Dear Dr. Roach: In 2016, I was fortunate to survive a saddle pulmonary embolism (PE). I was sent home from the hospital with an Eliquis prescription. My medical providers ran several blood tests, but no known reason was found to have caused the PE. My cardiologist recommended staying on Eliquis for one year because of the severity of the clot. After 18 months, my pulmonologist and cardiologist agreed to allow me to stop it.

In September 2021, I suffered three massive PEs: two in one lung and one in the other. They also found several deep venous thromboses (DVTs). I was rushed to the emergency room at one of our local hospitals, where they said I was close to death. The attending physician and staff got me on a clot-busting IV. I was then airlifted to the teaching hospital, where I only had to stay for one-and-a-half days. During the flight, my condition improved significantly.

Needless to say, I was put back on Eliquis, and I will be on it for the rest of my life. After reading the recent letter from the man who wanted to get off of his medication, I was prompted to give you firsthand information of the risk involved in stopping it.

— S.C.

Answer: Thank you for writing. A saddle PE is a large blood clot that lodges in the main pulmonary artery, where it splits into the blood vessels that lead to the left and right lung. (A “pulmonary embolism” is any kind of material such as a clot, air, or cholesterol that goes into the lung.) This is a rare and always life-threatening event, and you were lucky to survive.

In people with a life-threatening clot and no identification of what caused it, or if something caused it that can’t be fixed (like a genetic predisposition to blood clots), then most experts recommend lifetime anticoagulation with a medicine like Eliquis.

In hindsight, lifetime treatment was the correct choice, since you were even luckier the second time to survive the blood clots that came from your legs and lodged in your lungs. Giving thrombolytic (literally “clot-busting”) medications is dangerous because it can cause a stroke, but it is appropriate for such a dangerous condition.

Many people worry about the side effects of anticoagulant drugs like Eliquis or warfarin, but they prevent far more problems than they cause when prescribed appropriately. Many more strokes are caused from not prescribing these drugs or from stopping them too soon. They protect against clots far more than they cause serious bleeding events. The new drugs in particular are safer than warfarin, the levels of which, despite great care, can get too high or low in the body.

Dear Dr. Roach: I am 82 and take gabapentin for arthritis, but my niece takes it for anxiety. What is gabapentin all about?

— J.M.

Answer: Gabapentin was originally approved as a drug to control epilepsy, but it soon became clear that it was useful for chronic pain, especially the kind that comes from damaged nerves. But it can help with other kinds of pain, too. (It is specifically indicated by the Food and Drug Administration for the treatment of pain after shingles.)

It is also used off-label for anxiety and several other conditions, including menopausal hot flashes and restless leg syndrome. It takes experience and judgment to know when to use gabapentin as it has the potential for side effects, such as sedation and mood swings.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.