New Here, Question On Coumadin

[Greg Zeszotarski]

My father-in-law has been on coumadin for a number of years (7) as a result of a heart valve replacement. Lately, he has been experiencing sever nose bleeds that require a trip to the hospital emergency room and chemical cauterization. It has gotten to the point where he will not sleep in his bed or go anywhere for fear of another nose bleed. Also, he seems to have become rather depressed along with this. He is 79 years old, and up to this time very active. Has anyone else ever had an similar experience? Is this bleeding more likely to happen the longer he takes the drug? How important is maintaining a strict, no change in routine, diet? Any help would be greatly appreciated.

 

[Ross]

Hi Greg and welcome to the VR family

I've started this as a new thread so that you'll get better and more responses to your question.

How often does your father-in-law have his INR checked?
Is it on the high side and out of range often?
I'm assuming that the cauterization hasn't improved his nose bleeding episodes any and it should have stopped them. He may want to see an Eye, Ear, Nose, Throat specialist about this.

About his diet-how and what does he eat now?
He should be eating anything he wants to eat, but should watch out for leafy greens and other high Vitamin K foods. He should still eat those too, but in moderation and be consistent in the amounts that he eats.

Fill me in on more of the details and we'll try to get you some answers. Again, welcome to the forums!

 

[joy]

Hi Greg,I agree with what Ross said, but it also goes with where you guys live? Is it dry? Does he have forced air heat in the house? Those are another couple of things that might contribute to his bloody noses.

By the way, welcome to VR.COM, I don't know what I would have done without these guys!

 

[Greg Zeszotarski]

Thanks so much for the prompt response.

My father-in-law usually has a PT done once a week or so, more often if he is outside the limits. He usually stays within the recommended 2.5 to 3.5. His last nose bleed he was up to 4.0. He went to an eye, ear, nose and throat specialist after this last bleed out as recommended by his GP. The specialist cauterized a few more vessels and said that when he has another nose bleed to call 911 immediately. This, of course, did nothing for his confidence. He had spent about an hour trying to stop the bleeding himself before calling for help. I should mention, he also has had bleed outs in the region of his hip and back. Once during the summer while doing yard work, later in the day the muscles in his hip froze. We did an ER visit; they sent him home and told him to apply ice. He had a black and blue area all the way from his lower back to his foot. This has happened twice. These were both traceable to some physical exertion. He seems to be able to live with those. It?s the nose bleeds that have him really worried because the last one happened while he was asleep.

We have had an exceptionally dry and cold winter here this year. My father-in-law has a humidifier on his furnace and keeps it at about 40%. The specialist gave him some type of medicated salve to apply to the inside of his nose. I am wondering if he is not applying enough of it. The specialist applied it to the extent that it was almost dripping down his upper lip. My father-in-law applies a little with a Q-tip three or four times a day. I should also mention that as long as I have known him (30+years) he has had sinus problems.

Since the last nose bleed he is also afraid to sleep in his bed. He sleeps in a recliner in his living room. The first few nights he was fully dressed ? including shoes incase he had to make a quick exit to the ER. I am wondering if it would help to elevate the head end of his bed to take pressure off the vessels in his nose.

Sorry about making this book length, but these things are never simple. Once again many thanks.

 

[Ross]

As much as I hate to say it, this sounds like a very unusual case. I know my nose starts bleeding when I hit 4 to 4.5 and then I'll eat some greens, perhaps some brussel sprouts and usually with in one days time, the bleeding subsides.

I find it extremely strange that even after cauterization he's still having problems. I think I would go ahead and elevate his bed. I mean why not, he's sleeping upright anyway right? Can't hurt anything.

I'll leave it at this and we'll wait and see if Al or Marty can shed some light on this situation.

 

[Nancy]

Hi Greg-

I'm so sorry that your father-in-law is having those nosebleeds. They can be frightening.

My husband has a "bleeder" in his nose and for no reason at all, he can develop a nosebleed. We have always been able to stop them, but one time it was a real struggle. Finally it stopped, but he has had his INR checked out just after these, and most times it's normal. He's had that bleeder since childhood and also has sinus problems. If it doesn't stop within a reasonable amount of time, the ER is the only place to be, however you can get there.

My husband has been on Coumadin for 25 years.

I think he needs to see an ENT man. Perhaps it's higher up than your father-in-law can get the packing to, and there might be other conditions going on too. So a specialist is a very good idea.

You can get a large wedge shaped piece of foam to elevate his head if that would help. If you just elevate the bed at one end, he'll slide out on the floor! Those pillows probably can be found in a surgical supply place. Some sleep shops might also have them.

Best wishes to him. No one should have to worry when they go to sleep. I'm sure there a solution for him.

 

[Greg Zeszotarski]

Ross,
How fast does PT/INR respond to dietary changes? My father-in-law was 3.5 when he was checked on Monday, and woke up with his nosebleed at 3:00A.M. Tuesday morning. I am wondering if this was do to something he ate or did not eat for his evening meal. Also, have you had any experience with home monitoring. We live in a rural area, a long distance from his clinic. I was wondering if increased monitoring would be a good idea. I have heard of something called CoaguChek. Any thoughts on this?
Thanks,
greg

 

[Ross]

Generally, an INR of 3.5 isn't going to cause the nose bleed. He does seem to be a unique case. Does he run high blood pressure? The more I read through this thread, I'm starting to wonder if he's not a borderline Hemophiliac. You might want to ask the Doctor to check his clotting factors.

If I start getting too high, I'll eat a can of spinach or brussel sprouts which generally seem to knock the level down rather quickly. I don't have an exact amount of time, but I'm guessing within 24 hours. I'm not a Doctor, so you can take this idea but don't consider it gospel. What works for me, may not work for him or may cause him to fall too low and we don't want that to happen.

Home testing would be recommended though it's sometimes tough to get the insurance companies to pay for the machine and testing supplies. The wonderful people at QAS offer the protime unit from right here at VR. See the link below:
http://www.hometestmed.com/frames.php?f=http://www.hometestmed.com/p_protime.htm
They also have representitives that frequent this forum and answer questions about the unit, testing and so forth.
Given his cir***stances, I think it might be a good idea to check into either Coagucheck or Protime and see if it's possible to get a unit for him. I know the people here from QAS will go above and beyond in trying to get an insurance claim approved for you.

Check into it, it can't hurt to try!

P.S. You can reach Michele at QAS from email or Private Messaging from http://www.valvereplacement.com/forums/member.php?s=&action=getinfo&userid=547

 

[Greg Zeszotarski]

Ross,
Thanks much. I plan to gather together all this information and have a talk with my father-in-law this weekend and see how he wants to proceed. I will let you know the outcome. Also, many thanks for information on the home testing systems. This messaging system is really a God send.
greg