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.
[Read more...]
Addressing Coumadin
Coumadin causes cold feeling
DEAR DR. GOTT: I have a family member who takes Coumadin and always complains of being very cold. Nothing she does externally helps to warm her up. I figure that the thinning of her blood causes the cold feeling. I just want to find out if you have any suggestions on how to help her counter this side effect. I know of others who also have this problem. Please help them if you can.
DEAR READER: Coumadin does carry the side effects of cold intolerance and paresthesias, including feeling cold and chills. I suggest your family member speak with her physician. Perhaps a change in medication is appropriate. Other than that, she should wear layers and avoid going out in the cold or being in an air-conditioned building whenever possible.
[Read more...]
Daily Column
DEAR DR. GOTT:
You recently discussed warfarin, the brand name of which is Coumadin. It was discovered by serendipity by Dr. Karl Paul Link at the University of Wisconsin in 1948 and developed at the Wisconsin Alumni Research Foundation, hence the name.
As a physician, I feel your readers might be interested in the background of the development of how this drug got its name.
DEAR DOCTOR: Coumadin is an anticoagulant often prescribed for patients at risk of heart attack, stroke and some other serious medical conditions. It never occurred to me how the name came to be.
Bizarre Beginnings For Common Medications
DEAR DR. GOTT:
I was prescribed Coumadin/warfarin in 2005. I have just recently learned that both are a form of rat poison! Is that the best our “medical industry” can come up with? What’s next? Leeches?
I want to know what I can take in place of the “rat poison”. There has to be something better.
DEAR READER:
It is true that Coumadin’s generic form, warfarin, is one of the main ingredients in rat poison. However, that does not mean it is not beneficial for humans. Many life saving medications and treatments have been found in unlikely places. Aspirin was derived from the bark of willow trees. Penicillin was discovered by accident when mold blew in from an open window into a petrie dish containing bacteria. Many cancer treatments have been developed from plants found in rainforests and jungles. [Read more...]
Daily Column
DEAR DR. GOTT:
I am facing a dilemma regarding medication. Following a diagnosis of atrial fibrillation, my internist and cardiologist very strongly say I must be on Coumadin to reduce my chance of stroke.
I am not interested in doing this if there is any other possible alternative. I would appreciate your thoughts on this matter.
DEAR READER:
Many studies have proven that atrial fibrillation (an erratic, fast pulse rate) can cause a stroke if a clot forms within the heart, breaks off, and is carried to the brain. Warfarin (Coumadin) appreciably reduces this risk. Therefore, I advise you to follow your doctors’ recommendations.
Coumadin is available in pill form, is inexpensive and easy to monitor. To my knowledge, there are no other inexpensive substitutes. Plavix is another pill, but is expensive and may need to be combined with aspirin for optimal effects. Other anti-coagulant drugs (such as heparin) are given by injection, are expensive and are not suitable for home care.
I suggest you take the Coumadin. With proper dosing and monitoring, it is safe.
To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
Daily Column
DEAR DR. GOTT:
I am a 61-year-old male with no heart problems or recent surgeries. In June 2004 I developed a blood clot in my left lower leg which then resulted in a pulmonary embolus (clot) in my right lung. I was admitted to my local VA hospital and put on 5 mg Coumadin daily. My PT/INR was kept in the 2.0-3.0 range. I continued the medication until October 2006 when I was told I could stop it. All was well until February 2007 when I developed multiple pulmonary emboli in both lungs. This time I did not have any of the leg symptoms. I again went to the VA hospital where I was put on 5 mg of Coumadin every day. I was told that I would now have to take it for the rest of my life.
Because I did not understand why this was happening, I made an appointment with a hematologist (blood specialist). She took blood samples and did a genetic profile. Everything came back negative or normal. She concluded that I now have naturally “clotty” blood and I would have to live with it. There was no identifiable cause.
So now, Dr. Gott, my questions to you are: why, after 58 years of being a “normal blood clotter“, did the above happen to me? Will I really have to be on Coumadin for the rest of my life? Should the VA doctors be doing or have done more for me? Your opinions are appreciated.
DEAR READER:
I don’t know why your blood is now clotting in a dangerous fashion. Your hematologist appears to have run extensive tests and ruled out any genetic factors and disorders as the cause. Therefore, you will need to continue the Coumadin for the rest of life. If you were to discontinue it, you would run a very high risk of developing more pulmonary emboli (blood clots in the lungs). You would also be at higher risk for heart attack and stroke if the clots broke off and were carried to your heart or brain. Sticky blood is especially dangerous and your physicians have taken appropriate steps to normalize your blood and reduce your risk of serious consequences.
Another option to explore, albeit unlikely, is lung cancer. In my practice I have seen several cases where pulmonary emboli were the only symptoms of lung cancer. If you wish to explore this option, I recommend you see a pulmonologist (lung specialist). He or she will most likely take a medical history, do an examination and order some imaging studies of your lungs.
Let me know what happens.
To give you related information, I am sending you a copy of my Health Report “Pulmonary Disease”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.
Daily Column
DEAR DR. GOTT:
My husband has an unusual condition which none of his physicians have been able to diagnose or treat successfully.
He is 57, has had two heart attacks but is now healthy and has a low blood pressure. He is on Zetia, Benecar, Lipitor, aspirin and Effexor.
His problem is that when he lies on his left side, he hears a pulsating blood flow noise in his right ear. It has the same timing as his heart beat. If he turns his head to the right or lies on his right side the noise stops. Occasionally it happens while he is standing or sitting upright. It is not debilitating but is very irritating to him. If he presses on the carotid artery, the sound stops but resumes once he releases the pressure. He cannot remember if this started before or after his heart attacks.
His hearing has been checked and is normal.
We would both appreciate any suggestions you may have. He claims he will even sleep with a bar of soap under his neck if it will help.
DEAR READER:
A noise in the neck that stops when pressure is applied to the carotid artery suggests that there may be blockage in that artery.
This possibility can be very dangerous. If left untreated, the blockage will get larger and may severely reduce or stop blood flow through the artery. A piece may also break off and be carried to the brain where it could lead to stroke.
Therefore, I recommend that your husband ask his physician to order a carotid ultrasound. It is safe and easy. This will diagnose a blockage if one is present.
If, as I suspect, your husband has a blockage, treatment will depend on the severity. He will most likely need to start anticoagulant therapy such as warfarin (Coumadin). He may also benefit from a procedure called angioplasty that uses a balloon-like device to break up the blockage and restore blood flow.
Your husband’s cardiologist is the best source for more information about causes and possible treatment options. I suggest you start with him or her and bring along a copy of my response to your letter. Let me know how this turns out.
To give you related information, I am sending you copies of my Health Reports “Coronary Artery Disease” and “Stroke”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).