Recreational Tianeptine Has Potential for Abuse

DEAR DR. ROACH: I’ve been hearing about tianeptine being sold at gas stations. Is it really dangerous? -- S.F.

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ANSWER: Like so many substances, tianeptine can be a useful drug when prescribed and taken correctly (it’s used in several countries for depression), but it is indeed dangerous when used recreationally. Its use has been banned in several (unfortunately not all) states across the U.S. It is sold (yes, especially at gas stations) as a dietary supplement. Because it acts on the same receptor as morphine, when used at high doses far beyond the medically approved dose, it has potential for abuse and even overdose, with a handful of deaths ascribed to its use.

I recommend in the strongest possible terms against its recreational use and hope it is completely banned soon.

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DEAR DR. ROACH: I have severe pain in my right shoulder. I have seen two orthopedists and received X-rays, MRI scans and a cortisone injection, which didn’t work. Both surgeons recommended a shoulder replacement. I am taking three adult aspirins each morning (I am allergic to NSAIDs), which makes the pain go away. Is this safe? I am 83 and otherwise healthy. -- J.B.

Assistive Devices Help People Remain Mobile

Disabilities affect people from all walks of life. The Centers for Disease Control and Prevention estimates that around 55 million Americans have a disability of some kind. Of these people, 33 million have a disability that makes it difficult for them to carry out some daily activities. Statistics Canada states that, as of 2012, 13.7 percent of the population age 15 years or older reported having a disability that could impact daily life. People with disabilities may need assistive devices to reclaim some measure of their independence. For example, millions of people rely on wheelchairs or walking aids to get around. These are called assistive technology and rehabilitative devices, which include tools, equipment or products that can help people with disabilities get around more easily. These devices may be as small as magnifying glasses for reading to as large as wheelchairs.

The National Institutes of Health state that 2.2 million people in the U.S depend on wheelchairs for day-to-day tasks and mobility. More than six million use canes, walkers or crutches to assist with mobility. Assistive devices can be highly effective, but only when they are used properly and safely. Assistive devices should be measured for each user. Many walkers are height-adjustable. The width of a device also is important. A walker or another device that is too wide can affect mobility or require modifications to be made around the home. Weight is another consideration. The device should be lightweight so it can be maneuvered, but also weigh enough to provide enough stability to keep users upright. Users should proceed slowly and favor their stronger sides when relying on canes or walkers. Devices should not be used to climb atop other items like step stools. Children should not be allowed to play with or ride on assistive devices. If there are safety belts or locks on any assistive technology, they should be put in place before use to prevent further injury.

ANSWER: Aspirin is a type of non-steroidal antiinflammatory drug and has the toxicities common to all the drugs in that group, including an increased risk for bleeding and potential damage to the stomach and kidneys. But it has additional toxicities beyond NSAIDs like ibuprofen, especially at higher levels. I am very cautious about prescribing aspirin and generally prefer other anti-inflammatory medicines. However, people have long taken aspirin -- sometimes at much higher doses -- usually without problems. The fact that you are taking it only once a day reduces the toxicity, but I have to say I am surprised the benefit is lasting all day. The risk of toxicity is higher at older ages. At 83, you are at a significantly higher risk (seven times the risk) than younger people. Most of the data on exactly what your risk is comes from people taking low-dose aspirin (81 mg, not the 975 mg you are taking), so I can’t give you an evidence-based answer. But, for men in their 80s taking low-dose aspirin, about 1.5% will have a serious bleeding event per year. Your risk will be significantly higher due to the much-larger dose you are taking. However, one has to consider both the benefits of the aspirin treatment (the pain being gone is the best possible outcome) and the toxicity of other possible treatments, such as surgery (which is very significant).

There are many classes of NSAIDs, with very different chemical properties, and it is likely there is another type of NSAID you could safely take, with a lower risk than the dose of aspirin you are currently on. On the other hand, you can’t get any better effectiveness, at least in terms of pain, and the absolute risk is still fairly small, so I’m not sure I recommend you change. I am always very cautious about recommending surgery to someone in their 80s when there is an effective medication available to treat the issue.

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Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

© 2023 North America Synd., Inc. All Rights Reserved

GLUTEN-FREE IS MORE THAN A TREND

When someone with celiac disease eats gluten the body mounts an immune system response that attacks the villi, which are small fingerlike projections that line the small intestine. The villi, when damaged, cannot properly absorb nutrients from food. Untreated celiac disease also may lead to the development of other autoimmune disorders like type 1 diabetes and multiplesclerosis.

The intestinal damage from eating gluten often causes diarrhea, fatigue, weight loss, bloating, and anemia, and can lead to serious complications. Following a strict gluten-free diet can help manage symptoms and promote intestinalhealing.

More companies are producing glutenfree foods and stores are carrying them in greater numbers. In addition, there are a number of new baking flours available that provide alternatives to traditional wheat-based formulas. People with celiac disease or gluten intolerances can use these specially designed flours to make homemade items. Certain flours also may be billed as one-to-one alternatives, meaning they can be substituted for traditional flour in recipes without adjusting the measurements.

Ways to Become More Active Every Day

In addition to working toward at least 150 minutes of physical activity each week, it’s important to avoid being sedentary, when possible. You can do that by making choices that build activity in your day. Some examples include:

• Taking the stairs

• Printing to the printer farthest away from your desk at work

• Getting off the bus or subway one stop early

• Parking in the farthest space from the door

• Walking around while you are on the phone or having walking meetings