ArcaMax

DEAR DR. ROACH: In a recent column, you noted that many patients do not properly use their inhaled asthma/chronic obstructive pulmonary disease (COPD) medications, but you didn't tell us how to properly use them. I'd hate to think that I've been doing Advair and albuterol incorrectly all these years. A little help, please? -- Anon.

ANSWER: The proper inhaler technique is much more easily demonstrated than it is described. I found a good video showing proper technique from the American Lung Association at tinyurl.com/inhaler-video, but the ideal way is to have your doctor or nurse watch you use your inhaler.

I have seen people make several common mistakes including not taking the cap off the inhaler; activating the inhaler, waiting, and then breathing in; and breathing in, then activating the inhaler while breathing out. For it to work, the person needs to breathe in while the inhaler is being activated.

DEAR DR. ROACH: When you get a letter from a patient who is really sick, does your response take precedence over other people's emails? -- B.N.

ANSWER: My column is primarily to help educate readers about common and uncommon medical issues. While I hope I can be of some value to the readers writing in, I can't act as their doctor. Furthermore, due to the time that it takes to edit and publish the columns, there is several weeks between when I write my column and when it's published. So, I am often not much help to readers for urgent matters.

There have been a handful of times when a reader has written me with a concern that has terrified me. Very early on when I started writing this column, a reader wrote in that he had an aortic aneurysm of over 7 centimeters and didn't think he needed surgery. (The risk of rupture at this size is very high, and it would likely be immediately fatal.)

This letter came via the postal service, so I had no way to get a hold of him beyond taking my response (to please get this repaired as soon as possible) to the post office and mailing it back to him.

DEAR DR. ROACH: I am confused by your remark in a recent column that blood thinners are a good thing to take the rest of your life. My brother was put on them after suffering a stroke and ended up dying due to esophageal bleeding because of them.

Why can't doctors prescribe a natural way to thin blood without medication? Are there not natural alternatives like apple cider vinegar or something else? This confuses me as I would not take any long-term medication. -- G.B.

ANSWER: Anticoagulants, which reduce the blood's ability to clot, are only a "good thing" to take if you are at a high risk for a dangerous blood clot. In that column, the writer actually had his heart stop due to a large blood clot in the lung before being brought back by his wife.

In this case, anticoagulants are more likely to keep people alive by preventing a fatal blood clot than they are to cause serious bleeding. I am sorry for the experience of your brother, but physicians always need to weigh the risk of doing something against the risk of not doing something.

Apple cider vinegar has no effect on blood clotting. There are natural products that do. Warfarin (Coumadin) is based on a compound made by a fungus that grows on wet, sweet clover hay, and for decades, it was the most common anticoagulant. Newer drugs are safer and more effective for most people, but there are still a few conditions that require warfarin.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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