carolinemc
Well-known member
Hate to tell you talk to your sister again, for many mechanical valvers cannot take Eliquis.
Question regarding life on anti-coagulants
- Thread starter SatoriFound
- Start date
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Pellicle: You mentioned "small occasional issues which I believe are TIA's"
What kind of 'small occasional issues' are you referring to?
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As far as bleeding when on Warfarin, we should remember that INR is an approximate comparison between clotting time on warfarin and clotting time without warfarin.
If your INR is 2.5, this means that a cut will take 2.5 times as long (NOT longer) as it would if you weren't taking warfarin. So - if you get a small cut, or a barely significant nick (razor nick?) that would clot normally in 10 seconds, the blood will take 25 seconds to clot. You won't bleed to death
Plus, if you apply pressure to the cut - maybe even putting a bandage or kleenex (or even toilet paper) on the cut and apply a little pressure, you may stop the bleed faster than someone NOT on an anticoagulant who ignores the nick.
I've occasionally found that I was bleeding - not from pain, but because of the stickiness near the 'cut' body part (blood feels sticky when it clots). Maybe I've become less sensitive to little nicks and cuts through the years, or my pain threshold has changed, or I'm just not paying attention to the 'small' things. Warfarin doesn't seem to be much of a problem for me.
What kind of 'small occasional issues' are you referring to?
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As far as bleeding when on Warfarin, we should remember that INR is an approximate comparison between clotting time on warfarin and clotting time without warfarin.
If your INR is 2.5, this means that a cut will take 2.5 times as long (NOT longer) as it would if you weren't taking warfarin. So - if you get a small cut, or a barely significant nick (razor nick?) that would clot normally in 10 seconds, the blood will take 25 seconds to clot. You won't bleed to death
Plus, if you apply pressure to the cut - maybe even putting a bandage or kleenex (or even toilet paper) on the cut and apply a little pressure, you may stop the bleed faster than someone NOT on an anticoagulant who ignores the nick.
I've occasionally found that I was bleeding - not from pain, but because of the stickiness near the 'cut' body part (blood feels sticky when it clots). Maybe I've become less sensitive to little nicks and cuts through the years, or my pain threshold has changed, or I'm just not paying attention to the 'small' things. Warfarin doesn't seem to be much of a problem for me.
Lisa from LJ
Well-known member
When I had surgery in 1998, one of the rules they sent me home with was to use an electric razor to shave. I got one, but within a few months, it ended up in the bottom of the bathroom drawer, never to be seen again until we moved 13 years later. Any woman will tell you they just don't work that well, or at least they didn't back then. You're not going to bleed to death from a nick or even if you cut your finger off as long as you treat it quickly. In my (non-personal) experience, internal bleeding is what you need to worry about because you may not know about it until it's gone on a long time.
Over the years, there's been so much misinformation about anticoagulants. There was The Coumadin Cookbook, which avoided foods that contained Vitamin K. There were myths about not shaving with a blade because, presumably, a nick would cause you to bleed to death.
Even here, there was discussion about the safest razor to use when shaving. Again, the myth of bleeding from a nick (or a deep nick). I NEVER had good results from electric razors. If I use a new one, I still don't expect a close shave.
One of the users in that old forum suggested Harry's blades. They're okay. I've been using them for years. I grow a beard more quickly now, I think, than I used to - after a day or two, I should shave again. The best deal I found on Harry's blades is at Costco, about $1.50 a blade, plus a good handle.
I'm looking at Amazon Basics, for about $1 a blade.
But I don't expect that EITHER blade will cut me enough that I'll bleed to death.
I occasionally hear (or read) the thing about taking 'Rat Poison.' They don't use it anymore - the warfarin stays in the food chain and, FWIW, I read somewhere that there are some rats that developed a resistance to coumadin.
But these fears continue.
On-X decided to market their valve because the users of the new valve didn't need as high an INR (yeah, like there's a difference between aiming at 1.5 or so, and a safer 2-3), but the surgeons somehow swallowed that argument. (Again - warfarin fears)
I don't know what it will take to work around these ridiculous, incorrect, assumptions.
But, back to the last comment - using a blade wouldn't kill you unless, of course, you're shaving while walking across the freeway.
Even here, there was discussion about the safest razor to use when shaving. Again, the myth of bleeding from a nick (or a deep nick). I NEVER had good results from electric razors. If I use a new one, I still don't expect a close shave.
One of the users in that old forum suggested Harry's blades. They're okay. I've been using them for years. I grow a beard more quickly now, I think, than I used to - after a day or two, I should shave again. The best deal I found on Harry's blades is at Costco, about $1.50 a blade, plus a good handle.
I'm looking at Amazon Basics, for about $1 a blade.
But I don't expect that EITHER blade will cut me enough that I'll bleed to death.
I occasionally hear (or read) the thing about taking 'Rat Poison.' They don't use it anymore - the warfarin stays in the food chain and, FWIW, I read somewhere that there are some rats that developed a resistance to coumadin.
But these fears continue.
On-X decided to market their valve because the users of the new valve didn't need as high an INR (yeah, like there's a difference between aiming at 1.5 or so, and a safer 2-3), but the surgeons somehow swallowed that argument. (Again - warfarin fears)
I don't know what it will take to work around these ridiculous, incorrect, assumptions.
But, back to the last comment - using a blade wouldn't kill you unless, of course, you're shaving while walking across the freeway.
pellicle
Professional Dingbat, Guru and Merkintologist
small short duration "vision" related disturbances which at first felt like dizziness but I identified early on that this 'sensation' ceased when I closed my eyes. I later identified it was related to muscle control of one of my eyes. This ceased when I commenced taking aspirin. This began about 2016 IIRC then would resume occasionally if I ceased aspirin (it may take months for an episode to recur). So now I just take half a 300mg tablet every second day. I do not get them at all when I'm on the aspirin regime.
I'm aware, as is my sister.
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I remember we had somebody on the forum awhile back who was given 2 mechanical valves that she never should have had because she had some kind of bleeding disorder. In fact I think she maybe was looking at having to have them replaced with tissue. Her situation really was not good. : (
pellicle
Professional Dingbat, Guru and Merkintologist
if you mean Harriet she also had a lot of co-morbidities and her OHS was not her first rodeo. I'm just mentioning this because we have some other members here with two mechanical valves (aortic and mitral) who are doing quite ok
HarrietW
July 9, 2019 Open Heart double valve replacement aortic & mitral bovine tricuspid my own tissue tissue. Approx 160 transfusion 11 since Tuesdays. Stag 3 blockage A/F possible pacemaker if it doesn't even out by July 16 are in place.
Very sm lung capacity. Possibly reintabation.
3.5 years after open heart surgery January 2016 complete heart failure. Pulmonary hypertension 90mmg tricuspid regurg mitral regurg minimal aortic valve mechanical mild regurgitation.
Surgery & first Diagnosis
Rheumatic heart disease diagnosed April 2012 Mitral regurgitation, Aortic Stenosis with a chronic upper respiratory infection recently diagnosed with interstitial lung disease waiting biopsy results. Awaiting workup for OHS see Cardiologist End Jan 2015 .. And close to go time !
More medically tech info.
Aortic R
Sever LA Enlargement /Sever Stenosis /Left Atrium Severely Diolated
Sever MR /sever regurgitation Leaflet retracted
Pericardial Effusion -
Sever AR Sever thickening
Tricuspid R
LA/mod - sev hypertrophied
LA Sev Dilated
Harriet also had quite a few other co-morbidities such as a long prior history of substance abuse ...
I've not seen here back here in quite a while (from the About link: Last seen Jun 5, 2020)
I don't know if she's passed or still with us. I hope she still is fighting the good fight
Best Wishes
Yes, Harriet. I also hope she is doing okay somehow but she had a lot to deal with. And to your original point, I thought elevated bleeding risk was one of those things.
pellicle
Professional Dingbat, Guru and Merkintologist
yes, indeed it was. I have no idea why she was talked into ignoring that risk by a surgeon, but I recall the discussions well. I had a lot of sympathy and empathy for Harriet. Her surgeon's (quite rare) predisposition for a mechanical while ignoring her diagnosed and clear (IIRC) actual contra-indications for ACT bordered on malpractice. Still, I seem to see a disproportionate amount of that coming out of Canada; perhaps its just survivor bias (those who survived can complain, those who don't are quiet).
Best Wishes
pellicle
Professional Dingbat, Guru and Merkintologist
oh
which should have totally discounted her from ACT (and thus a Mechanical). Gosh I remember well how many times she was treated for GI bleeds and that she sought a change back to a bioprosthesis (IIRC actually got it). Sure bio has lower durability but at her age and in her condition durability should not have been the prime selector (by a long shot).
So many bad calls get reported here ... its hard to watch.
Just recently I was discussing this with a friend (who used to manufacture the tools that go down catheters for interventional cardiologists) about my area of "some knowledge" (managing ACT and its statistical risks); namely the tendency to tell people "to cease ACT a week in advance of a procedure" (sometimes no mention of starting bridging) and how that almost certainly contributes something to the (actually very small) number of thrombo events found in long term studies of mech valvers. My discussion centered around the idea that these "blanket instructions" are essentially wrong (esp in the light of the procedure seldom needing INR less than 1.4 let alone 1) as they fail to take into account each patients actual INR drop in relation to dose change and or cessation.
Anyway, sorry to go off the trail here.
Best Wishses
and just to continue about harrietW, she had this:
which should have totally discounted her from ACT (and thus a Mechanical). Gosh I remember well how many times she was treated for GI bleeds and that she sought a change back to a bioprosthesis (IIRC actually got it). Sure bio has lower durability but at her age and in her condition durability should not have been the prime selector (by a long shot).
So many bad calls get reported here ... its hard to watch.
Just recently I was discussing this with a friend (who used to manufacture the tools that go down catheters for interventional cardiologists) about my area of "some knowledge" (managing ACT and its statistical risks); namely the tendency to tell people "to cease ACT a week in advance of a procedure" (sometimes no mention of starting bridging) and how that almost certainly contributes something to the (actually very small) number of thrombo events found in long term studies of mech valvers. My discussion centered around the idea that these "blanket instructions" are essentially wrong (esp in the light of the procedure seldom needing INR less than 1.4 let alone 1) as they fail to take into account each patients actual INR drop in relation to dose change and or cessation.
Anyway, sorry to go off the trail here.
Best Wishses
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Pellicle:
Your symptoms suggest (to me, at least) that your brain was combining the images from both eyes, and failing to do so.
I wonder if you've got a problem that I've had for much of my life - my eyes sometimes diverge - giving me two images. My brain usually ignores the one on the left, or sometimes is able to merge them so I have good depth perception. If you get real close to something - maybe bringing a pen close to your face, one eye will focus on it, and the other won't.
It may also be possible that the vision in both eyes is so different that your brain only wants to recognize one eye, so you don't wind up with two wildly different images (I suspect that the vision in both eyes should be almost equal for the brain to combine images).
I don't think this is a TIA. This occasionally happens to me - and I don't think it's related to whether or not I'm taking aspirin. IIRC, being extremely tired can contribute to this happening.
Closing one eye or the other to stop this event strongly suggests that your brain had trouble dealing with both eyes at once - and that covering one eye fixed the issue. I doubt that these events were TIAs, and this is probably good news.
Your symptoms suggest (to me, at least) that your brain was combining the images from both eyes, and failing to do so.
I wonder if you've got a problem that I've had for much of my life - my eyes sometimes diverge - giving me two images. My brain usually ignores the one on the left, or sometimes is able to merge them so I have good depth perception. If you get real close to something - maybe bringing a pen close to your face, one eye will focus on it, and the other won't.
It may also be possible that the vision in both eyes is so different that your brain only wants to recognize one eye, so you don't wind up with two wildly different images (I suspect that the vision in both eyes should be almost equal for the brain to combine images).
I don't think this is a TIA. This occasionally happens to me - and I don't think it's related to whether or not I'm taking aspirin. IIRC, being extremely tired can contribute to this happening.
Closing one eye or the other to stop this event strongly suggests that your brain had trouble dealing with both eyes at once - and that covering one eye fixed the issue. I doubt that these events were TIAs, and this is probably good news.
pellicle
Professional Dingbat, Guru and Merkintologist
given that the eye could be seen pointing away from where it should be I have no doubt that my brain was having trouble combining that.
Either way the aspirin seems to coincide with no repeats of the issue (tested multiple times) and so for that I continue the aspirin
Lisa from LJ
Well-known member
This is very interesting. About 3 months after surgery, I had an episode of double vision that lasted maybe 5 minutes. It would happen again sporadically so I mentioned it to my Cardio and he said it could be TIAs and no big deal. Some years later, I was referred to a neuro-ophthalmologist, who did a brain scan and didn't see anything abnormal. The double vision episodes continued sporadically and as I started paying attention, I noticed that the true picture was on the right and the false picture was on the left and lower than the other. They decided that it wasn't TIAs because they wouldn't cause the exact same pattern every time. It wasn't really an issue except when I was walking, I'd have to stop and put my hand on something and when I was driving, I'd have to close one eye. I mentioned it to my Optometrist who said nothing indicated that it was an eye issue, but if we could "catch it" in the office, we might be able to figure it out. I decided that wasn't likely to happen and went on with life. Lo and behold, just as I was getting ready to leave on my annual visit back in June, it happened and after doing a few tests, he figured it out. My eyes focus at different levels and my left eye is having to work really hard to align with the right eye. Normally they adapt to the issue, but when I get tired or have been looking at a screen for awhile, the left eye gets lazy and double vision will occur. He said I've probably had it since birth and it's similar to what they call lazy eye. I asked why it would have been triggered by OHS, and he said it could have to do with time on the pump, but that's just a guess. I now have prisms in my glasses, as well as sunglasses, and so far, so good. Fortunately, the prisms can't be seen or I probably would have stayed with sporadic double vision!
pellicle
Professional Dingbat, Guru and Merkintologist
Interesting
I'm glad you got it sorted
I use single focal length / diopter glasses for specific tasks, +1.5 for TV +3 for reading. I've tried the various "multi diopter" lenses (at least that's what I think you're meaning because a prism in Australia is not used for that).
https://www.specsavers.com.au/glasses/lens-guide/multifocals
I would say that generally I don't use glasses but need them for detail work. Though I've tried the graduated and specifically stepped multi focal lenses I prefer not to wear them (or just stack) as needed.
I'm glad you got it sorted
I use single focal length / diopter glasses for specific tasks, +1.5 for TV +3 for reading. I've tried the various "multi diopter" lenses (at least that's what I think you're meaning because a prism in Australia is not used for that).
https://www.specsavers.com.au/glasses/lens-guide/multifocals
I would say that generally I don't use glasses but need them for detail work. Though I've tried the graduated and specifically stepped multi focal lenses I prefer not to wear them (or just stack) as needed.
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Lisa from LJ
Well-known member
Just like the rest of the developed world, Australia has prism lenses.
https://www.microprismvision.com.au/eyewear/prism-prescription-glasses/
pellicle
Professional Dingbat, Guru and Merkintologist
pellicle
Professional Dingbat, Guru and Merkintologist
@Lisa from LJ
right ... so entirely different thing to what I need glasses for (presbyopia and maybe a touch of astigmatism or maybe coma)
https://www.optometrists.org/vision-therapy/neuro-optometry/what-are-prism-lenses/
if I keep up at this rate by the time I'm 90 I might qualify as smart ( if dementia hasn't got me by then ;-)
Thanks
right ... so entirely different thing to what I need glasses for (presbyopia and maybe a touch of astigmatism or maybe coma)
https://www.optometrists.org/vision-therapy/neuro-optometry/what-are-prism-lenses/
They do not contain any focusing power, and therefore cannot correct any refractive errors. Prisms “trick” the eye into believing that an object is in a different location in order to improve eye alignment.
if I keep up at this rate by the time I'm 90 I might qualify as smart ( if dementia hasn't got me by then ;-)
Thanks
My daughter has pretty intense prisms. Last time she had a vision exam the doc kept asking, which is clearer, this or this? Ok it is clear? Ok great. Until she said “it’s in focus but there are two of them.” 
be careful what questions you ask I guess!
be careful what questions you ask I guess!Lisa from LJ
Well-known member
You mentioned a muscle problem that caused vision issues and dizziness. That's what the prism is for. I'm not certain when the current form first was used, but they've been around in some form since at least the early 1900s. There is a temporary prism lens that can be stuck on glasses called the Fresnel lens, named after the man who invented the prism lens for lighthouses in the early 1800s.
My glasses are progressive with the bottom for reading, middle for computer, and top for distance. The top is actually clear because I'm not nearsighted, but it means I don't have to take them off and on when I'm switching between writing and talking to someone across the room in meetings or reading the map and seeing where I'm going when driving.
