DEAR DR. ROACH: I was having hoarseness while taking ibuprofen. A friend got intestinal bleeding due to taking it. My doctor gave me 7.5 mg of meloxicam daily, but I’m not sure it’s OK long-term. I’m 73 with osteoarthritis and osteopenia. I exercise daily and eat a healthy diet, and I have high blood pressure that is controlled with losartan and amlodipine. — T.M.H.
ANSWER: Ibuprofen is generally a safe drug, but it does have the potential for side effects — some of them being serious. Gastrointestinal bleeding is a serious one, and it is most common in older women. I would not try a second nonsteroidal anti-inflammatory drug (NSAID) like meloxicam in a person who has a history of serious bleeding with any other similar drug.
Hoarseness could be due to an allergy, due to direct irritation of ibuprofen on the throat, or from the worsening of acid reflux, which can cause hoarseness if acid gets all the way into the throat.
Meloxicam is also an NSAID but is chemically in a different class from ibuprofen (Motrin, Advil and others) or naproxen (Aleve and others), which are closely related. It’s reasonable to give it a try, but if it causes hoarseness again, then an NSAID probably isn’t a good choice for your arthritis. You could consider acetaminophen (Tylenol) or topical NSAIDs, which do not get absorbed enough to cause an increased bleeding risk.
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DEAR DR. ROACH: I am a 76-year-old woman in what I thought was excellent health. On a recent coronary calcium CT scan that was ordered because of my age and slightly elevated cholesterol, an incidental finding was described in the report as “innumerable, tiny noncalcified pulmonary nodules bilaterally.” The largest of these is in the “left lower lobe with multiple additional 2- to 4-mm nodules,” and they recommended “clinical correlation and a consideration of a dedicated chest CT.”
I found the report quite scary, especially considering my mother and grandfather died of lung cancer (although they were smokers and I never smoked). My primary physician has ordered the chest CT but wants to wait four weeks. She says that the nodules could be caused by inflammation or infection and might resolve on their own.
My fear is that they’re actually lung cancer and waiting four weeks might be problematic, not to mention extremely anxiety-producing. I would appreciate your input. — M.S.
ANSWER: I certainly understand why you are concerned about lung cancer given your family history, but primary lung cancer is very unlikely. Since there are so many of these tiny nodules, I agree with your doctor that these are highly unlikely to be lung cancer, which is generally only a single nodule.
Your doctor is correct that there are inflammatory and infectious conditions that can cause a similar appearance on a chest CT. Some of these infections are serious (including tuberculosis), but people generally have symptoms. So, I think this is unlikely. Exposure to lung toxins, especially silicosis and asbestosis, are generally occupational, but they are another potential cause.
Some cancers can spread to the lungs. While the appearance of nodules on a CT scan in a person with no known cancer would be unusual, if the CT scan in four weeks shows that the nodules are enlarging, then this would be concerning. Getting another scan in less than four weeks might not be enough time to see a change.
I am sorry about the unavoidable anxiety in waiting for the scan, but it’s likely that the scan won’t show a change and you will be able to stop worrying.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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