Very Bad Painful Bruise, on coumadin...Need Advice Badly

[worktheday]

Hello all,

I hope this finds you all in good health.

I had AVR about 4 1/2 years ago. I am on Warfarin. My INR is within normal limits and has been, I do at home testing. With that said, about 7 days ago, in the middle of the night half asleep I walked directly into my bathroom door extremely hard hitting my tricep area of my arm. I didint think much of it at first. Woke up the next day a little sore but nothing to complain about. Over the last week the area has gotten much more....i dont want to say painful, well maybe slightly, but defintely extremely sore, tender, etc. In addition the swelling has continued to get worse, not better, and without even needing to say the bruising is horrible. Wraps 3/4 of the way around my arm, again starting from the tricep area, and around to the bicep area going from yellow to purple in color. I've gotten bruises since my surgery, but nothing that even comes close to this.

Now, I know with bruises with anyone, they get better before they get worse. But, I would of thought at this point, even being fully aware of the effects of being on coumadin, that i maybe would of gotten worse over say a 3 day period, maybe leveled out day 4 and 5, and began to see some reduction slightly in swelling and discomfort the last day or two. While actually I feel as if over the last 7 days it has continued to get worse each and every day. More swelling, more discoloration, more discomfort.

I havent done anything to treat it at all...ice, heat, etc. (I know I'm foolish for not having done that). But I'm not sure what to do at this point. I guess my questions are these:

Should this be a larger concern? Is this just a really bad muscle bruise and its going to take much longer because of the coumidin? Could there be something else going on I should be concerned about? And anything else any of you may have a feeling towards.

Unfortunately right now, I'm unemployed and without health insurance. Trying every day to obtain both, but has been an uphill battle. Hence, probably answering a lot of you who's first question is "if your that concerned how come you havent gone to your doctor or ER yet".

It really hasnt been until the last 24-48 hours that some concern has set in, not seeing any improvement. Any and all responses would be greatly appreciated!!

Thank you so much for taking the time,

Jay

 

[queenie]

I suggest you let your family doctor look at it. Better to be safe than sorry

 

[Lynlw]

I know this isnt what you want to hear, but I really would go to the ER to get it checked out. Well actually maybe you should call your doctor and ask to get checked out, maybe they would work with you if you explain about no insurance. Hopefully things are fine but there could be a chance there is small bleeding going on inside and maybe they would want you to lower yur INR for a couple days or have some other advice.

 

[dick0236]

I have had some bad bruising over the years and a bruise of seven days plus would not bother me. However, if it is continuing to get worse, the only way to be sure that there is not another problem is to get a medical opinion.

 

[worktheday]

Thanks for the responses so far. You know, Im thinking to myself as I read through my post myself, I think that if I was reading the same thing and someone else wrote it, I'm pretty certain I would respond saying simply to go to the doctor or ER. I would say IM 90% certain there isnt a larger issue. But I guess we all here for different reasons at different times have that 10% of "what if". Im not sure what the right thing for me to do right now is. Even if i go to the doctor, I mean really what are they or can they do for something like this? That isnt sarcasm, its an actual question.

 

[Jkm7]

ER could be a needlessly high bill but perhaps think about going to a walk in clinic if you don't have a PCP to see. It sounds like you should have a doctor look at it. I know you're trying to avoid a bill and understand but you could incur real injury and higher bills if you let this go. On the other hand, it might be fine if left alone. I'd err on the side of caution.

 

[worktheday]

Thanks for the response jkm7. I guess thats more to the point of where my questions stems jkm7....what possible "real injury" could this be other than a deep muscle bruise? What other things?

 

[kfay]

Jay, I know it has to be hard to make a decision about going to the ER for "just a bruise", especially when you don't have insurance. Do you know if you are at the high end or lower end of your range? If you are higher, and you feel comfortable doing it, perhaps you could try and get to the lower end of your range and see if that helps. If you google "bruising on coumadin", this was one of the first things that came up:

Bruises change in appearance over time, and it is possible to tell by looking at a bruise how old it is. When it first appears, a bruise will be reddish looking, reflecting the color of the blood in the skin. By one to two days, the reddish iron from the blood undergoes a change and the bruise will appear blue or purple. By day six, the color changes to green and by day eight to nine, the bruise will appear yellowish-brown. In general, the bruised area will be repaired by the body in two to three weeks after which the skin will return to normal.

What if the bruise doesn't get better or the area stays swollen?

On occasion, instead of going away, the area of a bruise will become firm and may actually start increasing in size. It may also continue to be painful. There are two major causes for this. First, if a large collection of blood is formed under the skin or in the muscle, instead of trying to clean up the area, the body may wall the blood off causing what is called a hematoma. A hematoma is nothing more than a small pool of blood that is walled off. This may need to be drained by your health-care practitioner.

A second and much less common problem occurs when the body deposits calcium, the material that makes up the majority of bone, in the area of injury. The area becomes tender and firm. This process is called heterotopic ossification or myositis ossificans.


It sounds like by your description of the colors, it may be getting better in places. Perhaps you had an area that continued to bleed for a longer period of time. I don't really know how much serious damage could have been done, other than excessive bleeding and I think you'd know by now if you were bleeding excessively. If I were in your shoes, I'd probably sit tight a couple more days. I'd put ice on it every chance I got. If it still doesn't get any better at that point, I'd head to an urgent care place, not the ER. Of course, if you get any signs of excessive bleeding in the meantime, i would head to the ER straight away. At the end of the day though, none of us are Dr's and can only tell you what we would do in your shoes. You have to decide what is right for you.

Good luck,

Kim

 

[worktheday]

Kim,

Thank you so much for your reply! Believe it or not, I googled the exact phrase you suggested previously and read the exact same thing you appear to have copied and pasted . As far as the progression of the colorization, its hard to say because it really wasnt to bothersome until about day 4 or so (again this is day 7). I didnt pay it much mind, even looking at it until then, and even then it was only a glance from the back (tricep) side. It wasnt until this morning when i lifted my arm up in the mirror and saw it extended all the way around to the underside of my bicep, and that area was/is by far the worst looking. Deep dark purple....possibly the pooling of blood mentioned above. The rest of it (tricep, underarm area) is yellowish/brownish/greenish. But im not sure if it looks better or worse than yesterday or the day before. I do know though that it is more swollen, and it is more painful, and i do have less of a range of motion....only being able to bend my arm 45 degrees than before.....again, im kind of at a loss.

I tend to think I'll be ok, but there is always that "what if"...

PS - I AM at the higher end of my range. Took it today...I'm supposed to be 3.0-3.5, Im at 3.9. So needless to say will be skipping tonights dose

 

[Lynlw]

Thanks for the response jkm7. I guess thats more to the point of where my questions stems jkm7....what possible "real injury" could this be other than a deep muscle bruise? What other things?

IF You have a bad muscle bleed, depending on how much blood and the location you could ( NOT will) have permant damage which can even be caused by the swelling pressing on nerves , arteries and veins etc. Also increases pressure in the muscls could cause "compartment syndrome"

As you said its rare, but getting worse for a week would have me concerned. Unfortunately most of the info on muscle bleeds is on the diferent sites for hemophiliacs, since they can be one of the groups that different bleeds are more common for. and of course the recomendations for treatments would be different, But they have some good info about different muscle bleeds and what can happen.

 

[Lynlw]

Kim,

Thank you so much for your reply! Believe it or not, I googled the exact phrase you suggested previously and read the exact same thing you appear to have copied and pasted . As far as the progression of the colorization, its hard to say because it really wasnt to bothersome until about day 4 or so (again this is day 7). I didnt pay it much mind, even looking at it until then, and even then it was only a glance from the back (tricep) side. It wasnt until this morning when i lifted my arm up in the mirror and saw it extended all the way around to the underside of my bicep, and that area was/is by far the worst looking. Deep dark purple....possibly the pooling of blood mentioned above. The rest of it (tricep, underarm area) is yellowish/brownish/greenish. But im not sure if it looks better or worse than yesterday or the day before. I do know though that it is more swollen, and it is more painful, and i do have less of a range of motion....only being able to bend my arm 45 degrees than before.....again, im kind of at a loss.

I tend to think I'll be ok, but there is always that "what if"...

PS - I AM at the higher end of my range. Took it today...I'm supposed to be 3.0-3.5, Im at 3.9. So needless to say will be skipping tonights dose

I don't know how much coumadin you take, but I really dont think I would skip a dose without at least talking to your doctor.

 

[Jkm7]

Depending upon how fast your INR level falls with a skipped dose, I agree to not skip a dose. You might think about reducing a dose but this again might be something you need to discuss with your care providers.

 

[Bina]

With an INR of 3.9 there is no way that I would skip a complete dose...not even half a dose. But I would be enjoying an
extra serving of spinach salad, broccoli, etc.
Also, before I even had my OHS, after the angiogram, that bruise was nasty and painful and hard to get rid of.

 

[kfay]

I'm with the others about not skipping a dose. I think Bina's idea about a big salad is good.

 

[worktheday]

I appreciate all of the responses. It means ands helps a lot....Thank you

 

[worktheday]

I think the standard response here is going to be anything can happen, but my question is this, is there a chance that this bruising and swelling 7 days later could have anything to do with a blood clot, even while being on coumadin and having an INR of 3.5 as of this morning. I'm still dealing with a lot of swelling...slightly decreased pain though since yesterday.

I suppose ultimately what I'm wondering is what is my biggest concern with this bruising and swelling a week after the initial banging of my arm. I actually made an initial trip to the ER yesterday, but after sitting in the waiting room & thinking about it after getting checked in then I thought I'd give it another day or 2 and decided to leave without being seen. I did get a chance to speak with a nurse for a few minutes who was very kind. she took a look at my arm said it was definitely very swollen, and I had a really bad bruise, but upon asking her something that if it was something she thought they would have to drain, she immediately said no. I proceeded to ask her what are they really gonna do for me here, to which her response was I can't speak for the doctors, and I'm not exactly sure. Which I understand as her response

thank you again in advance for any of your responses

 

[Lynlw]

I think the standard response here is going to be anything can happen, but my question is this, is there a chance that this bruising and swelling 7 days later could have anything to do with a blood clot, even while being on coumadin and having an INR of 3.5 as of this morning. I'm still dealing with a lot of swelling...slightly decreased pain though since yesterday.

I suppose ultimately what I'm wondering is what is my biggest concern with this bruising and swelling a week after the initial banging of my arm. I actually made an initial trip to the ER yesterday, but after sitting in the waiting room & thinking about it after getting checked in then I thought I'd give it another day or 2 and decided to leave without being seen. I did get a chance to speak with a nurse for a few minutes who was very kind. she took a look at my arm said it was definitely very swollen, and I had a really bad bruise, but upon asking her something that if it was something she thought they would have to drain, she immediately said no. I proceeded to ask her what are they really gonna do for me here, to which her response was I can't speak for the doctors, and I'm not exactly sure. Which I understand as her response

thank you again in advance for any of your responses

Like you guessed, my thoughts about could it be a clot, would be anything is possible..but I kind of doubt it at this point, my guess is if it was a clot and blood wasn't getting somewhere this many days it would be showing signs.but again that is just my guess
. My main concern would be what I mentioned earlier, compartment syndrome.

 

[AgilityDog]

One thing I would do, is reduce any aspirin intake. If you are on 325mg/day decrease to 81 mg per day. I've had so much less bruising since changing.

I've had so many honking big hematomas from Jet spinning her rock hard little body into my shins.... And last night my husband walked into the bathroom door, too. Owie!!!

I feel for you.

 

[Gail in Ca]

I still have a lump on my leg from whacking it with the car door in June! My cardio saw it in June, but wasn't too concerned. I'm always covered with various sizes of bruises.
I have gotten huge ones, and they take a long time to resolve.
I'd have to agree with many here, that if it is really worrying you, have it checked out with your doc or at a clinic. In my experience, 7 days isn't much time for us coumadin users where bruising is concerned. The largest bruises take the longest to go away! Small ones I see on my toes or hands seem to go away much quicker. I'm not sure I agree with the range in the high end having much to do with how long bruises last or how bad they get initially. I keep my INR in the 2-2.5 range and my bruising is just as bad as it was when I used to keep my range at 2.5-3.5, closer to 3.5.