Strategies for avoiding blood clots on long flight
Q: My wife and I will be flying to Europe in a couple of weeks. We’re concerned about the possibility of developing blood clots in our legs.
Air passengers are hardly allowed to walk around during the flight anymore. Is there anything we can do to reduce our risk?
A: There are a few things that will help. Make sure you wear compression hose for the flight. That can lower the risk of a clot. In addition, learn foot and leg exercises that can be done while seated, such as ankle circles, foot lifts and knee raises.
One other option is aspirin. For years, experts told us that aspirin was ineffective against blood clot formation in veins. A study in the European Journal of Internal Medicine (January 2014) contradicted that belief. Lowdose aspirin reduces the likelihood of clot formation in high-risk patients. Ask your physician if aspirin would be safe during your flight.
Q: You have written about people having a hard time stopping their antidepressants. More than a decade ago, I was having trouble getting one of my patients off Effexor. I wrote to the drug company for help, and the solution was ingenious. I have used it many times with patients trying to get off an SNRItype antidepressant.
Fluoxetine (Prozac) has an extraordinarily long half-life. Prozac “covers” the receptors that are unsettled in the discontinuation syndrome.
I put the patient on the lowest dose of the problem antidepressant that is comfortable: no discontinuation symptoms. I start 20 mg of Prozac. In two weeks, I lower the dose of the problematic antidepressant, keeping the patient on Prozac.
I continue to taper the problematic antidepressant down to zero, taking as long as is needed. When my patient is completely off the problem drug, I keep the Prozac 20 mg for two more weeks, taper it to 10 mg for two weeks and then stop it. The long half-life of the Prozac gives me an automatic long taper, and the patient has no withdrawal symptoms.
A: Thank you for providing this detailed account on how to avoid symptoms like “head in a blender” that many people experience when stopping their antidepressant.
Q: I wanted to quit smoking, so my doctor prescribed Chantix. The bad dreams and depression made me question whether life was worth living. I feared going out in public because I would sometimes fly into a rage for no obvious reason.
Even though I lost my urge to smoke, I wonder whether the side effects of the drug are worth it. I am tapering off, but the anxiety, rage and depression are still scary.
A: The manufacturer of the stop-smoking drug varenicline (Chantix) warns that it may cause insomnia, abnormal dreams, depression, agitation, aggression, hostility and panic, as well as suicidal thoughts. This drug may not be appropriate for you.
Q: I am a 34-year-old woman with a 53-yearold husband. I love him so much, but he has erectile dysfunction, and in the past year his sex drive has dropped as well. We usually make love once a month, although I would prefer daily or at least once a week.
I was fascinated to read that mint tea might dampen sexual interest, so I tried it. With a cup of mint tea morning and evening, I soon lost my constant nagging desire. It has made things much easier.
Others have said that those with the desire are the normal ones, and our partners should get help to raise their libido. In an ideal world, this is true. But you can’t change other people, only yourself. I hope the tea works as well for others in this situation as it has for me.
A: Spearmint tea (Mentha spicata) can lower testosterone levels, which might account for a drop in libido (Phytotherapy Research, February 2010). Not everyone will respond as you did, but others may want to consider this herbal approach.