Face touching or pinching associated with multiple causes

Dear Dr. Roach • I have a grandson who pinches his face. He just graduated from high school and will be going to college in the fall. He does not like to be around people, and when I ask him where or what would he like to go or do, he says nowhere. He does play a lot of games on his phone and TV. I have watched him and am very concerned. He does it several times a day. — D.F.

Answer • Many conditions are associated with repeatedly touching the face, and I can’t guess reliably what his might be. The list is fairly long, and includes anxiety disorders, obsessive-compulsive disorder, ADHD, Tourette’s syndrome and autism spectrum illnesses. The fact that he has done so well at school is reassuring.

If I were the physician seeing him, I would want much more information about his developmental history, school evaluations and any psychological assessments that might have been done. Interviewing his family could be very helpful. If it weren’t clear to me at that point, I would recommend a psychiatric evaluation.

Dear Dr. Roach • Earlier this year, my 59-year-old brother was diagnosed with atrial fibrillation. He underwent a cardioversion successfully, and the cardiologist put him on an anti-arrhythmia drug (amiodarone) and a blood thinner (Xarelto) indefinitely.

After four months, he suffered a major GI bleed event. A colonoscopy showed diverticulosis, which they concluded was what caused the event. He was recommended for lifelong medication.

Can a person with diverticulosis be on a blood thinner like Xarelto without a major risk of GI bleeding? Also, if the cardioversion got his heart beating normally again, and he is on an anti-arrhythmic drug, must he be on a blood thinner? — A.J.F.

Answer • There always is a risk of a serious GI bleed in someone taking an anticoagulant such as warfarin or one of the newer drugs, like Xarelto. However, for many people, there is less risk of a major bleed than there is of a stroke.

One tool for doing so is the CHA2DS2-VASc (pronounced “chads-vasc’’) score, which estimates the risk for stroke in someone with atrial fibrillation.

This does not look at the risk of bleeding, but a history of diverticulosis is not considered a major risk for bleeding. More than 80 percent of people who had a stroke with atrial fibrillation were not getting the recommended treatment.

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 ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Drive, Orlando, Fla. 32803. Health newsletters may be ordered from rbmamall.com.