FILE - In this Feb. 9, 2018, file photo, a nurse hooks up an IV to a flu patient at Upson Regional Medical Center in Thomaston, Ga. Relief from medical debt doesn’t top the typical holiday wish list. But help with unexpected medical bills could be a welcome gift for millions of Americans. (AP Photo/David Goldman, File)
Q: A few years ago, when being prepped for a colonoscopy and gastroscopy, I had an IV line inserted into my right arm with a sedative in it. As I waited to pass out, I noticed a large air bubble slowly moving down the IV line toward my arm. I got concerned about an air embolism and called the nurse over, who pooh-poohed my concern: “It’s just an air bubble. It won’t hurt you.” I insisted on seeing the charge nurse, who came over, turned off the drip, and flicked the line with her finger multiple times, getting the air bubble to move up the line. She then pinched the line shut and turned the drip back on and flicked the line a few more times, until the air bubble floated into the IV bag and wobbled to the top. She released her pinch on the IV line and said: “There. Are you happy now?” and walked away.
Was I right to be concerned? I’m glad the sedative had not set in yet when the problem occurred. But I’d like to know the answer, in case this happens again.
A: Before medical school, I had also heard that injection of air into a vein can be deadly, so I understand why you were concerned. However, I learned that the amount of air that is needed to cause harm is very large. An air bubble might be 0.2 cc and still look pretty significant in the IV tubing. The minimum amount that is likely to cause symptoms is a hundred times that, 20 cc, but it’s likely to take much more than that to be fatal, usually in excess of 150 cc. I bet nurses hear those concerns a lot. But it doesn’t excuse her behavior, which sounded pretty rude the way you describe it.
Q: Seeing as the AREDS (Age-Related Eye Disease Studies) and AREDS-2 supplements fail nearly 70 percent of the time, when you have a patient who clearly is progressing to the advanced stages of age-related macular degeneration, do you suggest that the patient stop the AREDS and AREDS-2 treatments?
A: Age-related macular degeneration is a common cause of visual loss in older people. There are two forms: the proliferative, or “wet,” form is aggressively treated, usually with injections directly into the eye. The more common “dry” form has no treatment beyond the mixture of vitamins and minerals that was used in studies. You are correct that the vitamins do not usually stop the progression of AMD entirely but may still slow progression.
In general, when a treatment isn’t working, it’s wise to stop it and try something else. However, since there are no other known treatments for dry AMD, the decision needs to be whether there are harms of the treatment that outweigh any benefits. In this particular case, the AREDS vitamins may be slowing progression compared with not getting any treatment at all. The risk of the treatment is negligible. (The beta-carotene in the original AREDS formulation increased risk of lung cancer in smokers. Smokers with AMD should quit smoking and use the AREDS-2 formulation.) The cost is fairly low, so I generally recommend continuing the supplement.
Q: My brother took turmeric every day, after hearing all the hype about it being the new superfood. At his next annual checkup, it was noted that his blood platelets were very low. A month later he died of a stroke. He was 70. After doing some research on turmeric, I read that indeed it can lower your blood platelets. Is there any chance that low platelets can cause a stroke? This is just a precautionary tale for your readers.
A: I am very sorry to hear of your brother.
Turmeric is a commonly used culinary spice that’s also used as a medication widely throughout the world. It is generally considered safe. However, there is ample evidence that curcumin (the active substance in turmeric) can increase bleeding risk, acting in a way similar to aspirin to reduce “stickiness” of platelets. Turmeric does not cause the platelet levels to go down but rather interferes with their function.
In most cases, this reduces the risk of stroke. Most strokes are caused by blood clots, and aspirin and similar drugs are often used to reduce the risk of strokes caused by blood clots. Unfortunately, any medical intervention runs the risk of causing an untoward effect. In your brother’s case, it’s possible the stroke was caused by bleeding inside the head. He may have had a condition that lowered his platelets — there are many, but the most common is an autoimmune disease called idiopathic thrombocytopenic purpura — which may have made the additional effect of turmeric on his platelet function more dangerous.
People with any bleeding disorder or those who are taking medication to prevent clotting, such as warfarin, apixaban (Eliquis) or clopidogrel (Plavix), should discuss curcumin or turmeric supplements with their doctor before taking.
Q: In a recent article regarding acid reflux, you mentioned Pepcid or Zantac as good options to treat occasional symptoms. I have seen these same two medications suggested before. But I never see cimetidine recommended. I am 75 years old and have used the OTC dosage for about 10 years with good results. I take it a few times a month, usually before I eat any Italian food or if I’m going to eat after 7 p.m. What I like about this med is the instructions indicate you can take it before, during or after eating. I believe that’s different from Pepcid and Zantac. Are there any problems taking cimetidine occasionally?
A: All of those medicines, as well as nizatidine (Axid), are called histamine 2 blockers, and all are good choices for occasional stomach upset from excess acid reflux. Cimetidine (Tagamet) was the first one approved in the U.S. and is still a good choice. None of the drugs you mention are affected by eating, so all can be taken with or without food. Cimetidine has more potential for drug interactions. The list is very long, so check with your pharmacist. It can occasionally cause gynecomastia (breast development in men) and erectile dysfunction. Cimetidine may also be more likely to cause dizziness and confusion. However, if you have never had problems, you aren’t likely to develop them, especially when taking occasionally. These problems tend to develop more frequently with long-term use.
Ranitidine by several manufacturers has recently been found to be contaminated with a carcinogen called NDMA, but cimetidine and famotidine (Pepcid) have not.
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 or send mail to 628 Virginia Drive, Orlando, FL 32803.