DEAR DR. DONOHUE: Will you comment on the treatment of blood clots in the legs? My 47-year-old son had terrible leg pain. An ultrasound showed blood clots in his leg. At first, he had blood thinner injections and was started on oral Coumadin (warfarin). His blood tests jumped around — 1.2, 1.7 and 2.6. His injections were stopped. His next blood test was 4, and the dose of Coumadin was lowered. Is this usual — trial and error to find the right dose? How will he know if the clots have dissolved? I understand he will be on Coumadin for six months. — B.G.

A: The name of your son’s condition is thrombophlebitis (THROM-boh-flea-BITE-us) — “thrombo” for clot; “phlebitis” for vein inflammation. When clots form in the deep veins of the legs — the ones you cannot see — they can be quite troublesome. Pieces of these clots often break loose and are swept in the circulation to the lungs, where they disrupt blood supply to parts of the lungs. The involved part of the lung dies. If it’s a large area of lung, the clots can be deadly.

Your son’s treatment follows the books. He was started on an injectable blood thinner for immediate prevention of clot enlargement and for prevention of new clot formation. He was also put on the oral blood thinner Coumadin, which takes time to have an effect. Once it does have an effect, the injectable blood thinner can be stopped. The effectiveness of Coumadin is judged by a blood test called INR, international normalized ratio. It tells if the blood is thin enough to prevent new clots but not so thin as to pose a danger of bleeding.

Trial and error determines the correct dose. For thrombophlebitis, an INR between 2 and 3 indicates the right dose of medicine. Six months of Coumadin therapy is standard to prevent new clots from forming.

Anticoagulants don’t dissolve blood clots. Clots that have formed sometimes spontaneously resolve or a channel tunnels its way through the clot to permit blood to return from the legs to the heart, or blood takes an alternate route to get back to the heart.

Readers with questions on stroke can find their answers in the stroke booklet. To order a copy, write to: Dr. Donohue — No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a 73-year-old man whose recent blood test came back with a PSA of.55. Please explain what this reading means as to the state of my prostate gland and what the future may hold regarding enlargement or cancer. — R.E.

A: PSA, prostate specific antigen, is a protein made by prostate cells and is made in excess by cancerous prostate cells. It’s used as a test for detecting prostate cancer. For a man of your age, a reading of 0 to 4 is considered normal. Your reading of.55 is low — not suggestive of prostate cancer.

The PSA test can be slightly elevated by prostate enlargement too. However, a finger examination of the gland is a more reliable indicator of prostate enlargement than is the PSA test.

No one can tell what the future holds, but your prostate gland future looks good.

DEAR DR. DONOHUE: I have read that omega-3 is good for joint pain. Is it safe to take if you are on the medicines I’m taking? — S.G.

A: On your list of medicines, I find none that interferes with omega-3 fatty acids, or any with which omega-3 fatty acids interfere.

Omega-3 fatty acids are things that make fish and fish oil such healthful foods. Their names are DHA, docosahexaenoic acid, and EPA, eicosapentaenoic acid. The American Heart Association endorses omega-3s for prevention of a second heart attack. Others tout them for prevention of first heart attacks and strokes.

Apparently, they have anti-inflammatory properties that can reduce joint tenderness.

It’s safe for you to try them.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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