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Miracle
Drug
By Gupta, MD
It seems
we are always learning something new and unexpected about
the medications
we take, and last week the surprise for me was about aspirin.
A lot of people, it turns out, are born
with, or are developing, a resistance to aspirin. This is
not the kind of resistance that drug users build up over time
or that, bacteria develop against antibiotics, but it is nonetheless
important. Aspirin
is one of our most commonly used over-the-counter medications
and is something of a miracle
drug. It can do everything from dull the pain of a headache
to reduce, as much as 25%, the
risk of a stroke or heart attack.
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So it was somewhat
unsettling to read in Circulation, the journal of the
American Heart Association, that about 30% of Americans
are aspirin resistant, which means they have to either
take more aspirin to get the same effect or use a different
drug. To find out more about the study, I called Dr. Salim
Yusuf, one of its authors and a professor of cardiology
at Mc Master University. “This very well-known drug
may have serious limitations,” he told me. “And
those people who are aspirin resistant have a higher risk
of dying from heart disease than those who are not.”
When aspirin is doing its job, it works by thinning the
blood and blocking a chemical called thromboxane which
promotes the formation of life-threatening clots in the
arteries. In some people, however, aspirin does not adequately
block thromboxane, and it is this phenomenon that scientists
are calling aspirin resistance.
Dr. Yusuf and his colleagues discovered it by measuring
thromboxane levels in the urine of more than 5,500 regular
aspirin users. “It became clear that the aspirin
was not affecting everyone equally,” Yusuf said.
The difference was significant. Patients who had high
levels of thromboxane in their urine had a risk of cardiovascular-related
death that was 3½ times as great as those with
low levels.
Before you rush out and have your urine tested, however,
you should know that nobody is quite sure what the ideal
urinary thromboxane level is. That makes routine testing
difficult. Moreover, Yusuf was quick to add, the study
doesn’t suggest that anybody should stop taking aspirin.
What it suggests is that some people may need more protection
than aspirin alone can offer. Doctors I consulted said
they would not recommend changing medications on the basis
of this study but they might be quicker to put high-risk
patients on move powerful anti-clotting drugs, such as
Plavix or Coumadin. For the rest of us, “Take two
aspirin and call me in the morning” probably still
applies. |
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Learning to Exhibit Patience
Rainer Maria Rilke writes: "Be patient toward
all that is unresolved in your heart. ... Try
to love the questions themselves like locked rooms
and like books that are written in a very foreign
tongue. Do not now seek the answers, which cannot
be given you because you would not be able to
live them. And the point is, to live everything.
Live the questions now. Perhaps you will then
gradually, without noticing it, live along some
distant day into the answer."
While I hear that profound advice and recognize
the wisdom of it, I identify more with one of
Carrie Fisher's characters in a movie script,
who says, "I hate instant gratification --
it takes too long!"
Patience. We are told it is a virtue. Few of us
would say it is one we do well. But, perhaps we
forget there is a difference in the way one feels
and the way one behaves. I was reminded of this
a few weeks ago when I went to Peshawar to celebrate
my granddaughter Sara's seventh birthday. Sara
has big blue eyes and long hair. She laughs easily.
She can be very funny. She is not afraid of adventures.
If she fails the first time, she simply tries
again, with more determination. She does not give
up easily. She is particular about the clothes
she wears, how her bed is made and how her sock
is folded on her ankle.
She can also be cranky, irritating and loud in
her protests when she does not get what she wants,
when she wants it. And if you are not paying attention,
you might miss something special about Sara. Sara
knows how to be patient.
It all began in February when her older sister,
Jamina, celebrated her birthday, and Jamina and
I went to the Gymkhana to spend the afternoon.
One of the items we returned with was a bear from
the Build-A- Bike store. Sara immediately wanted
one, too, and she wanted it that day!
I explained she would have to wait until her birthday
October 1. October 1? Too long. So, she started
in on her mother to take her. Her mother refused,
and Sara began the agonizing process of waiting
through May, June, July, August, and September.
Finally, October 1 arrived. I flew to Peshawar,
and off we went to the Galleria -- lunch at Gymkhana,
ice skating and a trip to the Build-A-Bike store.
Over lunch, Sara and I talked about waiting and
how it meant being patient. What she had learned
was that patience is not a feeling. What she had
felt was impatient, anxious, in a hurry, afraid
I'd forget. But she had waited without crying,
whining or being angry, although she did remind
me every time I saw her.
Patience, she decided, was certainly a hard thing
to do, and it was definitely not a feeling. It
is the way you behave when you feel the opposite.
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