Location: Wilford Hall Ambulatory Surgical Center, 3rd Floor, Wing B
Hours of Operation: Monday - Friday, 7:30 a.m. to 4:30 p.m.
Phone: (210) 292-4452 or 292-4453
The Alcohol & Drug Abuse Prevention & Treatment (ADAPT) Clinic offers drug/alcohol evaluation, education, and treatment. Outpatient treatment is available in-house. High levels of care are available in the local area (TRICARE approved).
Location: Wilford Hall Ambulatory Surgical Center, 3rd Floor, Wing D
Hours of Operation: 7:30 a.m. to 4 p.m., Monday, Tuesday, Wednesday & Friday; 7:30 a.m. to 3 p.m., Thursday
Allergy shots are by appointment only: Monday & Wednesday, Noon – 3:30 p.m.; Tuesday & Thursday, 7:30 – 11:30 a.m.; and Friday, 1 – 3:30 p.m. Call the Allergy Clinic to schedule.
Phone: (210) 292-4278
The allergy clinic at Wilford Hall provides evaluation and diagnostic assessment of allergy-related diseases for active duty and beneficiaries assigned to Joint Base San Antonio-Lackland. Patients who desire to be evaluated by the allergy clinic must have a consult placed by their primary care manager.
Allergy Services Include Evaluations for:
Location: Wilford Hall Ambulatory Surgical Center, 2nd Floor, Wing A
Hours of Operation: 6:30 a.m. to noon
Days of Operation: Monday - Wednesday & Friday (closed Thursdays)
Phone: (210) 292-7026
Anticoagulation is a term that means "reducing the blood's potential to clot." Many people interchange the expression "thinning of the blood" with the term "anticoagulation." In fact, this latter term is so common that anticoagulant medications are usually spoken of as blood thinners. However, anticoagulants do not really "thin out," dissolve, or dilute any aspect of the blood. The role of "blood thinners" rests solely with their unique ability to reduce clotting of the blood, and thus reduce the risk of certain conditions which arise from abnormal clot formation.
The most widely used oral anticoagulant (and one of the most commonly prescribed medications) in the Western World is Warfarin (also known by the trade name of Coumadin®). This unique medication does only one thing ... it reduces the tendency of the blood to clot. There are millions of patients worldwide safely taking Warfarin. However, the unique action and metabolism of this drug requires careful dosing, administration and follow-up.
The key to success with Warfarin management is education! Patients who understand the reasons for prescribing and monitoring Warfarin are universally successful in long-term therapy with this medication. The Anticoagulation Clinic is providing a thorough discussion of Warfarin management to assist you in taking the steps necessary for safe and successful usage of this important medication.
Please take the time to review all of the major Warfarin related topics below. If you still have questions, contact the clinic. Although it may not be possible to answer all such questions, the clinic will endeavor to provide additional information to you when possible.
Location: Wilford Hall Ambulatory Surgical Center, 2nd Floor, Wing D
Hours of Operation: 7:30 a.m. to 4:30 p.m.
Phone: (210) 292-5420
The Audiology Clinic at Wilford Hall Ambulatory Surgical Center provides comprehensive hearing and balance assessment services to active duty personnel, retirees, and eligible family members. A referral is needed to receive hearing or balance services.
Audiologists specialize in the assessment and management of hearing loss. Hearing loss can result from a variety of causes such as: aging, exposure to hazardous noise, congenital/medical conditions, and treatment with ototoxic drugs. Hearing loss can vary in severity as well as type. Sensorineural hearing loss results from damage to the inner ear and/or hearing nerve. Conductive hearing loss occurs when the outer or middle ear structures affect the transmission of sound into an otherwise healthy inner ear. Mixed hearing loss is a combination of inner ear damage and outer or middle ear concerns. Audiologists refer patients for further medical examination and treatment when a potential medical concern is identified.
Treatment and management of hearing loss is dependent on the type and severity of the hearing loss as well as the individual's needs. Management options that are supported at the audiology clinic include: communication strategies, assistive listening devices, hearing aids, implantable/bone-anchored hearing aids, and cochlear implants.
Assistive listening devices help in specific situations (on the phone or while watching TV), while hearing aids are a more general solution. The audiology clinic currently offers retired military members the option of participating in the Retiree Hearing Aid Purchase Program. Hearing aid services for active duty personnel and their family members are coordinated through the clinic.
Tinnitus is defined as the perception of sound when no external sound is present. Tinnitus can result from a multitude of causes, although hazardous noise exposure is most commonly cited. The audiology clinic offers assessment and management services for patients troubled by tinnitus.
Vestibular Assessments and Treatment
Dizziness, vertigo and balance problems can be related to inner ear disorders. The audiology clinic offers comprehensive testing to assess vestibular function related to balance. Audiologists coordinate with ear nose and throat physicians in assessing and managing specific types of ear-related balance problems.
American Academy of Audiology
American Speech-Language-Hearing Association
Military Audiology Association
Location: Wilford Hall Ambulatory Surgical Center, Reid Clinic
Hours of Operation: 7 a.m. to 4 p.m.
Mission: The BOMC initiative aims to improve the patient experience and streamline administrative health care processes by separating traditional clinical services from occupational medicine. BOMC facilitates practicing aerospace medicine in a way that mirrors the high reliability culture of aviation.
Hours of Operation: 7 a.m. to 6 p.m. Monday, Tuesday and Thursday; 7 a.m. to 4:30 p.m. Wednesday and Friday
Hours of Operation: 7:30 a.m. to 4:30 p.m. (Clinic is closed the first Thursday afternoon of every month for training)
FAX Consult: (210) 292-7737
The Cardiology Clinic is dedicated to the cardiac care of all patients who seek our services. We actively seek to assist providers with their patient's cardiac problems, and will meet or exceed access to care standards for new appointments.
We provide cardiac consultations. If your provider wishes to submit an urgent consult, they must call and speak with the clinic on-call provider or fax the information to the number above. Providers must provide the patient's phone number on the cover letter to help facilitate scheduling. Ensure all patient information, including the sponsor's social security number, is included on the referral.
If the patient is enrolled in TRICARE Prime, the physician will initially need to coordinate the referral through the proper channels using the Health Care Finders. Ensure the physician provides their name and contact information in the referral.
If the referring physician determines that the patient needs to be seen within 72 hours, please call the cardiologist assigned to your base in order to facilitate this referral. If there are any problems, call the assigned cardiologist or, contact our clinic for assistance.
Outpatient Cardiology Services Offered
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, Wing C
Hours of Operation: 7 a.m. to 4 p.m. (closed first Wednesday afternoon of the month for training)
Phone: (210) 292-3715
Our mission is to provide continuous, quality chiropractic care in support of a healthy, deployable force and to manage, support, and give chiropractic care to all eligible patients with the most current resources and techniques available.
At the present time, chiropractic services is not a TRICARE covered benefit and is only available to active duty service members. You must see your primary care manager for a referral to the chiropractic specialty clinic.
The Chiropractic Clinic sees patients by referral only. All initial appointments are schedule by the Consult and Appointment Management Office at (210) 916-9900. All follow-up appointments are scheduled by the chiropractic staff.
Hours of Operation: 7:30 a.m. to 4:30 p.m.
Phone: (210) 292-3376
The WHASC Dermatology Clinic diagnoses and treats diseases of the skin, hair, nails, and mucous membranes.
Appointments in are by consultation only through your primary care manager.
General Medical and Surgical Dermatology
Complete and thorough skin evaluations for inflammatory, neoplastic, metabolic, infectious, vascular, and traumatic skin diseases, as well as definitive treatment of them.
Moh's Micrographic Surgery
Margin control surgery in an outpatient setting for the treatment of cutaneous malignancies and tumors requiring tissue conservation surgery and reconstructive repair.
Consultative dermatopathology services offered for all biopsies performed at the institution, as well as for biopsies performed by any provider in the military health system worldwide who wishes to have dermatopathology consultation.
Pediatric Dermatology services offered from neonates on up including treatment of hemangiomas, cutaneous malformations, and cutaneous diseases requiring systemic medications or surgical intervention.
Numerous cosmetic procedures are offered on a space available and case by case basis (cosmetic service fees apply) including Botox for dynamic wrinkles and hyperhidrosis, laser resurfacing, laser treatment of vascular lesions and other benign growths, laser hair removal, chemical peels, surgical removal of benign growths or neoplasms, photodynamic therapy, endovascular varicosity treatment, sclerotherapy, dermabrasion, blepharoplasty, fillers, and face lift procedures.
Global reach through consultative teledermatology services extends quality dermatologic care to deployed and remote locations.
Wounded Warriors Program
Evaluation and treatment of cutaneous diseases and complications of military service with cutting edge technology is extended to our wounded warriors to include scar revision or laser resurfacing of injuries received on the battlefield.
Pseudofolliculitis Barbae Clinic
Weekly clinics at Reed Clinic on base for Active Duty trainees who have problems with "razor bumps", or pseudofolliculitis barbae.
Using Narrowband UVB (NBUVB), psoralen plus UVA (PUVA), or broad band light (BBL) for the treatment of various cutaneous diseases including psoriasis, vitiligo, mycosis fungoides, eczema, and various other conditions responding to ultraviolet light therapy.
As a major referral center, we have extensive patch testing trays and chemicals to test the skin for allergic contact dermatitis.
American Academy of Dermatology
American Cancer Society
Centers for Disease Control and Prevention
National Cancer Institute
National Eczema Association
National Eczema Society
National Institute of Arthritis & Musculoskeletal & Skin Diseases
National Psoriasis Foundation
Skin Cancer Foundation
US Food and Drug Administration
Vascular Birthmarks Foundation
Location: Wilford Hall Ambulatory Surgical Center, 3rd Floor, Wing D
Hours of Operations: 7:30 a.m. to 4:30 p.m.
Phone: (210) 292-2000
The Diabetes Center of Excellence is a premier Air Force Medical Service specialty clinic dedicated to providing standardized diabetes care to beneficiaries across the military health care system. The clinic includes three equally important sections: clinical division, outreach division, and research division. The clinical component provides diabetes management, diabetes education, and diabetes prevention programs through referral care to over 50,000 TRICARE beneficiaries.
The DCOE has an American Diabetes Association recognized Diabetes Self-Management Education program offering initial and refresher education to assist patients with management of their diabetes. Diabetes prevention is provided through a comprehensive 12-week Group Lifestyle Balance program modeled after the successful Diabetes Prevention Program.
The DCOE manages patient with both type1 and type 2 diabetes mellitus, those patients on insulin pumps, continuous glucose monitors, using U-500 insulin, and other complex medical treatments. Once controlled, patients with type 2 diabetes may be returned to their primary care manager.
The DCOE is staffed by board certified endocrinologists, endocrine fellows, internal medicine residents, diabetes nurse practitioners, certified diabetes educators, and licensed vocational nurses. The clinic has a mix of active duty, civilian, and contract personal.
To make or cancel an appointment:
Otolaryngology Head and Neck Surgery, often known as ENT (ear, nose, and throat), is a diverse specialty that encompasses the medical and surgical treatment of many diseases affecting the head and neck. The ENT clinic treats a variety of issues, including sinuses, tonsils, ears and hearing, facial aesthetics, facial nerve, salivary glands, nose, upper aerodigestive tract, thyroid, parathyroid, voice and speech problems, tracheotomies, and many other issues. Areas excluded from clinic management include the brain, the eye, the carotid arteries, and the spinal cord and associated vertebral column.
Medical and Surgical treatment of common maladies of the head and neck, typically including problems related to the ears and hearing, sinuses, allergies, mouth, snoring, tonsils, throat, and speech.
Specialists dealing with complex otologic disorders requiring intricate medical and surgical management typical problems include hearing loss, chronic ear disease, ear drum perforations, peripheral vertigo, facial nerve injury, and lesions of the cerebellopontine angle (CPA) and skull base. Surgeries include: tympanoplasty, ossicular chain reconstruction, stapes procedures, mastoidectomy, implantable hearing aids, cochlear implantation, surgical vertigo control, removal of tumors of the lateral skull base and CPA, and neurosurgical access to lesions of the middle and posterior cranial fossa.
Facial Plastic & Reconstructive Surgery
Specialists dealing with aesthetic and reconstructive issues of the face, head and neck. Typical procedures offered by this group includes rhinoplasty, otoplasty, rhytidectomy (face-lifts), blepharoplasty, browlifts, chin and midface procedures, injectable fillers (Restylane, Radiesse, Sculptra, etc.) , Botox injections, as well as scar revisions. Complex reconstructive soft tissue and skeletal deformities are addressed by a multi-disciplinary team of facial plastic surgeons.
Laryngology & Voice Disorders
Specialists offering state-of-the-art diagnosis and treatment for patients with voice, speech, breathing, and swallowing problems including hoarseness, paralyzed vocal folds, singer's nodules, vocal fold cysts, polyps, papilloma, aging voice, laryngeal and tracheal stenosis, paradoxical vocal fold motion (AKA Vocal Cord Dysfunction) and swallowing trouble. We specialize in office-based surgery using cutting-edge technology to enable patients to receive an accurate diagnosis and specialized treatment. Professional voice users and singers as well as everyday voice users are treated by our multidisciplinary team.
Rhinology & Endoscopic Skullbase Surgery
Specialists available for the comprehensive medical and surgical management of severe chronic rhinosinusitis especially related to the frontal sinus. All Draf procedures performed at this institution. Additional skullbase procedures available include endoscopic approaches for anterior/middle cranial fossa neurosurgical procedures, endoscopic orbital decompressions, optic nerve decompressions, dacryocystorhinostomy, and vidian neurectomy.
Pediatric Otolaryngology/Head & Neck Surgery
Specialists provide comprehensive medical and surgical treatment of the ear, nose, throat and related structures of the face and neck in the pediatric population.
The Speech Pathology clinic is comprised of four speech pathologists who are certified by the American Speech-Language-Hearing Association (ASHA) and are state licensed in speech-language pathology. We offer services for both adults and children with a wide range of problems. We help to diagnose swallowing problems, voice problems, problems with stuttering, language, articulation, and cognitive-communication disorders. We offer state-of-the-art evaluation and therapy including laryngeal videostroboscopy and voice analysis as well as voice therapy; endoscopic and fluoroscopic evaluation of swallowing and swallowing therapy, including VitalStim; provide care for patients who are undergoing treatment for head and neck cancer; and participate in several multidisciplinary evaluation boards for complex pediatric development, feeding, and craniofacial problems.
Location: WHASC Room 1T07 or 1T09, 1st Floor, Wing CHours: 8 a.m. to 4 p.m.Phone: 210-292-2775/5864/4721/4404
The Air Force Exceptional Family Member Program (EFMP) is designed to provide support to military family members with special needs. All branches of the military offer EFMP, and each Service includes a variety of personnel, medical and family support functions under the EFMP umbrella. Learn more about about the Exceptional Family Member Program and link it (in a new tab) to the EFMP microsite here: http://www.airforcemedicine.af.mil/EFMP/
Location: Wilford Hall Ambulatory Surgical Center
Hours of Operation: 24 hours a day/seven days a week
Phone: (210) 292-7331
The 59th Medical Wing is pleased to once again provide emergency care on Joint Base San Antonio-Lackland. The Family Emergency Center is the Air Force’s largest freestanding emergency clinic. Located on the first floor of the Wilford Hall Ambulatory Surgical Center, the Family Emergency Center can diagnose and treat a variety of emergency and non-emergency illnesses and injuries in both children and adults. The Family Emergency Center provides open access care for all eligible Department of Defense beneficiaries.
The Family Emergency Center treats approximately 33,000 patients a year, providing the finest acute care in the Air Force. We believe each patient is unique and your emergency is all that matters when you come to us for care. Whether you're suffering from head, chest, or abdominal pain; fractured, sprained, or broken bones; shortness of breath; vomiting; dehydration; or even seemingly mild symptoms like a fever or sore throat, you can trust that our team of experienced medical professionals will treat you as if you're the most important person in our facility, and provide you with friendly, immediate, patient-centered care.
What is the difference between a freestanding emergency center and a traditional ER?
Freestanding emergency centers function just like traditional ERs with the exception that they're not connected with a hospital. Because we experience a smaller patient volume than a large hospital based ER, we're able to provide immediate acute care services.
The Family Emergency Center is well equipped to handle most common acute illnesses and minor emergency conditions. However, in the event that a patient requires more extensive care or admission to a hospital, we'll stabilize them and quickly arrange transportation by ambulance to a nearby hospital.
An emergency is defined as an acute illness or injury that may pose a threat to life, limb or eyesight; result in unreasonable pain or suffering; or requires immediate care or attention to ensure the best recovery possible. When someone develops signs and symptoms of a stroke, heart attack, or other life threatening emergency then 911 should be called immediately, or the person should report immediately to the nearest emergency facility.
The Nurse Advice Line is available 24 hours a day, seven days a week, for free medical information and advice for TRICARE beneficiaries. Registered Nurses are available to answer your health care questions and direct you to the most appropriate level of care.
Nurse Advice Line: (888) 999-1212
The best place to receive all your routine medical care is with your primary care team. If you need an appointment with your primary care team contact the San Antonio Consult Appointment Management Office at (210) 916-9900.
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, A-Wing
Hours of Operation: Monday through Thursday, 7 a.m. - 5:30 p.m.; Friday, 7 a.m. - 4 p.m.; closed Wednesdays after 12 p.m. for training
Phone: (210) 292-2003
The Family Health Clinic serves 36,000 TRICARE beneficiaries. Our goal is to provide patients with quality, patient-centered care. Our staff includes active duty, civilian, and contract providers. Our providers are board certified family practice physicians, physician assistants, and family nurse practitioners. Your Primary Care Manager (PCM) Team includes providers, nurses, medical technicians, and administrative staff who work together to coordinate services to meet all of your health care needs. We call this your Patient-Centered Medical Home (PCMH), also known as your Air Force Medical Home (AFMH).
Primary Care Menu of Services
To make or cancel an appointment:
Specialty Clinic Referrals: You must see your primary care manager in order to be referred to a specialist or specialty clinic.
Preventative Services: Preventative services for active duty are scheduled with your primary care manager. Network preventative services for family members of active duty, retirees, and family members of retirees are available with or without being scheduled with your PCM. Under TRICARE, you are authorized one preventative service per year from any TRICARE network provider without a referral from your PCM. For more details, call the TRICARE benefits office at 1-800-444-5445 or visit
Location: Wilford Hall Ambulatory Surgical Clinic, 2nd Floor, Wing A
Hours of Operation: 6:30 a.m. to 4 p.m.
Phone: (210) 292-4980 or (210) 292-0020
The Gastroenterology Clinic enhances Air Force readiness by promoting healthy families through early digestive disease identification, monitoring, and treatment. Adult patients are accepted based on care requirements through physician referral.
The GI clinic provides a wide variety of endoscopy services including:
These procedures serve as both diagnostic and treatment platforms. During the course of these procedures physicians may perform tissue biopsies, polyp excision, gastrointestinal hemorrhage control, diagnostic photography, obstruction removal, stricture dilation, internal hemorrhoid ligation.
Location: Wilford Hall Ambulatory Surgical Center, 2nd Floor, Wing C
Phone: (210) 292-7293 (210) 292-7294
General Surgery is a broad specialty that encompasses the surgical treatment of many diseases. Within the specialty, there are many sub-specialties which are all accessible to patients that require care of a sub-specialist. Examples of sub-specialties are colo-rectal surgery, minor-minimally invasive surgery and wound/ostomy services.
General Surgeons address a wide range of problems within the human body. Gallbladder, intestinal, and hernia related issues are commonly dealt with by general surgeons, but general surgeons can manage surgical problems in body systems including the thyroid, parathyroid, lungs, stomach, liver, intestines, colon, and many other body systems. Generally excluded from a general surgeons practice include the skeletal system, neurological system, and the genitourinary system.
Gallbladder and biliary related
Problems of the gallbladder and the ductal system draining the liver. Stones within the gallbladder and the ductal system, infections of the biliary system, cancers of the gallbladder and biliary system are all problems addressed by general surgeons. Surgeries performed for these conditions most commonly include a laparoscopic cholecystectomy, but can also include many other surgeries.
Esophageal and stomach related
Problems with swallowing, GERD, and problems that arise within the stomach. Difficulty swallowing, severe heartburn, or tumors within the stomach are issues that general surgeons deal with. Surgeries include laparoscopic Nissen fundoplication, heller myotomy, and gastrectomy, EGD.
Problems that arise from the small intestines. Dysmotility of the intestines due to adhesions or tumors can be issues general surgeons deal with.
Problems of the large intestines, rectum, and anus such as tumors, diverticulosis, and hemorrhoids. Surgeries include colectomy to remove cancer/ diverticulosis, creation of ostomies, colonoscopies, and hemorrhoidectomy.
Hernias of the abdominal wall such as inguinal, femoral, incisional, and ventral hernias. Other more rare types of hernias include lumbar or spigelian hernias. Management of these typically includes surgery and can involve laparoscopic and open approaches.
Skin and soft tissue related
Encompasses soft tissue and skin related excisions including lipomas, cysts, and skin cancers. Basal cell, squamous, and melanoma skin cancers are all addressed by general surgeons.
Each year numerous routine and advanced level laparoscopic procedures are performed. The key benefits of laparoscopic surgery include decreased post-operative pain, shorter hospital stays and smaller incisions. Routine laparoscopic procedures include cholecystectomy (gallbladder removal), appendectomy, and hernia repair. In addition, Nissens (anti-reflux), adrenalectomies, splenectomies, pylorromyotomies, and colectomies can also be performed.
The WHASC Wound-Ostomy Clinic, housed within General Surgery, provides care for patients with selected disorders of the gastrointestinal, genitourinary, and integumentary systems. The WOC nurse provides direct care to people with abdominal stomas, wounds, fistulas, drains, pressure ulcers, continence disorders and participates in assessment, planning, implementation, teaching, and evaluation of patients with wound, ostomy and continence care needs.
Location: The Immunizations clinic is located at Wilford Hall Ambulatory Surgical Center, 3rd Floor, Wing D
PPD (TB) Placement: Monday - Wednesday & Friday with required paperwork
Smallpox: The smallpox clinic location is located at Wilford Hall Ambulatory Surgical Center, 3rd Floor, Wing D, Rm 3H001
Phone: (210) 292-6843 or (210) 292-5730
The Immunizations Clinic serves patients of all ages. Our staff of highly-skilled clinicians and technicians is trained to administer required/recommended immunizations per the Department of Defense, Centers for Disease Control and Prevention and Advisory Committee on Immunizations Practices guidelines and to maintain/track accurate records of immunizations provided. Walk-in/same day immunizations are administered during normal duty hours.
Beneficiaries should bring in all immunization documentation when visiting the Wilford Hall Immunization Clinic for the first time or if immunizations were received from an outside facility.
The Immunizations Clinic is a walk-in clinic. Please note that patients may experience increased wait times depending on patient volume.
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, C-Wing
Hours of Operation: Monday through Friday, 7:30 a.m. - 4:30 p.m.
Phone: (210) 292-5077 or (210) 292-7805
Pharmacy Refills: (210) 292-7000
To make or cancel an appointment, call the Consult & Appointment Management Office at (210) 916-9900. Visit TRICARE Online (log-in required) or send message through Secure Messaging.
Treatment Room Services (walk-in only by PCM request):
Procedure Clinic Services (walk-in only by PCM request):
Walk-in Hours: 7:30 a.m. to 4:30 p.m.
Phone: (210) 292-7361
Walk-in Appointments/Triage (seen in order of clinical priority)
Fill out short assessment form; briefly meet with technician, and then the triage provider. This service is to address immediate safety concerns. You will then be given resources specific to your mental health needs. If you present to the clinic for Triage based on a medical provider’s referral/suggestion, you will receive a safety assessment, at minimum.
Report to the San Antonio Military Medical Center, the nearest ER, or call 911, for mental health emergencies that cannot wait.
Deployment, PCS, Security & Job-Related Clearances
Mental Health Clinic Groups
All groups require a referral from a mental health provider
Clinical Health Psychology Groups
Health Habit Walk-in Classes:
The following classes require a referral from a mental health provider:
Behavioral Health Optimization Program (In Family Health) Groups
Disaster Mental Health
Phone: (210) 292-7578
Registered dieticians and dietetic technicians at the Wilford Hall Outpatient Nutrition Clinic are dedicated to serving our patients' diverse nutrition therapy needs. The clinic uses evidence-based Medical Nutrition Therapy to provide cutting-edge nutrition services to our active duty, dependent and retiree community. Classes and individual appointments are offered.
Basic Carbohydrate Class
Participants will learn what carbs are, where they come from and how many are needed every day. Label reading, portion control, and healthy restaurant dining tips are also discussed.
Participants will learn the five groups of MyPlate and how they are the building blocks for a healthy diet.
Nutrition experts have teamed up with the Cardiopulmonary Clinic for this 4-part program teaching participants about Heart Healthy living strategies to improve blood pressure, cholesterol levels and overall cardiovascular health. Participants learn proven weight loss tips, food label reading hints, and which foods can actually improve your heart health. A consult from your health care provider is required for enrollment in the program.
G.U.T.C.H.E.C.K. is a 4-week nutrition course that offers a stellar support team of registered dieticians, nurses, the psychology department and a fitness instructor. If you’re ready to ditch the fads and focus on lifestyle change, call the clinic for more information. All TRICARE beneficiaries welcome; no consult required.
This class provides an in-depth focus on warfarin (Coumadin®) including the relationship between vitamin K and warfarin (Coumadin®), sources of vitamin K and products that adversely interact with warfarin (Coumadin®). Participants will also learn tips about how to maintain a healthy, balanced diet while following the recommendations for vitamin K consumption. This class is taught in the Cardiology Clinic, please contact the Outpatient Nutrition Clinic for more information.
Individual Medical Nutrition Therapy (consult may be required)
Appointments available for
Human Performance Resource Center
American Heart Association
American Diabetes Association
National Heart Lung & Blood Institute
Location: Wilford Hall Ambulatory Surgical Center, 2nd Floor, Wing C
Phone: (210) 292-6030
Appointment Line (for initial appointments): (210) 916-9900
Ophthalmology is a branch of medicine specializing in the anatomy, function, and diseases of the eye. A team staff ophthalmologists and residents are available to provide complete vision care. Wilford Hall Ophthalmology Department accommodates patient care in general ophthalmology and six sub-specialties.
Our ophthalmologists specialize in medical and surgical care of the eyes and visual system and in the prevention of eye disease and injury. We provide a full spectrum of care including diagnosis and medical treatment of eye disorders and diseases, prescriptions for eyeglasses, surgery, and management of eye problems that are caused by systemic illnesses.
Cornea and External Disease
This subspecialty involves the diagnosis and management of diseases of the cornea, sclera, conjunctiva and eyelids, including corneal dystrophies, microbial infections, conjunctival and corneal tumors, inflammatory processes and anterior ocular manifestations of systemic diseases.
This subspecialty includes the treatment of glaucoma and other disorders that may cause optic nerve damage by increasing intraocular pressure. This area involves the medical and surgical treatment of both pediatric and adult patients.
Neuro-ophthalmologists diagnose and treat the optic nerve and visual pathways. Neuro-ophthalmology is generally practiced as a nonsurgical subspecialty but can be combined with surgery of the eye and orbit.
Ophthalmic Plastic Surgery
The practice of ophthalmic plastic surgery includes orbital surgery, lid and upper facial reconstructive procedures following trauma and tumors and cosmetic lid surgery. Oculoplastic surgeons combine ophthalmic surgery with plastic surgery and are trained in the use of radiotherapy, chemotherapy and chemosurgery to treat ocular and orbital disease.
Pediatric ophthalmic practice involves the medical and surgical management of strabismus, amblyopia, genetic and developmental abnormalities and a wide range of inflammatory, traumatic and neoplastic conditions occurring in the first two decades of life.
This subspecialty involves both the medical and surgical treatment of retinal and vitreoretinal disease. Diagnosis involves the use and interpretation of ultrasound, fluorescein angiography and optical coherence tomography. Treatment methods include laser therapy, intravitreal injections, cryotherapy, retinal detachment surgery and vitrectomy (removal of the vitreous).
Phone: (210) 292-2815
The Joint Force Optometry Clinic serves 218,000 patients. Our goal is to provide customers with quality, patient-centered care. Our staff consists of active duty providers; the support staff includes active duty and civilian ophthalmic technicians.
Optometry services active duty and TRICARE prime covered beneficiaries. It is a non-referral clinic.
Phone: (210) 292-7640
The Orthopedic Clinic sees patients by referral only for musculoskeletal and neuromusculoskeletal disorders.
What to Bring to an Orthopedic Clinic or Podiatry Appointment
Please arrive 15 minutes early; keep in mind if you need x-rays while at the clinic, or if your physician does not have your outpatient record, you may incur extra waiting time. Bring these items with you, if possible.
The Orthopedic Clinic is committed to educating patients on their orthopaedic conditions. We have a number of educational resources available, including printed materials. Our library contains overviews on carpal tunnel syndrome, arthritic hips, hip and knee replacement surgeries, shoulder arthroscopy, overcoming back pain, and lumbar disc surgery. We also offer comprehensive pre-operative classes on total joint replacements to ready patients and their families for surgery. If you have been seen in our clinic and would like more information on your orthopaedic condition, call (210) 292-2893.
Orthopedic Sub-Specialty Clinics
The Orthopedic Clinic sees patients only by referral for musculoskeletal and neuromusculoskeletal disorders. The below subspecialties are located in Wilford Hall.
Patient Education Resources
The American Academy of Orthopaedic Surgeons
The National Association of Orthopaedic Nurses
Provide global patient centered care through diagnostic and therapeutic services, education, training, and research.
Sustained superior services with seamless integration.
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, Wing B
Hours of Operation: 6:30 a.m. to 4:30 p.m.
Phone: (210) 292-2373
Specimen Collection Laboratory
Phone: (210) 292-7700
JBSA-Lackland Blood Donor Center
Location: Joint Base San Antonio-Lackland, Bldg. 3425
Hours of Operation: 8 a.m. to 2 p.m.
Phone: (210) 292-8100
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, D-Wing
Appointment Line: (210) 916-9900
Pediatric Patient Advocate: (210) 292-7520
Fax: (210) 292-2161
Hours of Operation: Monday through Friday, 7:30 a.m. - 4:30 p.m.; closed every Federal Holiday, AETC Family Day, and every last Wednesday of the month at 12 p.m. for training
The Pediatric Clinic provides services by appointment only to TRICARE Prime 59th MDW Pediatrics Clinic enrolled patients, newborn to 23 years.
Walk-in services (we do not have a walk-in clinic for acutely ill patients):
Hours of Operation: Monday through Friday, 8 - 11 a.m. and 1 - 3 p.m.
Patients will not be seen by a physician or nurse practitioner for the services listed above. All walk-ins are conducted by a medical technician or a registered nurse.
Communicating with Pediatric Providers: The best way to communicate with your PCM team is via
TOL Secure Messaging, or telehealth consults. TOL Secure Messaging has proven to be the most expedient way of communicating with your provider’s nurse; however, telephone consults can be left with your provider team by calling:
A Team: (210) 292-1520, option 1 or 2
B Team: (210) 292-1520, option 3 or 4
G Team: (210) 292-1520, option 5 or 6
The team nurse will return your call within the business for urgent concerns. For non-urgent concerns the team nurse will call back with-in three business days. Please follow the steps below and enroll in TOL Secure Messaging:
(1) Go to
https://app.tolsecuremessaging.com/welcome.aspx link and register yourself as a patient;
(2) Logon to email and respond to message from Relay Health, adding PCM;
(3) Finally, the parent will add each child/children under the parent’s account.
Request for school forms/paperwork for signature: Any forms or notes needing a physician's signature or review should be messaged to your Pediatric team nurse via TOL Secure Messaging, or can be dropped off with the administrative staff at the clinic front desk. You will be contacted when your paperwork is ready for pick-up in five business days.
Well baby/child visit schedule: Well baby exams and school physicals should be scheduled 1-3 weeks in advance.
Pediatric Sub-specialty Clinics
Location: Wilford Hall Ambulatory Surgical Center, Pediatric Clinic
Phone: (210) 292-6779
Pediatric clinic offers a variety of sub-specialty clinics to include Developmental Pediatrics, Adolescent Clinic, and Pediatric Licensed clinical social worker.
To receive care, a referral must be placed by PCM.
Adolescent Clinic: (210) 292-1520, option 7
Developmental Clinic: (210) 292-1520, option 8
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, Wing B
For information about the pharamcy click here.
Pulmonary & COPD Wellness Clinic Location: Wilford Hall Ambulatory Surgical Center, 2nd Floor, Wing A
Phone: (210) 292-7627
Sleep Clinic and Laboratory Location: Wilford Hall Ambulatory Surgical Center, 2nd Floor, Wing A
Phone: (210) 292-7621
Sleep Clinic Hours of Operation: 7:30 a.m. to 4:30 p.m.
Sleep Laboratory Hours of Operation: 8 p.m. to 6 a.m.
The Pulmonary clinic is committed to evaluation, diagnosis and treatment of multiple respiratory disease processes in adults including, but not limited to, chronic obstructive pulmonary disease, asthma, lung cancer, cystic fibrosis, pulmonary hypertension, and interstitial lung diseases due to a variety of disease processes i.e. sarcoidosis, rheumatoid arthritis, medication effects, etc. We also perform evaluations for a variety of symptoms and abnormal radiographic findings such as shortness of breath, dyspnea on exertion, chronic cough, coughing up blood, pulmonary nodules, pulmonary masses, etc.
We offer state-of-the-art diagnostic techniques to evaluate the etiology of respiratory issues such as pulmonary function testing, laryngoscopy, fiberoptic bronchoscopy, endobronchial ultrasound, electromagnetic guided bronchoscopy, thoracentesis, thoracic ultrasound, supplemental oxygen determinations, high altitude simulation testing, methacholine challenge testing, exercise induced asthma testing and cardiopulmonary exercise testing.
Chronic Obstructive Pulmonary Disease (COPD) Rehabilitation Clinic
In addition to our Pulmonary Clinic, we also have an in-house Chronic Obstructive Pulmonary Disease Rehabilitation Clinic where patients with respiratory disease can undergo a 6-week rehabilitation/exercise program that aims to increase the patient's knowledge of their respiratory disease process and the benefits of lower and upper body exercise as well as proper breathing techniques in hopes of increasing their exercise endurance and quality of life.
Sleep Disorders Center
The Sleep Disorders Center at Wilford Hall is a 10-bed Sleep Disorders Center accredited by the American Association of Sleep Medicine. The SDC is committed to providing care for patients with a variety of sleep disorders including sleep disordered breathing (obstructive and/or central sleep apnea), narcolepsy, idiopathic hypersomnolence, circadian rhythm disorders, restless leg syndrome, REM behavior disorder, etc.
Our services are offered to children as young as six years of age to the adult in their 70s or 80s. The SDC offers a full spectrum of diagnostic and therapeutic services including diagnostic polysomnogram, positive airway pressure titrations, multiple sleep latency testing, and maintenance of wakefulness testing. Our clinic is staffed by physicians who are board certified in Sleep Medicine either by the American Board of Sleep Medicine or the American Board of Internal Medicine.
Appointments: Consults are reviewed and prioritized daily by our Pulmonary/Sleep staff in the following manner:
Appointments can also be made by calling the CAMO appointment line at (210) 916-9000.
The mission of the 59th Radiology Squadron: To provide high quality, patient-centered imaging services while maintaining world-wide deployment capability and educating the next generation of Air Force radiology professionals.
Our vision: To be the imaging services provider of choice for our patients and referring providers, and to develop highly effective Warrior Medics.
Our goals: To sustain an environment where the Air Force core values guide our Airmen as they accomplish the mission of the Squadron, Group and Wing.
Computed Tomography (CT)
Hours of Operation: 7 a.m. to 5 p.m.
Phone: (210) 292-5200
Appointment Line: (210) 925-XRAY or (210) 925-9729
Computed Technology (CT) offers a wide range of routine and emergency services including 3D CT, advanced cardiovascular, and angiographic imaging.
Diagnostic Imaging (X-Ray)
Hours of Operation: 24/7
Phone: (210) 292-5210
Diagnostic Imaging offers a full range of routine X-ray imaging services and limited special procedures. Once your provider determines that you need an X-ray or special procedure, report to the Diagnostic Imaging (Radiology) reception desk located on the 1st floor. Routine radiographs such as chest, sinus, spine, abdomen, extremity, etc., are accomplished on a walk-in basis. Those requiring special procedures are typically scheduled due to pre-preparation requirements of the patient.
Magnetic Resonance Imaging (MRI)
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, Wing B
Magnetic Resonance Imaging offers routine and advanced MRI imaging. To schedule an MRI, call one of the numbers listed above, or report to radiology central scheduling office.
NOTE: WHASC does not have an open magnet for those patients suffering from claustrophobia. If you feel you are claustrophobic, please alert your provider for further consult.
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, Wing D (next to Women's Health Clinic)
Phone: (210) 292-5561
Appointment Line: (210) 925-XRAY or (210) 925-9729
Our goal is to provide clinical breast imaging support for all eligible beneficiaries by offering comprehensive breast care. Our multidisciplinary team of radiologists and technologists use modern technology, including digital mammography, to make early cancer detection more accurate than ever before. We are dedicated entirely to breast imaging services.
This Breast Screening and Diagnostic Center is fully accredited by the American College of Radiology and Mammography Quality of Standards Act. All staff mammographers and radiologists are certified in mammography and meet requirements of the Food & Drug Administration, ACR, and MQSA.
Ultrasound offers a wide range of sonographic services including: Abdominal, OB/GYN, small parts and vascular imaging. Some studies may be accomplished on a walk-in basis time permitting; however, most studies are scheduled due to pre-preparation requirements of the patient.
Phone: (210) 292-2010
Since opening in January 2001, the Refractive Surgery Clinic has performed over 30,000 treatments. Our staff performs FDA-approved PRK, LASEK, and LASIK treatments; including custom wave-front guided treatments. Refractive surgery is only available to active-duty military members.
For application and commander’s authorization forms, as well as checklists and policy information, visit the U.S. Air Force Refractive Surgery Program Website.
Outpatient Physical Therapy
Hours of Operation: 7:15 a.m. to 4:30 p.m. (closes at 1 p.m. the first Thursday of each month)
Phone: (210) 292-5040
Outpatient physical therapy is a rehabilitation setting in which we use therapeutic procedures to help patients regain normal physical mobility and activities of daily living. The PT clinic uses individualized programs based on an initial evaluation to promote the ability to move, reduce pain, restore function, prevent disability or achieve other specific goals. Our clinic utilizes a variety of techniques to include therapeutic exercise, manual therapy, modalities and pool therapy to achieve those goals.
The Occupational Therapy Clinic offers a wide range of therapeutic and rehabilitation services for upper extremity pathologies and physical dysfunction. Based on a referral from a patient's provider, OT uses state-of-the-art tools, equipment and hands-on expertise to deliver top-notch care to beneficiaries. OT utilizes leading edge technology and treatment modalities to treat a myriad of upper extremity cumulative and acute trauma. The goal of OT is to return a patient to the maximal functional level of performance of activities of daily living prior to onset of injury or illness. Our clinic has the resources needed to fabricate custom hand, wrist and elbow splints as well as providing patient education on work task modification, energy conservation, work simplification, prevention and rehabilitation to promote an overall healthier lifestyle.
Hours of Operation: 7:30 a.m. – 4:30 p.m. Monday – Thursday, 7:30 a.m. to 1 p.m., Friday
Phone: (210) 292-5381
The Orthotic Laboratory also known as the brace shop is located in the basement of Wilford Hall, near the clinic entrance just around the corner from the Orthopedic Clinic. We provide orthotic services for pediatric, adolescent, adult, and geriatric patients. Braces such as wrist, neck, back, knee, ankle braces and arch supports are available. We accept prescriptions from both military and civilian providers. Patients are required to bring their prescription and their military ID card to obtain treatment. Care is provided on a walk-in basis with minimal wait times. Some specialty items such as custom-made arch supports require a prescription from either a podiatrist or orthopedic surgeon.
Phone: (210) 292-7531
Urology is a diverse specialty that encompasses the medical and surgical treatment of many diseases affecting the genitourinary systems. The spectrum of pathologies covered and treatments offered is immense considering the small volume of the body that we serve.
The Urology Outpatient clinic provides diagnostic services to adult patients with genitourinary disorders. Minor procedures such as cystoscopy, vasectomy, prostate biopsy are available. Pediatric and Surgical Urology services are provided at our sister clinic, located at the San Antonio Military Medical Center on Joint Base San Antonio-Fort Sam Houston.
Pregnancy & Warfarin
Warfarin is a safe drug when administered and monitored properly. Indeed, oral anticoagulation is a vital treatment for certain conditions, such as those listed on the Indications page of his symposium. However, one of the drawbacks for Warfarin is the potential for birth defects and/or hemorrhage in the offspring of mothers taking the drug.
There is apparently a link between some birth defects and Warfarin taken by the mother during early pregnancy. The actual degree (or percentage) of risk to the unborn child is not known. In most circumstances, Warfarin should be avoided in women of childbearing age unless there is no other option. If possible, another anticoagulant regimen should be used.
However, there are situations in women of child-bearing age where Warfarin is still the mainstay of therapy, such as recurrent pulmonary emboli. If a young woman needs to start Warfarin during the child-bearing years, it is very important to educate the patient on the potential harm to the unborn child and establish an effective birth control plan.
Before starting therapy, female patients should be asked about their intent to bear children in the future, their birth control methods at present, and their religious beliefs. For the woman who is not planning or desiring further children, sterilization by tubal ligation or hysterectomy would be the most reliable preventative step.
In younger women anticipating a new or enlarging family, Warfarin should not be prescribed if any other possible choice can be used. For some patients, this might mean daily shots with heparin, another anticoagulant medication which cannot be given by mouth.
If Warfarin is still required for clinical reasons, then birth control intervention must be prescribed as well. A longer acting form of birth control should be used (consult your GYN provider), since daily birth control pills could be accidentally or purposefully discontinued, risking an unwanted or unexpected pregnancy while taking Warfarin.
Educational services like Planned Parenthood can assist in selecting birth control methods that are acceptable to the patient and their lifestyle and/or values. Prevention is far better than dealing with the consequences after a pregnancy has occurred.
Occasionally a woman is diagnosed with heart or vascular problems during pregnancy. The most common form of heart problem discovered during pregnancy is mitral stenosis (from prior rheumatic fever). Some of these mothers will not survive delivery if the heart disease is left untreated. Intervention may require heart valve surgery even during the later half of the pregnancy.
Fortunately, the fetus tolerates heart surgery remarkably well and spontaneous loss of the pregnancy is rare. If possible, a tissue heart valve design should be used in this setting. Nearly all of these valves can be used without the need for Warfarin. However, if anticoagulation is required during pregnancy for any reason, it is best to administer heparin instead of Warfarin. Heparin cannot be given by mouth, and must be administered by shots under the skin three times per day, or by continuous intravenous infusion. Some pregnant mothers with heart problems or clotting problems will be placed on heparin shots for many months before the birth of their child. Fortunately, there is no known association between heparin and birth defects.
Dietary Considerations in Warfarin Patients
Warfarin acts by impairing the utilization of Vitamin K. The liver requires Vitamin K for the manufacturing of certain key proteins in the native clotting mechanism. When Vitamin K is not made available, these clotting factors are not manufactured, and blood clotting is impaired. At the same time, oral intake of Vitamin K will thus counteract the medicinal purpose of Warfarin, essentially acting as the antidote for Warfarin.
Sudden intake of large amounts of Vitamin K can diminish the effect of Warfarin, permitting the blood to clot. Some physicians place Warfarin patients on strict Low-Vitamin-K diets. Foods that are high in Vitamin K are discouraged. However, dietary restrictions rarely succeed over a long period of time.
Most patients return to eating their favorite foods, gradually at first. Thus the more prudent approach for Warfarin maintenance is to adjust the medication, not the diet. That is one of the very reasons for repeating the Pro-Time until a steady dose is found that provides the right anticoagulation regardless of the dietary intake of the patient. For your information, the following lists presents foods known to be high in Vitamin K.
If your regular diet already contains these food items, Don't Change Your Eating Habits. Consistency in your daily eating pattern is the key. If you move to a new climate, or change your eating habits for any other reason, a new series of Pro-Times will be needed to make certain that your Warfarin requirement has not changed. However, even if it has changed, the best option is to change the dose which you take.
The information provided in this educational forum is solely for your information, and is not intended to replace actual recommendations or advice given by your treating physician.
Your Diet & Vitamin K
Warfarin works to keep your blood from clotting by decreasing the availability of Vitamin K. Vitamin K helps your blood to clot. These are opposing actions. Excessive Vitamin K intake can interfere with the Warfarin and allow your blood to remain susceptible to clots. Likewise, if you eat too little Vitamin K, the excess medication may cause your blood to become too thin. Your medication will be adjusted to the amount of Vitamin K typically in your diet. If you suddenly increase or decrease the amount of Vitamin K in your diet, your medication will not work properly.
A healthy, low fat diet following the Food Guide Pyramid is the best diet to follow. It is important for you to keep the Vitamin K content of your diet consistent. The amount of Vitamin K you eat affects the amount of Warfarin you require. Be sure to tell your healthcare provider if you change your diet. The medication will need to be adjusted to the amount of Vitamin K in your diet.
Some foods that are high in Vitamin K (i.e., leafy, green vegetables, broccoli, and cauliflower) can contribute to a healthy diet. Your efforts should be focused on keeping your intake of Vitamin K consistent from day to day. The first step is to evaluate your typical intake of Vitamin K foods by reviewing the food list in this packet.
Although there is little information about the effects of cooking, freezing, or drying on the Vitamin K content of foods, it appears that the Vitamin K content of cooked, frozen, or dried foods is about the same as fresh foods.
Evaluate your typical Vitamin K intake by reviewing the food list provided. The list contains foods that are known to be high in Vitamin K, as well as a few others that are not very high, but are often asked about by Warfarin patients. If you do not see a particular food on the list, it most likely contains very little Vitamin K, however, be sure to ask you dietitian about the food if you are concerned.
First, review the list to find foods that you are presently eating. Each list is identical. The first organizes foods from the highest Vitamin K content to lowest, while the second is in alphabetical order. Observe the amount of Vitamin K contained in the foods you eat. If you typically eat a larger portion than what is listed, be sure to increase the Vitamin K value proportionally. (i.e., there is 40ug of Vitamin K in ½ cup of lettuce, but you eat 2 cups worth in your salad, so you would actually have 160ug of Vitamin K in total). Add up the total amount of vitamin K that you typically consume in a day. Whatever it may be, 100, 200, 300, 400ug, etc., your job is to keep this daily intake as consistent as possible. By selecting combinations of foods, and/or adjusting portion sizes you should be able to consume about the same amount of Vitamin K each day.
If you should ever decide to dramatically change your typical daily intake of Vitamin K, be sure to inform your Doctor or pharmacist BEFORE making the change. They will most likely need to adjust your Warfarin dosage.
CAUTION - The following should be taken only with your physician's approval, because they also thin your blood, thus increasing the effect of your medication: alcohol, garlic pills, fish oil capsules, Vitamin E. Vitamin K tablets can also interfere with your Warfarin medication. Be sure to get your physician's approval, if you take Vitamin K tablets or a multi-vitamin pill with Vitamin K included. If you should have any additional questions or concerns regarding your daily intake of Vitamin K, please contact a dietitian at phone number (210) 292-7587 or 7472.
Highest to Lowest Vitamin K Content (Listed by food item, portion size and Vitamin K content)
Vitamin K Content by Food Item (Listed by food item, portion size and Vitamin K content)
** Current analytical findings indicate that the brew from green tea leaves has negligible Vitamin K content.
Conditions Treated with Warfarin
Medical Conditions Commonly Treated with Warfarin Anticoagulation
Blood is meant to flow continuously, bringing vital nutrients and oxygen to every cell of the body. Blood should clot only when there is some injury to the blood vessel wall. This is a natural mechanism which prevents potentially fatal bleeding. If blood did not clot when a blood vessel was injured, even minor injuries could cause a person to lose a large amount of blood. Thus nature's defense is the natural clotting action of the blood. As anyone can observe from their own injuries, blood will clot within minutes if the proper conditions are present. In some disease states, clotting occurs when it shouldn't.
Blood clots which form in an abnormal time or location can be dangerous. These clots can break loose from their attachment and migrate into other body organs, causing damage. Large clots can obstruct blood flow.
To treat patients with clotting disorders, anti-clotting (or more appropriately "anticoagulant") medications are prescribed. Many of the indications for prescribing Warfarin are common health problems. A discussion of the most common reasons for prescribing Warfarin is presented below. However, not every patient with the medical conditions listed below will need (or can tolerate) Warfarin. If you have questions about your Warfarin prescription, or the reasons for administering the medication, consult your physician directly.
Conditions Commonly Treated with Warfarin Anticoagulation
Warfarin Interactions with Other Drugs
Drugs Which Interfere with Coumadin® Regulation Increased Warfarin Effect
Decreased Warfarin Effect Highly Probable
No Warfarin Effect Highly Probable
Mechanisms of Warfarin Actions
Warfarin is an anticoagulant drug. It is only available by prescription, and should only be taken under the supervision of a physician familiar with its indications and actions. Warfarin is based on a chemical known as warfarin sodium. Warfarin causes its anti-clotting effect by impairing the production of certain blood clotting proteins by the liver.
Administration of warfarin sodium blocks the action of Vitamin K within the liver. The drug effectively competes for the same absorption sites within the liver needed for Vitamin K uptake. Thus, the levels of Vitamin K within the liver decrease. Reduced amounts of clotting factors VII, IX, X, and II are produced, and the clotting action of the blood is progressively impaired. All of the actions of Warfarin are due to the drug's inhibition of Vitamin K. Thus, ingestion or administration of Vitamin K can reverse the effects of Warfarin. In fact, clinical overdosage with Warfarin is corrected with Vitamin K.
Dietary intake of Vitamin K does affect the metabolism of Warfarin. This is one of the reasons that each patient seems to require a different dose of the drug to reach the target anticoagulation effect. Each person has different dietary intake of Vitamin K, and also different liver function, different excretion of the drug, etc. Thus it is important for the physician to monitor Warfarin effect on the patients clotting mechanism. Without a monitor, patients would frequently be overdosed or underdoses, with potentially hazardous consequences.
Monitoring of the Warfarin effect is performed with a blood test. This test is known as the INR or International Normalization Ratio. It is important that you review the INR information in The Anticoagulation Clinic and become familiar with the routine used to monitor this drugs effect.
Don't Mix Other Medications with Warfarin
The chief precaution with this drug revolves around interactions with other drugs. Some medications magnify the Warfarin effect, and some act as a relative antidote. Many common over-the-counter medications or remedies interfere with Warfarin regulation. Be advised that starting or stopping any medication could potentially affect your Warfarin control.
It is important to recheck your I.N.R. whenever starting or stopping any other medication. Aspirin is the most common drug which affects Warfarin regulation. Alcohol, antacids, antihistamines, antibiotics, and many other common medications also affect Warfarin. A list of medications which are known to interfere with Warfarin is included in this web site.
Follow a Schedule
Take your pill at the same time every day. It is easier to adjust your dose if you take your medicine in the evening. Although Warfarin can be taken any time in the day, it is prudent to take your dose at the same time each evening. If the doctor calls to adjust your dose, it is not much help if you have already taken your pills for the day. Thus the evening dosage schedule allows for easier adjustment. Many patients use a metered pillbox (one slot for each day of the week) and place it next to their toothbrush, for a convenient reminder.
Check Your Pills
It is possible for Warfarin pills to become mixed up. Even pharmacists have occasionally made errors, giving out the wrong tablet strength. Some patients who have had more than one strength of tablet in the household have mixed them up, with a resulting change in therapeutic dose. Keep close track of the color and insignia (indicating milligram strength) on each tablet, and at the time each prescription is filled.
If you are planning to travel outside of the country, refill your prescription. Make sure you have enough tablets for the entire trip, plus extras. Obtain your Pro-Time / I.N.R. before leaving to make sure that your dosage is proper. If you will be out of the area for an extended period of time, ensure that you obtain a "Travel Memorandum" from your provider. A Travel Memorandum allows you to travel and have your blood tested at other facilities that will fax the results back to your physician for them to properly dose and call you with any changes.
Let your family know you are taking anticoagulants. Make sure all your treating physicians know, especially new consultants who you have never seen before. Wear a Medic-Alert band or I.D. bracelet which informs others that you are taking Warfarin. Make sure your dentist is aware as well.
First, let your dentist know that you are taking Warfarin. Have regular check-ups to prevent and treat gum disease that might predispose you to bleeding during brushing or flossing.
Avoid traumatic sports, if possible. Wear protective gear for activities like bicycle or horseback riding. Use a soft toothbrush to prevent gum injury. Use an electric razor rather than a straight or blade razor. Wear gloves while gardening.
Dosing of Warfarin is individualized to each patient. There are different ranges of target values in different situations. It is important to know what target range your physician is using to treat your condition. Continue to have your blood draws as directed by your physician and / or nurse. After each blood draw, keep in touch with your physician's clinic to find out the results and what new dosage may be needed.
Warfarin is contraindicated in pregnancy. If pregnancy is a consideration, please consult your physician as soon as possible, preferably before conception.
What to Look For
The following symptoms could be a sign of excessive Warfarin dosage. If any of these symptoms occur, consult your clinic or physician.
Warfarin (Coumadin®) Tablets - Color & Numerical Value (i.e., Label)
Each tablet is imprinted with a bold-faced numeral, indicating the milligrams of warfarin base in each tablet. There is a dividing line (or "score") across the middle of the front face of each pill. This permits the patient to easily cut the pill into two equal halves with a dull kitchen knife. Notice the similar colors between the 1 (one) milligram (pink) and the 5 (five) milligram (orange) tablet.
You cannot identify the different pills by color alone. Whenever you receive your prescription from the pharmacist, look at the identifying marks on the tablets and confirm the actual dosage with what your doctor prescribed. If the pills do not match, don't ingest any of them. Return them to the pharmacy right away and fill the proper dosage. Ingestion of pills that are too strong can result in serious, potentially harmful, bleeding complications.
Most patients are advised to take their Warfarin pills in the evening time. The action of Warfarin does not depend on the time of day. However, evening dosing of this drug makes it easier to adjust the amount after obtaining the results of the morning blood test. If the Pro-Time or INR indicate that an adjustment is needed, it is best if you have not already taken the dose for that day. For example, if you have your Pro-Time drawn in the morning, but also take your pill in the morning, your doctor would have more difficulty reducing your dosage if you have already taken the medication.
So, evening dosing is preferred in order to make dosing changes quicker and easier. Most patients purchase a 7-day (Monday through Sunday) pillbox. Each Monday, all seven days’ worth of Warfarin is placed into the slots. The pillbox should stay in the bathroom near your toothbrush. The easier way to take Warfarin is at the same time that you brush your teeth at night.
If you have small children in the household, the pillbox must be secured against accidental ingestion by a child. Should this occur, contact the nearest emergency room or poison control center right away. If recognized quickly, the effect of Warfarin can be reversed by administration of Vitamin K. Treatment for Warfarin ingestion would require hospitalization.
Using Warfarin Safely
It is important that you maintain the dosage prescribed for your Warfarin therapy. When you take your Warfarin, check to make sure you are taking the right tablets in terms of:
You must take your Warfarin tablets on an unchanging schedule. You should take them:
If you forget to take a tablet, let your physician know. DO NOT take another tablet to "catch up." Your prescription for Warfarin should be refilled only as directed by your physician. Other medications may affect the action of Warfarin.
You may wish to carry a card that identifies you as a patient on Warfarin.
Women: Warfarin should not be taken while you are PREGNANT. Inform your physician immediately if you are pregnant or if you are planning to become pregnant.
Because may factors can affect the action of Warfarin, it is important that you maintain a consistent lifestyle in terms of:
Avoid excessive use of alcohol. If you wish to change the amount of alcohol you normally drink, tell your physician.
Please check with your physician before starting on any extended trip as this may influence your medication availability, scheduled Protime/I.N.R. test, and eating habits.
Because Warfarin therapy affects the clotting factors in our blood, it is important that you call your physician if any of the following occurs:
An Important Reminder
Please report all Protime/I.N.R. tests at scheduled times. This blood test is important. We will use this test to monitor the therapeutic effect of Warfarin in your blood and make adjustments to your dosage as needed.
If you have any questions about your Warfarin therapy, please ask your physician or clinic personnel.
Location: Wilford Hall Ambulatory Surgical Center, 1st Floor, Wing D
Hours of Operation: 7:30 a.m. to 4:30 p.m., Monday through Friday (closes at noon Thursdays)
Phone: (210) 292-6104 or (210) 292-8966
OBGYN Triage Nurse/Follow-up Appointments: (210) 916-2168
Routine Appointments: (210) 916-9900
The Women's Health Clinic is a self-referral clinic that provides routine obstetrical and gynecological care to active duty military, retirees and their dependents. The clinic ensures optimal care for patients with obstetrical, gynecological, and women's health care issues/illness from adolescence throughout the reproductive years and beyond.
An OB/GYN physician, women’s health nurse practitioners and a certified nurse midwife provides routine obstetrical and gynecological care including annual well women exams, contraceptive counseling, and evaluation and treatment of minor gynecologic problems.