DEAR DR. GOTT: My question is simple but serious. The blood thinner Coumadin is ordered for a 94-year-old lady. She is up and about and mostly self-care. Hospice sees her but she frequently complains of high blood pressure and a little chest discomfort. MOST FRIGHTENING is the leakage of blood so that her forearms are now very dark with seepage of blood under the skin, increasing up her arms. They are dark up to her elbows. Her blood pressure remains around 160/80. She does have ankle edema but wonders, realistically, if blood is also seeping elsewhere in her body and not showing up as it does on the thin skin on her arms. Her doctor does not discuss this. She is in home health care and seen once a week. I did write to you once and am sorry if I have mistakenly used your email.
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Addressing Coumadin
Medical issues plague patient
DEAR DR. GOTT: I am a 76-year-old female. My meds are Benicar, hydroclorothiazide, atenolol for hypertension, Zantac for GERD, potassium chloride, simvastatin for high cholesterol, Levemir for diabetes, an 81 mg aspirin most days, and a nitroglycerin patch for angina. I still have a lot of chest pain, even with the patch.
I am allergic to molds, most fragrances, smoke, many medications – (especially narcotics for pain). Twenty-five years ago I had a distal pancreatectomy and now have developed a small tumor in the remaining head of the pancreas. My father died at 83 from pancreatic cancer, my mother at 96 from multiple myeloma. My father had CAD which I now have. My doctor prescribed Plavix that causes extreme itching but no rash, so I discontinued its use. I tried Effient. Same itching. [Read more...]
Monitoring necessary and safe
DEAR DR. GOTT: Is it safe to have blood drawn while on a blood thinner?
DEAR READER: Yes, it is. When you cut yourself, the body’s defenses kick in to halt the bleeding by forming a clot. The process is known as coagulation and is how things should happen. On the other hand, without that cut and with blood moving through your veins and arteries, clots should not occur. Unfortunately, they do, and for a number of reasons. When they occur, a physician will likely prescribe a drug to bring the disorder in line. Some of the causes are inherited, such as sticky platelet syndrome or factor V Leiden; some are acquired, such as occurs with HIV/AIDs, inflammatory bowel syndrome, obesity, trauma and hormone-replacement therapy. These conditions and a host of others must be checked periodically with laboratory testing so a primary-care physician or hematologist can correctly monitor a patient. [Read more...]