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Dear Dr. Roach: I have been taking warfarin (Coumadin) for two years now. I started taking it after a knee-replacement surgery, when they discovered I had A fib. I have high blood pressure and high cholesterol that are controlled with medication, and diabetes controlled with diet. Do you think I need to be on warfarin if my blood pressure and cholesterol are well-controlled? Before the surgery, I was on two 81-mg tablets of aspirin. Could I safely go back?

J.K.

Dear J.K.: Doctors recommend warfarin or other anticoagulant medication for people with atrial fibrillation — a chaotic condition of the electrical system of the heart — if they have more than minimal risk for blood clots and stroke. Older age, female sex, high blood pressure and diabetes (even if controlled), congestive heart failure and history of stroke or vascular disease all increase risk for stroke in people with A fib.

Although I don't know how old you are, just being female and having high blood pressure and diabetes puts you in a risk category where you would normally be recommended to stay on anticoagulation.

Never stop warfarin (or similar medication) without first discussing it with your physician.

Dear Dr. Roach: I have heard of yeast infections, but I don't know what causes them.

How do they affect the body, and what can be done to get rid of them?

C.R.

Dear C.R.: Certain yeasts, but especially the Candida species, are found on our skin, mucus membranes and GI tract. They normally live in balance with the 100 trillion or so bacteria we carry around.

However, yeast can cause disease that ranges from fairly mild, like thrush of the mouth or vagina, to life-threatening, like a blood-borne, widely disseminated invasive infection.

Candida infection of mucus membranes is usually caused by changes in our bacteria, especially after the use of antibiotics. The antibiotics kill the bacteria they are supposed to (hopefully), but they also may kill the healthy bacteria that assist us in digestion (leading to diarrhea or worse), and this allows the other bacteria and yeast to grow.

Some people with genetic faults in their immune system are predisposed to chronic candida infections. These are uncommon but can be severe, and may require treatment by specialists, such as infectious disease doctors and immunologists.

The life-threatening yeast infections generally happen in people with severe illness and with poor immune system function.

Email questions to ToYourGoodHealth@med.cornell.edu.

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