Dear Dr. Roach: I am 79 and in good health considering the medical problems that have left their signature on my body.
My question has to do with the IVC filter that was placed before my mastectomy surgery, when it was discovered that I had a blood clot in my left leg. The Lovenox shots didn鈥檛 work and, because I have Factor V Leiden, my medical team recommended the filter.
I have had this since January 2013 and wonder if I should have it removed. Could I have a foreign- body reaction? Could it possibly shift around or encroach into surrounding tissues? I am on Coumadin. A recent column you wrote said filters may make varicose veins and clots somewhat more likely. S.K.
A filter is a metal device placed into the inferior vena cava (the major vein in the lower body) designed to prevent blood clots from the legs or pelvis from going into the lungs.
They appear to be effective at preventing this life-threatening complication, with only a few per cent of people with a filter developing a pulmonary embolism. But in people on Coumadin after a blood clot, 21 per cent of those with a filter had a blood clot in the legs compared with 12 per cent of those who did not have a filter, after two years.
The complications you mention are uncommon. Some filters are permanent and can鈥檛 be removed, others can be. However, the longer you wait, the harder they are to remove. Only about 10 per cent of people with 鈥渞emovable鈥� filters ever have them removed. You should talk to your primary doctor or your oncologist, but I don鈥檛 think either will advise you to get the filter removed.
听
Dear Dr. Roach: I have had chronic constipation most of my life. I have used most of the bulking (husk) things that are out there. Nothing works for me.
Years ago, I went to my doctor and he said that I could use MiraLAX for the rest of my life. It has worked. Now, my new doctor wants me off it, wants me to incorporate fibre into my diet. I already do this. Plus I drink a lot of water in a day. I start my day with a 24 ounces of water every morning before anything else. Is there anything wrong with taking MiraLAX every day? I do not take the full dose. V.B.
While I recommend non-drug treatments, such as increased water intake, high-fibre diet and exercise, as treatment for constipation, that doesn鈥檛 work for everybody. In that case, using a medication as recommended by your doctor makes sense. Polyethylene glycol (MiraLAX) is a generally safe treatment that works by increasing fluid in the bowel. It鈥檚 a good idea to use it as little as is needed to keep the stool from getting uncomfortably hard.
Email questions to [email protected]
