Dear Dr. Roach: I am an active 77-year-old male in relatively good health.
In April, I had some silent reflux causing mild asthma. My asthma doctor suggested trying Dexilant 60 mg, which stopped the reflux/asthma but started digestive discomforts, including loss of appetite, mild nausea and irregular bowels, but no cramps, pain or blood. I went to omeprazole, ranitidine and Pepcid, lowering the doses on each, to get relief. After seven weeks of this scenario, I quit everything and controlled the reflux by quitting desserts and my glass of wine with dinner, and raising the head of the bed. It took another four weeks to regain full eating habits, and during the whole 11 weeks I lost 20 pounds.
In the 15 weeks since being back to normal, I feel fine and have been eating well but have gained only two pounds. At my recent annual exam, my internist did blood work, took a chest X-ray (clear) and suggested a colonoscopy and possibly an upper endoscopy. I am due for the colonoscopy, as I have had polyps, but after some reading I do not want nor see the need for the upper endoscopy. Since I believe there is a clear explanation for the weight loss, and my appetite and enthusiasm have returned, I see no need to go further. I would appreciate your comments about regaining weight at this age and the need for upper endoscopy.
Anon.
I think you probably are right that the dexlansoprazole (Dexilant) may be the issue, as your symptoms can be side-effects. I have never seen as much weight loss as you report. If your weight comes back to normal, that would be strong evidence that the symptoms were drug-related.
However, that much weight loss is not typical. Serious problems of the stomach, including ulcers and even stomach cancer can have similar symptoms, and as you consider whether to have the upper endoscopy, I would ask you to consider the downside (a possibly unnecessary procedure with low risk of serious problems) against the benefit (possibly making a diagnosis of a serious and potentially treatable illness).
I also want to highlight that in many people, lifestyle changes (such as diet change, stopping alcohol and raising the head of the bed) are more effective, far less expensive and less likely to have side-effects than medications.
Dear Dr. Roach: With the rash of states voting to legalize marijuana, have there been any studies on the effects of secondhand smoke from pot, or is this something we will hear about years from now, as with tobacco?
P.G.
I can’t answer that directly, since current regulations make high-quality research on marijuana and its effects very difficult to do in this country. However, there is a study on laboratory rats, which shows deleterious effects on blood vessels of rats exposed for one minute to secondhand marijuana smoke. This effect appears to be larger in secondhand smoke compared with inhaled smoke. Thus, it is reasonable to suspect that secondhand smoke may cause problems in humans.
However, the amount of marijuana smoked is much less than the amount of tobacco smoked for most people; so, considering everything, it might not be as bad as the effects of secondhand tobacco smoke.
Regardless of the legal aspects, keeping marijuana smoke away from people who don’t want it is a public health issue.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
