Question: You advised a reader taking blood thinner to go easy with vitamin E. I've been on a thinner since my valve replacement surgery. I have a great curiosity, so I tried taking the E for a month, and it did indeed change the results of my protime test. So, can the vitamin be used instead of blood thinner? And what about use of aspirin as a thinner to prevent heart disease? Wouldn't E serve the purpose?
- J.L.
Answer: We must give folks a clue to what's going on here.
The possibility exists of a clot forming on an artificial valve. To prevent that, the patient takes Coumadin, a blood thinner. To be sure the dosage is right - that the blood is of correct consistency - you monitor the clotting facility from time to time. The protime blood test does that.
You're a canny reader, but somewhat misguided. Yes, vitamin E can add to the Coumadin effect and perhaps make the blood too thin. So you must use caution in the amount taken of either or both.
But can vitamin E replace a thinner drug? I'm afraid not. E has but minimal thinning qualities.
Aspirin also is out of Coumadin's blood-thinner league.
Some doctors might advise selected patients to take a daily aspirin for its effect on blood platelets in discouraging clot formation. The idea is to prevent heart disease. We have no assurance that vitamin E would have such a preventive effect.
Question: Please explain the main differences between osteoarthritis and osteoporosis. They seem so much the same that it is confusing.
- H.M.
Answer: Discard the idea that the two illnesses are alike. The only thing they share is the prefix "osteo," which indicates bone involvement.
Osteoarthritis is a joint disease. To this day, we understand little about the process that leads to its characteristic joint-cartilage erosion.
The erosion does, we know, remove the joint's internal cushioning. That fact fostered a mis-lead-ing notion of osteoarthritis as a singular "wear and tear" consequence of aging. But a modern view suggests some other factor. Some say it's a faulty composition of joint cartilage.
We understand a lot more about osteoporosis, which is strictly a bone disorder. It develops, we know, from loss of calcium from bone. That weakens its honeycomb substance.
It happens mostly in the hip, arms and back, where consequent loss of support leads to the hump you might notice in some elderly people.
The bone weakness occurs mainly in women, whose loss of natural estrogen with menopause plays a major role. Inadequate calcium and vitamin D are other factors in osteoporosis.
The chief threat is of fracture, which happens often in the hip from a minor fall.
For more on prevention and treatment of osteoporosis, see the report I'm sending you. Other readers can order a copy by writing: Dr. Donohue - No. 23, Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (55 cents) No. 10 envelope.
Confidential to P.Z.: An esophageal web is just that, a thin affair similar to a spider's web in the esophagus. It can, depending on location and size, make swallowing difficult, in some instances practically impossible.
I can't tell you why it happens. Occasionally, you find a patient in whom iron-deficiency anemia plays a role.
Treatment involves mechanically breaking up the web.