To Your Good Health
DEAR DR. ROACH: I’m 63 and in great health and shape. I work out daily, be it weights, running, hiking or cycling. I’m 5 feet, 10 inches tall and weigh 165 pounds. I have terrible balance. Added to that, I have postural hypotension. Combine the two and a fall seems to be destined in my very near future. Advice? — M.T.
ANSWER: It’s great that you are in such good shape, but a fall can be a devastating event for even a healthy person in their 60s. It is much more likely to be so in people who are older and frailer.
From a balance standpoint, I recommend you add in specific balance exercises. Although balance is certainly needed for the activities you do, an activity like tai chi has been proven to reduce the risk of falls. Even enthusiastic athletes like yourself can improve with the slow and controlled movements of tai chi, which train excellent balance.
Postural hypotension is when the blood pressure goes down upon change of position, especially from laying to sitting or standing. General advice includes taking extra time after changing positions to allow your body to get used to the new position — jumping out of bed and zooming down the hall is no longer a good idea for you.
Also, making sure you are getting enough fluids can help keep the blood pressure from going too low.
Ask your doctor about salt intake, as some people with symptomatic postural hypotension need extra salt, but I can’t give that advice without knowing a lot more about you.
DEAR DR. ROACH: My 75-year-old wife had two third generation medicine-eluting stents inserted into a branch of the left anterior coronary artery in January 2020. On 75 mg of clopidogrel and 81 mg of aspirin for nine and a half months, she has endured several serious nosebleeds, one of which required hospitalization for three days. She just had emergency surgery for a lifethreatening perforated ulcer. Going forward, we are scared to put her back on those blood thinners.
Could she get by with natural blood thinners, such as gingko, curcumin, vitamin E, natokinase, etc., since she is such a high risk and so sensitive to pharmaceutical blood thinners? — D.D.T.
ANSWER: One common treatment for blockages in the coronary arteries is to open the arteries with a balloon, and keep the artery open with the use of a stent. Older stents were made of bare metal, but most current stents are coated in medication that helps keep the arteries open. The downside is that stents, especially the new drug-eluting ones, are susceptible to clotting, and the risk is greatest in the first year after a stent is placed. To prevent this, people are placed on two medications to reduce clotting. Aspirin and clopidogrel (Plavix) in combination is the most common. The highest risk of clotting comes within the first month after stenting, where stopping even one of those drugs is associated with a very high risk of sudden clotting of the stent and a subsequent heart attack.
With longer time elapsed since the placement, the risk of stent closure decreases. Many cardiologists stop their patients’ clopidogrel at one year, and she is rapidly approaching that period of time. Other times, cardiologists continue double therapy for longer periods in people who have not had any bleeding complications. I think her cardiologist would be likely to stop the clopidogrel and continue aspirin alone, which has a much lower risk of bleeding complications, and which most people with coronary artery disease should take.