Are tiny red dots on my legs due to warfarin?????

[slipkid]

I have red dots .... PCP said it was an aging thing and nothing to be concerned with....

Yeah, but that is for chimpanzees Cooker!

Nice smile btw ;-)

 

[Paleowoman]

Thanks Pell and Slipkid for the method of posting photos without being a premium member ;-)

 

[slipkid]

The only thing I am wondering is if these are petechiae - if they are flat pinhead or pinpoint sized red or purplish spots under the skin that do not fade when you press them, they could be. They are basically broken capillaries (I don't know if an electric shock might also cause these, persistent muscle straining can). They have about a jillion different causes, but one is endocarditis so they did want to see me when I had them on my legs a few years ago.

They are also associated with Vitamin K deficiency according to the Mayo website, and I found this on Merck's website:

"Vitamin K deficiency results from extremely inadequate intake, fat malabsorption, or use of coumarin anticoagulants."

So to me, maybe they could be related to your warfarin if they ARE petechiae? Might be worth at least letting your doc know.

Showed the Dr. today. He said my dots are petechiae.

However he seemed to believe that these are NOT caused by warfarin (although from what I've read on-line they definitely can be). He had me get a blood test to check my "platelets" since he said low platelet count could cause this. Yes that is right, but I think he is confused as far as warfarin goes. No mention was made if having these spots could be a "problem" or not though.

Based on some other test results & what then subsequently happened this week, I can predict what is going to happen next - his assistant will call me in a few days & simply say "your blood test came back OK" and leave it at that like the issue is solved (when it only brings up more questions like "so then what is this due to and is there anything that needs to be investigated further or we should do or not do?"). I am so tired of this game of having to continually keep trying to make doctors followup on things though, if that is what happens then I give up on it.

 

[slipkid]

Thanks Pell and Slipkid for the method of posting photos without being a premium member ;-)

Btw, I looked into avatars too but can't see a way to do it. Was thinking maybe it was possible to do a similar way with pointing the avatar to somewhere on-line but I can't even find an option to define/create an avatar at all. Must be restricted to the el primo members (as you said).

 

[Paleowoman]

I am so tired of this game of having to continually keep trying to make doctors followup on things....

I hope you don't have this experience with your doctor again this time, it's a real pain to have to do and really you shouldn't have to push them, they should be doing their job.

 

[slipkid]

I hope you don't have this experience with your doctor again this time, it's a real pain to have to do and really you shouldn't have to push them, they should be doing their job.

In my experience of dealing with multiple doctors the past six months, this is the norm though, have had numerous things like this. I've reached the point where I do not have the strength to keep "bothering" doctors/their staff anymore to do their jobs. Basically I think the problem is combination of lack of caring, lack of resources to deal with the number of patients they have, lack of time for each patient etc.

Just getting an appointment today was a chore in itself. Had multiple things I needed to discuss (test results that needed explanations & approriate followup, the red dots on my legs, continued dizziness I am suffering, the lightning strike thing in my leg, going forward with trying to sort of the confusion on their part of how my INR is reported/handled) and, in a very long story I won't go into, was told by the receptionist when I made the appt "the doctor only has time to go over one thing per appointment so pick what the most important thing is". So I settled on "dizziness" but then attempted to go over the rest anyways.

 

[Paleowoman]

In my experience of dealing with multiple doctors the past six months, this is the norm though, have had numerous things like this….<snip>….and, in a very long story I won't go into, was told by the receptionist when I made the appt "the doctor only has time to go over one thing per appointment so pick what the most important thing is". So I settled on "dizziness" but then attempted to go over the rest anyways.

Which country do you live in ? This sounds like the kind of thing that happens often in the NHS in the UK. I have four long term conditions and am under four specialists plus my GP. It's the GP that it's tricky to get time to talk to, they are limited to ten minute consultations and, normally, don't like to discuss more than one issue. The GP I happen to see is extra good and I always get a "double appointment" - it's written on my notes for the receptionist to give me a double appointment - so I can discuss more issues, often there are three or four issues to discuss. I know this would not be allowed with some other GPs so it's only with routine appointments I can be sure of geting that GP. In an non-routine situation, ie trying to get to see a GP in under a week, I would have to see another GP and they don't like to disucss mutliple issues. I think this can lead to poor patient safety.

I would be inclined to write a letter of complaint to my GP practice if I were indeed told I could only discuss one issue by a doctor when I have several conditions which can be linked which can cuase mutliple issues (I did this once). Another option that I know some people take is to change to a different GP practice, but that is not always practical or possible.

 

[slipkid]

I am in the US Paleo.

When the receptionist asked me what I wanted to see the Dr. about I simply said "I have several things I need to talk to him about". She then pressed me to tell her EXACTLY what, and as I went down the list including needing some explanations & followup on lab results (again very long story, as she then even wanted to know exactly WHAT labs I wanted to ask about and EXACTLY what those questions were), then came the "stop right there, you can only see him about one specific thing" comment by her. At that point I did ask her "well then can you please schedule me for a block of appointments so we have enough time? I really need to talk about all this stuff", but she told me NO, only one appointment could be scheduled, and that I had to deal with things one at a time. I am still in shock over the whole thing. Never had anything like this happen before in 40+ years of seeing doctors. Yes I know the Dr's are under ridiculous insurance overloard bean counter guidelines for time but that is not my problem - and I was willing to schedule a longer block in advance if that is what it took. Sigh.

Back to the subject of this thread, Dr. called me today about an INR related thing and I also asked him if he had my blood test results back relating to the "red dot" question I started this thread on, and what he was concerned with there (platelet count) is OK so he said to not worry about the red dots. I'll just try researching them for myself I guess, to see if there is anything I should do or shouldn't do, hoping they do not get any worse etc.

 

[Paleowoman]

Hi Slipkid - not very satisfactory re your blood test results. Can you see your cardiologist for follow up and ask him about them ?

Shocking about the receptionist. She's not medically qualified to judge what you can to talk to a doctor about in a limited appointment system. You've recently had heart attack and open heart surgery !

 

[ManiSham]

hi I had similar red dots on my feet couple of months after my surgery (and after starting warfarin), but I never thought it was related to my INR levels so I didn't mention it to my cardiologist. It took several months for it to go off though, this was eight years ago!

As your doctor has mentioned sometimes when your platelet count goes down you tend to get similar spots (which I did on my hands) since I had several complications before the surgery which resulted in very low platelet levels.

 

[slipkid]

Hi Slipkid - not very satisfactory re your blood test results. Can you see your cardiologist for follow up and ask him about them ?

No, not really an option. The cardiologist is horrible as far as dealing with ANYTHING other than his emergency patients in the cath lab. He doesn't want to see me for another 6 months. He has handed off basically everything, wants me to go through the GP....

Shocking about the receptionist. She's not medically qualified to judge what you can to talk to a doctor about in a limited appointment system. You've recently had heart attack and open heart surgery !

Yeah, isn't the whole thing just mind blowing?

Forcing a sick patient, who is not qualified himself to judge what problem might be a more important than another, plus needing explanations on recent lab tests, to "just pick one thing" to discuss with the doctor that might be the most serious.

This is just one microcosmic example of the very frustrating, confusing, inside-out, bass-ackwards, lack of knowledge/advice, "health care" system which I have been exposed to in recent months. I am amazed I am even alive.

It really is par for the course, I don't even know where to begin to try to describe with all the craziness I've had to wade through the past 9 months - starting b4 I even had my heart attack, with my former GP's assistant having me perform an expulsion breathing test WRONG, leading the Dr. to diagnosis me with "asthma" & put me on horrible drugs that only made things worse, then when I figured out the test was done wrong & TOLD THEM, instead of the Dr. realizing he needed to pursue other possibilities to explain my feeling out of breath so often & the fact that the asthma medications made me feel WORSE instead of better, he just stuck with the "asthma/breathing" path & told me to start taking prednisone!! No mention of checking my heart or anything else. At that point I told him "no thanks on the prednisone" & realized I needed to see someone better but didn't know what to do....had it on my "to do" list, see a cardiologist/pulmonologist/somebody with a clue....then had a heart attack & emergency surgery b4 I got around to it though. I realize other people have similar experiences, even worse, and I am not meaning to complain, but I find it very hard to keep dealing with this kind of thing from my "health care providers" over and over and over again.

 

[dornole]

The only thing I can recommend is to figure out what the most expert practice is in your area, and switch your GP to that. In both my case and for my preemie twins (who were medically involved, and whose pediatrician was in way over his head), I found out which practice rounded at the premiere hospital in my area and had very good luck with those physicians. They had more experience with complex / low-incidence cases, they were they kind of folks that like to learn and keep up to date, and they were personally tight with specialists which eased referrals as well as them just calling somebody and getting some informal advice / guidance. I don't know if you're in a big city or how much choice you may have, but this worked for me.

I had the same experience with the asthma thing, it was the locum tenuns urgent care doc who figured out I needed an echo! My OB GYN missed it (I was pregnant and that was the only doc I was seeing at the time . . . ) NOW I see an internist from that premiere practice. I feel like he's on top of things.

 

[slipkid]

Thanks but it's really not an option for me to switch GPs at this point - not yet anyways. After my heart attack I switched to this guy on the recommendation of my cardiologist. Both of their practices are nearby each other in the same hospital as my surgeon/where I was operated on, where I was going for cardiac rehab, they are both buddies etc. Thinking more on it I have had bad experiences (that should have/could have been avoided) with every doctor I've ever seen in my life. Switching now would not only mean finding both a new GP AND a new cardiologist, but also dealing with whatever deficiencies someone new has. It's hard enough on me right now as it is. Unless something really serious happens wrong I'll stay with "the devil I know" rather than risk getting people even worse. I actually do LIKE this GP, and he seems very knowledgeable (about MOST but not all things), but man his practice is a disorganized mess (I can't remember all what I mentioned up here already but have some pretty crazy examples). At least he is a lot better than my last GP, and in a much more convenient location for me. None of these folks are perfect....I don't have a clue as to how to find that type of doc around here even if he actually existed either!

 

[Paleowoman]

I actually do LIKE this GP, and he seems very knowledgeable (about MOST but not all things), but man his practice is a disorganized mess (I can't remember all what I mentioned up here already but have some pretty crazy examples).!

It might be worth at least writing a letter to the GP reminding him of your recent heart attack and OHS and explain the problems you have had getting to see him because of the practice policy, and ask for his advice for when you have more than one issue you need to see him about.

 

[slipkid]

It might be worth at least writing a letter to the GP reminding him of your recent heart attack and OHS and explain the problems you have had getting to see him because of the practice policy, and ask for his advice for when you have more than one issue you need to see him about.

Thanks.I don't want to create any more waves than I already have at this point, but that is good advice.

Note that a week ago I went to his office to discuss some troubling examples of confusion/misadvice/possible mixing me up with another patient (long story). We talked through most of that. He didn't actually get to one issue though which needed to be addressed, kind of just swept it under the rug - I let it go. If I continue to complain/point out things wrong, he may just consider me too much trouble, & like another GP I had years ago whose "buddy" the internist acted very unprofessionally & screwed something up which I then simply asked the GP for a referral to see a different internist that someone had recommended, the GP freaked out and lectured me for 5+ minutes about being a "problem patient", told me to get a new GP, and stormed out of the room like I had just spit on his mother or something worse. All this happened directly after he had gotten into an argument with his boss on the phone, which I heard since he left the door open, so it seemed that he took it out on me since I dared to ask for a referral to see a different GI doctor than his friend. I'll stop there, although the whole incident is a pretty interesting tale. I did discuss what happened with multiple people at the time and it turns out that he freaked out/lectured a friend's wife in a similar way as well. Needless to say we both changed to other GPs of course...

Btw, I will say that coincidentally this Tuesday, after I made my GP appointment & encountered the strange receptionist issue, prior to me going to the appt, in my email was a request for me to fill out a survey relating to the appt I had the previous week, with also areas to comment on general practice issues. So I filled out that survey and in there I DID mention the receptionist issue and how bad that type of patient treatment was. I don't know who actually reads the survey, or if anyone cares a wit, but I got my 2 cents in that way.

 

[Aggie85]

Good to hear you finally had an outlet to let someone know. I encountered a similar problem several years ago. I had a scare with breast cancer and needed to finally deal with uterine issues that had been being treated with hormones. I hadn't been able to discuss the results of the biopsies, just had the letter of the scary results and CAT scan results that were odd and had never been discussed (multiple hot spots on uterus was reported but no explanation.) I was also having IBS (Irritable bowl syndrome) problems that I suspected were related to hormones as well. Along with the on going heart consideration in everything I did. I tried to set up an appointment with my GP to discuss ALL the issues as an unit and the possibility of needing a hysterectomy because I suspected they all were integrated. Everything would need separate consults but were also possibly tied in together and needed to know where to start. I was told the same thing, you have to do separate appointments to get each consult and can only make one appt, at a time! There must have been something else I'm forgetting, because it came down to 6 appointments needed. Luckily for me, the military has a Patient Advocates office where complaints could be taken. Sometimes as the spousal "dependent" my codmplaints were ignored, so my husband came with me, in uniform to talk about how to get the appointment I needed and in a more efficient way. Our argument was this nonsense was not only bad for patient care, but also a waste of the Dr., Staff, ect time. Why on earth is it more efficient to do something in 6 appointments than in one slightly extended one????? This may be an argument you can try with your GPs office. Also check with the insurance company or the parent company the GP practices under. They may be able to help. What it boiled down to for me, was that I needed to be in Internal Medicine instead of family practice because the IM Docs are given more time to deal with complex Pt. issues. As a side, I did eventually get the hysterectomy and have had no IBS issues, and knock on wood, no more pre- breast cancer signs since. Unfortunately, it sounds like you've already had a bad internist experience as well, so may not be open to that route. But your GPs company may have a similar Pt. Advocate type office who can help. Try the efficiency argument as well. GOOD LUCK, again.

 

[Aggie85]

How's the tiny red dots? Have they gone away? Figured out what's causing it? Hope they're better! Linda

 

[slipkid]

How's the tiny red dots? Have they gone away? Figured out what's causing it? Hope they're better! Linda

Thanks. Still have dots. Varies how many. Seems like some went away. Then some come back. No clue as to why. Obviously is something to do with the warfarin though (capillary bleeds). Doctor doesn't seem to be concerned at all (not that that means anything)....

 

[Aggie85]

Possibly, possibly not but unfortunately not something you can just stop taking to see if they go away. are you any other meds that you could be reacting to? Have you tried taking, assuming you can, Benadryl to see if they go away with that? I hope they're not itching, that'd be terrible! Linda

 

[slipkid]

Possibly, possibly not but unfortunately not something you can just stop taking to see if they go away. are you any other meds that you could be reacting to? Have you tried taking, assuming you can, Benadryl to see if they go away with that? I hope they're not itching, that'd be terrible! Linda

No, they don't itch, thanks. Not a rash per se. They are red spots under the skin, from leaky/broken capillaries, as I understand it. Benadryl will not affect them. They seem to have started as my warfarin dose has ramped up. I have less of them now though, maybe my body is adjusting to the warfarin, I dunno.

http://www.mayoclinic.org/symptoms/petechiae/basics/definition/sym-20050724
http://www.nlm.nih.gov/medlineplus/ency/article/003235.htm