I get sooooo ticked off!!!

[njean]

I want to get paid what doctors get paid for monitoring my own health!!!!

Well, as you may recall, I had to go into the hospital last Friday for a cath so I stopped taking my coumadin as of Thursday evening. Actually on Wednesday I took my last dose of 10mg.

When I went in on Friday, it was 2.5 which the doctor said was excellent because he did not want it dropping any more than that because of my two artificial valves. So I was off coumadin on Thursday & Friday & then took my usual dose on Saturday evening when I came back home. You would think that before releasing me, they (the hospital) should have checked my INR to see where it was! But like my husband said, they didn't do it because they didn't have orders from your doctor to do it!!

I just checked my INR & it is at 1.6. So, I just called my cardio & asked him why I wasn't checked before I left the hospital & all he could say was, well, it was at 2.5 when I did the procedure but you need to get on Lovenox right now & check it on Tuesday to see where it is then.

I'm sooooo PeeO'd right now w/doctors, hospitals, blah, blah blah!!!

Just had to vent!

 

[Karlynn]

That seems to be quite a miss on their part. The good news is I imagine you'll be inrange pretty quickly.

 

[Bina]

Norma, weren't you nervous skipping your coumadin for 2 days....Those doctors should have sent you home with some Lovenox knowing full well that your INR would plummet 3 days later.

 

[Duff Man]

Norma, I share your sentiments. I went to the cardiologist the other day and he wanted to check my d-dimer for any indication of thrombi... so I get my lab orders, go to the lab and guess what box is NOT checked? D-dimer. So the lab lady called up to the doc's office to verify it should've been checked. I was pissed... that's how bad things happen, ya know? Sometimes it feels like these guys are way too cavalier with their patients lives.

 

[njean]

Well everyone if I was PeeO'd two hours ago, I am a spitting mad cow right now!!!

I drove into town to go get my prescription of Lovonox because the pharmacy said that they had gotten a Lovenox call in & they believed it was mine & guess what??? When I get there, it was NOT mine & my doctor has never even called in! And so I called him & he was doing a procedure on someone & is suppose to call me back; that was 45 minutes ago! I want to strangle him!!!

Somebody stop me; I don't want to die in prison!!!!


And yes Bina, I was VERY nervous about stopping my coumadin for 2 days & look at where I am right now?? Spit, spit, spat!!!!!!

 

[ALCapshaw2]

Which Doctor is doing a procedure?

If it's your cardio, call your PCP.

Bottom Line: Call every Doctor you know until youcan get someone to call in an Rx for your Lovenox.

Unless your Coumadin Manager sets up a Bridging Schedule for invasive procedures, it is NOT uncommon for the 'Ball to be Dropped' with NO ONE taking responsibility to follow through. (Been There, had that done, had to raise H*** and threaten to call my Cardio. Nurse called cardio 30 minutes later, came back with Lovenox! Surprise, Surprise. IDIOTS.)

 

[njean]

Which Doctor is doing a procedure?

If it's your cardio, call your PCP.

Bottom Line: Call every Doctor you know until youcan get someone to call in an Rx for your Lovenox.

Unless your Coumadin Manager sets up a Bridging Schedule for invasive procedures, it is NOT uncommon for the 'Ball to be Dropped' with NO ONE taking responsibility to follow through. (Been There, had that done, had to raise H*** and threaten to call my Cardio. Nurse called cardio 30 minutes later, came back with Lovenox! Surprise, Surprise. IDIOTS.)

Thanks Al; I just called my PCP because my cardio has not called it in yet or called me.

The answering service took my call at my PCP's office but being that it's FRIDAY (TGIF!) no one probably gives a rat's a##!

If in case I can't get hold of anyone, I was going to take 15 mg's tonight & then 10 tomorrow night & Sunday & check Monday morn.

Do you think that will work??

 

[Ross]

Don't take more then your normal dose, it's not going to work any faster and will certainly throw you over range in the end.

 

[njean]

Don't take more then your normal dose, it's not going to work any faster and will certainly throw you over range in the end.

Thanks Ross --- my PCP just called me back & he's going to call in the Rx to the pharmacy!

 

[njean]

My cardio just called me & apologized for all the confusion ---- he called in the Rx to another pharmacy! (but not until I had called for him several times already!)


So I feel better & he's off the HIT list!

Have a good weekend everyone!!!

 

[ALCapshaw2]

Glad to hear it worked out for you NJ.
.......

Now if it only goes as well for Jody C who now has an INR of 1.1 after getting a Vitamin K shot Monday (INR 7.1) and her Cardio's NURSE told her to double her dose and retest Monday. YIKES!!!

(see SVT and A-Fib thread by Jody C in Post Surgery Forum for 'the rest of the story')

 

[Jkm7]

Happy it has worked out for you, Norma. I was going to suggest going to an ER and asking for a lovenox injection....and Rx for tomorrow, if needed. Good your doctors responded.

 

[CThrock]

Boy, what a mess Norma.. I can't believe the hospital,forgetting something like that. I can't belame you for being upset. I sure would of been.
Glad everything worked out and nothing serious happen to you in the long run.
I hope you let the dr know that this was very upsetting..... to say the least.

 

[Guest]

NJ

It looks to me like everything happened just as was to be expected. If your INR was 2.5 before the procedure, it would have been 2.5 after the procedure. The INR measures the decrease in clotting factors caused by taking warfarin. This takes several days. It does not change very much from hour to hour. Even when you restart warfarin, your INR is going to continue to go down. This is because of the slow effect on the clotting factors. There was no miostake on the part of the hospital. The mistake was entirely the fault of the doctor who did not understand this most basic fact about warfarin. If the doctor did not want you to go below 2.5 then the only way to do this would be to continue you on warfarin. He should have known it would continue to drop and prescribed Lovenox.

When it comes right down to the basics it is not necessary to hold warfarin for a cardiac cath. Dcotors who specialize in pulmonary hypertension do cardiac caths on an emergency basis. They say it doesn't matter what the INR is, the procedure needs to be done. They deal with the resulting hematoma after they save the patient's life.

Warfarin is held before cardiac caths because people don't want a gigantic bruise in the groin area. So doctors hold warfarin because patients complain. You are actually better off (in almost every case) to continue warfarin and have a hematoma rather than a stroke from stopping warfarin.

You are from new Mexico, I see. You have three of the best "clot docs" in the country in ABQ - Alex Spyropolous, David Garcia and Ed Libbey, an a well respected nurse warfarin manager, Laura Earl. If you can, get connected with one of them.

 

[njean]

NJ

It looks to me like everything happened just as was to be expected. If your INR was 2.5 before the procedure, it would have been 2.5 after the procedure. The INR measures the decrease in clotting factors caused by taking warfarin. This takes several days. It does not change very much from hour to hour. Even when you restart warfarin, your INR is going to continue to go down. This is because of the slow effect on the clotting factors. There was no miostake on the part of the hospital. The mistake was entirely the fault of the doctor who did not understand this most basic fact about warfarin. If the doctor did not want you to go below 2.5 then the only way to do this would be to continue you on warfarin. He should have known it would continue to drop and prescribed Lovenox.

When it comes right down to the basics it is not necessary to hold warfarin for a cardiac cath. Dcotors who specialize in pulmonary hypertension do cardiac caths on an emergency basis. They say it doesn't matter what the INR is, the procedure needs to be done. They deal with the resulting hematoma after they save the patient's life.

Warfarin is held before cardiac caths because people don't want a gigantic bruise in the groin area. So doctors hold warfarin because patients complain. You are actually better off (in almost every case) to continue warfarin and have a hematoma rather than a stroke from stopping warfarin.

You are from new Mexico, I see. You have three of the best "clot docs" in the country in ABQ - Alex Spyropolous, David Garcia and Ed Libbey, an a well respected nurse warfarin manager, Laura Earl. If you can, get connected with one of them.

Thank you Al --- I appreciate your advise & I agree with you 100%. I felt very worried about being taken off coumadin, PERIOD!! But, I figured, okay, I have a good cardio that I've ranted & raved about before & seems to know what he's doing but HE dropped the ball!

I should never have been sent home without the Lovenox injections! In fact, he was suppose to come in last Saturday at around 9:30am to visit w/me & my husband about my procedure before I got released & he never did.

There's quite a few things that he (my cardio) has told me about my condition that are not settling right & are beginning to give both my husband & I a "bad gut feeling" so I need to hash this out with him on the 28th. I hope my husband can go w/me to this appointment.

P.S.

Oh & on another note & perhaps I should have posted this on another thread --- I went to the hospital to pick up a copy of my "right heart cath" & that was a joke!

It reads:

FINDINGS: The pulmonary pressure is 50/20 with a wedge of 5 at this point. Fluoroscopy was also done of both of the valves, the aortic and the mitral. The aortic valve appears to function normally. The mitral valve leaflet CANNOT be visualized. The aortic valve appears to be a St. Jude, as the mitral valve appears to be a Shiley.

So if after reading this & trying to make some sense of it, which I don't & it appears to be very vague, what was the "thumbs" up for???

You see what I mean now??