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.