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. 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. ***

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.

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.

***

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

We are trying to contact all patients who missed their appointments during Covid. Please call our o ce if you do not have your cleaning recall schedule. ank you for your patience. Please remain safe and healthy.

All patients of Dr. Eleczko are now being seen at our o ce!

Inflammation

Inflammation can affect anyone, and those who have battled it likely have nothing positive to say. But while few people may associate inflammation with something good, inflammation is actually a process by which the body’s white blood cells and the substances those cells produce protect the body from infection at the hands of bacteria, viruses and other foreign organisms. While inflammation is protective by nature,sometimesaninflammatory response is triggered by mistake. When that happens, the body’s immune system, which is designed to protect the body, begins to damage its own tissues. The resulting symptoms of this faulty immune system response may include joint pain, joint stiffness, loss of function in the joints, and swelling of the joints. None of those symptoms are comfortable, and people suffering from them may be on the lookout for ways to alleviate their pain and suffering. While anyone battling persistent inflammation should speak with their physicians to explore their treatment options, a preliminary search of how to best treat inflammation will no doubt turn up information about heat therapy and cold therapy.

Junk cars appear everywhere in county

Editor, e largest one is in front and around the old Richmond store with over 19 vehicles.

Congratulations to Dom Martello, Supervisor of Ossian, which “may be the smallest town in the county,” for implementing the junk law on his agenda.

In Groveland Station, on Route 63, there is more than one place with numerous junk cars.

I doubt there is any other town with that many junk cars. Hard to believe? I have pictures.

Carolyn Vedder Groveland

My mother’s article back in 2002 about junk in Groveland. I have lived in Groveland for 72 as re chief - 2 term - town board and superintendent. I went to the town board to complain about zoning. e supervisor started yelling at the top of his voice to me and said if I don’t like zoning, when it’s time to vote again to vote him out. I guess he missed the work place violence meeting. Since then I took 25 pictures of the junk in Groveland and gave them to the town clerk. About the junk, I’ve tried everything to get it changed in the last 6 months. I called Channel 10 twice and they gave me Berkeley Brean’s number and he never called back. I will not be watching Channel 10. I guess my plans have to change so I’ve no choice but to le a lawsuit to make sure they will listen. I’ve talked to a Geneseo zoning o cer and heard their laws are working great along with a member from York who said their laws are working great too.

Respect, Jim Love

PAW’S CORNER

By Sam Mazzotta

Pet Sitting Can Be More an a Side Job

DEAR PAW’S CORNER: I was recently laid o from my job as a programmer, and have been thinking about taking a new career direction. I’m tired of being stuck in an o ce all day. And I love being around pets. But is it really possible to make a good living working as a dog walker or a pet sitter? -- Barry J., Cambridge, Massachusetts

DEAR BARRY: I know more than a few people who are full-time pet sitters and dog walkers. Most have their own business, while a few are employees of pet care companies. As you can imagine, the pay rates vary widely from person to person. ZipRecruiter reports that the average hourly wage, nationally, for pet sitters is about $19.23.

I think it’s great that you’re considering a career change. But I recommend testing out the world of pet sitting rst. Consider working part time for a pet-sitting company. Even better, if you know someone who does dog walking, ask to accompany them for one day to see what their job entails. Find out what the pitfalls of this business may be, and what makes it fun to do. Finally, o er to pet sit for a friend who’s going out of town for a day or two to get direct experience and really see if it’s something that you’d like to do full time.

Next, visit the Small Business Administration’s website (www. sba.gov) and check out its Learning Center section, which has several micro-courses that teach how to start up and run a small business. Being able to combine core business skills with a love for and dedication to pets is a great platform to start on. Best of luck.

Send your tips, comments or questions to ask@pawscorner.com.

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