foot surgery

[lovejoy]

I have to have a small mass removed from my foot. The foot surgeon is freaking out over the coumidin. He asked me to stop it and I said "no". I just got off the phone with cardio's office, and nurse said that I would probably have to go in hospital for 2 days before for heparin drip. Had that with my broken hip surgery. I don't want to go in hospital. This is normally an outpatient procedure. I suggested to cardios nurse maybe get INR down to 2.5 for a couple of days. Wouldn't that be ok ? All we are talking about is a small lump ( I thought it was a big wart ), probably no more than 6 stitches. Any suggestions on how to SAFELY avoid going in hospital ?

 

[catwoman]

Lovejoy:

What type of mass is it?

I have a ganglion on top of my left ankle that I would LIKE removed, but have decided to let it be. It developed in about 2000 or 2001, before my MVR. My PCP tried to aspirate it at that time -- telling me that it would only be an attempt, that it doesn't always work -- and sent me to a foot surgeon when it popped back up. The surgeon said it would require excision and my foot being in something to immobilize the ankle for about 6 weeks to prevent recurrence. In 1980, I had bilateral bunionectomy (2 places on each foot at the same time, which was loads of fun), so I decided to forego a surgery just for a ganglion.

And since my MVR, I've decided I can live with the ganglion. It's not really pretty, but it doesn't cause pain.

 

[Ross]

Ask the podiatrist if he expects it to bleed more then a gunshot wound. If his answer is no, then there isn't any reason to come off of coumadin.

 

[catwoman]

Ask the podiatrist if he expects it to bleed more then a gunshot wound. If his answer is no, then there isn't any reason to come off of coumadin.

And ask if HE has ever taken a Red Cross First Aid course.

Pressure is one of the first things you learn about in bleeding issues.

I've taken the course twice.

 

[jeffp]

Find another podiatrist. As a podiatrist myself, I'm embarrassed for the profession as a whole that too many of us practice the same way we did in the 1980's. We're trained and should be experienced in dealing with operative bleeding and know what to do with post-op bleeding. The foot's just not a meaty visceral bloody place to operate (unlike the chest or belly). I used to be one of those that subscribed to take the patient off all anticoagulants a week before, yada, yada. Now that I'm "one of them" (us) I am always espousing to my colleagues "go and do what you have to do with the patient on the meds and just be aware the you'll have to do a few more dressing changes". Even with only fair surgical technique; with ice, compression, and elevation, you might lose a cup of blood. You'll make more.
I'm serious about the first sentence though.

 

[lovejoy]

Thanks for the advice. Just heard from podiatrist's office this morning. My cardiologist talked with him Friday and he ( cardio) wants me in hospital 2-3 days prior to surgery for the heparin. So maybe this surgery is more involved than I thought. I am not happy however ! I do not want to be in hospital, but I also don't want this mass to keep growing. So its into the hospital I go. Really don't see any other options.

 

[CThrock]

Its best to have something like a growth taken care of. In the long run you'll probally be glad to get this done. Let us know when your having it done will keep you in my thoughts and prayers.

 

[bvdr]

I had a subtalar fusion on my right ankle last January and did come off coumadin but bridged with Lovenox. I spent one night in the hospital. I did have to have my surgical cast changed in the first few days because of the amount of bruising and swelling. It was a pretty involved surgery but I always feel more vulnerable when I'm off coumadin. I hope all goes well for you and you get a good report.

 

[ALCapshaw2]

Ask your Cardiologist why you couldn't just go OFF Coumadin for 3 (or 5) days beforehand and Bridge with Self-Administered LOVENOX injections until 24 hours Before the Foot Surgery. Then resume Coumadin that night. You may or may not want to ask about resuming the Lovenox 24 hours (or whenever the Bleeding Risk from the Surgery is negligible) until your INR is back in range.

I'm just about convinced that the Medical Community will NEVER be 'up to date' on Coumadin until everyone who was trained before 1990 is out of practice and NO Longer Teaching.

'AL Capshaw'

 

[lovejoy]

I spoke with cardios office today regarding stopping coumidin and starting the Lovenox injections at prior to surgery. Absolutely not !! Evidently this surgery that I thought was very minor isn't ! I asked today if I would be able to come home day of surgery.........huh, probably not.
So now just waiting to hear when I have to go in. Wish I was brave enough to not have the growth removed, but at the rate its growing, probably not a wise move, but I'm sure thinking about it.