Aspirin – Coated or Naked – Does it Matter?

Aspirin is often used to prevent heart attacks and strokes. Patients usually take an 81 mg (baby aspirin) or 325 mg (regular strength) pill. It also comes in plain, enteric coated, or buffered. Enteric coated aspirin is often recommended to decrease the risk of ulcers, the idea being that it doesn’t dissolve until it gets past the stomach, though there is limited evidence that it really makes a difference.

Another concern over the past decade is that some patients may be resistant to aspirin, and perhaps needed to be on more expensive medications, such as Plavix (clopidogrel), which recently went generic, though is still pricier than aspirin.

Now a new study from the University of Pennsylvania, published in the magazine Circulation, questioned the idea of aspirin resistance, and said that some patients who did not respond to the coated aspirin did respond to plain aspirin. But that does not mean you should conclude that taking coated aspirin may put you at increased risk for a heart attack.

This study looked at 400 health volunteers and gave them a single 325 mg dose of aspirin, either plain or coated, and measured the chemical cyclooxygenase-1 to see if it worked. If they appeared “resistant” then they gave one week each of coated 81 mg aspirin and clopidogrel. Although 49% of the volunteers did not respond to the single aspirin, they all responded to the daily dosing.

So the bottom line is if you take a coated aspirin every day, you probably don’t need to be concerned about it not working. If you don’t regularly take aspirin, but experience chest pain, after you call 911, take a plain aspirin, and preferably chew it to speed absorption. If you only have coated aspirin, it should work just as well if you chew it. Coated aspirin, made by Bayer and other manufacturers, are a little more expensive than plain aspirin, but are still fairly inexpensive.

Mega Millions – What Would I Do?

Copyright (c) 123RF Stock PhotosWhen I walked into work this morning, our referral clerk called my name and asked if I wanted to buy a lottery ticket. The Mega Millions lottery had an estimated $640 million dollar jackpot and everyone else in the clinic had chipped in $3 to an office pool. I hesitated on principal as such lotteries are a losing bet. With the jackpot size and potential gain, it was not as big of a losing bet, at least, as usual.

She pointed out that if I didn’t participate, I might be the only one to show up for work on Monday. “You’d quit your job if you won?” I asked. “Well, I’d give my two week notice,” she replied. For the first time in my life, I handed over my hard earned money for a lottery ticket.

My definition of the ultimate in job satisfaction is whether one would keep one’s job after winning a large lottery. Steve Job, Bill Gates, Warren Buffet and many others could have quit their jobs a long time ago, but did not do so because they enjoyed working.

I wouldn’t retire if I won the lottery because I enjoy practicing medicine. But I would change how I work. I would see less patients per day and spend more time with each one. I’d take more vacation, and pay someone to do the paperwork.

So if I win then I won’t have to write this blog anymore. Wait a minute, I’m not getting paid for this in any case.  So win or lose, I’ll keep writing.

An Apple A Day

You’re familiar with the first part, or a variation of it, but did you know the rest of this Mother Goose nursery rhyme?

An apple a day
Sends the doctor away.

Apple in the morning,
Doctor’s warning.

Roast apple at night
Starves the doctor outright.

Eat an apple going to bed,
Knock the doctor on the head.

Three each day, seven days a week,
Ruddy apple, ruddy cheek.

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