Pulmonary Embolism Risk Rises With Surgery

Dear Dr. Roach: I had a pulmonary embolism after surgery on my knee. I have been taking Coumadin for one year, and now I am off the medication. In your opinion, should I now take a test of some sort to make sure I am rid of the blood clot in my lung? — E.A.P.

Answer: A pulmonary embolus is when a blood clot travels to the lungs and lodges there. They occur frequently after surgery, particularly when the patient doesn’t get up and move right away. Several factors of orthopedic surgery make it particularly high-risk for PE. The good news is that the risk of another embolus is only about one-half of 1 percent per year after finishing your treatment. A blood clot or PE in someone who doesn’t have a clear risk factor, like surgery, is at much higher risk for recurrence, roughly 5 percent per year.

Tests to make sure the blood clot has dissolved usually are not done. The body is very good at dissolving them on its own, usually within a few weeks to months. The reason for the Coumadin was to prevent new clots from forming.

Dear Dr. Roach: One doctor says an iron tablet is good for pernicious anemia. Another doctor says it isn’t. What do you think? — R.

Answer: Pernicious anemia is a specific type of anemia that is caused by the body’s inability to absorb vitamin B-12 properly. It’s actually an autoimmune disease. Special cells in the stomach make a protein called intrinsic factor, which is necessary for absorbing vitamin B-12. People with pernicious anemia lack intrinsic factor. The treatment for pernicious anemia is B-12, not iron. The B-12 can be given either by injection or by an oral B-12 tablet containing 1,000 times the daily requirement of B-12. Even though the body can’t absorb B-12 normally, if you give a person that much, the body is able to absorb enough.

It’s possible to have both iron-deficiency anemia and B-12-deficiency anemia, so it may be that some people will need both. However, B-12 is the specific treatment for pernicious anemia.

Dear Dr. Roach: My husband has a shoulder problem, and was told that he needs a replacement. He was told this about 10 years ago, at age 33, but that they would not do it until he was 50, as he could only have one replacement in his lifetime. This shoulder has multiple issues, and he is unable to lift his arm or use it for anything over about 10 pounds. He has regular pain and discomfort. I would like him to get a second opinion, especially since so much time has passed. I wonder if there have been new advancements. He is determined to do nothing until he is 50. What do you think? — C.C.

Answer: I think he definitely should get a second opinion. Not only have there been new advances, it actually may be better to do the joint replacement before there has been too much damage to the rotator cuff, which often accompanies the kinds of arthritis that necessitate shoulder replacement. The No. 1 complaint I hear after people heal from their joint replacement is that they wish they had done so earlier. Finally, while nobody wants a second procedure, it can be done. Find the most experienced person around; shoulders are replaced less commonly than hips or knees.

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 request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.