vertigo, or hearing loss, Aspirin therapy must
be utilized with great care.
Another consideration is patient self-medication with
either of two other blood-thinning supplements, vitamin
E and Ginkgo Biloba. In the case of vitamin E, those
taking anticoagulants should never take more than 200
IUs of Vitamin E daily. Otherwise, the safe daily adult
dose of Vitamin E is 400 IUs.
Gingko Biloba (50:1 extract) should be restricted to
less than 60mg per day, if taken simultaneously with
either Aspirin or Vitamin E. Many professionals
recommend daily adult doses of Ginkgo Biloba of 120mg or
more, when taken without anticoagulant medication, if
taken for purposes for controlling tinnitus.
A gentler route---which does not appear to conflict with
either Aspirin Therapy or use of anticoagulants----for
cases related to high LDL cholesterol (for tinnitus
and/or vertigo) appears to be Chromium Nicotinate
(chromium with nicotinic acid). But this has not been
clinically investigated to the knowledge of this
researcher.
In all cases, it is important for patients to discuss
these aspects with their physician. If the physician is
not well-versed in respect to nutritional interaction of
medication, there are certainly numerous sources of
information available for their investigation.
Recommendations should not be made without adequate
research.
The general rule regarding Aspirin Therapy is that
unless the risk of heart attack or stroke exceeds the
risk of internal bleeding, the therapy is not
recommended. When it is recommended, the 81mg
enterically-coated version is usually the recommendation
of choice. But even then, one should inquire of
self-medication nutritional supplements, such as vitamin
E or Ginkgo Biloba, and counsel accordingly. Use with
cumadin requires constant and frequent monitoring.
References:
1.“Aspirin”, Lions Medical Research Foundation, P.O. Box
1030, GPO Brisbane, Australia 4001, (2003).
2. “Aspirin Therapy”, The University of Texas
Southwestern Medical Center, Dallas, TX (2003).
3. “Baby Aspirin Therapy”, CBS Health Report, London,
1/11/01 (2001).
4. Chartrand, M. S., “Tinnitus and Amplification”,
Audecibel, pp. 18-21 (1989).
5. Chartrand, M.S. “Are We Poisoning Our Ears?”, Hearing
Health, January-February issue (1994).
6. “Pharmaceutical Research”, Agency for Healthcare
Research and Quality (HS10548), U.S. Preventive Services
Task Force, http://www.ahrg.gov/clinic/3rduspstf/aspirin/
(2003).
7. RNID Tinnitus Helpline, 19-23 Featherstone Street,
London EC1Y 8SL (2003).
8. Stephen Epstein, M.D., “What you should know about
ototoxic medications”, International Federation of Hard
of Hearing People, (1995). |
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