The Problem With Playing Pharmacist
DEAR DR. ROACH: My wife has been diagnosed with atrial fibrillation. Doctors tried an electrical cardioversion, but it came back after a few days. She is taking metoprolol and Eliquis. We have read about the supplements red clover, turmeric, omega-3 and hawthorn. Should she discontinue the pharmaceuticals and take supplements instead? — J.C.
ANSWER: Please don’t do that, and let me explain why.
Atrial fibrillation is an abnormal heart rhythm. The goal of treating it is first to relieve symptoms, such as fast heart rate and dizziness, and second, to reduce the risk of stroke. Blood clots can form inside the heart when the atria are fibrillating (a chaotic, non-coordinated muscle movement). Those clots can break off and go into the blood vessels of the brain, causing cell death and loss of function in that part of the brain. That’s a stroke.
Your wife is taking metoprolol to slow the heart rate. Atrial fibrillation causes the ventricles to go too fast, causing a sensation of fast heart rate and palpitations. Metoprolol, a beta blocker, protects the heart from damage from a too-fast heart rate, in addition to relieving symptoms. Apixaban (Eliquis) is a powerful anticoagulant, reducing the risk of clot formation.
Red clover is usually used in herbal medicine for its estrogen-like activities. Unfortunately, estrogens INCREASE clot risk, so this herbal medicine absolutely should not be used by someone at risk for clots. Sweet clover hay is the source of warfarin (Coumadin), another often-used anticoagulant in people with atrial fibrillation: This may be the source of confusion. However, warfarin needs to be dosed precisely, with frequent blood-level checks.
Turmeric is an antioxidant that does have some mild anticoagulant properties. However, it is not remotely powerful enough to do the job of protecting your wife adequately from stroke.
Omega-3 fish oils were once thought to reduce risk of atrial fibrillation; unfortunately, a 2013 study showed no benefit.
Hawthorn has two potential benefits: To a slight extent, it acts as a beta blocker (like metoprolol) as well as an anticoagulant. However, no trials have proven its effectiveness. It may interfere with both her medicines. The metoprolol and Eliquis have much more safety data.
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DR. ROACH WRITES: In a recent column, a reader noted she had a history of irritable bowel syndrome and described intermittent sharp rectal pain. My answer discussed control of her IBS. When I saw the column printed in the newspaper, weeks after I wrote it, I realized instantly that the diagnosis was probably proctalgia fugax, which is a spasm of the muscles of the anus. It is thought to be related to nerve compression.
I learned from my predecessor of this column, Dr. Paul Donohue, that sitting on a baseball or tennis ball can sometimes stop the pain instantly, and that creams and sometimes oral or inhaled medications can be effective in harder-to-treat cases.
I also want to point out that I fell victim to something called an anchoring heuristic error. I read about my reader’s irritable bowel and became “anchored” to that diagnosis. Admitting an error and trying to understand why it happened are critical to reducing the likelihood of making the same error again. Anyone can make a mistake; it’s important to learn from them.
Dr. Roach regrets that he is unable to answer
individual questions, but will incorporate them
in the column whenever possible.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
© 2021 North America Synd., Inc.
All Rights Reserved
Keep Food Safe
One in six people get food poisoning — also known as a foodborne illness — every year in the United States.
Adults ages 60 years and older are at higher risk for foodborne illness because the immune system weakens with age. Likewise, young children are at higher risk because their immune systems haven’t fully developed yet.
Keep everyone safe by following these food safety practices.
Clean: Wash your hands thoroughly. Clean and sanitize food preparation surfaces.
Separate: Keep raw meats apart from other foods that may be eaten without cooking, such as fruits and vegetables.
Cook: Cook foods to the correct temperature.
Chill: Don’t leave food out of the fridge for more than two hours.
Keep yourself and loved ones safe by cooking and holding foods at the proper temperature. This will kill harmful bacteria and other pathogens that can cause foodborne illnesses. Remember to keep hot foods hot (140˚F or higher) and cold foods cold (40˚F or lower).
Winter will soon be upon us. The white stuff will be falling from the sky and the temperatures will make it hard to get out of bed in the mornings. With the winter months comes an increase in dangerous traveling. Are you prepared to be driving in the snow, ice, slush and cold? Do you have the needed supplies in your vehicle in case something would happen? Now is the time to do an inventory of your emergency travel kit so you won’t be left out in the cold.
First, make sure that you have a properly inflated spare tire and the tools needed to replace a flat tire. Being stuck along the road without any one of these makes for a bad day. Have a set of jumper cables and know how to use them. Write down the directions on how to use jumper cables and stick them in your emergency kit. Also, tell someone your plan of travel. This gives them a general idea of what route you took.
Carry a small shovel, a snow brush, extra windshield washer fluid and cat litter or sand. If you get stuck you have a shovel for digging out of the snow and the cat litter or sand can be used for extra traction. You can also carry extra salt that can be applied to the area around the tires. This can be used for traction but also will help melt the snow and ice.
Carry extra blankets, some extra water and non-perishable food items. In a blizzard, it may take a few days before crews can make it to you for rescue. Staying warm and having food and water is essential for survival. Make sure to have enough of each packed for the number of people traveling with you. For a complete list of items to have in an emergency travel kit go to www.Ready.gov.
If you have any questions or would like further information I can be reached at 563-589-4195 or at Dpaulson@cityofdubuque.org.
• You can cut the bitterness in some varieties of greens by soaking them in ice water for roughly an hour before serving. Use a salad spinner to get all of the water off.
• “Place an ice cube (or ice chips) in carpet divots left behind by furniture legs. This will help the fibers “plump up,” and the spot will disappear!” — A.I. in Utah
• Remove the annoying sticky residue from price tags with WD-40 or baby oil. This is for use on hard surfaces only. If you are unsure, test in an inconspicuous spot first to make sure the oil doesn’t leave a stain where the tag was.
• “To help repel the dust on baseboards between cleanings, wipe with a used dryer sheet. To make this even easier, you can put the dryer sheet over a Swiffer-type floor cleaner. This way, you don’t even have to bend down.” — M.E. in Alabama
• Felt circles are great for putting under small appliances on the kitchen counter. They are easier to move around, and they won’t scratch the countertops. You can find them at the hardware store, or make your own by cutting out what you need from a piece of felt and attaching it to the bottom of your appliance with double-stick tape ... or even a drop of glue!
• Running a washing machine that isn’t full not only wastes energy and water, it also wastes money because you’re paying to run more washes. Always fill the machine — but remember not to overload it! This applies to your dishwasher, too.
• Recipe substitution: If you need 1 teaspoon of pumpkin pie spice, use 1/2 teaspoon cinnamon, 1/4 teaspoon ginger, 1/8 teaspoon nutmeg and 1/8 teaspoon ground cloves.
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