Heartburn has hidden dangers
Dear Savvy Senior: I’m worried about my 72-year-old mother who has been taking the opioid medication Vicodin for her hip and back pain for more than a year. I fear she’s becoming addicted to the drug but I don’t know what to do. Concerned Daughter
Dear Concerned: The opioid epidemic is a national problem that is hitting people of all ages, including millions of older Americans. Here’s what you should know and do to help your mother.
The cause
The main reason opioid addiction has become such a problem for people over age 50 is because over the past two decades, opioids have become a commonly prescribed (and often overprescribed) medication by doctors for all different types of pain like arthritis, cancer, neurological diseases and other illnesses that become more common in later life.
Nearly one-third of all Medicare patients – almost 12 million people – were prescribed opioid painkillers by their physicians in 2015. That same year, 2.7 million Americans over age 50 abused painkillers.
Taken as directed, opioids can manage pain effectively when used for a short amount of time. But with long-term use, people need to be screened and monitored because around 5 percent of those treated will develop an addiction disorder and abuse the drugs.
Signs of addiction
Your mother may be addicted to opioids if she can’t stop herself from taking the drug, and her tolerance continues to go up. She may also be addicted if she keeps using opioids without her doctor’s consent, even if it’s causing her problems with her health, money, family or friends.
If you think your mom’s addicted, ask her to see a doctor for an evaluation. Go to the family or prescribing physician, or find a specialist through the American Society of Addiction Medicine (see ASAM.org) or the American Academy of Addiction Psychiatry (AAAP.org). It’s also important to be positive and encouraging. Addiction is a medical matter, not a character flaw. Repeated use of opioids actually changes the brain.
Treatments
Treatment for opioid addiction is different for each person, but the main goal is to help your mom stop using the drug and avoid using it again in the future.
To help her stop using the drug, her doctor can prescribe certain medicines to help relieve her withdrawal symptoms and control her cravings. These medicines include methadone (often used to treat heroin addiction), buprenorphine and naltrexone.
After detox, behavioral treatments such as individual counseling, group or family counseling, and cognitive therapy can help her learn how to manage depression, avoid the drug, deal with cravings, and heal damaged relationships.
For assistance, call the Substance Abuse and Mental Health Services Administration confidential help line at 800-662-4357, or see SAMHSA.gov. They can connect you with treatment services in your state that can help your mom.
Also, if you find that your mom has a doctor who prescribes opioids in excess or without legitimate reason, you should report him or her to your state medical board, which licenses physicians. For contact information visit FSMB.org.
Hidden dangers of heartburn
Dear Savvy Senior: Is regular heartburn or indigestion anything to worry about? My 60-year-old husband eats a lot of Tums or Rolaids throughout the day to help him manage it, but it keeps him up at night too. What can you tell us? Inquiring Spouse
Dear Inquiring: Almost everyone experiences heartburn or acid indigestion from time to time, but frequent episodes can signal a much more serious problem. Here’s what you should know, along with some tips and treatments to help relieve your husband’s symptoms.
It’s estimated that more than 60 million Americans experience heartburn at least once a month, with around 15 million people who suffer from it daily. If your husband is plagued by heartburn two or more times a week, and it’s not responding well to over-the-counter antacids, he needs to see a doctor. Frequent bouts may mean he has gastroesophageal reflux disease (GERD), which can severely irritate and damage the lining of his esophagus, putting him at risk of Barrett’s esophagus and esophageal cancer if it’s not treated.
Lifestyle adjustments
Depending on the frequency and severity of his heartburn, there are a number of lifestyle adjustments he can make that can help provide relief and avoid a more serious problem down the road. Consider these tips:
Avoid problem foods. Certain foods can trigger heartburn symptoms like citrus fruits, tomatoes, fatty foods, chocolate, garlic, onions, spicy foods, mints, alcohol, coffee and sodas. Your husband should keep a food diary to track which foods cause him the most problems and avoid them.
Eat smaller, slower and earlier. Smaller portions at mealtime and eating slower can help reduce heartburn symptoms. He should also wait at least three hours after eating before lying down or going to bed.
Lose weight. Having excess weight around the midsection puts pressure on the abdomen, pushing up the stomach and causing acid to back up into the esophagus.
Quit smoking. Smoking can increase stomach acid and weaken the valve that prevents acid from entering the esophagus. If your husband smokes, the National Cancer Institute offers a number of smoking cessation resources at SmokeFree.gov or call 1-800-QUIT-NOW.
Sleep elevated. To help keep the acid down while sleeping, get your husband a wedge-shaped pillow to prop him up a few inches. If that’s not enough, try elevating the head of his bed six to eight inches by placing blocks under the bedposts or insert a wedge between his mattress and box spring. Wedges are available at drugstores and medical supply stores. Sleeping on his left side may also help keep the acid down.
Treatment options
If the lifestyle adjustments don’t solve the problem, or if antacids (Tums, Rolaids, Maalox, Mylanta or Alka-Seltzer) aren’t doing the trick there are a variety of over-the-counter and prescription medications that can help, along with surgery. His doctor can help him determine which one is best for him. Treatment options include:
H-2 Blockers. Available as both over-the-counter and prescription strength, these drugs (Pepcid, Tagamet, Axid and Zantac) reduce how much acid your stomach makes but may not be strong enough for serious symptoms.
Proton-Pump Inhibitors (PPI). If you have frequent and severe heartburn symptoms, PPIs are long-acting prescription medications that block acid production and allow time for damaged esophageal tissue to heal. They include Nexium, Prevacid, Prilosec, Zegerid, Protonix, Aciphex and Dexilant. Prevacid 24 HR, Prilosec and Zegerid OTC are also available over-the-counter. But be aware that long-term use of PPIs can increase your risk for osteoporosis and chronic kidney disease.
Surgery. If the medications don’t do the trick, there are also surgical procedures that can tighten or strengthen the lower esophageal sphincter so gastric fluids can’t wash back up into the esophagus.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit http://www.SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
