Welcome back to my blog, which puts into writing the topics discussed during the June 15, 2012 episode of Let's Talk Medical with Doctor Gigi.
Rating Physicians:
Many websites are available to rate physicians, & you can use them to rate your doctor or even to learn about a doctor before you establish a relationship with him. Keep in mind however that like all statistics, these rating scales do not always tell the truth. Often times, the most dissatisfied patient is the one most likely to cast an opinion. Also, anybody is allowed to vote, so I could encourage friends & even relatives to give glowing reports. I generally get good scores, but I lose a few points when judged on timeliness. At first you might think that I don't respect my patient's time, or perhaps I overload my schedule, or perhaps I have too many distractions, but in fact I run late because I spend so much time with patients... they get the time they need, not just the time for which they were scheduled. So, the fact that I do not get a perfect score, does not truly reflect a defect or problem with my medical care. Keep in mind that a perfect doctor for you might not be the perfect doctor for someone else. If your doctor has good basic medical knowledge & judgement, if he listens to you, educates you, sincerely tries to understand & know you, & in general treats you as a friend or family member, you have a fabulous doctor... for yourself... & you should not worry about the rating he might get from other patients.
Generic Plavix:
Plavix (= Clopidogrel) is a medicine used to thin blood, thus it is used to decrease the risk of strokes & heart attacks. It is pretty expensive, so many people have been awaiting the release of the generic version. Happily, the generic Plavix hit the market in May 2012. If you have insurance coverage for your medications, you likely have seen the price drop. However, if you pay for your own medications, you might not see the price drop until after the first year that the generic is available. Thus you will get a cheaper Plavix around May 2013. Again, this illustrates the fact that although a generic medication is approved, the price often does not drop significantly for cash-pay patients until 1 whole year after the initial approval. This is due to the fact that usually only 1 company gets the right to produce the generic version the first year. Many companies can begin to produce their generic versions once that first year has passed, & this results in a significant cost savings for all patients (insured & non-insured).
Vicodin Reformulated:
With the use of narcotics on the rise... an epidemic you might say... there has been much concern about the fact that most narcotics are combined with Tylenol. Many doctors & most patients forget this, & frequently patients end up taking an overdose of Tylenol which can be lethal. In fact, we used to recommend a maximum daily dose of 4,000 mg of Tylenol, but now we have lowered that maximum dose to 3,000 mg of Tylenol per day.
Vicodin is a commonly used narcotic pain medication which combines Hydrocodone (the narcotic) with Tylenol. It used to be available with 5, 7.5, or 10 mg of Hydrocodone, combined with 325-500 mg of Tylenol. Physicians used to frequently prescribe the Vicodin 5/500 at a dose of "1 to 2 pills every 4 to 6 hours as needed for pain." Therefore a patient was allowed a maximum dose of 2 pills every 4 hours (6 times per day), resulting in a total daily dose of:
5 mg of Hydrocodone per pill X 2 pills = 10 mg of Hydrocodone per dose
10 mg Hydrocodone per dose X 6 doses per day = 60 mg Hydrocodone per day.
Unfortunately, if you figure out the dose of Tylenol, you will find that this dosing provides an OVERDOSE of Tylenol:
500 mg of Tylenol per pill X 2 pills = 1,000 mg of Tylenol per dose
1,000 mg of Tylenol per dose X 6 doses per day = 6,000 mg Tylenol per day!
Thank God for Pharmacists who have worked diligently to educate physicians about the dangers of these combination drugs, & have often suggested other doses which will not overdose our patients on Tylenol. This was not lost on the Pharmaceutical industry, who is now reformulating narcotic-Tylenol combination products.
Vicodin will soon be released in its newly reformulated version... which will use 300 mg of Tylenol regardless of the amount of Hydrocodone in the pill. Thus if a patient takes 2 pills 6 times per day, they will only get a max of: 2 pills X 300 mg Tylenol X 6 doses = 3,600 mg of Tylenol per day. Though this is higher than the new overdose level of 3,000 mg of Tylenol per day, it is at least below the 4,000 mg dose which is the known toxic dose. Expect to see this change occur during September or October 2012, & expect other narcotic medications to follow with similar reformulations.
By the way, Tylenol overdose is a nasty way to die. The Tylenol injures your liver, but it takes up to 5 days for your liver to show the full extent of that damage. Thus, a person who intentionally overdoses on Tylenol will often wake up in the hospital after having had his stomach pumped. Most times he is happy to be alive & thankful that the suicide attempt was not successful. Unfortunately, about 5 days later his liver will begin to die, & without a liver transplant, so might he. Physicians can check a Tylenol level when the person first shows up in the Emergency Room, & they can use this level to predict whether the liver will actually die or not. Of course, slow daily unintentional overdose is different as the damage to the liver occurs slowly over time, but the outcome is the same.
Stop Smoking:
If you or someone you love is trying to stop smoking, here are some helpful hints.
If you live in Florida, you should check out "Tobacco Free Florida" as I think they can provide you with free nicotine patches. If you have never tried these patches, you should, as they often work well for people truly committed to stopping smoking. Be sure to follow the directions, as the strenghth you will need varies depending upon the amount of cigarettes you smoke. The 21 mg patch is the correct strength for someone who smokes about 1 pack per day, whereas a 1/2 pack per day smoker should use the 14 mg patch. Of course you start with a high dose, then wean down over time.
Though the nicotine patches help many people stop smoking, I prefer the Nicotrol Inhaler device. It is a small plastic device that looks like the plastic tip on a cigar. It unscrews, & inside it holds a small sponge that is impregnated with nicotine. As you "smoke" the device, air comes in through the sponge & picks up the nicotine, thus carrying it into your lungs. Thus you get the nicotine... which is truly what you are addicted to... but you do not get the tar & smoke! Your hands & mouth feel as though you are smoking, so they are happy too! Over time you are supposed to use less & less of these inhalers, but even if you never stop using them, you will at least be doing less damage to your body than if you continue to smoke cigarettes. Also, because you only get nicotine when you "smoke" the Nicotrol inhaler, you can choose to smoke a real cigarette interspersed with the inhaler, thus you do not have to worry if you have an occassional "slip" with the tobacco cigarette.
Though Nicotrol inhalers are expensive, I recently saw where you can get a month's supply for a maximum of $50. To cash in on that deal, you should go to the website www.Nicotrol.com where you can get a coupon which will limit your cost to $50. You will still need a prescription, but I don't think there is a physician among us who would not be happy to provide you with that!
Headaches:
If a 50 year old lady starts to develop headaches which are associated with nausea, is this likely to be migraines? It is certainly true that migraine heasdaches can develop when ladies go through hormonal changes such as menopause, but at 50 years old you must also give consideration to neurologic abnormalities such as masses, tumors, strokes, or pre-strokes (called TIA's, which stands for transient ischemic attacks). Thus it is likely that this lady should have a neurologic examination & perhaps an MRI of her brain, just to be certain there is not a more ominous cause for her headaches.
Also, tension headaches, which are caused by muscle tension or spasm, can be associated with nausea as well. And don't forget, stress can cause both migraine & tension headaches.
Though you can certainly awaken with a tension headache or a migraine headache, you should also give consideration to the fact that morning headaches can be a sign of sleep apnea. So if you awaken with headahces, snore loudly, have daytime exhaustion, & awaken feeling as tired as you were when you went to bed, you just might have sleep apnea. Talk to your physician & he can order a sleep study to evaluate this further. As a cost-effective measure, ask if you can get a "home" sleep study, as these can now be conducted at your own home, which is less expensive than going to a sleep lab.
Blood Clots & Travel:
If blood sits still too long it tends to clot. Thus it should come as no surprise that travel increases the risk of getting blood clots in your legs which are called "deep vein thromboses" or DVT's. These unfortunately can break free & go to the lungs where we call them "pulmonary emboli" (= PE). Pulmonary emboli can kill you as they block up the blood vessels of the lungs, thus liquid blood cannot pass through the lungs to pick up oxygen, resulting in a deadly lack of oxygen to all the body's organs. So if you travel 2 hours or more, you should pump your feet up & down to push the blood through your leg veins. You should also stand up or at least try to stretch out straight so you remove the bend at your hips, thus re-establishing a straight course for the blood to flow from your feet to your heart. If you develop red, hot, swollen legs or shortness of breath after travel, do not delay in contacting your doctor & be sure to give him this history so he will evaluate you urgently. The best study to evaluate for DVT's is a Doppler ultrasound of the legs, & the usual test for a PE is either a ventillation-perfusion scan or a spiral CT of the chest. Again, these clots can be life-threatening, so if you think you have one, get your studies done urgently, even if that means going to the Emergency Room!
Thanks for visiting my blog, & I hope you learned something useful. Remember you can hear me live on WTAN 1340-AM on Fridays from 1-2PM Eastern time. Or if you prefer, check it out on www.SkipShow.com where you can listen live or to the podcasts. I would love to hear from you... comments of questions. You can reach me live during the show via (727)-441-3000 or on our toll-free number: (866)-TAN-1340. If you prefer, you can reach me any time via: DoctorGigi@SkipShow.com.
Here's to our health!
Doctor Gigi
PS I would love to impact more people, so please consider sharing this blog with your friends & family on Facebook or on your other chosen social media.
Sunday, July 22, 2012
Sunday, July 8, 2012
Bleeding After Menopause; Nipple Confusion?; PSA vs. BPH; Coumadin & Vitamin K; Iron for Anemia.
I recently attended the 25th Reunion of my medical school class. If you are quick with math, you know now that I graduated from medical school in 1987! The reunion of the LSUMC Class of 1987 was in New Orleans, & I guess we have gotten old enough that we "earned" the opportunity to celebrate at Arnaud's Restaurant. This grande restaurant served great food, & provided a balcony over-looking Bourbon Street... so we really felt the New Orleans experience! The highlight of the night was a tour of the restaurant, where we learned that it occupies the entire city block & is a conglomeration of 14 houses which were individually purchased & joined together over many years. I guess that explains the variable decor & the steps up & down from one room to another! And of course, the true highlight of the entire weekend was the opportunity to spend quality time with many friends, most of whom we see all too seldom! I have found that the bond we established during our 4 years of medical school seems to be an ever-lasting one, & I am already looking forward to our 30th reunion. Even better than that is the fact that due to social media, we will likely be better at keeping up with one another from here forward!
Despite my "play time," I did broadcast "Let's Talk Medical with Doctor Gigi" from my parents' home in Port Allen, LA. Following are the highlights of that June 8, 2012 episode.
Bleeding After Menopause:
We have discussed that menopause is the absence of ovarian function, either due to the "death" of the ovaries or due to their surgical removal. With the lack of ovarian function there is also a lack of a menstrual cycle as it is the ovaries which normally produce the hormones which cause this cyclic bleeding monthly. Once you lose ovarian function, you stop having periods, & though the bleeding usually does not just stop, the cycles usually get further & further apart. Once there is no period for one year, you are fully menopausal... also known as "post-menopausal."
It is very important to know that once you have stopped having periods for 1 year, you should never have a period or vaginal bleeding again... & this includes "spotting!" In fact, doctors call any of these "post-menopausal bleeding," & we generally assume that this is endometrial cancer (= cancer of the uterine lining) until proven otherwise. Of course, if you have had a hysterectomy then you have had your uterus removed, so you no longer have an endometrium (as this is the inner lining of the uterus). Thus a person with post-menopausal bleeding would not need to be as concerned if she does not have a uterus. But if she has a uterus, she MUST see her GYN or Primary Care physician for a physical exam, probably a pelvic ultrasound, & likely a biopsy of her endometrium... & she should NOT wait!
Fortunately most post-menopausal bleeding is found to be due to benign causes, but the work-up for cancer must prove this as it cannot be assumed! Often times the cause is infection, but I believe the most common etiology is vaginal dryness (= atrophic vaginitis) which is common is women who have lost their estrogen hormone. Fortunately a small amount of estrogen cream applied to the vagina & external tissues can make these dry tissues healthy again, resulting in resolution of the abnormal bleeding, as well as a return to more supple, pliable, moist genital tissues which makes sex more fun!
Also, note that if you take hormone replacement for menopause, you might have bleeding depending upon how you take those hormones, & how long you have been on them. If you take them in a cyclic fashion... 25 days of progesterone, with the last 10 days combined with estrogen, followed by 5-6 days of no hormones... you should bleed monthly (during the 5-6 days of no hormones). If you take both the estrogen & progesterone every day, you might bleed irregularly for the first 6 months, but after that, you should not bleed... so call your doctor if you do!
As a last note, a Pap smear only tests for cervical cancer. That means that it looks for cancer on the bottom of the uterus. It does not tell you anything about endometrial cancer, so even if your Pap was recently normal, you must call your doctor if you develop unexpected post-menopausal bleeding!
Nipple Confusion?:
Don't get me wrong, I strongly believe in breast feeding! It provides the most natural source of nutrition to our babies, & the first 3 days of breast feeding is particularly important as the breast milk is very special at that time. It is called "colostrum," & it is loaded with antibodies (from the mother) which provide the baby with a great immune system until he can produce his own!
But will it confuse the baby if you inter-mix the breast feeding with a bottle? People have proposed that if you feed the baby a bottle, he will get "nipple confusion" & not feed properly. I really don't subscribe to this idea, as I know that babies are born with what doctors call "primitive" reflexes, which are hard-wired from birth to help the baby survive. This includes a "rooting" reflex which causes the baby to turn his head toward anything that tickles or presses against his cheek, & a "suck" reflex which causes him to suck anything put in his mouth. So a baby really doesn't care about nipples or bottles, he just has reflexes which drive him to find nutrition! So I believe that most babies can be fed both & not get confused. Of course, over time they might develop a preference for one or the other, but you can deal with that when or if it happens. If he happens to prefer the breast, great! If he prefers the bottle, you can always pump your breasts & place that breast milk in the bottle he likes.
I propose that having a baby who will take both the breast & the bottle is beneficial. If somehow your breast milk does not come in properly, you could be starving &/or dehydrating your baby if you do not offer him a supplement! Also, what will you do if you get ill & have to take medication which is not safe for your baby (Mom's body will share many medications with her baby by secreting them into the breast milk as it is produced)? What will you do if you want to go out & have an adult beverage? And don't forget, breast feeding is a fabulous bonding opportunity for Mom & baby, but what about dear old Dad? Allowing him to feed the baby (with a bottle of breast milk OR formula) will help insure that he & the baby bond as well!
PSA versus BPH:
Does a normal PSA mean that the prostate is fine? No, it means that the "prostatic specific antibody" is normal, thus indicating that it is unlikely that you have prostate cancer or prostate infection/inflamation.
What about symptoms like: urinary frequency (= the need to urinate often), urinary hesitancy (= a delay in starting urination when you try), nocturia (= having to get up at night to urinate), or poor urinary stream (= a weak stream, so basically you don't make bubbles in the toilet, & perhaps you don't make noise)? These are symptoms of an enlarged prostate... what we call "Benign Prostatic Hypertrophy" or BPH. If you have these symptoms you should discuss them with your doctor, who will likely do a digital rectal exam (= DRE) to check the size of the prostate, & also to feel for masses which could be cancerous. If there are no masses & the PSA is normal, it is not likely that you have prostate cancer, so treatment for the enlarged prostate can begin. Certain blood pressure medications can shrink the prostate, so often Hytrin (= Terazosin) or Cardura (=Doxazosin) are used if the man has high blood pressure AND BPH. If he does not have high blood pressure, often Flomax (= Tamsulosin) is used. If these medications do not help, surgery is generally indicated. The old surgery is the Transurethral Resection of the Prostate (= TURP) which is more bloody & requires a longer time in the hospital with a foley catheter in the bladder. The newer pocedure is the GreenLight Laser treatment, which uses a laser to remove the excess prostate tissue. Due to the laser cauterizing the tissue, there is almost no bleeding & faster healing, so it is usually done as an out-patient procedure... though you usually go home with a catheter which is removed in the Urologist's office the next day.
Coumadin & Vitamin K:
Coumadin is a blood thinner used to decrease the risk of blood clots (and thus strokes) in people who have an irregular heart beat, such as atrial fibrillation. It is also used when a person has a deep vein thrombosis (= DVT) or even a pulmonary embolism (= PE), as these blood clots must be thinned, dissolved, & then prevented. Coumadin interacts with many foods & medicines, thus it will vary in effectiveness depending on what you eat & the meds you take. In particular, Vitamin K reverses the effect of Coumadin. For this reason, doctors recommend that anyone who takes Coumadin should also follow a low Vitamin K diet. This is difficult for many people as Vitamin K is found in large amounts in leafy green vegetables. So, must a person who takes Coumadin change his diet radically & avoid leafy greens? Well, it is best to simply avoid Vitamin K food products, but this is impractical for some people. I recommend therefore that if you really enjoy leafy greens or other high Vitamin K foods, eat them... but do so consistently. Find the amount of Vitamin K contained in these foods & try to eat the same amount of Vitamin K every day. In doing so, your Vitamin K level will be stable so the doctor will be able to find the dose of Coumadin that will work with that dose of Vitamin K. So if you ever end up on Coumadin, but love spinach, don't worry. You can eat it, but you will have to eat it daily or find something with a similar amount of Vitamin K to eat daily.
Many of you may know that there is a new blood thinner on the market. It is called Pradaxa, & it is very special in that it is not affected by food & meds. In fact, doctors need not monitor labs to insure proper effectiveness. Unfortunately it is new so we are still getting familiar with it, & of course it is expensive. Perhaps it's biggest downfall however is that it's effect is not reversible, so if you are injured & bleeding, the doctor cannot give you medicine to reverse it's blood thinning effect, meaning that you will bleed freely until it's effect wears off. Conversely, Coumadin can easily be reversed by giving the patient a large dose of Vitamin K... so perhaps in the long run, it is the safer blood thinner.
By the way, Coumadin is the name-brand version of Warfarin. You have likely used Warfarin around your house or camp, as it is commonly known as rat poison!
Iron for Anemia:
Anyone who has ever taken an iron supplement knows that iron often causes constipation & stomach upset. I learned many years ago about a supplement which is great for treating anemia, and which does not tend to cause stoamch upset. It is called "hematinic" which I tend to think translates to "blood tonic." Since learning of its existence I have not written a prescription for iron, as my patients have responded very well to the hematinic & have essentially no side-effects. You should be able to find a hematinic in a good health food store. Like any other medication, you need to follow your body's response to the supplement, so be sure to get lab work after 1-2 months to be sure your blood counts are improving.
Keep in mind that I am happy to answer your medical questions. Just call during the live show or e-mail me any time. "Let's Talk Medical with Doctor Gigi" airs live during "The Skip Show" on Fridays at 1:00 PM Eastern time. We're on WTAN 1340-AM in the St. Pete/Clearwater area, or you can catch us live via www.SkipShow.com where you will also have access to our recorded podcasts. Our contact info is as follows: (727)-441-3000 or toll-free (866)-TAN-1340 or DoctorGigi@SkipShow.com.
Hope to hear from you soon, & until then, here's to our health!
Doctor Gigi
Despite my "play time," I did broadcast "Let's Talk Medical with Doctor Gigi" from my parents' home in Port Allen, LA. Following are the highlights of that June 8, 2012 episode.
Bleeding After Menopause:
We have discussed that menopause is the absence of ovarian function, either due to the "death" of the ovaries or due to their surgical removal. With the lack of ovarian function there is also a lack of a menstrual cycle as it is the ovaries which normally produce the hormones which cause this cyclic bleeding monthly. Once you lose ovarian function, you stop having periods, & though the bleeding usually does not just stop, the cycles usually get further & further apart. Once there is no period for one year, you are fully menopausal... also known as "post-menopausal."
It is very important to know that once you have stopped having periods for 1 year, you should never have a period or vaginal bleeding again... & this includes "spotting!" In fact, doctors call any of these "post-menopausal bleeding," & we generally assume that this is endometrial cancer (= cancer of the uterine lining) until proven otherwise. Of course, if you have had a hysterectomy then you have had your uterus removed, so you no longer have an endometrium (as this is the inner lining of the uterus). Thus a person with post-menopausal bleeding would not need to be as concerned if she does not have a uterus. But if she has a uterus, she MUST see her GYN or Primary Care physician for a physical exam, probably a pelvic ultrasound, & likely a biopsy of her endometrium... & she should NOT wait!
Fortunately most post-menopausal bleeding is found to be due to benign causes, but the work-up for cancer must prove this as it cannot be assumed! Often times the cause is infection, but I believe the most common etiology is vaginal dryness (= atrophic vaginitis) which is common is women who have lost their estrogen hormone. Fortunately a small amount of estrogen cream applied to the vagina & external tissues can make these dry tissues healthy again, resulting in resolution of the abnormal bleeding, as well as a return to more supple, pliable, moist genital tissues which makes sex more fun!
Also, note that if you take hormone replacement for menopause, you might have bleeding depending upon how you take those hormones, & how long you have been on them. If you take them in a cyclic fashion... 25 days of progesterone, with the last 10 days combined with estrogen, followed by 5-6 days of no hormones... you should bleed monthly (during the 5-6 days of no hormones). If you take both the estrogen & progesterone every day, you might bleed irregularly for the first 6 months, but after that, you should not bleed... so call your doctor if you do!
As a last note, a Pap smear only tests for cervical cancer. That means that it looks for cancer on the bottom of the uterus. It does not tell you anything about endometrial cancer, so even if your Pap was recently normal, you must call your doctor if you develop unexpected post-menopausal bleeding!
Nipple Confusion?:
Don't get me wrong, I strongly believe in breast feeding! It provides the most natural source of nutrition to our babies, & the first 3 days of breast feeding is particularly important as the breast milk is very special at that time. It is called "colostrum," & it is loaded with antibodies (from the mother) which provide the baby with a great immune system until he can produce his own!
But will it confuse the baby if you inter-mix the breast feeding with a bottle? People have proposed that if you feed the baby a bottle, he will get "nipple confusion" & not feed properly. I really don't subscribe to this idea, as I know that babies are born with what doctors call "primitive" reflexes, which are hard-wired from birth to help the baby survive. This includes a "rooting" reflex which causes the baby to turn his head toward anything that tickles or presses against his cheek, & a "suck" reflex which causes him to suck anything put in his mouth. So a baby really doesn't care about nipples or bottles, he just has reflexes which drive him to find nutrition! So I believe that most babies can be fed both & not get confused. Of course, over time they might develop a preference for one or the other, but you can deal with that when or if it happens. If he happens to prefer the breast, great! If he prefers the bottle, you can always pump your breasts & place that breast milk in the bottle he likes.
I propose that having a baby who will take both the breast & the bottle is beneficial. If somehow your breast milk does not come in properly, you could be starving &/or dehydrating your baby if you do not offer him a supplement! Also, what will you do if you get ill & have to take medication which is not safe for your baby (Mom's body will share many medications with her baby by secreting them into the breast milk as it is produced)? What will you do if you want to go out & have an adult beverage? And don't forget, breast feeding is a fabulous bonding opportunity for Mom & baby, but what about dear old Dad? Allowing him to feed the baby (with a bottle of breast milk OR formula) will help insure that he & the baby bond as well!
PSA versus BPH:
Does a normal PSA mean that the prostate is fine? No, it means that the "prostatic specific antibody" is normal, thus indicating that it is unlikely that you have prostate cancer or prostate infection/inflamation.
What about symptoms like: urinary frequency (= the need to urinate often), urinary hesitancy (= a delay in starting urination when you try), nocturia (= having to get up at night to urinate), or poor urinary stream (= a weak stream, so basically you don't make bubbles in the toilet, & perhaps you don't make noise)? These are symptoms of an enlarged prostate... what we call "Benign Prostatic Hypertrophy" or BPH. If you have these symptoms you should discuss them with your doctor, who will likely do a digital rectal exam (= DRE) to check the size of the prostate, & also to feel for masses which could be cancerous. If there are no masses & the PSA is normal, it is not likely that you have prostate cancer, so treatment for the enlarged prostate can begin. Certain blood pressure medications can shrink the prostate, so often Hytrin (= Terazosin) or Cardura (=Doxazosin) are used if the man has high blood pressure AND BPH. If he does not have high blood pressure, often Flomax (= Tamsulosin) is used. If these medications do not help, surgery is generally indicated. The old surgery is the Transurethral Resection of the Prostate (= TURP) which is more bloody & requires a longer time in the hospital with a foley catheter in the bladder. The newer pocedure is the GreenLight Laser treatment, which uses a laser to remove the excess prostate tissue. Due to the laser cauterizing the tissue, there is almost no bleeding & faster healing, so it is usually done as an out-patient procedure... though you usually go home with a catheter which is removed in the Urologist's office the next day.
Coumadin & Vitamin K:
Coumadin is a blood thinner used to decrease the risk of blood clots (and thus strokes) in people who have an irregular heart beat, such as atrial fibrillation. It is also used when a person has a deep vein thrombosis (= DVT) or even a pulmonary embolism (= PE), as these blood clots must be thinned, dissolved, & then prevented. Coumadin interacts with many foods & medicines, thus it will vary in effectiveness depending on what you eat & the meds you take. In particular, Vitamin K reverses the effect of Coumadin. For this reason, doctors recommend that anyone who takes Coumadin should also follow a low Vitamin K diet. This is difficult for many people as Vitamin K is found in large amounts in leafy green vegetables. So, must a person who takes Coumadin change his diet radically & avoid leafy greens? Well, it is best to simply avoid Vitamin K food products, but this is impractical for some people. I recommend therefore that if you really enjoy leafy greens or other high Vitamin K foods, eat them... but do so consistently. Find the amount of Vitamin K contained in these foods & try to eat the same amount of Vitamin K every day. In doing so, your Vitamin K level will be stable so the doctor will be able to find the dose of Coumadin that will work with that dose of Vitamin K. So if you ever end up on Coumadin, but love spinach, don't worry. You can eat it, but you will have to eat it daily or find something with a similar amount of Vitamin K to eat daily.
Many of you may know that there is a new blood thinner on the market. It is called Pradaxa, & it is very special in that it is not affected by food & meds. In fact, doctors need not monitor labs to insure proper effectiveness. Unfortunately it is new so we are still getting familiar with it, & of course it is expensive. Perhaps it's biggest downfall however is that it's effect is not reversible, so if you are injured & bleeding, the doctor cannot give you medicine to reverse it's blood thinning effect, meaning that you will bleed freely until it's effect wears off. Conversely, Coumadin can easily be reversed by giving the patient a large dose of Vitamin K... so perhaps in the long run, it is the safer blood thinner.
By the way, Coumadin is the name-brand version of Warfarin. You have likely used Warfarin around your house or camp, as it is commonly known as rat poison!
Iron for Anemia:
Anyone who has ever taken an iron supplement knows that iron often causes constipation & stomach upset. I learned many years ago about a supplement which is great for treating anemia, and which does not tend to cause stoamch upset. It is called "hematinic" which I tend to think translates to "blood tonic." Since learning of its existence I have not written a prescription for iron, as my patients have responded very well to the hematinic & have essentially no side-effects. You should be able to find a hematinic in a good health food store. Like any other medication, you need to follow your body's response to the supplement, so be sure to get lab work after 1-2 months to be sure your blood counts are improving.
Keep in mind that I am happy to answer your medical questions. Just call during the live show or e-mail me any time. "Let's Talk Medical with Doctor Gigi" airs live during "The Skip Show" on Fridays at 1:00 PM Eastern time. We're on WTAN 1340-AM in the St. Pete/Clearwater area, or you can catch us live via www.SkipShow.com where you will also have access to our recorded podcasts. Our contact info is as follows: (727)-441-3000 or toll-free (866)-TAN-1340 or DoctorGigi@SkipShow.com.
Hope to hear from you soon, & until then, here's to our health!
Doctor Gigi
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