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
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.
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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.