DEAR DR. ROACH: I am on blood thinners, so I am unable to take ibuprofen or naproxen for pain. Do you know of anything I can take to help with pain? — K.B.
ANSWER: The body has two ways of clotting blood: the blood clotting factors and platelets, which are special blood clotting cells.
Warfarin (Coumadin), like newer agents such as dabigatran (Pradaxa) or rivaroxaban (Xarelto), work as anticoagulants, blocking proteins that help clot the blood. They don’t actually “thin” the blood; that would mean a change in viscosity. Clotting factors are needed for a mature, effective blood clot.
Aspirin and NSAID drugs, like ibuprofen or naproxen (Aleve and others), affect platelets, the specialized blood cells that start clotting the blood when necessary. If both the platelet system and the factor system are decreased due to medication (or underlying clotting disorder), then the risk for abnormal bleeding goes up.
This does not mean people can never take aspirin or NSAIDs if they are on a medication to reduce clotting risk, but it does mean that a careful evaluation must be done, based on a person’s unique circumstances, to determine the safety of doing so. In other words, your doctor should be able to tell you how often, if ever, you can take these over-the-counter pain relievers.
If you can’t take any, then acetaminophen (Tylenol) is usually the safest bet. However, too much acetaminophen can increase the effect of warfarin (measured by your INR level).
DEAR DR. ROACH: I must admit that I sit on the throne (toilet) for too long for my morning (or evening) constitutional, maybe 15 minutes or so. But I am busy with my crossword puzzles — it’s about the only time I can carve out for my little obsession.
The problem is, my legs almost always fall deeply asleep. This happens frequently. I’m wondering if I should cease this practice. Could I be doing damage to my nervous system? The tingling goes away after I walk around a bit, and there are no lasting effects. — V.K.C.
ANSWER: I’d recommend finding a different place to do your crossword puzzles.
I don’t recommend anyone sit on the toilet too long. Pressure in the colon from prolonged sitting (I don’t say you are necessarily straining, but I suspect that like most people you have increased pressure in the colon from sitting on the toilet) increases the risk of colon problems, both common (diverticulosis, outpouchings in the colon wall) and rare (volvulus, a twisting of the colon that is a surgical urgency). When you have the urge to go, you should take yourself to the bathroom and do so. If you are straining, it’s time to add more fruits, vegetables and fiber to your diet.
The numbness in your legs is not uncommon. The position of a toilet seat may put extra pressure on the nerves of the leg, especially the sciatic nerves. This pressure is what is causing the numbness. The fact that there are no long-term symptoms suggests no lasting damage, but I would argue this is your body telling you not to stay in that position.
Find a comfortable chair in which to do your crosswords, and ignore the world for a little while.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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