ArcaMax

DEAR DR. ROACH: I am an 81-year-old man in reasonably good health. When I had trouble falling asleep, I would take a swig of Zzzquil, which worked perfectly every time. However, since then, my cardiologist told me to stop taking such products, so I turned to 5-mg tablets of melatonin in the evening to help induce drowsiness. Sometimes it worked, and sometimes it didn't.

One night, after I had three beers, I also took two gelcaps of Gas-X to alleviate the bloated feeling just before bed. It was about an hour or so after the melatonin, and I quickly dozed off to sleep. Since then, I have noticed that if I awaken in the night and take another Gas-X, I shortly doze off again and have remarkable, complex dreams. Is this self-protocol of mine medically unsound in any way? -- W.G.

ANSWER: There's a lot going on here. First off, I completely agree with your cardiologist that the sleep aid you were taking, like most over-the-counter sleep aids, contains diphenhydramine, an antihistamine that sedates some people. The problem with this medicine is that the quality of sleep isn't good for many people. It also increases the risk of falls in older people and the risk of motor vehicle accidents in people who drive. It's not a good choice for older adults.

Melatonin is safer and has fewer side effects. One of them is vivid dreams. Five milligrams is a big dose. (I usually recommend 0.5 to 1 mg in my older patients.) Gas-X (simethicone) isn't absorbed into the body and shouldn't cause vivid dreams. A search found no reports of abnormal dreams with simethicone, so it was almost certainly the melatonin causing the dreams. Maybe the Gas-X allowed you to sleep while the melatonin was still around enough to give you vivid dreams.

In addition, three beers on a regular basis are more than what is considered healthy for anyone, and a man in his 80s will be affected by three beers much more than a younger man of the same size.

DEAR DR. ROACH: Seven years ago, I went to the emergency room and was told I had blood clots in my arms that traveled to my lungs. I started Eliquis. The doctor said I had a problem with factor V, but I don't have my blood results. Do I need to stay on this blood thinner? I know it has severe side effects. -- M.T.

ANSWER: Factor V is a protein that is critical in making clots, and an abnormality in this protein can make a person bleed (although this is very rare).

What is more common is a condition called factor V Leiden (FVL), which makes the body resistant to activated protein C, a natural anticoagulant. (Anticoagulants decrease blood clotting and are sometimes referred to as "blood thinners.") So, the net effect of FVL is that it makes blood clots a little more likely. Many people have FVL, but most will not develop a blood clot.

However, you apparently developed blood clots in both arms that led to the clots moving to the lungs, called pulmonary emboli. Determining the duration of therapy takes clinical judgment. Because you had clots in the arms rather than the legs, had a pulmonary embolus, and have FVL, some experts would treat you for the rest of your lifetime.

I wouldn't say that Eliquis has severe side effects. Because it reduces blood clotting, there is a chance of bleeding. For most people with a low to average risk of bleeding, the likelihood is on the order of 1% to 2% per year. If the risk of a life-threatening clot is higher than the risk of bleeding, then continued anticoagulation is preferred.

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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 Dr., Orlando, FL 32803.

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