This morning on WMBI I talked about a recent study on the popular Proton Pump Inhibitor (PPI) medications and their potential to cause "rebound" acid reflux. This could lead to a dependence on these medicines. Many callers and e-mailers have questions about this. If you are on these medicines, should you stop them? If so, what is the best way to stop? Is there any risk to staying on the medicine?

The PPI medications are commonly known as Prilosec, Prevacid, Nexium, Aciphex, and Protonix. The generic names have the common ending "-prazole". These medicines block the stomach's production of acid. They are useful for people with acid reflux disease, or gastroesophageal reflux disease (GERD). This class of medicines is one of the most commonly prescribed group of drugs in the world. Many doctors prescribe them the first time their patient reports symptoms of heartburn. Some of these drugs are now available over-the-counter without a prescription.

The problem that is now coming to light is this: it turns out that while these medicines are in the system, the stomach responds by attempting to crank up acid production. When the medications are stopped, the floodgates open and heartburn symptoms return, possibly in a more severe form than previous. This study actually placed people with no heartburn symptoms on a PPI medication for two months, and when the medicines were stopped, the patients with no history of GERD developed symptoms of heartburn within a few weeks.

So what are the implications? First, if you are on a PPI, there is no documented long-term risk of staying on the medicine. That being said, it is best to use these medications for the shortest time possible in order to avoid the "rebound" effect. The recommended time frame is 2-3 weeks, in order to treat a severe flare-up of GERD. During that trial, there are lifestyle modifications that should be tried. These include limiting the intake of alcohol, tobacco, caffeine, and spicy foods. Stress can also contribute significantly to GERD.

If you are already on these medicines, and you have been taking them for some time, talk to your doctor about stopping. One way to do this is to wean yourself off by cutting your dose in half, then going to every other day, then every third day, etc. Do this over the course of 4-6 weeks. What may happen, as suggested by this study, is that your symptoms may return when the dose is reduced. I would encourage you to try to ride this out over 1-2 weeks, because the stomach may re-calibrate its acid production on the new lower dose. This may need to occur over several weeks and multiple, step-down dose reductions.

For those who cannot manage their GERD through lifestyle modifications (mentioned above), another medication option is ranitidine (brand name Zantac). This medicine is available over the counter in a 75mg tablet. The maximum dose is 150mg (two tablets) twice a day. Start by taking one tablet at night, go to two if needed, and then add a morning dose if necessary. It is safe to start on the ranitidine while you are weaning yourself off the PPI's, and this may help with any "rebound" heartburn you may experience.

There is a group of patients that should be on PPI medications for life. These are people with something called "Barrett's esophagus". This occurs when the acid reflux is so severe that it causes tissue damage to the esophagus. This damage can progress to esophageal cancer and can be deadly. Barrett's esophagus is diagnosed by esophagealgastroduodenoscopy (EGD), a test in which a GI specialist passes a small camera down the esophagus and can look at or biopsy the tissue. Anyone with a positive test should stay on PPI's. For the rest of us, it seems best to limit the use of these medications.

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The recent death of famed pitchman Billy Mays was tragic (he convinced me to spend $19.95 for not one, not two, but six tubes of "Mighty Putty"). He apparently died from heart disease, but initial speculation blamed his death on a head injury he suffered during a rough airplane landing the night before. While the head trauma seemingly did not cause Billy May's death, it raises the question: what worrisome signs should I be looking for if I bump my head?

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There are many foods that are healthier than cereal bars (like fresh fruits and vegetables), and I am not endorsing Nutri-Grain products, but I am a big fan of their new ad campaign. Watch their commercial here and be inspired to make a small change today.

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One of my favorite Alfred Hitchcock movies is Vertigo. Jimmy Stewart plays the detective who becomes an unwitting foil in a complex murder scheme, then goes too far in orchestrating a second chance to absolve his gnawing guilt for failing to save a woman's life. The twisting plot and gripping finale will make your head spin.

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Some of you have possibly seen the e-mails going around that tout Listerine as an effective mosquito repellent. I decided to try it myself and... it seems to work. Most mouthwash products contain eucalyptus oil, which is known for its insect repelling properties. The only caveat: because the concentration of eucalyptus in the mouthwash is much lower than in commercially available repellents, the Listerine must be sprayed more frequently to keep up the effect.

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About 2 weeks ago, the "Check Engine" light began to appear each time I started my car. When this happens, my emotions go through several stages. First, denial. "There's probably nothing wrong, the light is just malfunctioning." Next, anger. "I don't have time to take my car in! Doesn't it know this is a crazy week for me?!" Then I move into bargaining. "OK, car, if you can hang on for one more week, I'll make sure to never again go over 3000 miles before changing your oil." And finally... well, back to denial. "Hey, the light went off- I knew nothing was wrong."

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A few months ago, I decided to start taking the stairs at the hospital instead of the elevator. I make rounds on the 4th floor of Advocate South Suburban Hospital at the inpatient unit for Advocate Hospice.

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This morning on WMBI-FM I spoke about Alzheimer's disease. Judging by the number of calls and follow up e-mails I received, this is a topic that affects many people. Below are more resources that I have found helpful:

Information from the National Institutes of Health (main site here)
Alzheimer's Disease Fact Sheet
Alzheimer's Disease Medications

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This weekend, Chicago celebrates the 60 year anniversary of Albert Schweitzer's only visit to the United States. Most of us know just a little about him. Maybe you know that he was a doctor who opened a hospital in Africa in 1913, during a time when Africa's desperate medical needs were largely ignored by the world. Perhaps you knew that he was friends with Albert Einstein. You may know that he won a Nobel Peace Prize for his work in and Africa and for his efforts to abolish nuclear weapons. This remarkable man has inspired me throughout my career.

Dr. Schweitzer is known for his philosophy of "Reverence for Life." He recognized that we each carry within us the innate "will-to-live." We naturally treat our own life with great care and respect. Schweitzer argues that ethical living is to apply that same care and respect to all life. In his own words:

"that is what gives me the fundamental principle of morality, namely, that good consists in maintaining, promoting, and enhancing life, and that destroying, injuring, and limiting life are evil. Affirmation of the world, which means affirmation of the will-to-live that manifests itself around me, is only possible if I devote myself to other life."

- The Philosophy of Civilization, p.79

Schweitzer's philosophy echoes the famous commandment from the Book of Leviticus, often quoted by Jesus, "Love your neighbor as yourself." Leviticus 19:18. This quotation has been increasingly used to justify the cultivation of self-love as the pathway to caring for others. The argument goes, "If you fully love and respect yourself, that will free you to show that type of love to others." I think that argument misses the point. Schweitzer, Jesus, and the author of Leviticus seem to agree- we are born with an deep instinct toward self-preservation. Self-love does not need to be cultivated; it is innate. This is nothing to be ashamed of. Your desire to care for yourself and acquire what you need to survive is part of what makes you human and alive. This instinct is only selfish if it ends there. What Schweitzer, and Jesus, seem to be saying is that our deep desire for self-preservation, what Schweitzer would call the "will to live" and what Jesus would call your "love for yourself," this desire is a gift. It should be used as the standard by which you measure your care for others. We are called to care as much about the needs of others as we automatically care about our own needs. Consider how Albert Schweitzer applies this principle to the problem of pain and suffering:

"Those who have learned by experience what physical pain and bodily anguish mean, belong together all the world over; they are united by a secret bond. One and all they know the horrors of suffering to which man can be exposed, and one and all they know the longing to be free from pain. He who has been delivered from pain must not think he is now free again, and at liberty to take life up just as it was before, entirely forgetful of the past. He is now a 'man whose eyes are open' with regard to pain and anguish, and he must help to overcome those two enemies (so far as human power can control them) and to bring to others the deliverance which he has himself enjoyed. The man who, with a doctor’s help, has been pulled through a severe illness, must aid in providing a helper such as he had himself, for those who otherwise could not have one. He who has been saved by an operation from death or torturing pain, must do his part to make it possible for the kindly anesthetic and the helpful knife to begin their work, where death and torturing pain still rule unhindered. The mother who owes it to medical aid that her child still belongs to her, and not to the cold earth, must help, so that the poor mother who has never seen a doctor may be spared what she has been spared. Where a man’s death agony might have been terrible, but could fortunately be made tolerable by a doctor’s skill, those who stood around his deathbed must help, that others, too, may enjoy that same consolation when they lose their dear ones. Such is the Fellowship of those who bear the Mark of Pain."

- On the Edge of the Primeval Forest, pp. 173 f.
To love others is to seek to bless them with the same blessings you yourself have received. This is an active love. Schweitzer's most famous quote is perhaps this one:

"My life is my argument."

May this be true of all of us, starting with me.

Recommended reading:
Out of My Life and Thought
- Schweitzer's autobiography, an excellent overview of his life. Though I do not agree with everything he wrote, particularly his theological conclusions about the person of Jesus, his life story is incredible.
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