I once heard someone say that soldiers under fire in a fox hole don’t fight because they want to defeat the enemy. They fight because they don’t want to lose the people they love the most. I’m starting to think that’s why I want to be a doctor. Maybe if I learn enough, I don’t have to lose the people I love the most. And it is with that in mind that I present to you an essay on Warfarin for treating atrial fibrillation.
I first heard about this treatment on Fox News, but don’t let that keep you from reading the rest of this article. According to them, over 20 million people in the United States currently take this drug. Now a new study out of Utah suggests that the drug may increase substantially a person’s risk for developing dementia. When you dig deeper into the report you learn that Fox News didn’t report it exactly right, which is probably why this reporter knew to dig a little deeper. The truth is, it isn’t necessarily the drug warfarin that is the culprit causing dementia. Rather, it is in the way warfarin is prescribed.
There is no one size fits all dosage that regulates the heart likely because warfarin is an anticoagulant and your heart is regulated literally by a node producing electrical impulses. Warfarin is something that simply thins the blood so that a person’s heart is less likely to get a blood clot, or pump a clot through to the brain or lungs thus causing a stroke. Heart doctors prescribe from a baseline based on age, weight, and their own personal experience with their patients to make an educated guess on how much warfarin someone should take. When they guess wrong, a person’s ankles swell, and the circulation throughout their body suffers, including the brain. Some scientists speculate that the lack of circulation for a significant period of time is the reason dementia risk is increased, and not the warfarin itself.
But, I’ve been thinking about this a lot since I heard about it. I think it is a combination of both. No, I don’t have a medical degree. Like George W. Bush, I have a gut, and this is gut instinct writing the rest of this article. And as Stephen Colbert so aptly pointedly out gut decisions could be completely wrong. Here me out anyway.
My great grandmother was someone I actually knew and hung out with when we lived in Texas. I remember dancing in her bedroom as she sang. I remember wearing her old military uniform from World War II. I remember she was nice to me, and she was always glad to see me. But as I got older, so did she. And her heart apparently was about to stop so they gave her a pacemaker and Coumadin. No, Coumadin is not Warfarin. But it is important to my anecdotal analysis.
My great grandmother was totally with it and cool before she started taking Coumadin. But afterwards, she started showing signs of forgetfulness, and while I don’t remember I’m told she apparently became one of the worst drivers on the planet. Over only a couple of years, her family members experienced a massive personality shift. Where she was one kind, she now was cruel. Where she was never violent, she was easily hostile and child-like. They say it was a ‘slowish’ decline. Doctors ran a CT scan on her, basically an X-ray of the brain, and did not detect anything like Alzheimer’s disease, a wasting of brain tissue. They concluded she was depressed, and gave her some sleeping pills and some other pill to make her less moody.
Very scientific. Now that I know, it kind of makes me want to smack someone. I really loved her.
The point is, that she was prescribed Coumadin, but no one made the connection that her change in behavior could be related to the drug. To be clear, the drug thins the blood. Thinner blood means fewer red blood cells carrying hemoglobin responsible for getting oxygen to all parts of the body, including the brain. Now I’m just a kid, but what idiot can’t figure out that less oxygen to the brain might cause damage? This seems like the biggest duh moment ever. Couple that with the fact that they loaded her up with even more meds…and now I kind of wish I could sue, or at least go back in time and scream until I got sent to my room for loving someone more than I should.
Enter Warfarin.
My grandfather I didn’t know very well at all, but I did get to see the first hand effects of Alzheimer’s, a disease he suffered from. Interestingly, he didn’t die from it. He died from heart failure, and he had a pacemaker that my parents agreed to deactivate because his Alzheimer’s had become so…well, bad. For those who don’t know, Alzheimer’s disease is when you can’t remember things, people you love, or your own personal life. Eventually, you can’t take care of yourself at all like eating, bathing, or getting dressed. You fight people who are trying to help you, and you call every five minutes because you can’t remember why you are in the nursing home instead of at home. It’s horrible.
According to my Mom, my grandfather was perfectly okay the day before his wife (who apparently my Mom thinks was eyeroll worthy because every time she mentions Grandmother Haney’s name she rolls her eyes in my interview) took him to the Veteran’s hospital for a routine check-up. Something happened at the appointment, and they put him immediately in the hospital for atrial fibrillation and high heart rate. Mom says that she remembers that he sounded fine to her on the phone when she spoke to him. He left the hospital a couple of days later with a prescription for Warfarin.
Now, again, this is anecdotal, but according to my Mom his memory within a year started slipping. She says that she remembers his swollen ankles that reminded her of her grandmother’s swollen ankles (my great grandmother whom I spoke of in this article earlier). And within just a couple of years she says that he would get lost, forget where he was, why he was there, and eventually people in the middle of a conversation. It was all a slippery slope from there.
Here’s the connection I make. They both were on drugs that effected blood circulation, and they both had swollen ankles up and down on an inconsistent basis. From what I understand, those ankles indicated circulation problems. Circulation problems means that a body isn’t getting enough oxygen everywhere it needs to go.
My conclusion: two different drugs, similar results. Is there a connection? Well, what else do I know. I know that people say drugs are bad and we aren’t supposed to take them. So, by that rationale, I can’t imagine that a drug simply becomes safe because a doctor gives it to you. The drug itself is still dangerous even if it comes to you from a guy with a white coat in a hospital as opposed to a guy in a leather jacket on a street corner.
I’ll end my story here, but I’d like to ask anyone who reads this to send in their own personal stories into the iGlobe school newspaper. We aren’t soldiers in a foxhole. But, that doesn’t mean we don’t have the opportunity to take care of each other over virtual connections as if we were. I think all of us are worth fighting for. And, while I may not be the most talkative person in the world in real life, maybe that’s because I’m watching what everyone else is saying and ready to fight for you like the war for someone’s life whom you love has just begun.
Sources:
"Popular Afib Heart Drug Warfarin Linked to Dementia Risk." CBSNews. CBS Interactive, n.d. Web. 08 May 2016.
"Coumadin Oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD." WebMD. WebMD, n.d. Web. 08 May 2016.
"Alzheimer's Disease & Dementia | Alzheimer's Association." Alzheimer's Disease & Dementia | Alzheimer's Association. N.p., n.d. Web. 08 May 2016.
"Common Blood Thinner May Increase Dementia Risk in Certain Patients | Fox News." Fox News. FOX News Network, 06 May 2016. Web. 08 May 2016.
Author’s note: I want to thank my Mom for spending a couple of hours on Mother’s Day talking about stuff I’m sure she’d rather forget. Having said that, don’t even think I’m letting you take warfarin or Coumadin. And just to be on the safe side, I’ve decided not to let you eat your Mother’s Day cake Dad just brought home. It was store bought anyway. I love you.
Image credit:
https://www.healthcitycaymanislands.com/what-is-atrial-fibrillation/
