Questions about Israeli PM Sharon's stroke

[Guest]

A couple of important points.

Warfarin and Lovenox do not break up or dissolve clots. They prevenr them from getting started or from growing after they are started.

The New York Times has not been a good source of news about warfarin in the past. They have written about warfarin changing the viscosity of the blood. It does not do that. It slows the ability to form a clot.

When you slow the ability of the blood to clot, then by definition you increase the risk of bleeding.

The problem is that you don't exactly know the limits of how much to give. With warfarin, staying in your range gives the most protection from a stroke with the least risk of bleeding. But like everything else in life, there are no absolutes.

I use a lot of driving analogies. It is rather like driving with no speed limit signs posted. There are speed limits - you just don't know for sure what they are. However, you are still likely to get into trouble for violating the laws.

Mary, I wish I could comment on your mother's case but I have no experience with this sort of thing.

 

[Blanche]

Gisele

Gisele

You certainly didn't bore me. I obviously have a vested interest in information about strokes and anticoagulants. I have not known how to respond here, so I have been holding my own counsel. The information that you presented did help direct my thinking. Thank you for sharing your experiences with us. Hope are well and enjoying life now. You have bee missed.
Blanche

 

[Granbonny]

I was the old friend that asked Gisele to post on this thread. She has 564 posts on VR.Com..A wealth of infomation on what she went thru..2 years ago...We old-timers went thru it with her.......Posting and praying that she would come thru her ordeal..........Thank you for coming back and posting, Gisele. ...You are a great friend and e-mail buddy. ...Bonnie

 

[Guest]

Gisele,

I applaud your courage. You have no idea how many pharmacy students I have discussed your experiences with.

I wonder if PM Sharon had failing kidneys and they didn't adjust his Lovenox dose downward for this and he was overdosed.

 

[Gisele]

I remember going through it all with you.......

I remember going through it all with you.......

You were all so much of a support team for me because I felt that you all were going through this every step of the way with me. Thank you.

I'll be honest though, I don't miss my Coumadin........and my Lovenox.........let's just say we didn't get along too well.

Guess I was just one of "those" patients who even though I followed the rules things just didn't work out. I wish eveyone here on the board good luck. There are so many new people here I just can't keep up!

 

[bvdr]

You are missed around here Gisele! Thanks for coming back in to visit. I hope all is going well with you. Sometimes I ponder the situation you were going through. If I remember right, you were totally off ACT while you awaited getting a biological valve. We were all anxiously awaiting with you and praying you would be fine. I also seem to remember that while you were in the hospital one of your family members posted that when they explanted your mechanical valve it was noted that some clotting had begun to develop. Do you remember how long you were off any anticoagulation therapy?

 

[Gisele]

Hi Betty!

Hi Betty!

Hmmm......Let me see..........I think I went off Coumadin in Boston with the subdural and after the heparin incident they decided I should not go back on it. I had to wait three months to get my heart surgery because they wanted to wait for my head to heal ???? Betty....I am not sure.....the reason..but I know I was at least three months with no Coumadin, no Lovenox, nothing......it might have been longer....wait..........closer to 4 mos.......so I guess I was lucky, huh? Especially with a mitral mechanical valve too.

Glad it is all behind me now. That was ever so scary.............how are you doing?????

 

[Guest]

Even though it has been quite a while since you posted, Gisele, it does not appear that you have aged at all.

 

[Gisele]

Lol

Lol

OK, I'll get Ross to help me change it..........ross?????

 

[Marge]

Ongoing debate over Sharon's treatment

Ongoing debate over Sharon's treatment

The BBC reports that debate over whether Sharon got/is getting appropriate treatment is "front-page news in Sunday's Israeli press."
There are several articles today in Haaretz, one of the major Israeli papers. Haaretz English language site: http://www.haaretzdaily.com/hasen/pages/ShArtVty.jhtml?sw=martin+rabbai&itemNo=667331

The BBC interviewed its own expert, who said that it was "very bad medical management to use anti-coagulant drugs" in this case:

<<A senior UK-based cardiologist told the BBC News website the fundamental question concerns possible misdiagnosis after the prime minister suffered a first minor stroke on 18 December.
After that incident, doctors found that Mr Sharon had a birth defect, a patent foramen ovalis (PFO) or hole in the heart, which they planned to close with a catheter operation. Doctors said the hole was thought to have contributed to the minor stroke.
But, in the light of subsequent developments, the cardiologist believes it created a blinkered, over-rosy picture, which allowed Mr Sharon to keep up his punishing work schedule at a time of high political importance.
"A PFO is a condition that 20% of people suffer from, but it's extremely unlikely to cause a stroke in a man in his 70s," the cardiologist said.
"If it's going to affect you it'll happen when you're in your mid-30s, not in your 70s."
Doctors at the Hadassah insist Ariel Sharon has received the best care
Instead of the congenital defect, Mr Sharon's first minor stroke was, the cardiologist said, more likely to have been caused by obesity, lifestyle or the severe stress that he has been under, with Israel at a political turning point and his son Omri embroiled in a corruption scandal.
His doctors prescribed anti-coagulation medicine as he awaited catheterisation and Mr Sharon brushed off the crisis, refusing to take the month or more's rest that most doctors would have ordered.
The UK doctor says the blood-thinning treatment would alleviate his condition as diagnosed but could prove "catastrophic" in another scenario, if, for example, Mr Sharon had suffered an undetected haemorrhagic stroke, or "small bleed" in his brain.
"It is very bad medical management to use anti-coagulant drugs in a case like this, because in the event of a small bleed it will make matters much worse," he said.
Professor Martin Rabbai, a senior Israeli neurosurgeon agrees with this view, in quotes in Sunday's Haaretz newspaper.
The heart catheterisation was "not recommended," the paper quotes the doctor saying, since it had not been proven that the stroke was caused by a blood clot crossing the hole in Mr Sharon's heart.
"On the contrary, it is advisable not to touch it," for someone in Mr Sharon's condition, Professor Rabbai said.
However the hospital director, Mr Krumer, defended all the treatments administered to Mr Sharon.
"These decisions were taken after consultation among senior staff at Hadassah hospital and with world-renowned specialists outside Israel," he said.
One neurologist told Haaretz he believed Mr Sharon was a victim of "VIP syndrome" - over-treatment given to prominent figures that is unnecessary, or even damaging, to their health.
Doctors say that, even if he survives, the condition is likely to have left him severely impaired physical and mentally.>> http://news.bbc.co.uk/2/hi/middle_east/4592488.stm

 

[hensylee]

Isn't it interesting that everybody in VR questioned his treatment!

 

[Guest]

I wondered about the VIP aspect, too. I remembered a case from when I was in college. The son of a prominent person in the medical school had an attack of appendicitis. The word was that the heads of all of the departments were called in. They operated on him and he died. Supposedly a case of clashing egos not allowing anyone to do what they thought was right.

My sister is a college history professor. When she goes to her university's medical center she refuses to be seen by anyone but the department head. I ask her if her department head is the best historian on the staff? It seems to me that department heads are the best politicians, not the best clinicians. I can't figure out why she would want to be treated by the best politician.

 

[lance]

Best politician--best physician?

Best politician--best physician?

Very well stated--gives pause for thought.

 

[Marty]

VIP syndrome?

VIP syndrome?

I agree that 1. Sharon very likely did not need to have his PFO closed. 2.He did not need to be put on enoxiparin. If he was not a VIP I think he would have been told to rest, and then re-evaluted later. VIP snyndrome? I think so!
I was a resident at Walter Reed in the 50's when Ike and a host of other VIP's were treated there. One of our internists in a moment of pique said if he ever became ill he would tear off his colonel eagles and all of his decorations and throw himself on the front steps and tell admissions he was a buck private!

 

[RCB]

Wow!

Wow!

You guys are so profound, it is scary!

 

[Mama2Rylan]

Cloxane?

Cloxane?

When reading some info about Sharon's stroke, it did seem to put alot of blame on the "blood-thinner"s (as they put it). I tried to read your posts first to see if it answerd my question I'm about to ask, but alot of this stuff is way over my head I'm afraid So my question is, what is Cloxane? That was the anti-coagulant that he was put on. Is it something new? All I have ever heard of is Coumadin (Warfarin) and Heperin...

 

[Lynlw]

I believe it's lovenox Lyn

 

[Guest]

Lyn is right. Lovenox is the US name, some countries use the brand name Clexane and maybe even Cloxane. It is all enoxparin - a heparin derivative.