MarkU
Well-known member
Just got out of the hospital last night. Been there since about 3:30AM Saturday morning with rectal bleeding. The bleeding was coming from the base of one of the polyps removed during my colonoscopy on 3/4.
At the hospital they had me start the bowel cleansing procedure right away so they could do another colonoscopy and either cauterize or use a laser on the bleeding area. Problem was that I had just gotten my INR back up to 2.75 in the week after my original colonoscopy. My gastroenterologist had a fit when he found out that I hadn't followed his instructions to stay off both my Lovenox and Coumadin for seven days after my first colonoscopy. He didn't want to risk a second colonsocopy until my INR dropped back down to a maximum of 1.5. Since I was "cleaned out" by this time, he decided to keep me in the hospital, put me on a strict liquid diet, and keep me off my Coumadin until my INR dropped down to 1.5. I mentioned that it might take several days for my INR to drop that low, but he didn't respond and just walked off.
By Sunday night the bleeding had stopped on its own, but the doctor wouldn't release me - he figured that since I was "prepped" they should keep me there and do another colonoscopy just to check things out again. (My blood count never dropped below 14, so it was obvious that I had not really lost that much blood.)
Without consulting me, he prescribed some vitamin K to lower my INR, which the nurse woke me up to take about 1:30AM Monday morning. I was fuzzy headed when I took it and didn't question it, but afterwards wished I had been alert enough to do so.
By Monday afternoon my INR was only down to 2.1, but they went ahead with the colonoscopy anyway. They found the place that had been bleeding, which by now had healed on its own (not doubt helped by the fact my bowel had been empty since mid-day on Saturday.).
He also found another pre-cancerous polyp that he had missed during my original colonoscopy. It was next to the one that had been bleeding, but he decided not to remove it since my INR was still so high. Instead he wants me to come back and have it done in six months.
He told me again to stay off Coumadin for another week. I insisted that he consult first with my cardiologist. He refused to call my cardiologist directly, but sent him a message that I wanted a consultation with him. In the meantime, he sent me back to the room, and again without discussing it with me, left instructions to keep me for another day and to remain on the strict liquid diet.
My cardiologist showed up in my hospital room a couple of hours later. After he heard my story he stopped short of criticizing the gastro doc, but told me that I had done exactly the right thing to question his instructions regarding my Coumadin. In his words, "It's a lot easier to replace blood cells than brain cells". He told me to go back to my regular dose of 5mg per day and schedule an appointment in a week to get my INR checked.
My cardiologist also said he didn't see any reason for me to still be in the hospital, so signed release instructions for me. Unfortunately, he wasn't the admitting doctor, so the hospital had to contact my gastro doctor to get me released. Try as they would, the hospital couldn't get the gastro doc to answer his pager or respond to their messages. So I was stuck there for another night, still on my liquid diet.
Finally at 4PM on Tuesday, not having heard back from the gastro doc, my nurse decided she was going to go ahead and release me. She wrote up release instructions that reminded me to take my Coumadin and come back if I had any more bleeding. Not having had anything to eat since Friday evening, I headed for home and wolfed down a peanut butter sandwich in record time.
After my first colonoscopy, the doctor told me one of the polyps was malignant, but he had "gotten it all" and I therefore didn't need any chemo or other treatment. That fact that he found another pre-cancerous polyp adjacent to the first one a week later somehow doesn't leave me with a warm fuzzy feeling.
I guess that I'm glad that I had the original colonoscopy and am now aware of something I need to be watching, but I am definitely in the market for a new gastroenterologist...
At the hospital they had me start the bowel cleansing procedure right away so they could do another colonoscopy and either cauterize or use a laser on the bleeding area. Problem was that I had just gotten my INR back up to 2.75 in the week after my original colonoscopy. My gastroenterologist had a fit when he found out that I hadn't followed his instructions to stay off both my Lovenox and Coumadin for seven days after my first colonoscopy. He didn't want to risk a second colonsocopy until my INR dropped back down to a maximum of 1.5. Since I was "cleaned out" by this time, he decided to keep me in the hospital, put me on a strict liquid diet, and keep me off my Coumadin until my INR dropped down to 1.5. I mentioned that it might take several days for my INR to drop that low, but he didn't respond and just walked off.
By Sunday night the bleeding had stopped on its own, but the doctor wouldn't release me - he figured that since I was "prepped" they should keep me there and do another colonoscopy just to check things out again. (My blood count never dropped below 14, so it was obvious that I had not really lost that much blood.)
Without consulting me, he prescribed some vitamin K to lower my INR, which the nurse woke me up to take about 1:30AM Monday morning. I was fuzzy headed when I took it and didn't question it, but afterwards wished I had been alert enough to do so.
By Monday afternoon my INR was only down to 2.1, but they went ahead with the colonoscopy anyway. They found the place that had been bleeding, which by now had healed on its own (not doubt helped by the fact my bowel had been empty since mid-day on Saturday.).
He also found another pre-cancerous polyp that he had missed during my original colonoscopy. It was next to the one that had been bleeding, but he decided not to remove it since my INR was still so high. Instead he wants me to come back and have it done in six months.
He told me again to stay off Coumadin for another week. I insisted that he consult first with my cardiologist. He refused to call my cardiologist directly, but sent him a message that I wanted a consultation with him. In the meantime, he sent me back to the room, and again without discussing it with me, left instructions to keep me for another day and to remain on the strict liquid diet.
My cardiologist showed up in my hospital room a couple of hours later. After he heard my story he stopped short of criticizing the gastro doc, but told me that I had done exactly the right thing to question his instructions regarding my Coumadin. In his words, "It's a lot easier to replace blood cells than brain cells". He told me to go back to my regular dose of 5mg per day and schedule an appointment in a week to get my INR checked.
My cardiologist also said he didn't see any reason for me to still be in the hospital, so signed release instructions for me. Unfortunately, he wasn't the admitting doctor, so the hospital had to contact my gastro doctor to get me released. Try as they would, the hospital couldn't get the gastro doc to answer his pager or respond to their messages. So I was stuck there for another night, still on my liquid diet.
Finally at 4PM on Tuesday, not having heard back from the gastro doc, my nurse decided she was going to go ahead and release me. She wrote up release instructions that reminded me to take my Coumadin and come back if I had any more bleeding. Not having had anything to eat since Friday evening, I headed for home and wolfed down a peanut butter sandwich in record time.
After my first colonoscopy, the doctor told me one of the polyps was malignant, but he had "gotten it all" and I therefore didn't need any chemo or other treatment. That fact that he found another pre-cancerous polyp adjacent to the first one a week later somehow doesn't leave me with a warm fuzzy feeling.
I guess that I'm glad that I had the original colonoscopy and am now aware of something I need to be watching, but I am definitely in the market for a new gastroenterologist...
That just infuriates me the way your gastro handled the whole situation. My first question would be why did he have you stop coumadin to begin with. That is in total contradiction to the guidlines set forth by the ASGE Standard of Practice Comittee. Here is the link.
