DEAR DR. DONOHUE: What is your opinion of the newly approved drug dabigatran for stroke prevention? My husband and I currently take warfarin (Coumadin). I have had the cardioversion procedure, but it was unsuccessful. — W.G.

ANSWER: Pradaxa, dabigatran’s brand name, is the first anticoagulant (blood thinner) to emerge on the scene in more than 50 years. In all those years, Coumadin (warfarin) has been the standby when anticoagulation is the goal. One of the leading reasons for using Coumadin is the heart-rhythm disturbance atrial fibrillation. Here the upper heart chambers, the atria, are not contracting. They’re fibrillating, chaotically squirming. That diminishes heart pumping, but more significantly it raises the danger for a stroke. In those fibrillating atria, blood pools. Pooled blood forms clots. Those clots can be swept into the circulation, carried to a brain artery and obstruct blood flow to part of the brain — a stroke. Coumadin prevents clots from forming. You have atrial fibrillation. That’s why cardioversion was attempted on you. It’s the procedure where a shock is delivered to the heart to get it beating regularly again. Does your husband also have it?

Pradaxa works as well as Coumadin at stopping clot formation; perhaps it works slightly better. On the negative side of the ledger, Pradaxa is more expensive. On the positive side, it does not require ongoing testing of the blood to see how well it is working, as Coumadin does.

Pradaxa is a true breakthrough. See if your doctor thinks it can be used for you and your husband.

DEAR DR. DONOHUE: Some of my older relatives are taking fish-oil capsules on the advice of their doctors. I have been eating flax meal for years for its omega-3 fatty acids and the benefits of its fiber.

Am I missing the benefits of fish oil by substituting flax? Please compare the benefits of the two. — Anon.

ANSWER: Bear with me while I give some background information so you and I stay on the same page. Some years ago, investigators puzzled over the fact that Eskimos had few heart attacks. They searched for a reason and came up with the Eskimos’ diet — mainly fish. After more searching, they found that the omega-3 fatty acids in fish kept Eskimo arteries free of obstructing buildup. Two kinds of omega-3 fatty acids are found in fish — EPA, eicosapentaenoic acid, and DHA, docosahexaenoic acid. These two materials curb artery wall inflammation that attracts the buildup of cholesterol; lower blood triglycerides (fats that add to buildup); and keep the heart in optimum rhythm. Salmon, herring, lake trout, albacore tuna and sardines are especially good sources of omega-3s.

Flax and flaxseeds contain linolenic acid. The body converts linolenic acid into EPA and DHA, but the conversion is not 100 percent. Only 8 percent to 20 percent of linolenic acid changes to EPA, and only 0.5 percent to 9 percent into DHA. Flax does, however, supply fiber.

If you want to make this an either-or situation, fish oil is the better choice. Or you can choose both. The American Heart Association recommends getting some of your omega-3 fatty acids from the plant kingdom — things like flax, flaxseed, soybeans and walnuts. Another way to reach the goal of adequate omega-3s is to have two fish meals a week. One fish meal is 3.5 ounces of fish. You also can use fish-oil capsules if you don’t like fish.

DEAR DR. DONOHUE: Many years ago in science class, my teacher made this statement: When you drink milk, swish it around in your mouth before swallowing. It’s good for your teeth. Why? — G.J.

ANSWER: Maybe the teacher thought it would deposit some of its calcium on your teeth and strengthen them. Or maybe she thought it would eliminate the mouth bacteria that promote cavities.

As far as I know, swishing milk accomplishes neither.

I can’t come up with any other explanations.

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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