Colonoscopy today...

[MarkU]

Another frustrating day.
When they were checking me in today at the colonoscopy lab, the nurse told the doctor that I had been on a Lovenox bridge and asked if they should check my INR prior to the procedure. "No need to" was the answer from the doctor.
In recovery, they told me they had removed three polyps - should have the biopsy back in a week or so.
The doctor told me to stay off Lovenox for three more days and Coumadin for another week!
I called my anticoagulation clinic on my cell phone and relayed what I had just been told. Their response was "Doesn't he understand that you need the protection of the Lovenox if you're off your Coumadin?" Evidently not.
The anti-coag lab told me to stay with the original plan for the Lovenox bridge - one shot tonight, start Coumadin again tommorrow and overlap with the Lovenox for three days. They advised to check for any rectal bleeding for the next few days and call if I noticed anything. Better that than playing Russian roulette with a stroke.
The thing that really bugs me is that both my cardiologist/coag lab and G I doc are all in the same large medical practice. I wish they would communicate better among themselves!
Thanks for letting me vent...
Mark

 

[Ross]

Mark if it ever happens in our lifetime, I think we'll have witnessed a miracle.

 

[tommy]

Mark,

Good to hear from you.

Hope those results are NEGATIVE!

Way to stick up for yourself regarding anitcoagulation.
I'll be happier for you once you get that next Lovenox shot tonight.
My opinion is that your greatest likelyhood of bleeding are the next 24 hours and then the last 24 hours that you are on Lovenox (and Coumadin at the same time).

Get some rest.

 

[Guest]

I wish they would communicate better among themselves!

*rolls eyes*

Ahhh...that'll be the day .

Sure would be nice, wouldn't it? I know I get frustrated with doctors that refuse to communicate, asking the patient to communicate the news, when one wrong inflection of a word can mean a very different thing to the other doctor....

*shakes head*

I think this goes along the category of "there oughtta be a law"....

Mark...thinking positive thoughts for you for NEGATIVE results .


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
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What's it like to buy your favorite car brand new? Wish I knew...

 

[Rich]

Mark,
I don't think that day will ever come.
The doctor who did mine had me stop my Coumadin for two days.
I resumed taking it as soon as I got home that day.
He removed five polyps from me and I never had any bleeding whatsoever.
They were all benign and I hope the same for you.
Rich

 

[MarkU]

The thing that really bothers me is that I see many other patients, especially the many elderly retirees here in Florida, who blindly take whatever advice or instructions given by their doctors.
I feel very fortunate that thanks to this site and some of my own research, that I have become something of an "informed consumer".
Mark

 

[Guest]

Sounds like the GI doc didn't want a weekend call about bleeding.

If you stroke, it is the neurologist who gets called.

 

[MarkU]

Colonoscopy Wars, Episode III: Revenge of the Jedi Valver...

Colonoscopy Wars, Episode III: Revenge of the Jedi Valver...

So I go to get my INR checked this morning - 0.9! Not good. Anti-coag nurse tells me to double my Coumadin from 5mg to 10mg and continue the Lovenox (2 x 0.8ml per day) until she can check me again on Thursday morning.

If I had followed the written instructions from the GI doctor who did my colonoscopy, I wouldn't be using ANYTHING until NEXT Saturday! (And probably lying in the stroke ward at the hospital...)

So just as I'm finishing giving myself a Lovenox injection, a nurse from the GI office calls to see how I'm doing after my procedure on Friday (Bad timing on her part). Of course, the ONLY thing she is concerned about is whether I'm showing any intestinal bleeding. After I tell her that I am deliberately NOT following her boss's written instructions, she passes me off to GI Nurse #2, who at least seems to understand what Lovenox bridge therapy is and agrees with my assessment of the relative risks of stroke v. intestinal bleeding. She just cautions me to keep checking myself for any signs of bleeding and call them if I do. She tells me "I think I'll tell somebody about this".

Next call I get is from my cardiologist's nurse who had been briefed by my anti-coag nurse. She tells me to absolutely stay on my Lovenox/Coumadin regimine until I am back in range. She also tells me that my cardiologist intends to approach the GI doctor and try to educate him on the theory & practice of anti-coagulation therapy for patients with mechanical heart valves. She said he would be diplomatic and not mention any names. I told her that he was free to use my name, as I have no intention of going anywhere near the guy again.

The really sad part was that she candidly told me they see stroke victims ALL THE TIME who were victimized by improper management of their anti-coagulation therapy by doctors in other areas of specialty. She said it was particularly an issue among their older patients who tend to take any doctor's instructions as Gospel - even when it's wrong and not in their best interest.

So here I am for the next few days, feeling like I'm juggling hand grenades with the pins out, just waiting for one to go off.

Of course the benefit of sitting here worrying about having a stroke is that it keeps my mind off worrying about the results of the biopsy of the polyps they removed during the colonoscopy.

But the thing that is REALLY ticking me off is I've got my next triathlon in three weeks and I can't go out and train hard again until I'm "safe" to do so...

Mark

 

[warrenr]

Mark,

Just wanted to wish you the best outcome possible.
Please keep us up to date.

Warren R. Mead

 

[brendamarlene]

This coumadin therapy and what the docs tell you to do is so frustrating!

And I have just started on the the therapy a little over a week ago!

 

[Guest]

Mark,
You are not juggling hand grenades. The Lovenox has you fully protected. The only reason to go back on warfarin is so that you do not have to take injections forever. There is no more danger of a stroke when you are on Lovenox than when you are on warfarin. Lovenox does not register on the PT test but it does not mean that you are not protected. Lovenox is complicated and time consuming to monitor but the effect is so predictable that you do not need to have it monitored unless you are in kidney failure.

Train all you want, you might be a little more likely to bruise but little risk of bleeding.

There was really no reason to do your INR today since you only restarted the warfarin on Friday and you already knew the correct dose. There was a 99% chance that the INR would be 1.0 today.

 

[Karlynn]

Mark,
You are not juggling hand grenades. The Lovenox has you fully protected. The only reason to go back on warfarin is so that you do not have to take injections forever. There is no more danger of a stroke when you are on Lovenox than when you are on warfarin. Lovenox does not register on the PT test but it does not mean that you are not protected. Lovenox is complicated and time consuming to monitor but the effect is so predictable that you do not need to have it monitored unless you are in kidney failure.

Train all you want, you might be a little more likely to bruise but little risk of bleeding.

There was really no reason to do your INR today since you only restarted the warfarin on Friday and you already knew the correct dose. There was a 99% chance that the INR would be 1.0 today.

This is why we love Al - he definately has our backs. I was wondering if Lovenox would register an INR. Mark, I hope this gives you some peace of mind. I was scared for you to until I read Al's post.

 

[MarkU]

Thanks Al,

Appreciate your input.

Guess my frustration is showing. Just went through a similar scenario with my oral surgeon in November when I had to get an implant.

Actually, I don't mind giving myself the Lovenox injections - other than my stomach is starting to look like a bruised pin cushion.

I feel fortunate to have yourself and the others on this site for info and support.

Thanks,
Mark

 

[Guest]

Actually, I don't mind giving myself the Lovenox injections - other than my stomach is starting to look like a bruised pin cushion.

The condition is affectionately referred to as "Eggplant Belly". But I doubt that many triathalon competetors are shaped like eggplants.

FWIW my office partner's wife has qualified for the Boston Marathon. One of my students (50-ish age) last year ran the Pike's Peak Marathon. Up to 14,110 feet and back down. Took 7 hours, but she did it.

 

[MarkU]

Went back to get my INR tested again this morning. Still only back up to 1.9, six days after resuming my Coumadin after my colonoscopy. At least it?s up from the 0.9 on Monday. To be safe, the nurse is keeping me on the Lovenox for one more day. She also is keeping me at twice my 'normal' daily doseage of Coumadin (10mg v. 5mg) until I get tested again next week ? hopefully I will be back in range by then.

This importance of this effort to get my INR back in balance seems somewhat diminished in importance as I sit here. I got the call from the gastrointestinal doctor's office late this afternoon.

Of the three polyps they removed during the colonoscopy, one was benign. Unfortunately, the other two weren't...

I have an appointment to go back in on Tuesday to discuss some further testing. Hoping for the best, but we'll just have to wait and see.

Guess I'm a bit numb at this point, and a bit angry, if anything.

Not really scared or fearful for myself, but we had to watch my father suffer and die from renal cell cancer last year and I know how much of a strain it puts on the family. I just hate to have people worry about me or be a burden to anyone.

I guess I would appreciate it if you would keep my family and me in your thoughts and prayers for the next week or so.

Thanks,
Mark

 

[geebee]

Mark,

I am so sorry to hear the news. I will pray that any treatment you receive is fast and successful.

I had a really tough time today with a family problem concerning my brother. I had a number of VR.com family members praying for us and I felt comfort in knowing.

I wish the same comfort for you and your family.

One other thing. Since your INR is up to 1.9, it is obviously climbing. I would be concerned about taking twice your pre-procedure dose for too long in the fear that your INR might get too high. How long before you are tested again?

I would hate for you to have one more thing to worry about.

Stay in touch.

 

[MarkU]

Thanks for the kind words, Gina.

Hope all is well with your brother.

Yes, I have the same concern about the higher doseage of Coumadin. Am going to get tested again on Tuesday. Hope I don't spike too high. At least I can stop the Lovenox after tomorrow - starting to feel like a human pin cushion. Actually, I can tell from the amount of bruising from the injections that my INR is climbing - not a pretty picture.

Take care,

Mark

 

[ALCapshaw2]

GOOD GRIEF Mark ...

Doesn't your Coumadin Clinic use FINGER STICK machines for INR? If not, why not...OR, find a Coumadin Clinic that DOES use the modern and less painful finger stick testers. BOTH of the Coumadin Clinics I've used here in ALABAMA have finger testers. Is FLORIDA as far behind us in INR testing as they are in Voting Machine Ballots?

'AL Capshaw'

 

[MarkU]

Hi Al,
Yes, my Coumadin clinic uses a finger stick machine. The bruising I was refering to is on my stomach from the two-a-day Lovenox injections I've been giving myself for the past eleven days.
Thanks,
Mark

 

[Karlynn]

Mark, so sorry to hear your news. Take it one step at a time and try not to project to much into the future. Most often the stress of the unknown is worse than what you eventually find out.

One of our best friends had emergency surgery last year because they discovered a tumor the size of a grapefruit had grown in his colon. Obviously, he was ignoring warning signs for quite a while. He went to the ER from severe pain and anemia. The tumor had perforated his colon. He had chemo for sixths months. We learned from our web research, his treatment was a newer approach. His cancer was diagnosed as 3+. Trying to make a long story short, he just had his one year anniversary and colonoscopy & blood work. The report is that his colon looks healthy and pink with no signs of reoccurance and his blood work came back also showing no signs of reoccurance. He's not out of the woods yet since it's only been a year, but we were all so certain, given the report after his surgery, that he didn't have much of a chance. We all held our breath waiting for his latest test reports and breathed a huge, surprised, sigh of relief.

Take reassurance in the fact that the reason routine colonoscopies are recommended is that colon cancer is a very treatable disease with a high success rate when caught early. IF they find that this is what your polyps are indicating - I know you'll beat it.

You have my prayers and best wishes.