DEAR DR. GOTT: I’m diagnosed with von Willebrand’s type 2B bleeding disorder. My doctor wants to put me on cholesterol medication and my cholesterol to be under 70. I’m 60 years old.
I’m terrified of statin side effects and wonder why doctors push so hard to prescribe statin meds.
DEAR READER: VonWillebrand’s results from a deficiency in or impairment of a protein in the blood clotting process. Essentially, those with the condition will take longer to stop bleeding when they are cut and longer than normal to form clots. This can occur during a particularly heavy menstrual flow, from bleeding of the gums following tooth brushing, a razor cut, nosebleed, tooth extraction, and countless other conditions that occur every day.
Essentially, the cause is an hereditary defect in the gene that controls a protein known as the von Willebrand factor. During a malfunction, platelets cannot stick together as they were designed to, nor can they attach themselves to the blood vessel walls normally when an injury occurs. The result is uncontrolled bleeding. Most cases are autosomal dominant inherited, implying a person only needs one abnormal gene from one parent to be so affected. If a person has the gene for von Willebrand, he or she has a 50% chance of passing that gene to any offspring. The most severe form, type 3, is autosomal recessive, meaning both parents would have to pass the abnormal gene on for offspring to be affected.
There are three major types of the disorder. The first and most common is referred to as type 1. Symptoms are generally mild. In some of the individuals in this category, levels of factor VIII are also low. Type 2 symptoms tend to be more significant. In type 3, which is very rare, the von Willebrand factor is absent and levels of factor VIII are low. Signs will likely be severe and there may be bleeding into muscles and joints.
This is a life-long condition that has no cure, yet it can be treated effectively by a physician. The type of treatment used will vary, depending on the severity of the disorder and whether or not prior methods had been effective. The first step is often desmopressin (DDAVP), a medication that is administered into a vein or through a nasal spray. This synthetic hormone controls bleeding by stimulating the body to release additional von Willebrand factor stored in the lining of the blood vessels. DDAVP is often effective in treating type 1 and some subtypes of type 2.
Replacement therapy consists of the infusion of prepared doses of concentrated blood-clotting factors that contain von Willebrand factor, as well as factor VIII. If DDAVP doesn’t provide good results, this may be useful for all types of the disorder.
Medications that are clot-stabilizing can slow the breakdown of clotting factors which, in turn, can keep a clot in place once it has formed. This may be an option for those who must undergo tooth extraction or a surgical procedure.
On the home front, anticoagulant medication such as aspirin or warfarin should be not taken without the consent of a hematologist or primary care physician. Acetaminophen should be the replacement. Some anti-depressants can cause mild platelet dysfunction and obviously should not be taken.
Remain as active as possible; however, avoid contact sports that can cause bruising and other injuries. Restrict activities to walking, biking, tennis, swimming, yoga, tai chi, and other non-contact activities.
Because some people with the disorder have extremely mild signs, the condition can be difficult to diagnose. Those who feel they may have a bleeding disorder should be under the care of a hematologist who will perform blood tests.
If you haven’t done so already, I recommend you seek a second opinion from a hematologist before going on a statin drug. While one will reduce your total cholesterol which will subsequently lower your risk factor for developing cardiovascular disease, I have never heard of anyone having a blood level of 70. Perhaps you misunderstood your physician who is actually attempting to bring your LDL (“bad”) cholesterol down to 70 or lower rather than your total cholesterol level. Do you have a cardiac condition you failed to mention? Are there other issues you haven’t mentioned? Get the facts and weigh them carefully before you make a decision in this regard.
Readers who would like related information can order my Health Report “Understanding Cholesterol” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
