74-year-old dad with ulcer from long-term use of NSAIDs--what to do?
March 23, 2020 2:00 PM   Subscribe

For the past month, my dad has been unable to eat much beyond porridge. When he eats anything else, he has diarrhea and wakes up in the middle of the night with terrible acid reflux. After speaking with a friend who used to be a nurse, we think he might have an ulcer from long-term use of NSAIDs. He was hit by a tow truck and fractured one of his vertebra in October 2019, and he's been taking ibuprofen daily to manage the pain. He stopped taking the ibuprofen last week. What can we do?

You are not his doctor. These are crazy times, and his regular doctor recommended against coming in given his age (they live in NYC, so transmission of COVID-19 risk is very high). He is also in a lot of pain and has lot a lost of weight over the past month. His digestive issues worsen if he eats anything other than porridge, and it gets particularly bad if he eats any animal products (his favorite).

Two complicating factors: (1) His English is very limited, and he shies away from non-Japanese doctors because he doesn't understand what they're saying. (2) I am far from him and can't convince him to see a doctor via a telemedicine appointment--neither can my mom and sibling, who live with him.

I am very, very worried about him and want to know what our options are. Hive mind, any thoughts on what he can do / what I can do from afar?
posted by saltypup to Science & Nature (6 answers total)
He should see a doctor. Really. Prolonged acid reflux can be serious. Many ulcers are bacterial infections that can be readily treated with the appropriate antibiotic. Please urge him to see a doctor.
posted by tmdonahue at 2:04 PM on March 23 [3 favorites]

NSAIDs can cause ulcers with long-term use because one of the 2 chemical pathways that causes inflammation is also the trigger that causes the stomach lining to regrow as the acid eats it away (the exception being acetaminophen, which blocks the other one instead). So when ibuprofen etc blocks the inflamation that is causing pain, it is also preventing the stomach's natural repair mechanism from working.

If you are not able to get to a doctor for tests and prescriptions right now, over-the-counter acid blockers are the short-term solution, to allow the stomach lining time to heal.

Long-term, there are (mostly patent-chasing, IMO) drugs that combine both into a single tablet (e.g. Vimovo is naproxen (Aleve) and esomeprazole (Nexium)) but they are going to be more expensive because they are new and still protected against generic versions.
posted by CyberSlug Labs at 2:23 PM on March 23 [1 favorite]

I agree with you that your dad needs to talk to a doctor, and I agree with his regular doctor that that the COVID risk is such that he shouldn't come in.

(I am not a medical professional! But I am the daughter of two people who are both over 80, and if one of my parents were experiencing what your dad is experiencing, I would urge them to opt for telemedicine, though I bet it would take some convincing, like with most of us and new things.)

Do you know why your dad doesn't want to see a doctor via telemedicine? Is there anyone he knows who has had a good telemedicine experience and could answer any questions he might have about it?
posted by virago at 2:25 PM on March 23 [2 favorites]

Yes he should go to a doctor. A data point: my husband had good results from a course of otc Omeprazole, I think it's two or three weeks. This is not medical advice.
posted by pintapicasso at 2:30 PM on March 23 [2 favorites]

Many large group practices will allow you to search for doctors by language. Especially in NYC you may be able to find one who speaks Japanese and will teleconference.
posted by Hypatia at 3:48 PM on March 23

This might be an ulcer from nsaids, but it might not be. Weight loss from lack of eating is plausible, but weight loss is a common symptom for other serious conditions. It's essential he confer with a doctor.

Perhaps you can help by scouting around for a Japanese-speaking physician who would be willing to have a video appointment with him. If you find a Japanese speaking gastroenterologist, especially one in NYC might be most expedient to his getting a timely diagnosis and treatment.
posted by citygirl at 4:01 PM on March 23 [3 favorites]

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