Question: I am a 77-year-old female who has been taking the blood thinner Coumadin for an irregular heartbeat (atrial fibrillation) for the last five years. It has been suggested by a trusted relative that I discontinue the Coumadin and take minerals, niacin, potassium, and magnesium. Do you agree?

Answer: I emphatically disagree with the well-intentioned but bad advice from your relative.

In atrial fibrillation, the electrical impulses that trigger synchronized contractions of the upper and lower chambers of the heart become disorganized; the atria contract rapidly and ineffectively. Instead of blood moving smoothly into the ventricles, it tends to slosh around in the right and left atria, looking like a bag of worms.

Sometimes that causes a rapid heart rate with symptoms of dizziness, palpitations, and weakness. Other people may be completely unaware they have atrial fibrillation until it is discovered by their physician during a routine exam.

Regardless of whether the person has symptoms, the condition needs to be dealt with. The sloshing around of blood greatly increases the risk that a clot will form. If a clot is pumped from the heart and becomes lodged in an artery of the brain, it will cause clotting there.

Some patients can be converted back to a regular heart rhythm; others with long-standing atrial fibrillation or with a very large left atrium chamber cannot. Regardless, it's imperative that we prevent clots to avoid a stroke.

The clear consensus medical opinion from numerous trials looking at long-term anticoagulation to prevent stroke is that Coumadin - not aspirin, Plavix, or any of those supplements - is able to show a dramatic reduction in the risk of stroke from atrial fibrillation.

The advantages of needle biopsies

A: I cannot comment on your specific breast mass, but there are very few instances where an open surgical biopsy would be needed as the initial diagnostic procedure - although many doctors apparently still do it.

A panel of leading breast surgeons at the 2009 International Consensus Conference on Image Detected Breast Cancer III unanimously agreed that needle biopsy should be the gold standard for the initial diagnosis of breast abnormalities. The conference chair commented that, since only 15 percent to 20 percent of abnormalities found by mammography turn out to be cancer, a significant number of women with benign lesions are undergoing unneeded diagnostic surgery, since needle biopsy - done while awake using a local anesthetic - is equally effective for discovering cancer.

A report published in the October issue of the Journal of the American College of Surgeons noted that 35 percent of initial breast biopsies were still being performed under general anesthesia, using an open-breast procedure such as you had. This is despite the fact that such procedures are much more invasive, require general anesthesia, and cost two to four times more than the far less invasive yet equally accurate needle biopsy.