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Robt Z
Has anyone had a colonoscopy with a mechanical aortic valve. Am concerned re being off warfarin for 3 days prior. This will be the first time since my surgery and I am concerned. Thanks. Robt Z.
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Robt Z
wow! I just read the "search" results on this topic and learned that none of my doctors ever mentioned lovenox injections or the virtual colonoscopy to me. I am thinking of cancelling my colonoscopy scheduled for monday am. A colonoscopy for one of us may turn into a real problem if they have to cut.Has anyone had a colonscopy without lovenox? Am suprised this was never mentioned to me. Any more info will be appreciated.
A
ALCapshaw
Hi Robt,
One of our members had a colonoscopy while still ON Coumadin. The plan was to take a look without having to go through to withdrawal protocol. Of course if they found anything that needed removal, then they would have to REPEAT the procedure OFF Coumadin.
I saw a news piece on Virtual Colonoscopy using some sort of technique similar to a CAT scan. I would like to know if it is compatible with mechanical valves.
I believe there is also a Virtual Colonoscopy technique using a small camera that you swallow and allow to 'pass through'.
Sounds worth looking into.
'AL'
One of our members had a colonoscopy while still ON Coumadin. The plan was to take a look without having to go through to withdrawal protocol. Of course if they found anything that needed removal, then they would have to REPEAT the procedure OFF Coumadin.
I saw a news piece on Virtual Colonoscopy using some sort of technique similar to a CAT scan. I would like to know if it is compatible with mechanical valves.
I believe there is also a Virtual Colonoscopy technique using a small camera that you swallow and allow to 'pass through'.
Sounds worth looking into.
'AL'
LUVMyBirman
Well-known member
Colonoscopy
Colonoscopy
I had the unfortunate pleasure
coming off the Coumadin, and using Lovenox for the proceedure. This was 2 years ago. Prior to the Lovenox warnings.
My cardiologist now wants me admitted for any such tests and placed on Heparin. Looks like this would be a 2 day 'pre admit'. Then another week for my levels to come up. What a major pain. But, it beats a stroke.
I would be leary of having that procedure on the Coumadin. Adverse effects are rare, but there is a possibility the scope could penetrate your intestines, etc. To someone on Coumadin, could prove to be fatal. Also, if there is something to be removed they can safely do so with you having to return and go though it all again. If I recall, the memeber that had it done on Coumadin had to go back.
Would like to know more about the virtual testing. In my case, family history of colon cancer. I am on the 2 year plan for life.
Let us know how it works out for you.
Take care
PS. Don't forget to premedicate.
Colonoscopy
I had the unfortunate pleasure
coming off the Coumadin, and using Lovenox for the proceedure. This was 2 years ago. Prior to the Lovenox warnings. My cardiologist now wants me admitted for any such tests and placed on Heparin. Looks like this would be a 2 day 'pre admit'. Then another week for my levels to come up. What a major pain. But, it beats a stroke.
I would be leary of having that procedure on the Coumadin. Adverse effects are rare, but there is a possibility the scope could penetrate your intestines, etc. To someone on Coumadin, could prove to be fatal. Also, if there is something to be removed they can safely do so with you having to return and go though it all again. If I recall, the memeber that had it done on Coumadin had to go back.
Would like to know more about the virtual testing. In my case, family history of colon cancer. I am on the 2 year plan for life.
Let us know how it works out for you.
Take care
PS. Don't forget to premedicate.
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K
KIRSONRON
I have a St. Jude Aortic mechanical valve and had a colonoscopy while on Coumadin in December of 2000. This was to be screening colonoscopy since I had just turned 50 years old. I had discussions with my cardiologist, gastroenterologist and internist. Since there was a low risk of finding a polyp, we decided to roll the dice that it would be a clean bill of health. As you can imagine, they found a polyp that appeared precancerous. I was told to stop the Coumadin on a Tuesday afternoon and return to the hospital on Friday morning for a stat INR test. At that time, my INR had dropped from 3.0 to 1.4. The second colonoscopy was done asap and I was then put on a Heparin IV and hospitalized. On Sunday, two days after the polyp removal, I began to bleed. This worsened over the next 48 hours until we all decided to go back in for a third time and have the removal site cauterized. This was done, the bleeding stopped and I was released the following day.
Since the removed polyp was precancerous, I will be having another colonoscopy next month - again on Coumadin. As with the first time, they don't expect to find anything and thus the dice are re-rolled.
Obviously I inquired about the Lovenox this time. My internist asked to to speak to the cardiologist who was adament that there have been problems with Lovenox for this type of valve and procedure and that given the risk of developing a clot, the lowest risk was to use the Heparin again if needed. Given the consequences, I'm deferring to his judgement. I'm in much better shape this time because I do home testing and would have been aware when my INR dropped below 2.0 and taken steps to begin the Heparin sooner.
This said, may gastro's won't touch a Coumadin patient given the chance of a bleed. My doctor was great and we worked through it. Since everthing can be equated to cost/benefit, had I not had the colonoscopy because of the associated complications, I would probably be a member of a colon cancer support web site. Ignorance is not bliss. Whether you do it on or off Coumadin, definitely get it done. It's no picnic either way. I would suggest that if you are low risk and this is being done for screening purposes, try it on the Coumadin.
Since the removed polyp was precancerous, I will be having another colonoscopy next month - again on Coumadin. As with the first time, they don't expect to find anything and thus the dice are re-rolled.
Obviously I inquired about the Lovenox this time. My internist asked to to speak to the cardiologist who was adament that there have been problems with Lovenox for this type of valve and procedure and that given the risk of developing a clot, the lowest risk was to use the Heparin again if needed. Given the consequences, I'm deferring to his judgement. I'm in much better shape this time because I do home testing and would have been aware when my INR dropped below 2.0 and taken steps to begin the Heparin sooner.
This said, may gastro's won't touch a Coumadin patient given the chance of a bleed. My doctor was great and we worked through it. Since everthing can be equated to cost/benefit, had I not had the colonoscopy because of the associated complications, I would probably be a member of a colon cancer support web site. Ignorance is not bliss. Whether you do it on or off Coumadin, definitely get it done. It's no picnic either way. I would suggest that if you are low risk and this is being done for screening purposes, try it on the Coumadin.
G
Guest
Send a private message to MATXR asking about the virtual colonoscopy etc - he is a radiologist (XR = X-Ray) and will be most helpful.
What you need to remember here is that that there are several competing interests. The cardiologist, the gastroenterologist and you. While it would be ideal if all of your goals are the same, this is often not the case.
I had a patient whose gastro doc took her off warfarin for a week for a colonoscopy. (2 or 3 days would probably have been sufficient) She had a stroke. When I spoke to the gasto his attitude was - well I couldn't do a colonoscopy while she was anticoagulated and I've seen paytients who were still high after a week. That is my standard procedure. Obviously his interest was to not cause bleeding - strokes be damned those become someone else's problem.
The cardiologist's goal is to keep your valve in good working order. While there was never really any good evidence that Lovenox was equivalent to heparin it seemed to work OK. (Actually the use of heparin is more tradition than science). Then last spring there were reports of pregnant women with valves who died while on Lovenox. This immediately turned many doctors away from Lovenox for valve patients. They generalized that if pregnant women with valves died on Lovenox then nobody who has a valve should get Lovenox for any reason.
Where does this leave the patient with a valve? Wondering who has their best interest at heart. Each specialist may have only their chunk of your body as their major concern. You have to decide who you trust and then may have to shop for a doctor who will help you with what you feel is right.
What you need to remember here is that that there are several competing interests. The cardiologist, the gastroenterologist and you. While it would be ideal if all of your goals are the same, this is often not the case.
I had a patient whose gastro doc took her off warfarin for a week for a colonoscopy. (2 or 3 days would probably have been sufficient) She had a stroke. When I spoke to the gasto his attitude was - well I couldn't do a colonoscopy while she was anticoagulated and I've seen paytients who were still high after a week. That is my standard procedure. Obviously his interest was to not cause bleeding - strokes be damned those become someone else's problem.
The cardiologist's goal is to keep your valve in good working order. While there was never really any good evidence that Lovenox was equivalent to heparin it seemed to work OK. (Actually the use of heparin is more tradition than science). Then last spring there were reports of pregnant women with valves who died while on Lovenox. This immediately turned many doctors away from Lovenox for valve patients. They generalized that if pregnant women with valves died on Lovenox then nobody who has a valve should get Lovenox for any reason.
Where does this leave the patient with a valve? Wondering who has their best interest at heart. Each specialist may have only their chunk of your body as their major concern. You have to decide who you trust and then may have to shop for a doctor who will help you with what you feel is right.
LUVMyBirman
Well-known member
Al
Al
Couldn't agree with your statement more. Generalized at best.
I have used Lovenox more times than I can count. When I come off the Coumadin.....it has taken up to 2-1/2 weeks for my INR to come back up! I would be taken off Heparin at about 2.0 and sent home with the injections. Like I said, 2 weeks, x2 daily until I was therapeutic. It seems that when Warfarin is taken away from my system.....it fights it all the way back up.
I take 6-1/2 daily. If I stop my Coumadin for only one day, rock bottom. At least I have that much figured out.
PS. Marty, if you could start a thread on information regarding the virtual colonoscopy, would appreciate it. There appears to be a few of us that are interested in this new technique. Thanks!
Al
Couldn't agree with your statement more. Generalized at best.
I have used Lovenox more times than I can count. When I come off the Coumadin.....it has taken up to 2-1/2 weeks for my INR to come back up! I would be taken off Heparin at about 2.0 and sent home with the injections. Like I said, 2 weeks, x2 daily until I was therapeutic. It seems that when Warfarin is taken away from my system.....it fights it all the way back up.
I take 6-1/2 daily. If I stop my Coumadin for only one day, rock bottom. At least I have that much figured out.
PS. Marty, if you could start a thread on information regarding the virtual colonoscopy, would appreciate it. There appears to be a few of us that are interested in this new technique. Thanks!
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Marty
Well-known member
VIRTUAL COLONOSCOPY
VIRTUAL COLONOSCOPY
Virtual colonoscopy is a promising new non-invasive technique that combines rapid spiral CT scannining of the abdomen with advanced computer programs capable of reconstructing sharp 2D and 3D views of the colon and rectum.
Recent studies comparing the technique with conventional colonoscopy and barium enema show that it is already slightly more accurate in detecting polyps larger than 1 cm.
The technique is faster, and more comfortable than conventional colonoscopy, and does not require sedation. It does require a bowel prep and air insufflation.
Virtual colonoscopy is still a research procedure. My HMO
Mid-Atlantic Kaiser Permanente with 600,000 members does not yet offer the study. Before virtual colonoscopy can be promoted for population based screening for colorectal cancer further questions of accuracy, availability, acceptibility, and cost-effectiveness must be answered.
VIRTUAL COLONOSCOPY
Virtual colonoscopy is a promising new non-invasive technique that combines rapid spiral CT scannining of the abdomen with advanced computer programs capable of reconstructing sharp 2D and 3D views of the colon and rectum.
Recent studies comparing the technique with conventional colonoscopy and barium enema show that it is already slightly more accurate in detecting polyps larger than 1 cm.
The technique is faster, and more comfortable than conventional colonoscopy, and does not require sedation. It does require a bowel prep and air insufflation.
Virtual colonoscopy is still a research procedure. My HMO
Mid-Atlantic Kaiser Permanente with 600,000 members does not yet offer the study. Before virtual colonoscopy can be promoted for population based screening for colorectal cancer further questions of accuracy, availability, acceptibility, and cost-effectiveness must be answered.
G
Guest
Marty, Are you going to Las Vegas?
Today in the journal Formulary James Groce and Gordon Vanscoy, two prominent pharmacists in anticoagulation, wrote an opinion piece about Lovenox with mechanical heart valves. They basically agreed with what I wrote yesterday. I'm going to wait and present this in Las Vegas, then I will post it on these forums.
Today in the journal Formulary James Groce and Gordon Vanscoy, two prominent pharmacists in anticoagulation, wrote an opinion piece about Lovenox with mechanical heart valves. They basically agreed with what I wrote yesterday. I'm going to wait and present this in Las Vegas, then I will post it on these forums.
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P
pnd1
I have a history of adenomatous colon polyps. They were first discovered in 1996 and removed. A followup in 1998 showed none. In 2001 I had my aortic valve replaced with a St. Jude artificial valve. This year I was due for another followup colonoscopy, my first since my valve replacement.
My cardiologist insisted that I be admitted to the hospital two days prior to this colonoscopy, so that IV heparin could be administered in place of my warfarin. This procedure was necessary to allow my blood to increase it's clotting ability so I would not have internal bleeding in the event they found and removed any colon polyps. At the same time, the heparin was intended to protect me from having a stroke as my blood gradually increased it's clotting ability.
The colonscopy showed a small benign polyp, which was cut out. Because my blood clotting level was normal, there was no internal bleeding. The heparin, meanwhile, greatly diminished my chances of having a stroke.
My cardiologist insisted that I remain in the hospital, hooked up to my heparin drip, for two more days following the colonoscopy. At the same time, they reinstated my warfarin, and when my INR was at a safe level, I was discharged.
Both my gastroenterologist and cardiologist have told me that I will have to go through this all over again in 2004, when my follow up colonoscopy is due.
I do not particularly enjoy spending five days hooked up to an IV drip in a hospital, but since I will do whatever is necessary to avoid colon cancer, internal bleeding, or strokes, there is no viable alternative for me. I trust the judgement of my doctors and accept the fact that until a viable alternative is offered, I must go through this every few years.
My cardiologist insisted that I be admitted to the hospital two days prior to this colonoscopy, so that IV heparin could be administered in place of my warfarin. This procedure was necessary to allow my blood to increase it's clotting ability so I would not have internal bleeding in the event they found and removed any colon polyps. At the same time, the heparin was intended to protect me from having a stroke as my blood gradually increased it's clotting ability.
The colonscopy showed a small benign polyp, which was cut out. Because my blood clotting level was normal, there was no internal bleeding. The heparin, meanwhile, greatly diminished my chances of having a stroke.
My cardiologist insisted that I remain in the hospital, hooked up to my heparin drip, for two more days following the colonoscopy. At the same time, they reinstated my warfarin, and when my INR was at a safe level, I was discharged.
Both my gastroenterologist and cardiologist have told me that I will have to go through this all over again in 2004, when my follow up colonoscopy is due.
I do not particularly enjoy spending five days hooked up to an IV drip in a hospital, but since I will do whatever is necessary to avoid colon cancer, internal bleeding, or strokes, there is no viable alternative for me. I trust the judgement of my doctors and accept the fact that until a viable alternative is offered, I must go through this every few years.
Marty
Well-known member
Give "virtual" a try in 04?
Give "virtual" a try in 04?
Phil, If I were you I would check with your doctors about getting a virtual colonoscopy in 2004. I think the test will be standard by then. If the virtual shows no polyps you are home free and won't have to spend 5 days in the hospital hooked up to IV's. They should be able to do this test at Good Sam in Phoenix or at the med school in Tucson. There is another Xray test called the Barium Enema Air Contrast thats pretty good when done by an expert. The BEAC has been around for almost 100 years and its still done a lot today. I have one every 5 years. I simply didn't want to take the time, withdraw the warfarin, etc. that some gastroenterologists demand. A few will colonoscope first while you are anticoagulated and then only if they find something that needs cutting will they admit you to the hospital.
Give "virtual" a try in 04?
Phil, If I were you I would check with your doctors about getting a virtual colonoscopy in 2004. I think the test will be standard by then. If the virtual shows no polyps you are home free and won't have to spend 5 days in the hospital hooked up to IV's. They should be able to do this test at Good Sam in Phoenix or at the med school in Tucson. There is another Xray test called the Barium Enema Air Contrast thats pretty good when done by an expert. The BEAC has been around for almost 100 years and its still done a lot today. I have one every 5 years. I simply didn't want to take the time, withdraw the warfarin, etc. that some gastroenterologists demand. A few will colonoscope first while you are anticoagulated and then only if they find something that needs cutting will they admit you to the hospital.
Nancy
Well-known member
Hi Marty-
Joe had a virtual colonoscopy a couple of years ago. I don't know if the hospital was trying one out or taking part in a study. But anyway, it was a good thing with the Coumadin. He had to have one recently while he was in the hospital and it was the same old, same old, tube type. He was in fragile condition at the time, so they didn't have to do any cutting, thank God.
Joe had a virtual colonoscopy a couple of years ago. I don't know if the hospital was trying one out or taking part in a study. But anyway, it was a good thing with the Coumadin. He had to have one recently while he was in the hospital and it was the same old, same old, tube type. He was in fragile condition at the time, so they didn't have to do any cutting, thank God.
Nancy
Well-known member
Now for you Phil-
Sorry for the double post, but I wanted to welcome you to this site. It's a wonderful place to meet and greet your online valve buddies and also significant others of valvers. You'll love the info here and it sounds as if you have a lot of contributing to do.
That's great
Nice to see a new member, post lots and lots.
Sorry for the double post, but I wanted to welcome you to this site. It's a wonderful place to meet and greet your online valve buddies and also significant others of valvers. You'll love the info here and it sounds as if you have a lot of contributing to do.
That's great
Nice to see a new member, post lots and lots.
P
pnd1
Thanks, Marty
Thanks, Marty
Thanks, Marty, for your suggesting regarding getting a virtual colonoscopy in 04. If my doctors feel that this test is capable of detecting the kind of small colon polyps I've developed in the past, it makes sense to have it instead of the regular colonoscopy. Another idea is, of course, to have a regular colonoscopy for examination purposes only, and if polyps are detected, return to the hospital for a week's stay and another colonoscopy to remove the polyp(s).
A complicating factor, of course, is my insurance coverage. I am with a Medicare HMO here in Phoenix (Pacificare), which initially turned down my last colonoscopy with hospital stay because it had been only three years since my last one. I appealed, and the Medicare review board overturned the HMO's denial. However I tremble at the thought of trying to get approval for a double colonoscopy if it ever came to that. And I don't know how they would handle a request for a virtual colonoscopy, and then a regular one with a week in the hospital should the VC turn reveal polyps.
Anyway, I thank you for suggesting these options, and I will certainly suggest them to my doctors in two years.
Phil
Thanks, Marty
Thanks, Marty, for your suggesting regarding getting a virtual colonoscopy in 04. If my doctors feel that this test is capable of detecting the kind of small colon polyps I've developed in the past, it makes sense to have it instead of the regular colonoscopy. Another idea is, of course, to have a regular colonoscopy for examination purposes only, and if polyps are detected, return to the hospital for a week's stay and another colonoscopy to remove the polyp(s).
A complicating factor, of course, is my insurance coverage. I am with a Medicare HMO here in Phoenix (Pacificare), which initially turned down my last colonoscopy with hospital stay because it had been only three years since my last one. I appealed, and the Medicare review board overturned the HMO's denial. However I tremble at the thought of trying to get approval for a double colonoscopy if it ever came to that. And I don't know how they would handle a request for a virtual colonoscopy, and then a regular one with a week in the hospital should the VC turn reveal polyps.
Anyway, I thank you for suggesting these options, and I will certainly suggest them to my doctors in two years.
Phil
P
pnd1
Thanks, Nancy
Thanks, Nancy
Thanks, Nancy, for the welcome to the forum. I would be delighted to share any opinions I might have gleaned from the medical adventures I've encountered in the past couple of years with anyone dealing with valve replacement and it's ramifications. I am doing extremely well since my surgery in March of 01 -- in fact, I feel better now than I've felt in the past 40 years. It's amazing what adequate blood flow can do to the system. I exercise daily, eat a low fat low carb diet, and of course take warfarin and Lipitor. I look at all of this as a positive experience, with great personal benefit.
The only problem to date has been dealing with the hassles involved in routine tests such as my colonoscopy. But it's a very small price to pay, considering the alternative.
Thanks, Nancy, for the welcome.
Phil
Thanks, Nancy
Thanks, Nancy, for the welcome to the forum. I would be delighted to share any opinions I might have gleaned from the medical adventures I've encountered in the past couple of years with anyone dealing with valve replacement and it's ramifications. I am doing extremely well since my surgery in March of 01 -- in fact, I feel better now than I've felt in the past 40 years. It's amazing what adequate blood flow can do to the system. I exercise daily, eat a low fat low carb diet, and of course take warfarin and Lipitor. I look at all of this as a positive experience, with great personal benefit.
The only problem to date has been dealing with the hassles involved in routine tests such as my colonoscopy. But it's a very small price to pay, considering the alternative.
Thanks, Nancy, for the welcome.
Phil
G
Guest
Phil it is so refreshing to read that someone's doctors did everything right.
Being new you might not realize that Marty is a physician - radiologist (MATXR for X-Ray).
Did you know that the actual pronunciation of your insurance is
P - A - See - If - I - Care?
Welcome - we have a lot of fun here too.
Being new you might not realize that Marty is a physician - radiologist (MATXR for X-Ray).
Did you know that the actual pronunciation of your insurance is
P - A - See - If - I - Care?
Welcome - we have a lot of fun here too.
hensylee
Well-known member
Hey, Phil - welcome to the site. Such a nice picture, too. Sounds like you have much to contribute, so please stay around. God bless
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pnd1
Thanks, allodwick and hensylee for your kind responses -- I'm glad I found this site and hope I can eventually be of some help to others. I have noticed a very supportive and positive tone in most of the posts I've seen so far. As for my own medical experiences, I am very satisfied with the skill, knowledge, and understanding I've received from all of my doctors, nurses, and technicians to date. All have been very positive, and that has helped me view my recovery to date as a life-enhancing, as opposed to a life-threatening, experience.
Thanks again for your warm welcome.
Phil
Thanks again for your warm welcome.
Phil
