DEAR DR. DONOHUE: I have an artificial heart valve and will be on Coumadin (warfarin) for the rest of my life. I want to learn all I can about it. How is a person on Coumadin prepared for surgery? Does this medicine have long-term dangers? – R.S.

ANSWER: People with conditions that lead to blood clots must often take the blood-thinning medicine Coumadin for life. One example is the common heartbeat disturbance atrial fibrillation. The irregularly beating upper heart chambers, the atria, become places where clots form and break loose, and from there they can find their way to brain arteries and cause a stroke.

That’s why people with fibrillation take this medicine. Mechanical heart valves also favor clot formation – another situation that calls for anticoagulation. (Tissue valves – such as those from pigs – don’t induce clots and don’t require Coumadin treatment.)

Coumadin users, when faced with the prospect of surgery, are often taken off the medicine for five days before the scheduled procedure. For those at high risk of clots, heparin, an injectable medicine, can serve as a substitute. It has a fast offset of action, unlike Coumadin, and it can be safely continued up to the day of surgery. Sometimes, instead of stopping Coumadin, all that’s necessary is to reduce its dose. And for some procedures, where the chances of brisk bleeding are slight, it can be continued at full dose.

If there is a need to reverse Coumadin’s blood-thinning action quickly, that can be accomplished with fresh frozen plasma, vitamin K or a substance called recombinant factor VII.

Most people take Coumadin for life without ever having even a minor complication. Bleeding is, of course, the major concern, and that concern is lessened through regular lab monitoring of the degree to which a person’s blood is thinned. Coumadin has caused skin rashes in a few, death of skin in fewer still, and in a very few it has affected the liver.

DEAR DR. DONOHUE: I am 79, and sometimes I smell smoke when it isn’t there. I have never heard of anything like this. I hate to tell anyone about it because they would say this is all in my head. I do worry about it. – M.M.

ANSWER: You would be surprised at how many letters I get asking this very question. In the batch of letters with yours was another describing this problem in almost the exact same words.

Abnormal odor perceptions are not uncommon. Infections of the nose and sinuses cause them. So can some medicines. Impairment of the olfactory nerve, the nerve that delivers smell sensations to the brain, is another reason for such a distortion of smell. A deficiency of vitamin B-12 can produce it, too.

Tell your family doctor about this. The doctor can check for any of the possible causes. If there happens to be a correctable one, so much the better. In truth, often no cause is found.

DEAR DR. DONOHUE: I am a 55-year-old woman who weighed 236 pounds a year ago. I began to lose weight by cutting out sweets. Then I started walking, just 10 minutes a day. I upped the time until I was walking 30 to 40 minutes on my lunch break. In six months I had lost 54 pounds. At that point my doctor took me off blood-pressure and diabetes pills. Then I added a morning walk for a total of five to six miles a day. I have now lost 90 pounds.

However, the weight loss has resulted in excess skin on my thighs, upper arms, breasts and abdomen. I look good when dressed, but without clothes it is not pretty.

Can I, at my age, tighten up my skin? I need to know what to do. I cannot wear shorts or short-sleeve tops. – P.E.

ANSWER: I included the details of your story to let people know that a program of calorie restriction and exercise can take off weight without having to resort to outlandish weight-loss schemes and diets.

I am sorry to say that I know of no way to get rid of redundant, stretched-out skin other than surgery. It is not a huge operation, and your family doctor can put you in touch with a surgeon experienced in such removal.



Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.