DEAR DR. DONOHUE: For the past eight months, I have had a heart rhythm problem. I am on Coumadin. One day I forgot I had taken it and took another dose. My blood test showed that I had taken far too much. You wrote about ablation being a treatment for rhythm problems. Would it benefit me, and could I go off Coumadin? — W.K.

ANSWER: I’m sure your rhythm problem is atrial fibrillation, a common and serious heartbeat disturbance where the heart beats rapidly and irregularly. One consequence is a drop-off in the amount of blood pumped by the heart. The second, and the more dangerous consequence, is the formation of clots in the upper heart chambers because blood in those chambers isn’t moving — stagnant blood forms clots. Clots in the heart can be swept into the circulation and to the brain, where they block a brain artery. The result is a stroke. Coumadin prevents those clots from forming.

Many times, the goal in treating atrial fibrillation is only to slow the heart so that it pumps out an adequate blood supply.

Are there other ways of dealing with this rhythm problem? Yes. Ablation is one. It involves eliminating the heart tissue generating the abnormal rhythm. It’s done by inserting a thin tube that’s outfitted to deliver radio waves to the specific heart sites from which the abnormal beating arises. Does it sound simple to you? It isn’t. It’s very intensive work, and requires special training. Generally, ablation is restricted to those younger than you, but not always.

I’m on your side when it comes to taking Coumadin. It’s a bothersome drug, requiring frequent blood tests to be sure that enough drug is taken but not too much. Too much poses the danger of bleeding.

Talk with your doctor about having a consultation for ablation. The doctor might side with you, or tell you that you’re not a candidate for the procedure. At least you’ll have the satisfaction of having tried.

The booklet on heartbeat abnormalities, including atrial fibrillation, discusses them, their significance and their treatment. Readers can obtain a copy by writing: Dr. Donohue — No. 107, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Will you discuss erythema nodosum? I’ve dealt with it since 2006. It flares up at different times. I wonder if a food allergy or chemicals could have something to do with it. When I was diagnosed, the doctor did a chest X-ray, blood tests and a throat swab, but not a TB skin test. — D.A.

ANSWER: Erythema nodosum is an outbreak of painful red bumps, mostly found on the shins. Infections can be responsible, especially strep infections. TB is another infection linked to an outbreak, as are some fungal infections like valley fever of the Southwest. Medicines linked to its appearance are sulfa drugs and the birth control pill. Ulcerative colitis and Crohn’s disease are examples of illnesses that make it appear. You have had this condition for four years. If you had one of these illnesses, you would be demonstrating other signs by now. You most likely fall into the classification of idiopathic — cause unknown. Food or chemical allergy is unlikely.

Have you tried drugs like the anti-inflammatory medicines — Aleve, Advil and Motrin? How about liquid potassium iodide? It often works.

DEAR DR. DONOHUE: Please discuss liver cysts. Two CT scans, taken years apart, revealed two liver cysts. I was told not to be concerned. Should I be? — B.S.

ANSWER: Since scans have become so routinely a part of medical practice, liver cysts are seen quite frequently. Most liver cysts neither cause pain nor upset liver function. No one is sure why they form. Unless they are large or are causing symptoms, they can be left alone.

Trouble-making liver cysts do exist. Some parasite infections cause them. Those cysts almost always produce symptoms that call for treatment.

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.

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