Talked to Surgeon

[denobobeno]

Hello everyone,
I know your probably getting tired of seeing my name on the forum...but, one more time..
I just thought I'd update you all on what I've found out. My Surgeon called yesterday (Sat) and told me he heard from his nurse that I would like to know my INR in the hospital etc..He had me on 5mg in hospital to start off.

He said the second day after surgery it was 1.
The 3 rd day it was 1.4
The 4th he said it jumped up to 2.1 so he lowered my Coumadin to 1mg to send me home because it jumped up so fast. I went home that day.
Just curious what your thoughts are on these numbers.
Thanks,
Deana

 

[Ross]

It was doing exactly what it should have and he should never have adjusted the dose. 2.1 is nothing to cut back on. If you'd of been 4.0 then perhaps there would have been reason for concern. The person doesn't understand Coumadin. It takes between 36 and 48 hours to reach a peak and be testable. He should never have backed it off and especially to 1mg. By backing it off to 1mg, he likely sent you below range over night and most likely is the cause of the clot that you threw.

 

[Karlynn]

I agree with Ross. The surgeon was just playing huge guessing games. Unfortunately for you, you are the living (thank God!!!!) proof of one of our most popular mantras - Doctors fear bleeding, patients fear stroke.

You were on 5/day for 3 full days, tested a 2.1, so he dropped your dose to 1 mg. Basically, he dropped your weekly dose by 80%. (Even though you hadn't been on it a week, that just gives an idea of how hugely he over-reacted.) Doctors who know Coumadin would have been thrilled with the 2.1 for a day 4 INR.

I'm so glad you are doing well despite the surgeon's ignorance.

 

[Lynlw]

From what i know about coumadin.(mostly things i learned here) it takes 3 days for coum to show up in the INR. since someone who is not on coum would measure at 1+/- that makes sense the first 2 days were at at 1 and 1.4, by the 3rd day when they coum was finally showing up you were close to range, w/ your 2.1 (what's your range? 2.5-3.5 or something like that?)so In my unmedical opinion, he should have left you at the 5 and tested you again in a few more days. and I thought when you change the dose it should be in small increments like 10%.
The fact that he changed it from 5mg to 1 mg when you were close to range makes no sense to me,BUt even worse he changed it to 1 mg, sent you home and didn't have you tested for 10 days.EVEN if he didn't change you from the 5 you still should have been checked before 10 days passed.
After hearing his logic, I pray even harder that you get to different doctors to manage your coumaden, I also think this should be reported. Honestly this scares me, if this is how he manages coum I wonder how many of his patients don't have stroke or worse. Lyn

 

[geebee]

Certainly understandable why you had the stroke. You weren't even really much in range at 2.1. For the doctor to back off your dose at that point is just plain ignorance on his part at best and malpractice at worst.
I pray that you get through this and end up better than ever. I am sure you realize how lucky you are to be here.
Take care.

 

[denobobeno]

Thanks for helping

Thanks for helping

Okay, thanks. I'd rather ask ya'll than my Card. I figure they'll (docs) stick together. I just wanted to know before I went to alot of trouble checking into alot of things.
My primary care Doc is closely watching my INR. He is fabulous and is VERY careful. He is the one that set up home health. His Nurse calls me as soon as she gets the results. She doesnt' even wait an hour! Very attentive!
I see my Neurologist Tues. I'm hoping he gives me a positive outlook for the future as far as my 'brain' is concerned...
Thanks again,
xxooDeana

 

[TikTak]

Yeah, it's not like that the INR is (constant) rising on a certain dose. At starting of treatment and dose changes, it takes a few days for the INR to level out and reach "steady state". At which level is of course dose dependent.

Wish you a full (or at least damn close ) recovery from this incident.

 

[Lynlw]

Okay, thanks. I'd rather ask ya'll than my Card. I figure they'll (docs) stick together. I just wanted to know before I went to alot of trouble checking into alot of things.
My primary care Doc is closely watching my INR. He is fabulous and is VERY careful. He is the one that set up home health. His Nurse calls me as soon as she gets the results. She doesnt' even wait an hour! Very attentive!
I see my Neurologist Tues. I'm hoping he gives me a positive outlook for the future as far as my 'brain' is concerned...
Thanks again,
xxooDeana

Deanna, If it makes you feel any better while you walt for your nuero testing, i have been very impressed w/ your thought process and typing skills since the stroke, if they are any indication of your long term, i think it is a good sign. is your new picture recent? if so you look really great too Lyn

 

[ALCapshaw2]

Deana,

I REALLY hope that you will ask some knowledgable professional in Coumadin Management what they think should be done about how your case was managed.


I would be giving serious consideration to reporting your case to the Director of the Hospial and maybe even the State Medical Board.

What your surgeon did sounds like a serious case of MALPRACTICE based on total IGNORANCE of how to manage Coumadin (in my non-professional opinion).

You may want to send a Private Message or e-mail to Al Lodwick for his opinion.

'AL Capshaw'

 

[catwoman]

Deana:

Have you requested a copy of your surgical report & hospital records, showing everything that was done to/for you? Not just an itemized statement from the hospital to insurance, but listing everything -- when any blood test was run, results/temp taken, results/pathology on tissue/etc. etc.

Might be worthwhile to pursue getting copies of these.

 

[Guest]

I agree with some of what was done. When you are starting on warfarin, it often takes 3 days for any change in the INR to show up. An INR of 1.4 after 1 or 2 doses surely indicates that you were overdosed. 2.1 on the third day is a huge jump for just starting warfarin. Your dose needed to be reduced but surely not by 80%. 3 or 4 mg per day with daily checks of the INR were what was needed. Not necessarily daily dosage adjustments just daily checks. When you raise the INR too fast at the very start of therapy, you increase the risk of clotting (unless you were on heparin) because you are also knocking out some natural anticoagulants,too.

This is another reason to not become fixated on the lab values but to look at the whole picture. By forcing the INR to jump early in therapy the doctor is saying, "Lets put this person at risk of a strokeso we can get them out of the hospital with nice looking labs" -most surgeons do not like mucking about with pills, so they do not know enough about this to think it through.

 

[denobobeno]

leakage

leakage

Okay,
Thank you everyone!!! I am requesting all my records from the hospital. I haven't yet....but, I am tomorrow!

New subject...my Surgeon called Sat. and said he believes the leakage is normal. My Cardiologist told me today that the perimeter leakage was normal but, he wanted to look more closely at the center of the valve that apparently has some leakage and a better look at the left ventricle. He wants to do a transeosophogial (sp?) I really dread having to go through that...I still remember that 'big ole tube' down my throat and feeling like I was choking to death ... okay exageration.. but, if you've had one you know what I mean.. it's miserable.
I'd rather be safe than sorry but, my Surgeon told me he had a 'specialist' with echos look at it and he said the leakage was normal.
Who do I listen to ??
What would ya'll do?
Thanks,
Deana

 

[Ross]

If they start the sedation soon enough, the TEE shouldn't be that bad. The trick is, getting that sedation going.

 

[denobobeno]

Sorry, I forgot...Lynn, that pic was taken last Christmas.
I think I have a few more wrinkles now!!
xxooDeana

 

[catwoman]

Deana:

I've read quite a few posts here about leakage around perimeters right after VR, until the cuff or stitching (whatever it's called) heals & settles in. I'm probably not describing it correctly, but that's my intepretation of what I've read.

I still have a trace leak of my MV, but neither my former nor my current cardio have been concerned. Echos have been OK.

Re: medical records.
Most of us here do keep files of our medical records. My former cardio scheduled me for echo first, then echo was interpreted, report written, & then I saw him -- all at the same appointment. The new one saw me in mid-May, then scheduled me for an echo 2 weeks later (TWO @#&*@ co-pays!!!). I had to call to get a copy of the echo. We are going to be changing that procedure, or I will be looking for yet another cardio.
I keep all my echos, results of all lab work together. I also keep all my little PT/INR booklets together. My PCP gives me record booklets provided by Coumadin's manufacturer. I also record each time I recharge my ProTime 3's battery (if I had an INRatio monitor, I'd record when I replaced batteries), any factors that might have influenced a jump or drop in my INR (new meds, sickness, dehydration, etc.).

If you haven't already, you'll probably be considering some kind of ID bracelet or necklace in case of emergencies. The week after my surgery, I bought a generic necklace one @ Wal-Mart for just a couple of bucks, then spent $15 or so having info engraved on it. Several months later I discovered Medic-Alert, & signed up & got a bracelet that looks like a watch.
I would have stayed with a necklace -- if only cats hadn't kept trying to grab it & choke me.