July 10, 2014 at 1:00 am

To Your Health

Surgery while on an anticoagulant is risky

Dear Dr. Roach: About five years ago, I developed atrial fib­rillation and received a pacemaker. I also was put on blood thinners — first warfarin, and now Pradaxa. Last year, I developed a hernia in my left groin area. I believe it has grown wo­rse. Neither my heart specialist nor my general practitioner says much about it. I assume they would not recommend an operation because I am on the blood thinner. Is there anything that can be done? I am almost 82.


Dear R.A.: Atrial fibrillation increases the risk of blood clots in the heart because of the lack of coordinated rhythm. As a ro­ugh guide, the risk of blood clot leading to stroke is about 5 percent per year for a person with A fib. Surgery on an anticoagulant like warfarin or Pradaxa is risky, because the blood doesn’t clot normally. However, it still can be done. Depending on the risk, the anticoagulant is stopped entirely for a few days before and after surgery, or an injection anticoagulant like heparin or Lovenox is used around the time of surgery. In A fib, the risk of stroke is low: very roughly 0.1 percent in the week you might be off anticoagulation.

A surgeon can tell you whether a hernia needs to be fixed. It depends on how large it is, wh­ere it is and how much it’s bothering you. Most surgeons would be cautious in any 82-year-old even without the A fib; however, yours still may need repair, in which case your cardiologist will recommend the correct anticoagulant regimen for you.

Dear Dr. Roach: How is it that, at age 67, I’d never heard about the abomination called scabies? Last year, I was rubbing cream onto my aged mother’s rash, and now I have this disgusting infestation on my body! Why haven’t people been advised of this scourge!


Dear Anon.: Scabies, sometimes called, “the itch,” is caused by the mite Sarcoptes scabiei, and is common, with an estimated 300 million infected worldwide. It is transmitted person-to-person by direct contact.

Often, the hardest part is figuring out the diagnosis, because a lot of people don’t know about this condition. When the rash is classic in distribution (belt line, under the arms, wrists, genitals and especially in the finger web spaces), most regular doctors and any dermatologist can figure it out.

Permethrin 5 percent cream (Elimite and others) over the entire body for eight to 14 hours is the standard treatment. Many physicians recommend a second treatment in one to two weeks. Clothing and bedding need to be disinfected, too.

Dear Dr. Roach: I am a male, 74, with a breast issue. When I press on the nipple or around it, I feel pain. It has been seven weeks, and no change. I can’t say I feel a lump, but it does seem harder under the nipple compared with my other breast.


Dear R.F.C.: You should go and get it checked out right aw­ay. While breast cancer in men is rare, it does happen, and the sooner it’s evaluated, the better.

Email questions to ToYourGoodHealth@med.cornell.edu.