Need advice from Al!

[csutherland]

From what I've read on here today, I'm thinking Jerry has been given some bad instructions.

Every tooth in his mouth is capped since 2000. He's been having some pain in a wisdom tooth (what's left of it) for a while. He's very tolerant to pain and waits forever before even saying anything. Anyway it got intolerable yesterday. He was sent to an oral surgeon who says he probably has a pus pocket under there and wants to extract it next Friday (the 3rd). He prescribed 30 Amoxil capsules to take 3xday until then, plus the 4 to take 1 hr before. I'm glad he has the 30 to take in the meantime because I don't like the idea of an abcessed tooth with a mechanical valve.

In addition, they've been in contact with the cardio who says to stop his coumadin for 5 days prior! I'm not liking this at all. I'm way more scared of a stroke for him than a bleed. But to add to the dilemma, yesterday he had his monthly INR check and it was 4.7. It has been well in range, 2.5 - 3.5, forever. He's been stable with no changes in dosage or times between checks. We can't figure it out. He's very active, has been eating several leaf lettuce salads and even had "wild greens" a couple of times lately. (Only you folks from the South will understand what I'm talking about) I'm even wondering if he should be re-checked in case there was an error in the testing.

My question for you Al is this: How do I approach them with my questions? I don't want them to think I'm some old woman who gets her info off the internet (I am). I'm thinking I might call the nurse at the coumadin clinic instead of the cardio's office. Jerry suggested we just do our own thing, lowering the dose somewhat as instructed yesterday, then resuming the normal after the extraction. Whatever we decide will have to be fast, because the weekend is coming up and Monday's a holiday.

 

[geebee]

I know I am not Al but this advice is WRONG, WRONG, WRONG AND WRONG!!!! I cannot believe a cardio actually told him to stop his coumadin for 5 days. What an idiot.

Bleeding can be a bit of a challenge for an extraction but nothing that cannot be handled. You could certainly lower it yourself to 2.5 or so with the help of the clinic. You will still have some bleeding but it should be manageble.

Talk to the coumadin clinic folks and see what Al has to say but the instructions of the cardio are way out of line. Also, once Jerry has been on the antibiotics for a few days, the infection will get better and this will not be such an emergency. Certainly something to address but you have time to research.

 

[Mary]

I know I am not Al but this advice is WRONG, WRONG, WRONG AND WRONG!!!! I cannot believe a cardio actually told him to stop his coumadin for 5 days. What an idiot.

Bleeding can be a bit of a challenge for an extraction but nothing that cannot be handled. You could certainly lower it yourself to 2.5 or so with the help of the clinic. You will still have some bleeding but it should be manageble.

Talk to the coumadin clinic folks and see what Al has to say but the instructions of the cardio are way out of line. Also, once Jerry has been on the antibiotics for a few days, the infection will get better and this will not be such an emergency. Certainly something to address but you have time to research.

Gina,
I'm so glad you posted what you did. I haven't had replacement, I 'm not on coumadin, but even I read the post and thought, "NO WAY!"
It's pretty bad when I know it's bad advice!

I don't know how you should appraoch the cardio (well, you could print off these responses and show them to him ), but I do know you shouldn't follow his advice.
Mary

 

[tobagotwo]

I completely agree with Gina that the cardiologist is wrong in this case. Is the oral surgeon okay with Jerry having a stroke in the chair, as long as he doesn't bleed too much?

He is not going to bleed to death from a pulled tooth, Coumadin or not. Why should anyone risk a stroke to have a tooth pulled?

The antibiotic sounds quite sufficient to keep Jerry safe from endocaditis, so the oral surgeon has his head screwed on right about that, anyway.

Best wishes,

 

[Guest]

Almost every time I see someone with a toothache, their INR is high. It would seem logical. Toothache, hurts to chew, eat less, less vitamin K intake, constant warfarin dose, INR goes up.

These things off the internet have medical journal references
http://warfarinfo.com/procedures.htm

http://warfarinfo.com/dentalprocedures.htm

the chart shows what can be safely done at what INR and is reprinted by permission from the Journal of the American Dental Association.

If the oral surgeon won't agree to doing the procedure at the recommended INR, then find someone who will.

Several years ago, I successfully helped defend a dentist whose patient had a stroke in the chair. However, I think that it would be impossible to do today.

 

[Karlynn]

Keep a close eye on his INR now that he's on the antibiotic. It can hike it up somewhat.

 

[hensylee]

I think you should call the cardio nurse, too. These nurses are pretty up on things. You need more advice from a good professional - and you can't beat what Al tells you.

 

[Nancy]

Hi Celia-

Just wanted to address your concern that you'll be viewed as some kind of meddlesome creature if you speak up in Jerry's behalf.

Please don't let that concern you one little bit. The ONLY thing that matters is that Jerry gets proper help as soon as possible. So you just go ahead and "let 'er fly" with your questions and concerns. Let the doctors sort it all out. And by the way, who cares if they are rubbed the wrong way? It's not easy at all to sit there and listen to something you know is wrong and then have to follow through with it. Been there, done that WAY too many times.

No one on the earth is perfect, and that also includes members of the medical profession, patients and their spouses.

The only thing that matters is that Jerry gets proper help as soon as possible--to repeat myself.

 

[Blanche]

Celia:
I am an old woman who gets her information off the internet--the largest liabrary in the world, filled with articles written by experts and published in juried journals. Because of this and the ancedotal information presented on Valvereplacement, with the expertise of a nationally and internationally recognized expert on anticoagulation, Al Lodwick, I have been able to help my husband's doctors, dentists, nurses and other medical professionals avoid life threatening practices and procedures in the care and treatment of my husband. Doctors are overwhelmed with patients, medicare dictates, insurance pressure and requirements, and the accelerated rate of new information and research in their profession. It is mandatory that we act as advocates for ourselves and our families. My husband's internist calls me his favorite PITA.

Last year Albert needed periodontal work for two teeth. His periodontist told him to hold Coumadin for three days. Anticipating this, I arrived at the appointment with a copy of 18 articles which all stated that this practice was not only unnecessary, but that it was dangerous and could put the patient at serious risk for a stroke. The periodontist not only looked at my materials, he did his own search and found others. Albert had his procedure with an INR of 3.0 and had no difficulty. He did bleed at first, but the periodontist was able to control this and the bleeding stopped in a few hours. Actually, Albert said that the bleeding was not much more than that which he had on similar procedures before he was on anticoagulation.

I am including some of the materials that the periodontist gave me. Celia, maybe we should start our own club.....What do you think?

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=11829234&dopt=Abstract

http://www.perio.org/resources-products/pdf/23-Cardiovascular.pdf

http://www.attract.wales.nhs.uk/question_answers.cfm?question_id=1092

Kind regards,
Blanche

 

[csutherland]

Update: dental work & coumadin

Update: dental work & coumadin

I called the coumadin clinic this morning first thing. When I told her the cardio had instructed the oral surgeon to tell us to stop coumadin for 5 days she said, "no, more like two". (Remember, his INR was 4.7 Wed) That's pretty consistent with one of the articles Al posted. She was very receptive to my concerns and wants to see Jerry on Tues for an INR check to see whether or how long to hold the coumadin. He previously had not even been told to have it checked again prior to the extraction.

We had forgotten that a year or so ago we went through something like this with a colonoscopy. The dr who did the procedure wanted the coumadin held for a certain number of days afterward I believe. I convinced him that I was more concerned with stroke than bleeding and he reluctantly compromised with us. Jerry even had one polyp removed and had absolutely no bleeding afterward.

Anyway, we feel better about it. Obviously the coumadin clinic, which is closely associated with the cardiology group, knows more about this than the cardios.

 

[Guest]

I have had a cardiologoist tellme that he didn't go through all that schooling to dose warfarin.