Q. A couple of years ago before Vioxx was taken off the market, my husband took it for joint pain. (His job requires a lot of lifting.) He had no cholesterol issues or clogged arteries, so I am convinced the Vioxx was responsible for his heart attack.

He has recovered, but his joints still ache. His doctor has prescribed Mobic. Is it safe for him to take this drug?

A. Since the controversy surrounding Vioxx and similar drugs, the FDA has scrutinized other NSAID pain relievers. All will have stronger warnings about an increased risk of cardiovascular events (like heart attacks and strokes). Until there is more long-term safety data about NSAIDs like Mobic, your husband might discuss acetaminophen or other alternatives with his doctor.

Q. I’ve been taking the blood thinner Coumadin to treat atrial fibrillation for eight years. My cardiologist told me I need to avoid grapefruit juice, broccoli, spinach and all other green leafy vegetables except iceberg lettuce.

I was concerned about missing out on vitamins so I asked if I could take a multi. He said only if I could find one with no vitamin K. That has been difficult.

Is there a way I could get my vitamins without interfering with my Coumadin?

A. Ask your doctor to refer you to a dietitian. His restrictions on your diet are more stringent than most experts think is necessary.

You and your doctor should be monitoring the effectiveness of your Coumadin (warfarin) with tests such as PT or INR. If you are having tests done regularly, you may be able to add some vegetables to your diet without interfering with your Coumadin. You will have to consume approximately the same amount of vitamin K each day, and your doctor may need to adjust the dose of Coumadin to compensate.

To help you discuss this issue with your cardiologist, we are sending you our Guides to Coumadin, Grapefruit, Food and Drug Interactions for a list of vitamin K content of foods and information on other food-drug incompatibilities. Anyone who would like copies, please send $3 in check or money order with a long (no. 10) stamped (63 cents), self-addressed envelope: Graedons’ The People’s Pharmacy®, No. FJD-190, P. O. Box 52027, Durham, NC 27717-2027.

There is no data to suggest that grapefruit, which affects many other drugs, would interfere with Coumadin.

Q. I’ve read that it’s safe to drink a couple of cups of coffee a day. How much is that?
I drink my coffee from a mug. It looks bigger than the coffee cups in my china cabinet.

Is decaf healthier than regular coffee? I grind my beans fresh each morning. Is there still caffeine in coffee if I keep it in the refrigerator for two days?

A. Your coffee mugs probably are bigger than a standard 6-ounce coffee cup. Many mugs hold 10 or even 12 ounces of liquid, so a single mug full of coffee would supply your “two (coffee) cups a day.

There are definitely some differences between regular and decaf coffee. A study presented to the American Heart Association last year demonstrated that drinking decaf can raise fats in the bloodstream, eventually leading to higher levels of bad LDL cholesterol.

If you brew your coffee on Monday and take it out of the fridge to warm it up and drink it on Thursday, it will still have the same amount of caffeine in it. Caffeine is quite stable and won’t disappear into the refrigerator air.

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