Dr. Roach: Medication must be balance of risk, reward

Keith Roach
To Your Health

Dear Dr. Roach: Please tell me about Celebrex. I am 86 years of age. I took it 15 years ago, and it helped me not to be so stiff. Now my present doctor will not prescribe it for me. I have tried several different medications, but I don’t get the results I got with Celebrex. It never bothered my stomach, and I want to take it again.

D.A.

Dear D.A.: Celecoxib is a relatively new drug, having been released in 1999. Its long-term safety is not as well-established as that of other medications. Like similar medicines, celecoxib can cause acute kidney failure in a small number of people, especially those with pre-existing kidney disease. Allergic reactions are possible with any medication. Stomach problems, especially ulcers, happen at lower rates than with other medications, such as aspirin, ibuprofen or naproxen.

The most important risk, and the one that probably has caused your doctor to not want to prescribe it, is the increased risk in heart disease. A related medication, rofecoxib (Vioxx), was removed from the market when studies showed an 80 to 130 percent increase in heart attack risk among rofecoxib users, compared with other anti-inflammatory drugs. Celecoxib has an increased risk, as well, but it is estimated to be about a 35 percent increase in risk, based on a 2011 study. This translates to roughly 1.5 more heart attacks per thousand people per year.

The major benefit of celecoxib you know already: It helped with your pain and stiffness. You might not know that it may reduce your risk of colon cancer, or that it has little bleeding risk compared with other anti-inflammatory medicines, especially aspirin.

I had patients who were bitterly disappointed when Vioxx was removed from the market and who were more than willing to accept the increased risk of heart disease because it was the only medication that helped their arthritis symptoms. Although I don’t recommend celecoxib as a first-line treatment, I would consider its use in people who haven’t had good response to other agents, who are at generally low risk for heart disease and who do not have kidney problems, provided they understand and accept the increased risk for heart disease.

Let me end with the reminder that exercise may be the best treatment for arthritis, since it improves function, reduces pain and has innumerable other benefits, with low risk.

Dear Dr. Roach: I am a 58-year-old male with well-controlled diabetes without medications (my A1C was 7.3, and has been steady at 5.9 for eight years). A few years ago I tried a low-fat vegan diet. While on that diet, my energy level dramatically increased, but I was forced to quit because of the intestinal gas and diarrhea, which could be only partially controlled with massive doses of probiotics. Do you have any dietary suggestions for the positive effects without the negative?

T.P.V.

Dear T.P.V.: It is likely that the high fiber in your vegan diet was responsible for the abdominal symptoms. What I would recommend is to make only a gradual change in your diet, allowing your system to adjust to the new foods. Vegetarian (but not vegan) diets, with animal protein in amounts much smaller than the standard North American diet, are generally healthy, and you don’t need to go strictly vegan to get many health benefits.

I would allow weeks or even months to let your body adapt to the diet, if needed.

Email questions to ToYourGoodHealth@med.cornell.edu.