An­ti­co­ag­u­la­tion ther­apy length depends on clot

Cape Breton Post - - Advice/ Games - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­ or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I had a blood clot in my lower leg. I was told that the clot moved to my lung. I had only a lit­tle pain in my leg, then some short­ness of breath. The ur­gent-care of­fice went crazy, telling me that I could die, and it scared me. They put me in an am­bu­lance and rushed me to emer­gency, where they watched me for hours and couldn’t find any­thing wrong. They told me to see my fam­ily doc­tor. All he did was put a pre­scrip­tion in my hand for a drug that costs $300 a month. I took it for a month. I have not been on a blood thin­ner now for two years. I am on a good diet, work out and drink plenty of wa­ter. Do you think that some­body who had one blood clot should be on med­i­ca­tion for the rest of their life? I am 55 years old and in pretty good health. -- S.D.

AN­SWER: Blood clots in the leg can cause symp­toms of leg pain and swelling, but the wor­ri­some part is that they can break off and travel to the lung, where they are life-threat­en­ing. Treat­ment usu­ally is in­jec­tion med­i­ca­tion for five days or so, fol­lowed by sev­eral months of an oral an­ti­co­ag­u­lant (some of which are very ex­pen­sive).

How long peo­ple stay on ther­apy depends on why they got the clot in the first place and how dan­ger­ous it was. Some­one with a clear risk fac­tor, like surgery or pro­longed air travel, needs a shorter du­ra­tion of treat­ment than some­one with­out a clear rea­son. Some­one with a rea­son that can’t be re­versed (say, a ge­netic con­di­tion) or with mul­ti­ple or life-threat­en­ing clots (such as those that go to the lung and cause changes in blood flow to the lung) are usu­ally rec­om­mended for life­long treat­ment. Treat­ment shouldn’t be stopped lightly or with­out the knowl­edge of your doc­tor. Un­for­tu­nately, I don’t have enough in­for­ma­tion to say whether you should have been on more pro­longed treat­ment.

DEAR DR. ROACH: I have been a di­a­betic for go­ing on six years now. I take met­formin. My A1C level has gone any­where from 7.8 to 9.4. My liver en­zymes started ris­ing af­ter I was di­ag­nosed with a fatty liver eight years ago. In July, I had my blood­work done, and it was 170 (ALT). I started re­search­ing sup­ple­ments for liver cleans­ing and di­a­betic re­ver­sal. I started on milk this­tle and berber­ine, along with pro­tein pow­der for my morn­ing smooth­ies. I started walk­ing a lit­tle more, and try­ing to be good about what I eat. I felt good tak­ing these. I also lost about 10 pounds over a three­month pe­riod. All my num­bers im­proved: ALT from 170 to 24, triglyc­erides from 313 to 156, choles­terol from 185 to 167, HDL 32 to 38, LDL 98 to 90, and my A1C to 6.6. Is there any­thing wrong with tak­ing these sup­ple­ments? I read pre­vi­ously where you had stated that bi­otin could give false lab read­ings. Is it true that these all could be false read­ings? -- D.B.

AN­SWER: Milk this­tle has been eval­u­ated for treat­ment of chronic liver dis­ease, but a re­view of stud­ies showed no ben­e­fit. A pilot study of berber­ine in just 36 pa­tients showed prom­ise, but I can’t rec­om­mend ei­ther sup­ple­ment based only on the ex­ist­ing ev­i­dence.

How­ever, whether the sup­ple­ments helped or not, I con­grat­u­late you on your suc­cess. Ten pounds of weight loss, ex­er­cise and an im­proved diet cer­tainly could ex­plain the im­pres­sive changes in your lab tests.

Bi­otin specif­i­cally af­fects the lab test for thy­roid tests: I don’t know of any in­ter­ac­tion with milk this­tle or berber­ine on lab tests, and don’t be­lieve that these are false read­ings.

READ­ERS: The book­let on heart at­tacks, Amer­ica’s No. 1 killer, ex­plains what hap­pens, how they are treated and how they are avoided. Read­ers can or­der a copy by writ­ing:

Dr. Roach, Book No. 102, 628 Vir­ginia Dr., Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

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