Drug interaction could be cause of allergic reaction

Q: I am a 78-year-old female. Eight months ago, I was diagnosed with atrial fibrillation and congestive heart failure. I was put on Coumadin, but take generic warfarin. Since the regimen began, I have itched all over, especially in body crevices. I have a number of lesions and, even as I write this, I have bandages on three areas of my torso trying to protect spots where the skin is raw from scratching because of the itch.

I went to a dermatologist, who gave me a sample of a white ointment and recommended I buy a small bar of soap for $10. This has helped little, if at all.

Before being put on the warfarin I never had any problems like this. The Coumadin clinic I go to for lab work and my doctors seem unconcerned. In fact, I asked my doctor about another treatment, and all I got was that Coumadin is what I need, period!

For information, I take medication to lower my blood pressure and Prilosec for heartburn from a hiatal hernia. None of my medications have been changed.

A: Coumadin and its generic form of warfarin act as an anticoagulant to help reduce the formation of blood clots. The medication was prescribed because of your atrial fibrillation, a rapid and irregular heartbeat. This is important because most people with this condition are at higher risk of blood clots, which may lead to stroke.

Hives, rash and itch are side effects. You are likely experiencing an allergic reaction to the drug or a possible cross reaction from the hypertensive medication you are on. I believe your dermatologist is off base. Lotion will not make your problem go away. If your physician is unwilling to work with you, request a referral to another physician or cardiologist. Also, consider seeing an allergy specialist.

Q: Your column recently had a letter from a 73-year-old female who was constantly fatigued. Her blood work showed Epstein-Barr virus, and she wondered if that were the cause.

I, too, had unexplained fatigue for several years, and my blood work also showed the Epstein-Barr virus. My doctor said almost everyone has it, and it is unlikely to cause fatigue, so she tested me extensively and even referred me to an internal-medicine specialist.

The fatigue remained a mystery until Christmas Eve 2008, when I was doubled up with abdominal pain for three hours. I finally called 911 and was taken to the hospital, where it was determined I needed a bowel resection owing to adhesions resulting from an earlier surgery. I am now healed, and the fatigue has disappeared.

Oddly, an acquaintance told me the same story about three months after my surgery. For both of us, the only symptom was increasing fatigue.

I would urge your reader to request an abdominal MRI, because it can't hurt and might even prevent a serious medical condition from becoming worse.

A: I have not heard of fatigue as a symptom of abdominal adhesions, nor of bowel obstruction. The most common symptoms include pain and cramping. Because you also mentioned knowing another person with symptoms matching yours as the result of abdominal adhesions and bowel obstructions, I am printing your letter for the interest of my readers. Thank you for writing.

Q: I am an 85-year-old almost completely retired surgeon and thought my story may be of interest to you and your readers.

During the 1970s and 1980s, I experienced excruciating tic douloureux on the right side of my face. I had three nerve injections at a hospital in Massachusetts and another at a hospital in Pittsburgh, Pa. Each injection lasted about six months.

Then, some 15 years ago, I returned to Pittsburgh for devascularization of the middle branch of the right trigeminal nerve by a world-renowned surgeon whose name escapes me. It has given me a complete cure in all these years since then, for which I am so grateful.

I thought you might spread the world in your column about this surgery for those who suffer the very, very acute variety of tic douloureux.

A: Thank you for sharing your success story.

Tic douloureux, also known as trigeminal neuralgia, is a painful condition caused by abnormal compression or inflammation of one of the trigeminal nerves that supplies feeling to each side of the face. It is best treated by a neurologist, but I can't argue against surgery because of your positive experience.