DEAR DR. GOTT: My situation is a bit complex, but I will try to make it as brief as possible.

In 1997, I was short of breath, and I had stress tests and a heart catheter, which indicated an 80 percent blockage in one artery and 50 percent in the other two. In the artery blocked 80 percent, I had angioplasty and a stent put in. Relief was immediate.

I felt fine until recently. I have arthritis and attributed the pain in my left shoulder and upper arm to that. It started approximately two or three months ago. About three weeks ago, I experienced extreme shortness of breath, weakness and fatigue. At the hospital, I was diagnosed with blood clots in both my lungs associated with a low INR. I was in the hospital for six days on a course of Coumadin and shots of Lovinox. I was discharged when my INR reached 2.1. I take 10 milligrams Coumadin daily and felt fine for about a week. Then back to the emergency room with shortness of breath. Tests showed no clots, but my INR had fallen to 1.7. I then consulted with my heart doctor, and he ordered another stress test. Again, everything was fine.

This leaves me in a dilemma. Chest X-rays and CT scans show nothing relative to the lungs, and the stress test shows nothing relative to the heart. However, I still continue to be extremely short of breath, fatigued and weak. As far as I know, I was never diagnosed with asthma or emphysema. I used to be a heavy smoker (two packs per day), but I stopped more than 12 years ago.

Please give me your expert thoughts on this. Should I opt for a second opinion at a place like the Mayo or Cleveland Clinics?

DEAR READER: Yours is a complicated ailment. For example, why did you develop blood clots in your lungs? Could this be a symptom related to a primary lung disorder or a clotting disorder?

Based on the information you gave, I am fairly confident you have a clotting disorder. Your INR (International Normalized Ratio; higher numbers mean less clotting ability, lower numbers mean more clotting ability) is abnormal despite treatment with an anticoagulant. Make an appointment with a blood-disorder specialist (hematologist). Bring your lab work and test results with you to the appointment. This will provide background information and aid the specialist in his or her diagnosis. The doctor may choose to order more specific tests. If this specialist doesn't find anything abnormal, a visit to a top-notch medical facility is appropriate.

You need to know why you developed blood clots and why your INR is consistently low. In other words, your doctors may be treating your symptoms instead of searching for the cause. Let me know how this turns out.

To give you related information, I am sending you a copy of my Health Report "Blood — Donations and Disorders." Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.