♪ Bob and Brad ♪
♪ the two most famous ♪
♪ Physical Therapists ♪
♪ on the internet ♪
- Hello, Brad Heineck, Physical Therapist,
and we're having a podcast and YouTube channel,
Bob and Brad,
but, only one half, Brad Heineck here,
is going to be here,
but we have a better half,
other than Bob, and it's Chris, the Pharmacist.
- Hey guys.
- So today we're going to talk about
the title is
how does aspirin work?
And today's guidelines
This is going to be very interesting
for people 50 and over,
but everyone will have a good interest in it.
We're going to explain how it works
and that the new guidelines,
which is really was interesting to me,
cause it changed how my mother takes her medication.
- Yeah, it sure does.
- Right. So, before we go any further,
Chris do you have anything else
to mention about this aspirin?
Cause what I'd like to do is go to a little history
- Sure
- Because aspirin
- has been around forever.
- Right, and when I was a kid, that's all there was.
I mean, I never heard of Tylenol,
you know, in the sixties.
- Nope
- All these other, Ibuprofen was not there.
If you had a problem,
it was aspirin.
- Everybody did aspirin back in the day.
- But I understand it goes back a little bit further
than the 1950's.
- A little bit further.
- Then we can just touch on that.
- Yeah, I mean.
- Because some people might be interested.
- Absolutely.
Well, aspirin has been around for thousands of years,
but it hasn't been in the form of,
you know, the aspirin tablet that we see today.
I mean actually, ancient Egyptians and Sumerians
like 4,000 years ago,
were chewing on Willow bark.
And so Willow bark, just the components of it,
have, naturally have salicylate in it.
- Yeah
- Which is the anti-inflammatory component of aspirin.
- Okay.
- So basically, they knew whether, you know,
through trial and error, that if they chewed on
the bark of this plant,
and they had a headache or a fever
it actually gave them relief
and it's documented.
- Oh wow.
- So ancient Egyptians documented it,
Hippocrates, the father of modern medicine.
- Oh sure
- So you're talking, you know,
he actually used to use a tea
that he would give to pregnant mothers to help to relieve
their pains with childbirth- - Sure
- and labor.
And he also used it
for fevers and headaches.
- So, that had aspirin that-
- Well, it was Willow bark, - Sure
- So it had the salicylate in it.
And so it was just,
but there's a variety of different plants
that actually contained the salicylate.
- Oh okay.
- So it's not just Willow bark,
but that is probably one of the more common ones
that's been used for years and years.
I mean, you're talking about thousands of years
and then as we roll fast forward into
the 1700s and the 1800s,
you had interested pharmacists and scientists
that would just kind of tweak and go,
well why does this work?
- Sure.
- And about the mid 1800s,
an enterprising pharmacist actually isolated
the active compound.
And then a few years later,
they could actually make it in a tablet form.
So they knew exactly what it was.
And then by 1897, Bayer,
which is the famous company in Germany -
- Oh, okay.
- that got the patent in 1899.
Essentially patented it,
and was the first, you know, basically.
- So, Bayer was a pharmacist or a doctor or?
- Bayer, Bayer was a scientist.
It was a huge German pharmaceutical company.
- Okay.
- But, that was based after a doctor,
and they invented this and they used to actually market it
exclusively to pharmacists.
They actually did 'em in powder packets back then
before they made tablets.
- Okay
- And so they,
their marketing ploy at the time was
to give it to pharmacists and doctors
and they would give it out to their patients.
- Sure.
- For fevers and aches and pains
- So, that it just kind of continued to be a
common used, treatment, and then,
how does it work?
I mean, we talked a little bit about.
- Yeah.
- So you said it is for this plant and -
- It is the granddaddy of all NSAIDs.
So I mean, its the -
- So natural -
- Non-steroidal anti-inflammatory drugs.
- So anti-inflammatory, if you want to simplify it.
- So actually it works for fevers as well.
So it's antipyretic,
would be another name for that.
- Okay.
- So basically, so you can use it for headaches.
You can use it for toothache.
You can use if you sprain your knee or your ankle.
- Yeah.
- You can use it for fevers.
If you're over the age of 18, if you're below the age of 18
that can cause very serious Reye's Syndrome,
which you may or may not have heard of.
That's a pretty fatal brain
and liver condition that can be brought
on by the use of aspirin after a virus or.
- So is there an age component with that
or are you said after.
- Yeah, you really don't want to use aspirin
under the age of 18.
- Oh.
- So at least if you're using it to treat a fever
or if you've recently had a viral infection
Reye's Syndrome is very rare, but very difficult to treat.
Oftentimes it's even, even with the best trained minds
it looks a lot like meningitis,
at least in the early get go.
So it's something that we have to be careful with.
- But I'm thinking, you know, when I was a kid
it was always talked about.
- Yeah.
- But I mean, in the last 20 years,
my daughter, 20 years ago,
I don't even know if aspirin was an option.
I mean, the doctors never said, use aspirin.
It was usually some other -
- Yeah.
- things that we were familiar with.
- It was either Tylenol or ibuprofen at that point.
- Sure.
- Or acetaminophen.
- Sure, right, right.
- But yeah, so I mean -
- But that's not because of this.
- No, they just stopped using it
probably in the mid seventies.
They just said, if you have a fever, don't use aspirin.
If you're a child below the age of 18.
- Okay.
- After that, I mean, you know,
cause like when I had my teeth extracted
when I was like 11 years old, doctor,
or the dentist just told me to take two aspirin.
- Yeah.
- I still remember it.
(gentle laughter)
I mean, it was like two,
and it was kind of a running joke always,
take two aspirin, call me in the morning.
- Sure.
- I was just kind of a running thing.
- Right, right. I remember that.
- And so, you know, we're, we're old enough
to actually remember some of those things.
- Right, right.
- But, at the same time, I mean, it's certain, you know
I mean the drugs got 120 year,
plus 120 year track record.
- Right.
- So, it's unbelievably safe.
It's unbelievably effective.
The WHO, World Health Organization,
they listed a top of their list
as one of their most essential drugs
that everybody should have.
- Still today.
- Yup, and a buddy of mine had a Pharmacy Professor
that said, if you're trapped on a desert island,
this is what you want to have with you,
is aspirin because it's going to help if you have a fever,
it's going to help if you had pain.
- Sure.
- A headache, so it actually does a lot different of things
and oddly enough, there's the coronary effects,
so it helps to thin your platelets,
so it minimizes your risk for heart attack and stroke
and it actually may help to prevent colorectal cancer.
So there's, there's a lot of things that aspirin does.
It's a very versatile Jack-of-all-trades drug.
- So then, keeping that in mind,
it's like now they say like,
for my mother, use it for, to prevent any heart problems
or CVA or stroke.
And they said -
- Stop
- stop that.
That the new research says it's not good. And maybe -
- It's because of her age, specifically.
- Okay.
- So, we're talking about,
about this one right here.
This is what you said, 81 milligrams is that?
- Yep.
That is low dose aspirin, which therapeutically, most
most doctors now are going to recommend the 81 milligram
or the three,
I mean the 325 is used effectively as well,
but more often than not, you're going to see it
as an 81 milligram.
- Yeah.
- And you notice the reason that we kind of selected these
for a couple of different reasons.
This is just plain old, normal, regular strength
325 milligram aspirin.
This is low dose, 81 milligram aspirin.
In the old days used to call baby aspirin.
You'll notice that it says safety coated.
So with that, Luke, sorry.
Safety coated.
(gentle laughter)
[Male Background Speaker] Wait, wait.
- Don't hit that one.
- I'm not going to touch it.
- It'll be all right.
(gentle laughter)
- All right. That said.
Yeah. That's what happens with the new guy.
So, but nonetheless the 81 milligram
seems to be more efficient
at helping to keep platelets from being, you know,
to help them from agglutinate or getting sticky
and clogging up your arteries.
So, this is why it works.
It works a little bit better than that one does.
- But not anymore because if you get over what age
and they say.
- So, basically aspirin,
the guidelines are now between 50 and 70.
- Oh.
- So, and the reason for that is, is that,
there is a risk of bleeding with aspirin.
- Oh.
- And so I've seen that personally firsthand,
with my mother-in-law.
- Oh.
- So it was something, she had a hemorrhagic stroke
and she was a regular aspirin user.
- Oh, I see.
- So, whether or not it was the essential causative factor
that caused her brain bleed or not?
- Sure.
- It certainly didn't help because -
- If you're over 70 doctors are probably
going to say, drop the baby asprin?
- With discretion.
- Okay.
- So, it just kind of depends on your risk factors.
And, and so that's where all of this comes down to.
So they're looking for, you know, stomach ulceration,
which is a GI bleed.
- Sure.
- Or other bleed, or, you know
if you burst a blood vessel and, you know
because this slows down the clotting effects
which is why it's so protective for your heart.
- Sure.
- For heart attack and stroke, you know, especially
as we age, we all get atherosclerotic plaque
that builds up in our arteries around the heart.
And so, if we can basically just think of like
when you take aspirin, and not to get over,
you have thromboxane, you have cyclooxygenase,
these are all things that help
with the stickiness or the slickness of platelets.
And when we take aspirin -
- Uh-hum.
- it makes those platelets slick
so it's kind of like coating them with WD 40
to get them to squirt through.
- So you don't get a clot.
- So it doesn't clot.
So it allows blood to move more freely.
So it minimizes the risk of ischemic damage done.
Let's say it's in your heart, the cardiac muscle.
- Right.
- Or, you know, obviously in the brain with a stroke.
- Right, okay.
- But then, and there's the two types of strokes.
So there's the bleeding stroke, which is rare,
like 3% of the strokes.
- Sure.
- And the other ones are all due to a clot.
- Yep.
- So those are the ones that, that 97%
is what aspirin does so well at protecting against.
- But if you're over 70 -
- For over 70 -
- then it's, there's a gray zone?
- it's a very, yeah, it's a very gray area.
And so that's, the risks for bleeding is much,
much higher at that point.
- Oh.
- And so right now, the newest guidelines
on the studies were done, Florida Atlantic,
University of Wisconsin, Madison,
and also Harvard, Brigham and Young Women's Hospital.
- Hum. Okay.
- So those three schools all kind of came together
and did a significant amount of of research.
- Okay.
- Kind of, relaying these new guidelines.
So it's not to say that if you're
under the age of 50, you can't use aspirin.
I mean, a lot of people can safely use aspirin
for you, sprain your knee, sprain your ankle,
you got a headache, you got a fever.
- Sure.
- If you're over the age of 18
on that fever category, it's very effective stuff.
- Uh-hum.
- It works, as you know, but
but there's risks with ibuprofen too.
One of the most common, or excuse me, aspirin
the most common one is usually stomach ulceration.
- Sure.
- So it's always important, you know,
I always, you've noticed this one has the safety coating,
the coating was designed to protect your stomach
against stomach ulceration.
- Ah.
- So it doesn't dissolve in the gut.
It dissolves in your intestines.
- Oh.
- And that's where it absorbs.
- Kinda bypasses that part.
- Yeah. But the controversy with that now is
that they actually think that that's not that great either
because you may not get as much benefit from the aspirin.
- Oh.
- When you need it in a hurry.
So particularly like if you're having a heart attack
if you call 911, hey, I think I'm having a heart attack.
Those 911 operators are trained to ask some
specific questions, like, are you on a blood thinner?
Is there anything else?
- Yeah.
- They may actually have you chew a couple of aspirin
before the ambulance gets there.
- Oh, really.
- And that difference can save your life.
- Oh wow.
- So it's important.
And if you had an enteric coated tablet
that slows down the absorption.
- Oh, sure.
- It's not going to do as much good.
- Right, right, right.
- So that's where some of that controversy is in, but.
- So this 325 milligram, that's your standard dose aspirin.
- Plain dose.
- And that's what you would take, one or two of those.
- Yup.
- If you had a fever, had some swelling?
- One to two every four to six hours apart.
Yeah. That's kind of how that would be dosed.
- Okay.
- For pain and inflammation or fever.
- But if you have a history of like GERD
or heartburn, then aspirin is not a good choice.
- Yeah, then you want to,
and it really, when it comes down to
"what do I, I'm between the age of 50 and 70,
what do I do?"
You want to discuss this with your doctor.
- Sure.
- Your doctor's going to have the most intimate knowledge
about your medical history,
so that we can assure that what we're giving you
is going to be the most essential thing.
- Right.
- You can certainly talk it over
with your neighborhood pharmacist.
They're going to be happy to share their thoughts,
but at the end of the day, your doctor is going to
be the one that says.
"Well, you know, Brad, you're a newly dosed diet,
you know, you got a diabetic,
and you're a smoker and you don't exercise much".
These are all, this is anti-Brad.
(laughter)
But so, but I mean, it's just,
it's one of these things where.
- Sure.
- You know, then in that case, maybe a daily aspirin.
- Sure.
- We're going to pretend you're 38 years old,
maybe a daily aspirin would be effective for you,
but your doctor should the one making that test.
Because there is that bleed risk.
- Sure.
- Which actually can,
I have some very severe complications?
- Yep.
- So, and usually for the younger patient
it's going to be mostly GI, but also older patients too
just the way that our bodies work.
Cause we coat the stomach as well as they used to
so higher risk for ulcerations.
- Yeah.
- So we have to be careful.
So, you know, what do we tell people when
they take aspirin to use it safely?
You want to make sure they take it at least
with eight ounces of water.
- Oh.
- That's probably one of the most
important things you can do with aspirin.
- Okay.
- And probably to take it with a little snack
or a meal that will also help to buffer
and make it absorb a little bit more easily to the stomach.
- Sure.
- So that's how you try and minimize
the risk for GI disorder, but really,
it's that eight ounces of water.
Then you probably don't lay down and recline.
- Oh.
- Because, that you can get some of the refluxing action.
- Come back up. Sure.
- And then they all sit, and it can start
to cause some damage, because it is, you know, a mild acid.
- So if you take it before bed,
take it an hour or so before bed?
- At least an hour before you laid down.
So, but you know, the lay down, so,
but the key with any time you're taking a daily dose
of anything is consistent timing.
- Yup.
- So we want to take it about the same time.
And you know, the interesting thing about aspirin, I mean
within an, it begins to work within an hour
of it being put in your body.
- Oh.
- And it lasts, it has the effect on platelets for 10 days.
- Wow.
So, you know, sometimes people -
- So that's the, were you would,
prevents the heart problem or the stroke, yeah?
- Yup. So when you're,
and that's the most common use these days, I mean,
people typically gravitate more towards the
acetaminophen or Tylenol or ibuprofen for headaches.
- Sure.
- You know, Motrin, Advil, that type of thing.
It's just because they're faster acting.
They, they still, ibuprofen does have platelet effects
but not to the extent of aspirin.
- Sure.
- So they kind of gravitate to those more just
because they're a little bit more gentle on the stomach
less side effect prone, but still incredible stuff.
- So if we have someone, you know, older like me
or even older were aspirin was their kind
of their go-to thing and they're healthy.
They don't have any problems.
They could still go ahead -
- Oh, yeah.
- and use it without any?
- I think you could feel very confident
in the product itself.
- Yeah.
- So I mean the, the things to watch out,
you don't want to take it if you're on a blood thinner,
you don't wanna take it if your doctor tells you not to,
(gentle laughter)
you don't want to take it if you have either asthma,
because sometimes it can trigger bronchial spasms.
- Oh. Okay.
- So it's kind of interesting, so there.
But it could be more or less due
to the allergic component of aspirin.
It's still kind of a hotly debated topic.
- Sure, okay.
- But that said, you know,
so there's a couple of precautionary things
that would, maybe we would tell you to be careful with
and or to avoid.
- Yeah. That's pretty -
- Yeah, it's pretty specific.
- yeah, so, I get it.
If you're generally healthy, like, you know.
I don't really have a doctor because I never go
and, I've went to have a physical
and he doesn't know me that well.
I mean, he just talked to me once
in the last time I had a physical that doctor left
and they keep running away on me.
I don't know.
They don't like me.
- I know, I know.
(laughter)
- But anyways, so, I personally
would feel comfortable taking an aspirin
if I sprained my ankle or had a fever.
- Yeah.
- And I would feel very relaxed.
- Oh yeah.
And it's phenomenal stuff.
And again, it goes back to how versatile the drug is.
- Sure.
- So it can be utilized by many.
I mean, the other thing I wanted to touch on too,
just as a precautionary tale, you know,
there's some debate as to,
let's say you're going to have a dental procedure
or a surgical procedure.
- Oh right.
- Because this does create a bleed risk.
It stays in your body for 10 days.
So, but if it's a minor procedure -
- Sure.
- most doctors and dentists are saying,
you can keep taking it.
- Okay.
- So, that is AOK because the bleed,
they have special, they have hemostatic gauze,
and gelatin containing products.
- Sure.
- That help to cause clotting.
- And I'm sure,
if you're going to have a procedure where that aspirin,
the doctor's going to say no aspirin so many days prior.
- Correct. Yeah, so but,
always, you should always let your doctor,
"Hey, I'm on an aspirin regimen".
- Sure.
- So it is important for your long term safety as well
to let everybody that's going to be involved
with whatever aspect of healthcare
they know what you're on.
- Yep.
- So share it with your pharmacist,
because it's over the counter in so many cases.
- Yeah.
- Although we do see prescriptions for it,
but it should let everybody involved know.
- Yep.
So it looks to me like aspirin is here to stay.
- I think so, it's not going anywhere.
It's cheap, it's effective.
You know, I just had a case the other day at work
where I had an uninsured patient
and they needed to take a prescription anti-coagulant.
And what was selected by the physician was uber expensive.
I mean like 1600 bucks a month.
- Oh, wow.
- No insurance.
- Uh-ha.
- So that's a mortgage payment for-
- Yeah.
- and it was just something that couldn't be,
so, aspirin to the rescue.
We just said, well-
- So did you make that decision or did you call the doctor?
- we call the doctor and said,
okay, this guy's uninsured,
even with things that, we have discount cards
and things that every retail pharmacist works on
that uses to try and defer costs
if they don't have insurance.
- Sure.
- And it just wasn't making anything reasonable
for the gentleman.
- Sure.
- And so as a result of that
we just said, you know, what about aspirin?
- Yeah.
- And the doctor said, yeah,
we're going to have a discussion about that.
So I think it was on the doctor's radar, but-
- Sure.
we just called,
we weren't privy to the conversation
but we saw the price tag and we're like, ooh,
this is going to be really hard on this person.
- Sure. Yeah.
Well wow. Good job.
- So, I mean, it's just, it's just something
and every, I'm not special.
I mean, every pharmacist does that, that's normal. Yeah.
- You know, and I,
I gotta say outside of the aspirin thing,
I've got a friend and, you know, but he said, yeah,
Chris saved me a ton of money at the pharmacy,
Cause he made some recommendations.
And I didn't realize that that happened.
- Oh yeah, yeah.
- I mean, cause I never go.
- Well, I mean -
- Except for (indistinct).
- It's just an aspect of our job.
- Right.
- You know, if we can see a cost saving alternative,
and we can mention it to the doctor
and if the doctor, more importantly,
the doctor has to agree to it.
(gentle laughter)
We don't get to do those things.
- Right.
- So, but it's like;
hey, this is available.
And sometimes, oh yeah,
I didn't even think about that.
Yeah, let's do it.
- Sure.
- So usually it's just kind of a case -
- Ya.
- and it works out slick for the patient.
Everybody wins.
- I say most excellent to that.
All right. Very good.
- Most excellent, indeed.
(gentle laughter)
- Asprin, in a nutshell
from 4,000, 6,000 years ago?
- 4,000 years ago to today.
To the day and it's all right in front of you, so.
- And it's going to keep going.
- That's right.
Enjoy.
And hopefully you don't need any aspirin.
- Have a good day guys.
Thank you.
(synthesizer boping)