Chest Pain...what to do?

[ALCapshaw2]

Dee:

You need to contact your cardiologist DIRECTLY or at least through his primary Nurse.

Tell him (them) that you are MORE concerned about the Risk of Stroke than the risk of bleeding.

Then TELL them you know of several people who have had TEE's while still on Coumadin and that is your preference.

Surely there must be some standard protocols for TEE's while on Coumadin. Ask him to LOOK THEM UP.

If he refuses to do a TEE while you are on Coumadin then TELL him you want Bridge Therapy Before and After the procedure to minimize your risk of stroke.

If he still refuses to accomodate your requests, ask for a referal to another Cardiologist who would be more inclined to accomodate your desires.

Changing the subject slightly, have you ever had a Heart Catheterization and Angiogram to check for Blockages of your Coronary Arteries? If not, why not? Chest pain is a CLASSIC symptom of Coronary Artery Disease.

'AL'

 

[ccrawford]

Dee - Let me try another approach. Quite simply stated, if anything happens to you while you were ordered off coumadin by your doc for a tee, you could sue him big time and probably win. You really don't want to do this - Don't beleive us? - get another opinion from a doc. Chris

 

[Granbonny]

Hi Dee

Hi Dee

You stated in your last post..that you told your nurse ..that you drop like a rock with 1 missed dose..When was that? And why did you miss a dose..and how low did your INR drop??? How long did it take for your INR to be back in range?....Last year, I was told by my dentist to stay off coumadin for 3 days before my 2 teeth extractions on a Monday morning..early...Called my Cardio and he said..Do what your dentist tells you to do...So, I cheated..just missed Sat and Sund..and started back up as soon as I got home.. I waited another day to take my INR..Around 2.0 but by tweaking a tad..for few days..it was back in range......but, I have a good track record of coumadin... Just curious to high low you fell. with 1 skipped dose. ...At the time, I didn't trust my dentist..but did trust my Cardio...He is now head of our Heart Hospital in Gainesville, Ga...He is the one that found my aneurysm..after 4 other different doctors I went to for 3 months..couldn't find anything. ...I'm sure it's hard for you to make a decision.. Good luck on what you decide to do..Bonnie

 

[Dee]

I hope everybody had a wonderful Thanksgiving!!! That's why I haven't replied for a couple of days....got caught up in the Thanksgiving madness.

So, I called and talked to a nurse with the cardio group that my cardio is associated with in a another town (where I had my surgery). She talked to the cardio that took care of me while I was in the hospital for my OHS and then he talked to my cardio here and they decided that I skip just the day before my TEE. I fee much better about that, but I know that alot of you think I shouldn't skip at all, but I have found some things on the internet where it states there is a small risk of bleeding with a TEE. So, I feel like we're meeting in the middle.

Bonnie, to answer your question as far as how much I drop when I skip a dose and why I've skipped in the past....I had a hard time getting regulated on coumadin when I first started and would all of the sudden be at 6 or 8 and my cardio would tell me to skip two doses to bring it back down and that made me nervous, so I would skip one and then check my blood and find that it dropped a lot with just one skipped dose so I didn't skip the other one. Usually it drops almost half of what I tested at. If I'm at 6 it would drop to around 3 with one skipped dose. So now when I'm high I never skip a dose, I just adjust slowly to get it back down. And when I'm low, I seem to respond quickly with getting it back up.

My question is, and this seems kind of funny, but what is a "normal" person's PT or INR that isn't being treated with blood thinners?? It's something I've always wondered about but have never found the answer to.

Thank you guys for all of your info and I'll let you know how things go on Mon. I really don't want to go through this and keep trying to chicken out, but everytime I get these chest pains, I know I need to have it checked out, even if it's just for peace of mind. There's a very small chance that the myxoma tumor that I had can come back and it wouldn't show up on an Echo until it got pretty big, they can see so much more with the TEE and make sure that something like that isn't happening again. I hope this is all for nothing and then I can quite worrying about the chest pains and blame them on my teenagers!!!

 

[Ross]

My question is, and this seems kind of funny, but what is a "normal" person's PT or INR that isn't being treated with blood thinners?? It's something I've always wondered about but have never found the answer to.

All of us are telling you that there is no need to reduce or hold period. This is a clear cut case of Doctors not understanding how this stuff works. They are following blindly that someone on Coumadin will bleed to death from a simple pin prick and it just won't happen. I'd feel a whole lot better if listened to us this time, but do as you see fit. It's totally unnecessary though.

To answer your normal person INR question=1.0 for the uncoagulated folks. That's roughly 9.? seconds to start clotting vs our 2.5 to 3.5 of 24.? to 34.? seconds to start clotting. Yes, that's how little difference there is between us, mere seconds.

 

[Granbonny]

Hi Dee

Hi Dee

I'm sure you will be fine..with 1 skipped dose.. I think a normal person would have a 1.0 INR ??? but, wait and let's have an expert like Al tell you....Good luck, Monday. Bonnie

 

[Gnusgal]

I was always told that it takes a few days for coumadin to get into/out of the system. So wouldn't holding the dose the day before really be effecting your INR the day AFTER the procedure??? Maybe I'm just confused on how this stuff works, but it seems to me that these docs don't know how it works either.

I know that I have had a TEE since my AVR, and I was not taken off of coumadin. I'm with everyone else and think there is no reason to skip any doses at all (at least not without lovenox until you're back up). But you should do what you feel comfortable with.

 

[Ross]

I was always told that it takes a few days for coumadin to get into/out of the system. So wouldn't holding the dose the day before really be effecting your INR the day AFTER the procedure??? Maybe I'm just confused on how this stuff works, but it seems to me that these docs don't know how it works either.

I know that I have had a TEE since my AVR, and I was not taken off of coumadin. I'm with everyone else and think there is no reason to skip any doses at all (at least not without lovenox until you're back up). But you should do what you feel comfortable with.

Nope, your pretty much right. One dose takes up to 36 hours to show in a blood test, so holding a day before isn't going to do much of anything, but will cause a drop after that hence the reasoning that there is absolutely no reason to reduce nor come off it to start with.

 

[Karlynn]

Dee, I hope it doesn't feel like we are picking on you. We just get very frustrated at doctors who aren't up to speed on how to treat Coumadin patients. I think this is purely a case of the doctor trying to CYA (his own). He's gone from 4 days down to one? If he had solid science and statistics backing him up, he wouldn't have done that. He's just one of many, many doctor's frightened of warfarin usage.

You have to do what you feel comfortable with, and frankly 15 years ago I would have followed my doctors' directions to the letter without question. Unfortunately I had to learn the hard way that not all doctors know what they practice and those directions caused me a good deal of harm.

You will be fine most likely. One day off isn't going to make a huge difference, unless it causes you to start swinging back and forth and it takes you a while to get regulated again.

 

[Dee]

Thank you Karlynn, I am feeling a little picked on and feeling shamed by the decision I have made. I understand all of everybody's frustration with Doctors and their lack of knowledge when it comes to coumadin, it is frustrating and I've had my share. I monitor my own INR and adjust my dosages myself, so I feel like I have a good understanding of how my system reacts to it. And I think you're right Bonnie, one skipped dose isn't going to hurt.

Ross, on the subject of how long it takes for the coumadin to get through your system, you said 36 hours. I take my coumadin at night so my last dose will be at 8:00 tonight and by the time I have my procedure Mon morning, it will have been 47 hours, so I wouldn't be skipping the coumadin for no reason. I appreciate your concern, but I'm doing what I feel comfortable with. I don't feel that missing one dose is going to cause a serious problem and then I also eliminate the possiblity of any unecessary bleeding, if a problem were to arise. I hope you understand that I'm not ignoring your advise, but doing what I feel is right. Believe me, I have taken everything into consideration and this is the decision I've made. I've had two cardiologist tell me the same thing and that's the way they do it with all of their patients. I would think if they were having a big problem taking people off their coumadin for a TEE, they would stop doing it that way. Either way, you're taking a risk I know. It's a bummer that it has to be that way and that is definitely one of the down sides of being on coumadin.

 

[geebee]

Dee,
I know how frustrated you must be. You want to get advice but ultimately it is your decision to make with your doctor's recommendation. I think the fact that you questioned him at all will, at least, make him realize that you are not the type of patient to just sit by and accept everything. Good doctors will respect that and he obvisouly listened to your concerns. 1 day is a huge difference from 4 days and, while I still question the need to go off at all, you have a history with your cardio that causes you to respect his decisions also. I have a cardio that is very conservative yet he did a cardiac cath without taking me off coumdin because he did not want to create any further TIA issues. That was a big step for him and he did it because of my concerns. However he still feels an MRI is too dangerous for me because I have a St. Jude mitral. This is a position that others think is crazy and ignorant but I respect him and am not willing to take any chances with my life. So I truly understand your ultimate decision to work with your cardio.
I wish you well and hope your INR comes right back up.
Take care and smiles,
Gina

 

[Ross]

I don't mean to make you feel picked on either. It's your decision, but you can't say we didn't tell you so. I wish you the best as you know. If I sound rash, mean or just rude, it's not because of your decision, it's because I haven't found one Doctor yet that knows what Coumadin really does. It really is pathetic. I'm always hoping I'm going to hear one of them say the right thing, but they continuously show that they don't have a clue.

The last person who drew my blood is a prime example. As soon as she was through drawing it, she started to let me leave and then asked if I was on Coumadin. I said yes, which got me promptly put in the chair and a pressure bandage applied to the NEEDLE PUNCTURE site. What did she say? I wouldn't want you to bleed out! Give me a break for crying out loud.

I hope you see what I mean and forgive me if I come off as a butthole. I don't mean to, I just hate people being mislead.

 

[Karlynn]

The last person who drew my blood is a prime example. As soon as she was through drawing it, she started to let me leave and then asked if I was on Coumadin. I said yes, which got me promptly put in the chair and a pressure bandage applied to the NEEDLE PUNCTURE site. What did she say? I wouldn't want you to bleed out! Give me a break for crying out loud.

Maybe she really was getting pressure from the Haz-Mat cleaning crew. One time when I was still getting a venous draw in the hospital lab for my INR I started walking down the hall to leave and felt a warm sensation on my arm. I looked down and saw a nice trail of blood back to the lab. Oops. And if I remember correctly, my INR was a bit low that day. I think it started bleeding again when I put my purse on that arm. Since then I've stopped carrying the 10 pound dumb bells in my purse.

 

[Nancy]

Regarding Coumadin-

It takes approx. 3 days to ENTER your system, however, if I remember correctly, for every 48 hours of HOLDING your INR will drop by half if your normal dose is not too high. Two different scenarios, not understood by many doctors. Vitamin K reacts very fast also. It will drop your INR like a rock if used in a pre-surgery injection.

Someone please correct me if I'm wrong.

 

[Karlynn]

Vitamin K reacts very fast also. It will drop your INR like a rock if used in a pre-surgery injection.

Or in fresh peppermint tea.

 

[SHerrin Hutt]

Dee
Good luck with your test. It your decision to make. And I know it hard when you get so much advise. But I know from my own problems that if they hadn't had a angel watching over me I wouldn't be here today.

 

[Dee]

Just a quick update on my TEE yesterday. Besides the miserable swallowing of the camera, it went well. My heart and valve look good, in fact he was impressed by how much my muscle (that they had to remove because of the tumor) had regenerated itself.

So, I guess I can chalk the chest pains up to having a senior and a freshman living in the house, getting one set up for college and the other one ready to start driving, running our own business, being in charge of the high school booster club and not knowing when to say "NO" more often!!! Stress???? What Stress?????

Wish me luck on Thurs. I'm having steroid injections in the lower part of my scar because it didn't ever heal quite right. How much torture do I have to go through in one week???

 

[Karlynn]

Dee, so glad to hear that things went well. I'm right there with you on the stress of teenagers!! Mine are both in college now, and were home for the week of Thanksgiving. My husband and I were sitting in our familyroom last night and he looks up from the paper and says "It's nice to have the kids back at school."

 

[SHerrin Hutt]

Dee
I am glad to hear all went well. I have two daughter 31 & 21 it was like having two family. The youngest is still in college. She was home for Thanksgiving and just went back this past sun.But she doesn't come home as much as the oldest one did. She has a job at school during xmas break. My oldest just moved back home from Boston for two months and is was nice when she bought her own house. I love her but I don't want to live with her. It is nice to have her closer but not in the same house!

 

[ShezaGirlie]

Dee....

Dee....

I also had the steroid injections....ouchie!

Hope one visit does it for you. I had several...

And yep, that "empty nest syndrome" is great...