Tuesday, August 7, 2007

Your memory or your life?

An interesting article appeared in the news last week. One which got my attention more than most.

Elderly black people who are chronic users of acid-inhibiting drugs in the family that includes Zantac, Pepcid and Tagamet have 2½ times the normal risk of developing dementia, Indiana researchers reported Friday.

The drugs block production of stomach acid by inhibiting histamine-2 receptors; the stomach releases hydrochloric acid when stimulated by histamines. But they also inhibit the brain’s cholinergic system, which is involved in memory and cognition. Low levels of cholinergic activity have been linked to dementia.

Now I am neither elderly nor black, but I hope to be one someday, and I'm pretty sure that the biochemistry we're talking about here isn't race-related. The study subjects were black, driving the wording above.

Why did this get my attention? Because, like many married men my age who, forced to take pleasure where they can find it, long ago installed a mirror over the kitchen table, I was also long ago diagnosed with a hiatal hernia and GERD. Of more concern, a recent EGD (The fog of anesthesia of which I emerged from alternating a recitation of the "Prologue" of The Canterbury Tales in Middle English and my favorite line of "jive" from Airplane. That the portions of my brain governing memory and language awakened well before those responsible for discretion did not amuse my spouse . . . but that's another story.) brought with it the news that the bottom five centimeters of my esophagus is being assimilated by my Borg-like stomach. The technical name for this is Barrett's Esophagus. It is a precursor condition to cancer, which, doesn't so much run in my family as sprint. But, Picard escaped the Borg, so resistance is never wholly futile.

While opinions seem to differ on whether esophageal tissue that has become stomach tissue can ever really become esophagus again, there is at least agreement that treating the GERD (with both lifestyle changes and drugs) can at least stop the damage.

My drug is Aciphex. Which, I am happy to report, is not in the class listed above, but is instead, a proton pump inhibitor. That's good news:
The study did not look at Caucasians and there was not enough data to suggest a risk from a different family of drugs called “proton pump inhibitors,” which includes Prilosec, Nexium and Prevacid.

It would be a wicked irony indeed that asked a person to choose between risking an early end to life by leaving one condition unchecked and prolonging life, but not being able to remember why you wanted to in the first place. Which is why, in the end, lifestyle changes, when possible, are always a superior, if more difficult, option than drugs.