Dear Dr. Roach: I have a history of polyps. I recently had nasal polyps removed, and a previous colonoscopy had also revealed polyps. I have been put on a blood thinner (Xarelto) and an aspirin. Since I started taking Xarelto and the aspirin, my hemoglobin level dropped over the course of four months.
What is the best way to approach this? I have another colonoscopy scheduled again. The cardiologist thinks Xarelto is not the cause, even though my hemoglobin count was always in the normal range prior to starting Xarelto.
S.M.
Anticoagulants like warfarin (Coumadin) and rivaroxaban (Xarelto) act as kind of a “stress test” on your system in terms of bleeding. They themselves don’t cause bleeding, but if you have something like a polyp that easily bleeds, your body can’t stop the bleeding as well while on anticoagulants. You can lose blood faster than you can replenish it, especially if you are low on iron.
So, for people who are at the age where colon cancer is a concern (over the age of 45 for an average-risk person), a colonoscopy is a wise idea if you haven’t had one recently. Even people younger than 45, or people who have had a colonoscopy in the not-too-distant past, may still be recommended another look if there is no other explanation for the blood loss.
There are certainly other causes for a low hemoglobin count besides slow blood loss (so slow you aren’t seeing blood), including bone marrow diseases and problems absorbing nutrients like iron, B12 or folic acid. But, for those with a history of colon polyps, a colonoscopy is usually the critical first step.
Dear Dr. Roach: As I set my pills up for the week, I wonder why calcium supplement pills are so huge? There are “minis” on the market, but they require taking four pills to equal two “regular” pills. Take a gander at any other type of supplement on the shelves. None appear to require such a proportion.
J.C.R.
We need a lot of calcium! We have about a kilogram of calcium in our bodies, and the recommended calcium intake is about a gram daily (a bit more for older adults) to replace what we lose.
A gram doesn’t sound like much, but compared to other supplements, it’s actually a lot. For example, the body needs about 1 mcg of vitamin B12 daily. That’s a millionth of a gram! Calcium in those doses takes up a lot of volume, therefore requiring a bigger pill.
However, in my opinion, calcium tablets are not the ideal way to get calcium into the body. Calcium from food tends to be better absorbed. Further, calcium tablets increase the risk of kidney stones with their transient high level of calcium, whereas calcium in food reduces kidney stone risk. Some studies have shown that calcium tablets may increase heart disease risk; the jury is still out, but calcium in food definitely does not do so.
Calcium can be found in dairy products; small fish like sardines that have bones; calcium-fortified foods like some orange juices and plant-based milks; and some vegetables, like winter squash and dark leafy greens.
Of course, some people can’t get in enough calcium from food and, because of osteoporosis or other medical issues, need to take calcium. So, if your doctor has recommended a calcium tablet, you can always break them in half or even dissolve them if that’s easier.
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 [email protected]
