DEAR DR. ROACH: I would appreciate any insight you can give me regarding a diagnosis that I was given after my last colonoscopy. I was being tested because of anemia. The gastroenterologist said that I had arteriovenous malformations — “too many to treat” — in my ascending colon and that I should take iron for the rest of my life because that was probably the cause of my anemia. I asked more questions, even at a follow-up appointment, but was not given much information except that I should avoid ibuprofen.
What does “too many to treat” mean? Should I be concerned about taking blood thinners if they’re needed? I am 80 and in good health. I received this diagnosis about four years ago. I have not volunteered to have an additional colonoscopy by another practitioner, nor was I told that I needed to follow up. I would greatly appreciate any information you can give me. — M.L.
ANSWER: Angiodysplasias, also called arteriovenous malformations, are abnormal blood vessels that are commonly found in the intestines, but may be found in many places in the body. They are most common on the right side of the colon. These abnormal blood vessels are thin-walled and prone to bleed with slight pressure. They can be found in combination with other diseases, such as end-stage kidney disease on dialysis or in people with a blockage of a major heart valve (aortic stenosis). Some people only have one, and some have many.
When angiodysplasias are observed to be the site of bleeding in people with anemia (not enough red blood cells), they can be treated locally by endoscopy, with electrocoagulation or laser. I think what the gastroenterologist meant by “too many to treat” is that it’s not possible to identify which one is bleeding and that it’s not physically possible to treat them all. You must have a large number of them, which makes me wonder if there’s an underlying reason as to why you have these.
I am struck by your gastroenterologist’s apparent lack of interest and follow-up on your condition. If there are “too many to treat” endoscopically, you might have been offered medical treatment. There are medicines (such as thalidomide, never to be used in a woman who might become pregnant, which isn’t a problem for you) that have proven potentially useful in some studies.
On the other hand, if iron alone is keeping the anemia under control and you haven’t needed any transfusions, you might not need additional treatments, which comes with their own risks. You are right to be concerned about anticoagulants, which could definitely be a risk for bleeding. I would even caution you against taking aspirin.
I’m not sure additional colonoscopies are called for as long as your blood count remains stable. That should be checked periodically.
DR. ROACH WRITES: A recent column about a woman on warfarin who was constantly cold generated a lot of letters, most of which advised turning the thermostat up — noting that 69 degrees Fahrenheit is uncomfortably cold for many, especially older women. However, several people noted cold intolerance, which they attributed to the anticoagulant warfarin (Coumadin). I found a study from 45 years ago that noted 45% of people on warfarin agreed that their medications made them feel cold, while 22% of people who weren’t on warfarin agreed. The authors wondered if the incorrect term “blood thinner” made people feel more susceptible to the cold, or whether a “hitherto unknown pharmacological effect” might be responsible.
