WATCHMAN device is alternative treatment for a-fib
DEAR DR. ROACH: I have been diagnosed with a-fib. For various reasons, it has been determined that I should not be on blood thinners for any sustained length of time (neither Coumadin nor the more recent generation). My cardiologist has suggested that a good alternative in my case might be the WATCHMAN device, which involves surgery. This would put me on blood thinners a month before surgery and up to six months after, but not indefinitely, as normally would be the case. I know that the device has been in use in Europe for about eight years but only recently has been approved by the Food and Drug Administration and Medicare. I am wondering what you can tell me about this option. Beyond the normal risk of any surgery, is it a better option than just a regimen of aspirin for someone with a-fib who can’t be on blood thinners indefinitely? -- M.H.
ANSWER: Atrial fibrillation -the lack of an organized rhythm in the atria, the small chambers in the heart that the blood flows into before going to the ventricles -- may cause several problems, but the most worrisome is a blood clot. It can embolize (break off into the blood) and cause damage, especially to the brain, where it causes a stroke. The part of the heart where blood clots form is called the left atrial appendage. The WATCHMAN device is one of several (but the only FDA-approved one, as of this writing) designed to block off the appendage. It is about as successful at preventing stroke as medication therapy, such as warfarin (Coumadin) or dabigatran (Pradaxa).
The major risks from the WATCHMAN device include pericardial effusions (fluid in the sac containing the heart) requiring drainage, and migration of the device. However, there were fewer strokes in the WATCHMAN device, and with longer use, those with the device had a lower overall death rate and higher quality of life scores.
The decision to use a therapy like warfarin or the WATCHMAN requires an individual assessment of risks (cardiologists use a scale called the CHADSVASc score), and since you are recommended for treatment, I must assume your doctor found your risk high enough that the benefits of more aggressive therapy outweigh the risks. If this is the case, then the WATCHMAN is a reasonable option for you.
DEAR DR. ROACH: When I first had gout, the wife of a friend, who was into homeopathic healing, suggested I eat several dried sour cherries for a few days. I had about a dozen dried sour cherries a day for only three days, and the pain was gone. This also has regularly worked for my wife. When she first feels a twinge, she has some dried sour cherries, and the pain goes away. Sour cherries work! They also work for some arthritis conditions. -- M.M.
ANSWER: I was able to find two papers on gout and sour (Montmorency) cherries. One showed that they reduce uric acid levels in healthy volunteers; the other that they reduce the likelihood of an acute attack in someone with established gout. I could find no evidence that they treat an acute attack. In fact, lowering uric acid levels suddenly can make an acute attack worse, so I can’t recommend tart cherries (or juice, or extract) for acute gout.