IR US Breast Biopsy

Eva said:

Eva said:

Following my cardiologist’s instructions ...

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Should I be scared? I’m not sure if my cardiologist might answer my call tomorrow in due time!

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Eva - Since you say you are following your cardiologist's instructions, I'm not understanding why you are waiting for a call from your cardiologist. If you need additional guidance from them, call their office, get a human on the line, and then ensure they understand this is a time critical issue. If your call is send into a menu system, sometimes pushing the "0" button, or repeatedly saying "operator" will override the menus and actually give you a connection to a human.

It is natural to be scared, but channel that energy into the things you can do to help yourself. I hope and pray this goes well!

Eva said:

I just tested my INR, and it’s 1.5.

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Eva said:

Should I be scared? I’m not sure if my cardiologist might answer my call tomorrow in due time!

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I would not be scared. By holding warfarin the idea is to drop your INR. If I am in normal range and hold warfarin for one day, I expect that I'd also be about where you are, close to INR of 1.5. But, that is why your cardiologist has you on the Lovenox. The idea is that the Lovenox is working as a bridge to protect against thromboembolism while your INR is low. And Lovenox reaches peak effectiveness within a few hours, so its protective effect in this regard is already in effect for you. Also, what he may not have explained to you is that Lovenox does not affect your INR, so it is normal for your INR to drop now that you are off warfarin, and the protective effect of the Lovenox will not show up on INR.

I would encourage you to contact your cardiogist if speaking to his office will make you feel better, but everything that you are describing seems normal to me as you are approaching your procedure.

Eva said:

Feeling a bit scared.

Following my cardiologist’s instructions:

1. I didn’t take my warfarin yesterday.
2. I injected myself with Lovenox this morning.
3. I took my second injection now.

I just tested my INR, and it’s 1.5. I’ll test again tomorrow. However, I’m worried because I shouldn’t take warfarin or Lovenox tomorrow or the day after (which is the biopsy day).

If you have experience or knowledge about these injections, I’d appreciate your opinion since I have no experience with them or how they work.

Should I be scared? I’m not sure if my cardiologist might answer my call tomorrow in due time!

Thanks in advance.

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Should you be scared? It's OK to be scared, you've been trained to keep your INR high. However, the doctors who manage your INR also manage your bridging, take heart in the fact that they have your best interests at heart. When I need to drop my INR for a procedure I feel a twinge of fear, but I've yet to have a problem. I haven't bridged, but I have read other's accounts and they went well.

tom in MO said:

Should you be scared? It's OK to be scared, you've been trained to keep your INR high. However, the doctors who manage your INR also manage your bridging, take heart in the fact that they have your best interests at heart. When I need to drop my INR for a procedure I feel a twinge of fear, but I've yet to have a problem. I haven't bridged, but I have read other's accounts and they went well.

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Thank you, Tom. I trust my cardio…he’s caring and a top notch, but never dealt with him before regarding such matter. “Que sera sera”, hoping I’ll’ stay around and inform you all how tomorrow will go!
Hope you stay and remain well.

Chuck C said:

….. And Lovenox reaches peak effectiveness within a few hours, so its protective effect in this regard is already in effect for you. Also, what he may not have explained to you is that Lovenox does not affect your INR, so it is normal for your INR to drop now that you are off warfarin, and the protective effect of the Lovenox will not show up on INR.

I would encourage you to contact your cardiogist if speaking to his office will make you feel better, but everything that you are describing seems normal to me as you are approaching your procedure.

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Than you, Chuck.
I didn’t realize that though my INR is low, I’m still protected by lovenox!
INR is still 1.5 today, hoping I’ll remain protected until after tomorrow when I’ll resume the lovenox!
May you stay well and healthy.

3mm said:

Eva - Since you say you are following your cardiologist's instructions, I'm not understanding why you are waiting for a call from your cardiologist. …?

It is natural to be scared, but channel that energy into the things you can do to help yourself. I hope and pray this goes well!

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It’s just some anxiety, I think, which I should overcome as I trust him and he’s great!
I agree and I always advocate not to waste energy unnecessarily, but I could not apply it on myself yesterday! I’m better today hoping all will go well tomorrow
Thank you, 3mm. Stay safe and well

Eva, how did the biopsy go? Keeping my fingers crossed for a negative result.

Eva said:

I didn’t realize that though my INR is low, I’m still protected by lovenox!

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I'm wondering then, what you thought it was for?

Lisa from LJ said:

Eva, how did the biopsy go? Keeping my fingers crossed for a negative result.

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Thank you, Lisa, for asking. I have both good and bad news.
I have been diagnosed with non-invasive papillary carcinoma which will be removed by lumpectomy. Yet, the definitive assessment of invasion ought to await histopathological examination of its complete excision.
I shall be meeting with a surgeon and an oncologist on August 30th, hoping I won’t need radiation nor chemotherapy!
Keep your fingers crossed. Thanks again, Lisa. Stay well yourself.

pellicle said:

I'm wondering then, what you thought it was for?

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Honestly, I didn’t know what I was thinking. Maybe I thought my INR should still be within 2.5-3.5 range!

Hi

Eva said:

Maybe I thought my INR should still be within 2.5-3.5 range!

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I'm unclear if you're being sarcastic, but in case you aren't; when you aren't on any other anticoagulants (lovenox is a heparin and heparins are anticoagulants) then you are on anticoagulation therapy. We know that heparin is a good anticoagulant, but interestingly we just don't have anything like the long term data on it as we do for warfarin (because its onerous to take and we can't handily measure the anticoagulation effect you are having).

If I was to speculate I'd say that being on heparin is more like being a haemophiliac than being on warfarin but because the duration of action of heparin is so short you are in and out of that condition sooner.

https://www.ncbi.nlm.nih.gov/books/NBK560651/

but make no mistake, heparin (of which Lovenox is one of the family) is a potent anticoagulant. There would be no need to be on warfarin if (while) you were (are) on heparin.

Cessation of warfarin and replacement with heparin is called bridging therapy, an older post of mine is here: link. From that


so basically you remain "anticoagulated" while ceasing warfarin. Then the control of the duration of "no anticoagulation therapy" (which is essential for healing) is done by withholding then re-commencing heparin and warfarin. You remain on heparin until INR (a convenient measurement for warfarin, which heparin does not effect) rises until you're "in the safe range".

HTH

Of course, @pellicle, I was not sarcastic. I, never, am!
I was simply confused, worried, and anxious after the unpleasant repeated calls from my doctor’s office … once to repeat mammogram, then to have an ultra sound, followed by the request for the need of biopsy! I could not think clear … it was a stressful time and my first experience with lovenox injections.

Eva said:

Of course, @pellicle, I was not sarcastic. I, never, am!
I was simply confused, worried, and anxious after the unpleasant repeated calls from my doctor’s office … once to repeat mammogram, then to have an ultra sound, followed by the request for the need of biopsy! I could not think clear … it was a stressful time and my first experience with lovenox injections.

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Eva said:

Thank you, Lisa, for asking. I have both good and bad news.
I have been diagnosed with non-invasive papillary carcinoma which will be removed by lumpectomy. Yet, the definitive assessment of invasion ought to await histopathological examination of its complete excision.
I shall be meeting with a surgeon and an oncologist on August 30th, hoping I won’t need radiation nor chemotherapy!
Keep your fingers crossed. Thanks again, Lisa. Stay well yourself.

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I hope everything breaks your way from here on out, Eva. Wishing you awesome doctors, as much calm as possible, and a good outcome.

Eva said:

course, @pellicle, I was not sarcastic

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In which case I hope my explanation helped you understand that there was nothing to be concerned about (and why)

Best wishes

dornole said:

I hope everything breaks your way from here on out, Eva. Wishing you awesome doctors, as much calm as possible, and a good outcome.

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This is very kind of you, @dornole. I wish you the same in return.

pellicle said:

In which case I hope my explanation helped you understand that there was nothing to be concerned about (and why)

Best wishes

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Yes it did and I hope it will help others who too have little experience with heprain/Lovenox/?

Eva said:

Thank you, Lisa, for asking. I have both good and bad news.
I have been diagnosed with non-invasive papillary carcinoma which will be removed by lumpectomy. Yet, the definitive assessment of invasion ought to await histopathological examination of its complete excision.
I shall be meeting with a surgeon and an oncologist on August 30th, hoping I won’t need radiation nor chemotherapy!
Keep your fingers crossed. Thanks again, Lisa. Stay well yourself.

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Glad for the good news, though cancer is scary even if it's a "good" cancer. Praying for clear margins and no need for radiation or chemo.

The short answer to the low INR is that Lovenox doesn't affect the INR, nor does Heparin or the newer anticoagulants. As far as I know, Warfarin is the only anticoagulant that does.