REQUEST TO STOP WARFARIN.......DRS orders

[zipper2]

This is regarding a cancer spot on my moms cheek size of a dime @ they will
need to take and graft of skin to cover this.
In 1994 she had a blood clot and heart attack reasons due to her being on comadin now
never had any heart surgery however i feel we lower it but donot take her off it.
she takes 2.5 mg daily for the week her inr stays 2.5 2.8 range where required for her
and is stable on the inr checks . They will take skin graft out of her neck to cover the site on face.
I just finished explaining to this Dr from Saskatoon she will not be coming off her warfain for 4 or 5 days for this procedure thats unreal.:eek2:
she will be having this proceedure March 30th and the cancer is nothing to worry bout
it just keeps reoccuring biggar each time and needs to be cut out.
Am i correct to stand my ground with this dr that i refuse to stop her warfarin entirely?
thankyou for your side of this input any suggestions would be appreciated

 

[Protimenow]

I certainly can't advise about this, but I do suggest that you find some of the latest literature and perhaps provide a copy of some of the recent thinking to this surgeon from Saskatoon. It's certainly kind of scary for a doctor who has visions of uncontrollable bleeding from a procedure like this, but I think the fear may be greater than the actual facts. Again, I'm just suggesting finding some of the latest papers related to surgery and anticoagulation.

Some others on this forum - somewhat more resourceful than I am - may even be able to direct you to articles with current thinking about this topic.

 

[Natina13]

Have a second opinion done, with a Hematologist and an Endocrinologist . Best of luck, hope all goes well. Your family will be in my prayers.
Renee

 

[JimL]

Some years ago I had to have some cysts removed. I had to search for a doctor who would do so while I remained on coumadin, and I did find one about an hour drive away. I had several cysts cut off at different times while I remained on coumadin, and did not have any bleeding problems at all. I'm not sure how the cancer compares to the cysts as far as bleeding problems.

 

[lance]

Deb
I sent you a private message.

 

[Herb M]

I had 2 cancers removed, one on the nose and another on the chest. I did not stop coumadin and there was no unusual bleeding. I think the physician does not know much about coumadin. He should get advice from a physician that has more knowledge.
Stopping for 4 or 5 days is rediculous. Did he at least mention anything about taking lovenox if coumadin is stopped for a few days.

 

[zipper2]

Im waiting to get a phone call back regarding the use of her coumadin
i mean this doc is just in diaper training himself,like coagulation education is
not part of his training obviously take her off 4 to 5 days prior to removal of
this skin cancer tells me he knows nothing but what hes been taught falsely,
the fear of coumadin.
when discussion of bridging was questioned he said no just stop the warfarin so
isn't alot of bleeding he said,OH MY GOSH:rolleyes2:i knew where i was headed.
No dought he is a great dr but not on the knowledge of coumadin anyway i'm not
allowing her to stop the coumadin and she will be fine will keep an eye on inr's and thats
that he looses his way and be it another doc then be it.
Imhaving trouble with my big toenail awhile back some i stubbed it the nail and on
March 21st :eek2:im having it removed surgically.At least ohs your asleep...GOSH
I am on 8 mgs daily of coumadin 19 years now im not coming off it to do this proceedure
and i know from experience my mom will be fine also only differance is the way each her
plastic surgeon looks at it and my Dr looks at it a differance of two drs and what and how they are taught to look @ coumadin one fears, it one doesnt i guess only way for
some of these doc's to ever understand coumadin is take it themselves its a losing
battle with them so best to keep quiet @ do what they are experienced best ,only.:wink

 

[AgilityDog]

Hey Zip, look for the articles where the EPs are now replacing pacemakers without taking patients off coumadin. Really, it's a much bigger surgery to remove a device the size of a cell phone and reimplant it than what your mom is going to have done.

 

[Protimenow]

If you can avoid having that toenail removed, do so. I had one removed years ago, and the nail bed killed with Silver Nitrate (and this incompetent boob who did the surgery didn't completely kill it, so I get a stub growing at the right and left side of my big toe -- a real pain in the .... uh... foot). I had another on the other foot, removed twice, and the nail never really bonded well to the underlying tissue. If there's a way to avoid that fairly simple procedure, I would do so if I were you.

I couldn't really fully understand what you were saying in your previous post - but second the suggestion to find another doctor who is more familiar with the actions of warfarin and the latest recommendations.

 

[Duff Man]

+1 second opinion

 

[zipper2]

The doc is so ....FIRED..... Returned my telephone call and his request was now 6 days off her coumadin
I phoned my family doctor who is also my moms dr. and he set up a new Dr. we will meet tomorrow.
HAPPY DANCE.....HAPPY DANCE i will keep u updated on this for now gonna start a toe post (LOL)

 

[Protimenow]

OTOH -- because it's a skin graft - and the skin is very richly supplied with blood - and it's a fairly large area of skin being removed, it may be prudent to want the INR to be somewhat closer to 2.0 than you normally keep it -- and to have a finger stick test to see what it is before surgery, so the doctor knows what he or she is dealing with. However, a second opinion -- or second surgeon -- is certainly not a bad idea.

And what's wrong with a toe post?

 

[Freddie]

Deb, I wish you luck on finding a Doctor around here that knows anything about warfarin, except for my cardio and "Ron". Man I hate to think what I would do if I had to have any kind of procedure done.

Who is the doctor you first talked to? The one that said to hold for 6 days?

 

[zipper2]

Freddie his names Burnell plastic @ reconstructive surgery:rolleyes2: dont ever go
to him
seeing new doc this afternoon for her

 

[Protimenow]

I hate to think how many other patients were advised to stop taking coumadin, and didn't bother to ask questions like you did. I wonder if any actually had negative consequences because they listened to this doctor. (It'll probably be impossible to find out, but it's certainly a good reason why people should continue to be encouraged to learn all they can about their conditions and, if they're on warfarin, to be able to come to forums like this for a bit of somewhat educated (I'm including myself here) feedback).

 

[zipper2]

An update to this thread

We had a great doctor did her surgery on March 31st her inr was 2.3
We didnot hold any coumadin for 6 days prior did monitor her inr with home monitor.
the cancer was on her nose just where here glasses drop on her cheek it was a big
ulcer so they cut alot and deep to get it all.
The doc grafted with piece taken off her neck area,then stitched bandaging to it.
Bandage was removed 5th of april and it looks good and healing nicely with prior
cleaning of water @ epson salts and just a bit polysporin and large enough bandage
cover are the instructions.
I just donot agree to coming off coumadin as was requested by 1st doc.
She had no accessive bleeding all went great and i'm glad it is over,she sees the doc
in 4 weeks time but this doc has phoned me at home and to her home,nuerous times
just to see how she is doing any problems he will come up and even left his phone
number to his house.....AWESOME DOCTOR fro what we started with:smile2:

 

[Protimenow]

This sure sounds like a great doctor. It's too bad there aren't more of them all over the world (or if there are, that they'll be easy to find). I'm glad your mom was able to get this done without following the first doctor's advice - and I'm glad that you were able to check with this forum for some valuable feedback.

This is good news. Thanks for the update.

 

[Lynlw]

I'm glad things are going so well for your Mom. Thanks for the update.

 

[Bina]

Deb, that is great news. Whenever a patient gets an unsure feeling about a doc, get a second opinion. Yay !!

 

[Jason]

Great news. You were a great advocate for your mom!