Bruizer back in the Hospital!

[conk]

Just wanted to let you know that Bruce Akins is back in the hospital. He is doing OK now, but probably will have to spend the weekend at USC University Hospital before he gets out.

Here's what happened. He had AVR on 9/12/03 with a St. Judes Mechanical and was headed to see his Surgeon for a follow-up appt. on this last Tuesday, 10/7. On the way there he stopped to get money from an ATM and experienced sever dizziness and sweating when he had gotten out the car. This cleared up in just a bit, so he proceeded to his appt. As he was waiting in the Doctor's office he experienced the same thing. They immediately saw him and discovered that he had a very fast heart rate (over 200).

They tried to alleviate the problem by massaging the carotid artery. This did not work so they checked him in to the adjacent USC University Hospital. They gave him some medicine to bring down the heart rate, but before it came down, it reached 225.

They said that this was a superventricular tachycardia (SVT). They said that he had also experience some AFib.

On top of all this, they discovered that his INR was 1.1 and was lucky to not have had a stoke. His internist who was monitoring his INR was misreading the Prothrombin time number as his INR. Well 10-12 is normal time and his was 12.1, so the Dr. said he was high, thinking it was INR. Heck, he should have been bleeding all over her and she should have been in a panic to get him to the hospital. No...Just reduced his Comadin and told him to come back in two weeks.

One wonders how someone can get into this position of trust and blunder so badly. Therefore, Bruce was basically at a normal anti-coagulation, which is not so good as we know with a Mechanical Valve. Fortunately they are getting this under control and that is why they are keeping him in the hospital through the weekend. Gotta go since much to do tomorrow, but thought I'd provide a quick update.

Keep Bruce in you prayers and thoughts.

Thanks...Denis

 

[Kevin M]

Your right. This isn't just frightening, it's terrifying. That is poor care at its worst.

Please tell Bruce we're pulling for him.
Kev

 

[Ross]

Sorry to hear about this. As I've said before and I'll say it again, there are too many places that do not know how to manage Coumadin patients. It's either how they get their readings, how they dose, or just plain ignorance. I've seen it happen too many times before. This is exactly why I tell everyone that is being tested to make sure they know what their INR number is. If the testing facility doesn't want to tell you, run from the place and find one that will. They are going to get you killed one of these days.

 

[hensylee]

What an awful thing. He must've been feeling bad for some time. Bad medicine is all around us and we have to be so careful. They all truly believe they are the 'know all' and we are the 'know nothing' - ain't true.

My brother has his INR taken at the local hospital and it's sent directly to his doctor before the day is out and THEY make the decision when the numbers show up at their office. Whoever took Bruce's should definitely be taken to task and sent back to school to learn how to interpret tests.

I pray that he is going to be fine now that the problem has been discovered - and that he gets a whole different person to read his tests hereafter. Maybe the doctors will get that person on the ball.

 

[Nancy]

I certainly hope that Bruizer doesn't ever go to that terrible doctor again. That is just about the most basic mistake that a monitoring doctor could make.

She flunked Basic Coumadin 101, with a BIG "F". She actually shouldn't be monitoring anyone, ever.

He will be in my thoughts and prayers.

People, please be knowlegeable about your conditions, and be very, very vigilant.

 

[labguides]

Bruizer

Bruizer

Who is Bruizer's internist? We live near you in Camarillo. Was his surgery done at USC? Were you pleased with his care? Who was his surgeon?

Please reply via email to [email protected]

 

[conk]

About Bruizer

About Bruizer

Bruizer (Bruce) and I had the same surgeon, Dr. Vaughn Starnes. I don't know the name of the internist who was monitoring his INR. When he had told me about the 12.1 reading some time ago I had expressed some concern on where and how his coumadin was being monitored. This is such a vital role in the overall scheme of things, you want someone who is without a doubt experienced and handles these type of patients as a routine and not an aside.

Bruce's surgery was done at USC University Hospital and mine was done at Huntington Memorial Hospital (A very nice hospital). We were both happy with the surgeon and in hospital treatment.

Dr. Vaughn Starnes is the same surgeon who performed the Ross procedure on Arnold Schwarzenegger.

Regards...Denis

 

[mamsram]

hi,

Could someone please tell me what INR means. What would be a number for one with no medical conditions. does a person on coumadin have to go thru a seesaw routine to reach a desirable no.? Why was a mistake made in this case? besides ignorance---what is lack of knowledge or confusion?
thanks

 

[Nancy]

Hi ram-

I'll answer as much as I can and maybe others can elaborate.

When you go to get tested for your anticoagulation level, the test is called a protime (short for Prothrombin test). The result is INR (International Normalized Ratio) and is reported with a number 2.5, 3.5, 2.7, etc, etc.

In the past the unit of measure was called protime (hence the name of the test) and those numbers are higher than the INR numbers. This is not used now to determine the results, but this number is still shown in the lab report. So the lab report might show both numbers.

Where Conk's doctor made the mistake was confusing the protime number (which was much higher) with the INR number, and she kept reducing his Coumadin dosage thinking he was way too high, until he just about bottomed out.

When you first start on Coumadin, and also when you restart it after being off it for a couple of days, it can see-saw a little until eventually the desired number is reached.

And Coumadin fluctuates a great deal for most individuals, that's why testing needs to be done frequently.

If you have an inexperienced person monitoring your Coumadin, you can get into a long-term see-saw situation. This is caused by the doctor overcorrecting the dosage at each test. Coumadin takes about 3 days to reach the level after an adjustment, so if someone is getting tested every day, that level will be according to what the adjustment was 3 days ago.

So how's that for major confusion---I'm confused myself.

I recommend Al Lodwick's website warfarinfo.com. He'll straighten you out. Maybe he'll see this and straighten me out.

 

[conk]

Clarification

Clarification

I'll provide a little more information, not to counterdict Nancy but to clarify.

It was actually Bruizer's internist who made the mistake.

Prothrombin Time (PT or Protime) is the most common way to express the clotting time of blood. PT results are reported as the number of seconds the blood takes to clot when mixed with a thromboplastin reagent.

The International Normalized Ratio (INR) was created by the World Health Organization because PT results can vary depending on the thromboplastin reagent used. The INR is a conversion unit that takes into account the different sensitivities of thromboplastins. The INR is widely accepted as the standard unit for reporting PT results.

A person's INR number is typically considered normal when it is in the range of 0.8 to 1.4. For mechanical valves most Cardiologists typically stive to have the number be between 2.5 and 3.5 and they would really like the number to be on the higher end of the range vice the lower.

A person's Prothrombine Time is typically considered normal if in the range of 10.0 to 12.0 seconds.

When Bruizer's internist looked at the numbers, she must have mistaken the 12.1 as the INR. I'm not sure how often this might happen in the real world, but with a bit of common sense knowledge, this high of an INR could only signal a bad test or a mistake reading the results becuase one would probably be dead with this high of an INR. At 6.0, the risk of bleeding is fairly significant. I can't imagine anyone even getting to an INR of 12.1.

Hope this helps...Conk

 

[LUVMyBirman]

I survived an INR of 14.0. Barley. Also have of the lab report
. Specifics in my personal story.

 

[conk]

Gina

Gina

Glad to hear you made it through with that high of an INR. When I made the comment about 12.1, I was wondering if anyone had a reading that high. Now I know it's possible to get very high. Hope I never have to experience anything over 3.5, but I know that's all tall order.

 

[mamsram]

THANKS GUYS

THANKS GUYS

I'm getting the picture. It seems that bruiser was too close to normal and mechanical valvers need slower clotting blood-time.
It would seem that since so many things determine the inr level that it may take a lot of carefully controlled experimentation and then when all facts are learned you deviate at your own risk. I would hope that after a little deviation, and then, back to controlled consumption, your inr would be back to your normal#.

I would think that a person in the medical field that is dealing with this type of situation would have a clear and complete understanding of what is going on. Its not a casual situation, its LIFE (the blood must get thru, yes?)

 

[LUVMyBirman]

Hi Denis,

Thank you..... it's good to still be around

Mistakes like the one made on Bruiser and myself are pure negligence. No excuses. Matter of life or death. It upsets me to no end hearing stories of such.

 

[Nancy]

Those kinds of mistakes don't happen too often, but often enough so you have to be vigilant.

Joe's monitoring doctor is excellent, but Joe's had times when under the care of others, they have made some big errors. Fortunately, we have caught them before any harm was done. They get kind of "huffy" about having the error pointed out, but this is Joe's life, and you do what you have to do to be safe. I'm beyond worrying about people's feelings when it comes to his care.

Joe used to have a doctor who didn't understand about Coumadin. Every testing period was a mystery. He was overcorrecting all the time and testing sometimes every other day, which of course wasn't right, because the lag time for Coumadin is 3 days.

Things are better now.

 

[Ross]

I just got back from my Coumadin clinic and the nurse made a major goof with me. She was looking at the wrong patients chart and started adjusting my dosage for him. They were terribly busy and she was not focused. This is exactly how these things happen. If I hadn't of said something, I'd probably be in the 10.0 range before weeks end.

 

[conk]

Bruizer Update

Bruizer Update

He did leave the hospital after 5 and hasn't had the same problem with SVT since leaving. He has also got some better control over his coumadin (Cardiologist monitoring vice Internist). Prognosis appears to be good. The valve itself appears to be working well. Hopefully smooth sailing from here on in.

 

[Susan BAV]

Well, that's all scarey!

Well, that's all scarey!

Thanks for the update, Conk! I hope things go better for Bruizer. I had my AVR last Wednesday at Good Samaritan Hospital in LA, and was in a-fib (not knowing why I was feeling so bad) most of yesterday. My very well-meaning local doctor was going to admit me at the local hospital when my husband said he'd rather drive me back up to LA. Fortunately, the stuff they prescribed though, Lanoxin, seemed to knock it right down.

I am only supposed to take Coumadin for three months because I opted for a tissue valve this time. I sure hope my doctor's office knows how to read the blood tests correctly because we are over two hours away from LA!

Glad you are continuing along so well! Thanks again for the update! And Bruizer, if you read this, I sure hope you are doing better now! Truly, my best wishes to you! ~Susan