Aspirin Reduces the Risk of Several Gastrointestinal Cancers

With everyone focused on surviving the Coronavirus epidemic, it’s easy to miss articles dealing with issues other than COVID-9   The Annals of Oncology published a review study performed by Cristina Bosetti, M.D. and colleagues from Milan, Italy.  They performed a literature search examining studies looking at the relationship between aspirin consumption and gastrointestinal cancer.

They found that taking one or two aspirin per week was associated with a reduced risk of pancreatic cancer, colon and rectal cancer, squamous cell esophageal cancer, stomach cancer and hepatobiliary cancer.  When they looked specifically at colon and rectal cancer, they found the risk of developing the disease dropped with increased aspirin dosages. “An aspirin dosage between 75-100 mg a day was associated with a 10% reduction in a person’s risk of developing cancer compared to people not taking aspirin.  A dose of 325 mg a day was associated with a 35% reduction and a dose of 500 mg a day was associated with a 50% reduction in risk.

To obtain this type of risk reduction, patients had to be taking the prophylactic aspirin for a long time, at least 10 years. The ingestion of aspirin may have lowered the risk of intestinal cancer, but it carried with it the increased risk of bleeding.

Much has been written recently about the lack of protection against cardiovascular disease in patients without diabetes or documented heart disease who take daily aspirin. That may be true but there does appear to be a positive effect in preventing intestinal cancer. This is a complicated topic which should be discussed with your physician before embarking on a course of prevention.

Dogs, Cats and Coronavirus

There has been conflicting information on whether our pets can contract and pass on COVID-19 to other pets and humans. Initially, a report out of Wuhan, China noted that a dog tested positive for COVID-19 infection. Additional evaluation of that animal proved the test result was a false positive and the animal was neither ill nor contagious.

Several articles have appeared in newspapers and on TV news shows encouraging individuals to cuddle with their pets for anxiety and stress reduction. Then came the report out of New York City that one of the big cats at the Central Park Zoo tested positive for Coronavirus and was ill. Shortly thereafter, several more of the big cats tested positive.

This week an article was published in the peer reviewed journal called Science. Zhigao Bu, PhD, of Harbin University Veterinary Research Institute of the Chinese Academy of Agricultural Sciences in Harbin , China looked at whether animals could pass the virus through respiratory transmission. The purpose of the study was not initially to determine whether the virus could travel from pets to humans. The real purpose was to find an animal model that they could test new vaccines against COVID-19 on and test medication regimens.

They first looked at ferrets and found that while the virus could replicate in the upper respiratory tract of the animals for three to eight days, it did not make them sick and they were not contagious. They next turned to young cats. They inoculated their nasal passages with the virus and placed these infected kittens next to healthy kittens. They found that the virus was transmitted to the healthy non-inoculated cat with the animals developing the respiratory disease. Necrotic lesions were found in the respiratory tract of these test animals and they were found to transmit the virus by an airborne route.

They next tried the experiment on young beagles. While the virus was detected in the blood of the dogs inoculated with the virus, none of the healthy dogs exposed to them contracted the virus. The inoculated dogs developed antibodies against the disease but none of the beagles became ill. The dogs were felt to be non-contagious. Similar experiments showed that pigs, chickens and ducks did not contract the virus nor were they contagious to their species or humans when inoculated with the virus.

From their research it is probably true that dogs will not contract the disease and transmit it to other dogs or humans. It appears that felines however are susceptible to COVID-19 and may be a reservoir for the disease or a vector of transmission.

Ranitidine (ZANTAC) Removed from Market By FDA

Ranitidine is an H-2 receptor blocker marketed in the United States as Zantac. It is sold over the counter (OTC) without a prescription at the 20 mg dosage and with a prescription at the 40 mg dosage. It is used for peptic ulcer treatment, gastritis treatment, heartburn, gastroesophageal reflux and other diseases in which gastric acid causes inflammation of the lining of the stomach and discomfort.

It is being recalled because when manufacturing this product, new techniques are apparently inadvertently producing a probable carcinogen known as NDMA (N-Nitrosdimethylamaine). The longer the ranitidine sits around, the more NDMA is found. None of the levels measured are believed to be toxic.

Ranitidine is a relatively inexpensive blocker of histamine-2 receptor sites resulting in less digestive acid secretion in the stomach. The NDMA in the production product is the same chemical that resulted in the blood pressure medicine losartan and similar products being recalled. There are several alternative H-2 receptor blocker drugs on the market to replace ranitidine or Zantac. NDMA has not been found in Pepcid (famotidine), Tagamet (cimetidine), omeprazole (Nexium), lansoprazole (Prevacid) or omeprazole (Prilosec).

Globalization started during the Clinton administration, and encouraged by subsequent Republican and Democratic administrations, has resulted in pharmaceutical manufacturers moving their plants to Asia and other overseas areas where labor is cheaper, and regulations are less rigid. Ronald Reagan eliminated the Food and Drug Administration’s testing lab which set the gold standard for protecting Americans against tainted drugs. Prior to this action, no pharmaceutical product ever reached the American market and had to be recalled.

Subsequent administrations reduced the funding for the FDA, especially in the inspection department. With production now overseas, and virtually unregulated, we are dependent on the goodwill of foreign governments, and the liability attorneys for big pharma, to protect us from tainted products. Almost all antibiotics, both oral and intravenous, and all IV solutions are produced overseas in addition to most of the oral generics we are forced to take by our insurer every day.

We are currently living in a civilization altering pandemic with Coronavirus COVID-19. When this plague is under control, the country will need to reset our economy. My hope is that the big pharmaceutical firms will be legally forced to bring the pharmaceutical manufacturing back to U.S. soil. At the same time, the FDA inspection division needs to be funded fully to ensure that the products we need and ingest are safe and pure!

COVID-19: Warning of Treatment Risks

Physicians have been asked repeatedly by patients to prescribe a Z-Pak and hydroxychloroquine to patients to have on hand “just in case they get sick.” This is based on a limited study out of France showing hospitalized patients with COVID-19 improving somewhat on this regimen. There were anecdotal tales of this combination having limited success in Chinese hospitals.

Patients requesting this medication must understand that taking this combination carries significant risks of sudden death due to heart arrythmias. When this combination is tried in the hospital the patients are having daily electrocardiograms (EKGs) and are maintained on a telemetry monitor to screen for the medication induced sudden death causing arrythmias. In addition, these patients have been taken off any drugs that can prolong the “QT interval” such as antidepressant and antihistamines and increase the likelihood of sudden death.

In addition to the cardiac risks of this medication combination, there is a concern that the medication can cause retinal damage and vision loss. We routinely obtain slit lamp exams on rheumatology patients requiring hydroxychloroquine as a treatment before and during their therapy.

There is also concern over patients who need the medication not being able to obtain it due to hoarding. In certain states, the Governor, by executive decree, has forbidden pharmacies to dispense the medications unless the patient has a documented positive test for COVID-19, or they carry a diagnosis of rheumatoid arthritis or systemic lupus erythematosus.

As a patient and citizen, what you should be doing is pestering your state representative, Governor, Congressman, Senator and the President and demanding easy access to testing for COVID-19. Despite reassurances from the White House and Governor of Florida, it is virtually impossible to be tested outside a hospital in Palm Beach County, Florida.

If you are ill and concerned about having COVID-19 call the office and we will talk about it and discuss the options. A drug combination like azithromycin (Zithromax) and hydroxychloroquine is a desperation “Hail Mary” approach to treating Coronavirus and, hopefully, with social distancing you will not need it.

Call me if you wish to discuss this and please STAY HOME unless you absolutely need to go out.

Passover and the COVID-19 Pandemic

Passover has never been one of my favorite holidays. As a child with nuclear families still within walking distance the work of changing dishes and silver ware, disposing of the chametz and cooking for 15 or more people made the event not very likeable. The seder’s were long while being conducted in a foreign language (Hebrew).  Even the attraction of having thick sweet red wine as a minor and getting a cash reward for finding the hidden matzo, were not enough to overcome the long tiring nature of the meal and storytelling.

It’s now 2020 and the world is suffering through a plague of its own. The numbers of sick and dying are simply numbing and force you to slow down and remember that each statistic represents a human being. This is someone’s loved one.

With that said my family is following the guidelines of staying home and social distancing. That will mean my grandson, who lives 60 minutes away with my daughter and wonderful son in law, will be having their holiday dinner in their home. They have been distancing for over three weeks now with no trips into the community except to walk the dog and to see her obstetrician.

My daughter lives in the zip code with the most cases in South Florida and she comments constantly that her young affluent neighbors fail to obey most of the restrictions and guidelines announced by the Governor and the Florida Department of Public Health and the CDC. Her sisters in Venice, California and Berkeley Heights, New Jersey will do the same. They are social distancing, staying home sharing their seders’ via Zoom. They will have company with their cousins in Boston, one working in a hospital with the Harvard School of Public Health and Washington, DC at Washington’s Children’s’ Hospital. Their parents from Naperville, Illinois will be in on the computer seder as well. We have no idea how this will turn out but, unlike usual years where I lead the seder service or split it with Uncle Alan, this one will involve assigned roles per Aunt Meryl.

The traditional food will be different as well. The days of me coming home from school and running to my maternal grandmothers’ apartment to see the white fish swimming in her bathtub prior to her making her own gefilte fish are long gone. In recent years, it has been finding the correct Jewish deli that makes its own fresh gefilte fish and chopped liver but even that is on hold due to the coronavirus outbreak.

If there is fish it will come from a jar. Without the chicken to make chicken soup our matzo ball soup will come from a can as well. The matzo will be real. The concord grape Manischewitz wine will be real. The Passover Farfel or a potato nick will be real and there are no dry Passover dessert cakes or macaroons. This year my daughter’ s birthday fell prior to the holiday so we are all spared her complaints that the holiday prevented her from having a “real” birthday cake.

This is not the year for community or restaurant or country club seders. This is the year to stay home, be thankful for your loved one’s health and look forward to better healthier times.

Immune Boosting Foods – Lessons from a Dietitian on the Front Lines

Allison Pingel is a registered dietitian working with the Moffit Cancer Center to provide patients with the nutritional knowledge they need to stay healthy. As we know, COVID-19 is a severe threat to those individuals with an impaired immune system. Allison talks about building a strong immune system by eating correctly on a consistent basis.

The construction of this strong immune response does not occur overnight but occurs over time when you give your body the correct nutrients. She is quick to point out that there are no scientific studies that document or prove that vitamin supplements are a good substitute for foods which provide these building blocks naturally. “Fruits and vegetables are a more economical and nutritious way to obtain your necessary vitamins and minerals as well as other nutrients that are helpful including fiber.”

“Foods high in Vitamins A, C D, E and zinc support the immune system.” She cites broccoli, berries, garlic, ginger and spinach as products containing high amounts of these vitamins which assist the body in fighting infections. She encourages yogurt and nuts as plentiful sources of probiotics and zinc, which she considers essential for building a strong immune system. Additionally, she is a strong advocate of fruits and vegetables. One and a half cups to two cups of fruit per day, plus 2-3 cups of vegetables per day, are helpful for building a strong immune response.

While eating correctly to build your immune system is essential, so is some regular exercise and activities that are social and put you in touch with others in a safe manner. As spring descends on our country, it’s a fine time to take a walk or ride a bike and say hello to your friends and neighbors from a safe distance. Just make sure you adhere to your community’s stay-at-home restrictions.

The COVID-19 pandemic is frightening but with healthy eating, regular exercise and safe social interaction we will prevail and come out of this crisis stronger.