Issue link: https://www.epageflip.net/i/110253
Tuesday, February 19, 2013 – Daily News 5B FEATURES Effects of Pradaxa are as yet unknown bleeding in the DEAR DOCbrain (a side TOR K: My wife effect of any antihas atrial fibrillacoagulant). tion. Her medicaWhat's more, its tion was recently effect on the changed from warblood is more farin to Pradaxa. predictable than Her doctor says warfarin's. As a the new medicine Dr. K result, regular does not require by Anthony L. INR tests aren't regular INR tests and is just as Komaroff, M.D. necessary. That's a big advantage. effective. Is that There are, however, so? DEAR READER: Yes, two risks to Pradaxa. it is. Before I explain why, First, the drug has a short let me provide some back- half-life: It is largely out of your system in less ground. In people with atrial than 24 hours. If you fibrillation, the upper miss a dose, you have an chambers of the heart (the increased risk of develatria) lose that strong oping a blood clot combeating action that keeps pared to if you missed a the blood moving effi- dose of warfarin. So it's important to ciently. As a result, blood really tends to pool in the atria. remember to take the pill When it does, clots are every day. The second risk is that more likely to form. If a blood clot gets treatments to rapidly pumped out of the heart reverse the effects of and lodges in a blood ves- Pradaxa are unproven. sel in the brain, it can It's easy to reverse the cause a stroke. Clots that effects of warfarin. Why get stuck elsewhere can would you want to rapidalso cause serious prob- ly reverse the effects of lems. Anticoagulant drugs either drug? If you were and started like warfarin (Coumadin) injured and dabigatran (Pradaxa) bleeding profusely, for reduce the tendency for example, you'd want to quickly, if temporarily, blood to clot. Warfarin is an impor- reverse the anti-clotting tant anticoagulant medi- effects of the drug. Another issue with cine, but the dosing is tricky. If the dose is too Pradaxa is expense: It low, clots form. If it's too costs a lot more than high, bleeding problems warfarin. And because may result. The interna- it's new, we don't have tional normalized ratio good information on any (INR) is a blood test. Any- possible long-term side one on warfarin must have effects. Anticoagulant drugs regular INR tests to ensure that don't require regular their dose is correct. To make matters blood tests are quite worse, the body can attractive. Not surprischange over time in how ingly, there are several in it reacts to the warfarin. the pipeline. Rivaroxa(Xarelto) is One month the dose is ban having just the right approved in the United effects, but the next States to prevent blood month the dose is either clots in the legs, and in not strong enough or is people having certain too strong. Because of types of surgery of the this variability, warfarin legs. It has not yet been is the drug most respon- approved for atrial fibrilsible for causing emer- lation. gency hospitalizations Dr. Komaroff is a from drug side effects in physician and professor people over age 65. Harvard Medical Pradaxa appears to be at To send just as effective as war- School. go to farin at preventing blood questions, or clots. It is probably more AskDoctorK.com, effective at preventing write: Ask Doctor K, 10 strokes, and probably Shattuck St., Second causes fewer cases of Floor, Boston, MA 02115. Reader worries about inappropriate uncle ther my aunt nor Dear Annie: my adult cousins Several years ago, I have any idea stayed with my what's going on. aunt and uncle for a My parents aren't week. My aunt sent eager to create a me down to the rift, and the grandbasement to tell my kids really love uncle to come their grandpa. But upstairs for dinner. I would feel awful When I turned the corner, I caught Annie's if I later learned he had abused these him pulling up his kids. pants in front of the If my parents computer screen. by Kathy Mitchell He asked me not to and Marcy Sugar don't address the situation, should I tell my aunt, and I tell my aunt? My cousins? didn't. During my time there, — Don't Want It To Haphe did several other things pen Again Dear Don't Want: that made me uncomfortable. He asked me personal That hug from behind was questions about women's a type of molestation. Your bodies, and one time when uncle isn't likely to change I was alone with him, he his behavior on his own, so hugged me from behind, it is important that the relapushing himself against tives be informed and the me. Eventually, I told my younger children protectparents about it. Although ed. Tell your parents that if they believed me, I don't they are unwilling to hanthink they ever said any- dle this, you will talk to thing to my aunt and uncle. your sisters and adult So I made my own rules cousins. Your cousins may about how close to get to not believe that their father would harm their kids, and him when we visited. The reason I'm writing they may be angry with is because I have two you, but they should know younger sisters, both nonetheless. Dear Annie: Like teenagers, and I have noticed my uncle looking ''Worried and Confused in at them when we visit. Calif.,'' I am also turned Even more troubling, my off by a dear friend who uncle has two young allows her dog to eat off of granddaughters who visit her plates and slurp from on a regular basis. While I the same glass. If it were don't like to think he'd do only in her own home, it anything to them, my aunt wouldn't bother me too and uncle often babysit for much. But ''Beth'' brings the girls, so he has regular her dog to my house and opportunities to be alone does the same thing. It is very annoying. with them. Beth is wonderfully The situation worries me, but I don't know what generous, kind and ethical. to do. I'm pretty sure nei- I cannot think of a way to Mailbox tell her without hurting her. Do you have any suggestions? — Love the Friend and Her Dog, But Dear But: You have already given Beth the impression that you don't mind, so it will require telling her directly that she either not bring her dog, or not allow the dog to lick the plates. You can be gentle about it, saying you've become more concerned about germs lately and would prefer that the dog eat from a dish you've supplied for him instead of off of her plate. You might have to remind her a few times, but if she's as generous, kind and ethical as you say, she will comply. Dear Annie: You often recommend grief counseling for readers whose loved ones have died, and you say to check with their local hospital. I'd like to suggest an alternative. Not all hospitals offer grief counseling, except in the immediate aftermath of a death. But hospices throughout the country offer bereavement support, and the vast majority of them serve the entire community, often at no cost. Please encourage anyone who is grieving to explore what is offered in their community through local hospices. — Loyal Reader Annie's Mailbox is written by Kathy Mitchell and Marcy Sugar, longtime editors of the Ann Landers column. Please email your questions to anniesmailboxcomcast.n et, or write to: Annie's Mailbox, c/o Creators Syndicate, 737 3rd Street, Hermosa Beach, CA 90254. Support our classrooms, keep kids reading. DONATE YOUR VACATION newspaper dollars to the Newspaper In Education Program HELP OUR CHILDREN Proposed transfer of Orland Project to water association ORLAND – The Bureau of Reclamation has scheduled two public meetings in March on the potential title transfer of Reclamation's Orland Project to the Orland Unit Water Users Association. Reclamation officials will outline the proposal and provide information on affected facilities and preliminary future plans for recreation services at East Park and Stony Gorge reservoirs. Reclamation will also accept written and oral comments at the meetings. There will be additional opportunities for public review and comment on the proposal as part of the National Environmental Policy Act process. The public meetings will be held: Wednesday, March 13, 7-9 p.m., Orland Veteran's Memorial Hall, 320 3rd St., Orland. Thursday, March 14, 7-9 p.m., Elk Creek School Multipurpose Room, 3430 County Road 309, Elk Creek. To request special assistance to attend a meeting, please contact Sheri Harral, Public Affairs Specialist, at 530-2762030 (TTY 530-275-8991) or sharral@usbr.gov. For more details call Circulation Department (530) 527-2151 DAILY NEWS RED BLUFF TEHAMA COUNTY T H E V O I C E O F T E H A M A C O U NTY S I N C E 1 8 8 5 PHONE: (530) 527-2151 FAX: (530) 527-5774 545 Diamond Avenue • P.O. Box 220 • Red Bluff, CA 96080 HOME SERVICES DIRECTORY $ 109 Online: Publishes 24/7 Print and On-Line www.redbluffdailynews.com Three additional online locations at no extra cost! 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