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Spokane, Washington  Est. May 19, 1883
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Benefits of therapy must exceed risks

Peter Gott United Media

Dear Dr. Gott: My 72-year-old father has been treated with Coumadin by the local veterans hospital. According to what I’ve been told, his small “coronary blockages need no therapy.” However, his arms and legs are now covered with bruises. Could the Coumadin cause this?

Dear Reader: Absolutely. Coumadin retards blood clotting and, consequently, may help patients to avoid having strokes. In contrast, the risks of Coumadin (warfarin) therapy are significant, and include uncontrollable bleeding.

You do not indicate in your letter the reasons why your father is taking Coumadin therapy. Should there be a valid medical necessity, such as irregular pulse rate (atrial fibrillation or others), Coumadin treatment is appropriate.

If no conclusive need is present, doctors must reconsider the whole situation. In a phrase, the benefits of treatment must exceed the risks. From your brief note, I cannot conclude which position is appropriate. Check this out with your family physician and let me know the results.

At the very least, your father needs a blood test to measure the INR (international normalized ratio), to determine the effects of Coumadin therapy. The optimal value in this circumstance is 2.0-3.0. If it is higher (or lower), Coumadin adjustments need to be made.

Let me know 1) What the Coumadin levels are, and 2) How your primary care physician approaches the situation.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: As a new grandmother, I am painfully aware that many new mothers often cover their babies’ faces with heavy blankets. Would extended exposure to carbon dioxide be harmful?

Dear Reader: In theory, yes. But, in reality, such harmful side effects are unusual, possibly because infants are remarkably adaptive when it comes to breathing.

I do not know why some new parents choose to cover their babies’ faces with blankets when the infants are exposed to cold. I never did it with my three sons, was never advised to do it by a pediatrician, or knew of any colleague who behaved this way.

As a general rule, babies should be appropriately dressed, as adults are, depending on the weather. Recirculation of CO2 in the system is a secondary issue, unless – as you imply – it is associated with low levels of oxygen. I urge parents of newborns and infants to subject their children to the same breathing criteria that we all enjoy; anything that interferes with a baby’s breathing should be avoided.

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