Well, it seems there is always something new to learn. I'll try to make this as short as possible. I have a long time shoulder problem which was compounded by a fall last spring. Many tests and treatments later I am at the point of having a cervical epidural done tomorrow to help relieve the shoulder and arm pain.
It was mandatory that I hold 5 doses of warfarin. Lovenox is not permitted within 24 hours of the epidural either.
Thurs: INR 5.8 (we were hours off the plane from vacation) Held warfarin (I take 6.5mg per day)
Friday: INR 4.7 ...held warfarin
Saturday INR 2.8...held warfarin
Sunday INR 1.5.....held warfarin
Monday INR 1.2 ..............will hold tonight and have epidural tomorrow.
It seems the risk of spinal hematoma is greater than the risk of a stroke. I had to bend Al's ear on this one....thanks, Al. Today I saw my PCP and he said next time I need to be hospitalized and put on heparin, and would have preferred me doing it now. He would have had me in the hospital 2-3 days already. I start Lovenox as soon possible following the epidural. In this instance, my post-vacation INR was to my advantage as I ended up staying in range a little longer.
My PCP seems to be more in favor of skipping the epidural and proceeding straight to the neurosurgeon. It seems like a surgical correction is likely. To make the situation more interesting we discussed some other test results including the last echo which showed my pulmonary pressures still to be increasing. (last RVSP 48.4). He said we should do a right and left heart cath (this time with hospitalization for heparinization) and then armed with the fresh data head up to the PH specialist at Duke.
Well, I'm just going to take it one day at a time for now. The reason I'm posting this is because I think it shows, what has been for me anyway, one of the most difficult aspects of being on warfarin. Most of the time it is just something that is no big deal at all but when there are other medical situations that arrise then it just makes some already complicated situations even more so.
I'll let you all know how it goes.
It was mandatory that I hold 5 doses of warfarin. Lovenox is not permitted within 24 hours of the epidural either.
Thurs: INR 5.8 (we were hours off the plane from vacation) Held warfarin (I take 6.5mg per day)
Friday: INR 4.7 ...held warfarin
Saturday INR 2.8...held warfarin
Sunday INR 1.5.....held warfarin
Monday INR 1.2 ..............will hold tonight and have epidural tomorrow.
It seems the risk of spinal hematoma is greater than the risk of a stroke. I had to bend Al's ear on this one....thanks, Al. Today I saw my PCP and he said next time I need to be hospitalized and put on heparin, and would have preferred me doing it now. He would have had me in the hospital 2-3 days already. I start Lovenox as soon possible following the epidural. In this instance, my post-vacation INR was to my advantage as I ended up staying in range a little longer.
My PCP seems to be more in favor of skipping the epidural and proceeding straight to the neurosurgeon. It seems like a surgical correction is likely. To make the situation more interesting we discussed some other test results including the last echo which showed my pulmonary pressures still to be increasing. (last RVSP 48.4). He said we should do a right and left heart cath (this time with hospitalization for heparinization) and then armed with the fresh data head up to the PH specialist at Duke.
Well, I'm just going to take it one day at a time for now. The reason I'm posting this is because I think it shows, what has been for me anyway, one of the most difficult aspects of being on warfarin. Most of the time it is just something that is no big deal at all but when there are other medical situations that arrise then it just makes some already complicated situations even more so.
I'll let you all know how it goes.
Hate to hear the news about your ph, too.
