Question: Over the past two months I have had some stomach issues that my doctor and I have been working on. It is not new; I have had some disquiet before. I had a stroke in May 2011 and a regular (325MG) enteric-coated aspirin daily was prescribed as an important preventive measure. I also take a simvastatin and enalapril and atenolol for blood pressure control. My current problems started around Christmas this year. My doctor thinks it unlikely that aspirin is the culprit since I tolerated it so well for nineteen months and I always take it with food. Then, last week I was diagnosed as lactose intolerant, a possible cause of the moderate indigestion. I received a 31 reading on a scale of 0-18. He said it would take about four to six weeks for a change in diet to really feel truly better. Is aspirin a likely or unlikely culprit, or should I stay with it for obvious reasons? Does calming the lactose take four -six weeks of being careful and recalibrating the system? Should I just move calmly forward, not worry about minor setbacks, take the aspirin for safety, and see what happens. Stopping the aspirin for two weeks is probably not a good idea, at least yet. Am I getting prudent advice from my doctor.?

Dear Dr. XXXXXXX

Thank you for your thoughtful reply. It is good to have your opinion that the aspirin is not the prime cause right now of the stomach discomfort. And I am assuming that you feel with my doctor that stabilization can take four to six weeks, just to get the system back on line. (Yes?)

I was interested in your observation about my aspirin dosage. I currently take two baby aspirins (81 mg) in the morning, two at night. Am I reading you correctly that I could receive the same protection, no lessening of the positive effect of the aspirin, buy taking, say, one baby aspirin in the morning and one at night, cutting the dose in half to 162 mg daily? This might be worth adding to the healing process if it provides the same protection and you think 325 mg daily could be an added factor. Maybe it is not right now, but I could still reduce and be safe. One wants to be careful with the aspirin regimen; too much is unnecessary, not enough can be deadly. Appreciate your thoughts greatly.

Dear Dr. Bernard:

Thank you form your careful follow up and useful information. I believe I can incorporate it into my plan to attack the lactose intolerance issue over the next four to six weeks, while reducing the aspirin dosage and still achieving preventive protection. I think it is now a matter of remaining focused, dealing with periods of not feeling 100%, knowing the aspirin therapy will still work at the lower dosage, and getting better, I hope. One final question. Among the other meds I take, atenolol and enalapril (ten years each), and simvastatin (two years), are any of them likely to cause in gastric problems? I think we are zeroing in on the lactose, I am just making sure. Tests have been done to rule our celiac disease and hpylori presence. Then I think I am on my way. Thank you so much!