Early in the week, Fio's cardiologist prepared her for eye surgery by having her hold her coumadin pills and inject herself with lovenox instead. Fio called him on Friday, the day after surgery, and asked if she could discontinue the lovenox because the shots were unexpectedly painful, so Dr. H worked out a new regimen that would take her off lovenox by Monday, although she would have to go to the ER of her local hospital on Sunday to be sure her INR was 2.0 or above.
Fio followed directions, giving herself what she hoped would be a final shot of lovenox Sunday morning, then driving off to St. D's Hospital for the INR check. However, no one knew what to do with her because Dr. H hadn't given them any "orders." The nurses finally got another doctor to write the "orders" and, about an hour later, Fio was ushered into a room where a phlebotomist took a vial of her blood. Fio protested, saying that the procedure should be a simple finger-prick, but the phlebotomist said she'd never heard of INR and that that Fio could get the results from Dr. H on Monday. Fio explained that she was supposed to get the results immediately so she would know whether or not to use lovenox in the evening, so the phlebotomist said the lab would report to Dr. H within an hour and he himself would call Fio.
Five hours later, Fiorella got hold of Dr. H on her own. Bad news--her INR is too low to discontinue the lovenox so she'll have to shoot herself up for three more days.
Fiorella is not happy on several accounts.
Showing posts with label coumadin. Show all posts
Showing posts with label coumadin. Show all posts
Monday, September 4, 2017
Saturday, November 10, 2012
Bloody Battles
Fiorella is not happy with her coumadin nurse.
Because she has an artificial aortic valve, Fio takes a daily dose of coumadin/warfarin to thin her blood and thus keep her from forming a blood clot. The goal is to maintain her INR (a blood analysis figure) between 2 and 3. But whenever she has surgery, Fio has to stop taking coumadin--usually five days beforehand because coumadin has a three-day bounce--to enable the wound to heal properly.
Starting the coumadin again afterwards is tricky. After her facelift, Fio was started too soon with dosages that were too high and ended up with an INR of 3.9 and coagulated blood in her cheeks.
Once burned, twice shy, Fiorella informed everyone involved in her hip replacement of the coumadin bounce problem before the hip surgery. The surgeon emphasized he wanted her in the low 2s after the surgery. But before Fio knew it, by following the dosages prescribed by the coumadin nurse, she was up to 3.4--and a second hematoma was forming.
She called the coumadin nurse, who was too busy to take her call. She called the surgeon's office and was told to call her cardiologist. She called the cardiologist's office and was told to call the coumadin nurse. Finally she got hold of someone else in the coumadin nurse's office and was told what dosages to take. Four days later, she still high, at 3.1. The remedy?--she was told to take high dosages five days a week and lower dosages twice a week, which is sure to send her up to 4 in no time.
Despite the temptation to go all passive aggressive and bleed out in an emergency room just to prove how wrong the nurse was, Fio's not going along with it the nurse's prescription. She's putting herself on a reasonable dosage, then requesting copies of her records for the past two years so she can figure out her dosages for herself.
Because she has an artificial aortic valve, Fio takes a daily dose of coumadin/warfarin to thin her blood and thus keep her from forming a blood clot. The goal is to maintain her INR (a blood analysis figure) between 2 and 3. But whenever she has surgery, Fio has to stop taking coumadin--usually five days beforehand because coumadin has a three-day bounce--to enable the wound to heal properly.
Starting the coumadin again afterwards is tricky. After her facelift, Fio was started too soon with dosages that were too high and ended up with an INR of 3.9 and coagulated blood in her cheeks.
Once burned, twice shy, Fiorella informed everyone involved in her hip replacement of the coumadin bounce problem before the hip surgery. The surgeon emphasized he wanted her in the low 2s after the surgery. But before Fio knew it, by following the dosages prescribed by the coumadin nurse, she was up to 3.4--and a second hematoma was forming.
She called the coumadin nurse, who was too busy to take her call. She called the surgeon's office and was told to call her cardiologist. She called the cardiologist's office and was told to call the coumadin nurse. Finally she got hold of someone else in the coumadin nurse's office and was told what dosages to take. Four days later, she still high, at 3.1. The remedy?--she was told to take high dosages five days a week and lower dosages twice a week, which is sure to send her up to 4 in no time.
Despite the temptation to go all passive aggressive and bleed out in an emergency room just to prove how wrong the nurse was, Fio's not going along with it the nurse's prescription. She's putting herself on a reasonable dosage, then requesting copies of her records for the past two years so she can figure out her dosages for herself.
Saturday, October 27, 2012
Battle of Blood
Fiorella took on the medical establishment yesterday, although it wasn't supposed to be that way.
First, a little background. Because she has an artificial heart valve, Fio takes coumadin, and her blood "thinness" level, or INR, is closely monitored so it stays between 2 and 3. In preparation for any surgery, though, she lays off the coumadin so her blood will be thicker and she will heal better. After the surgery, the coumadin is started up again, although it takes three days for each pill to register.
It's a balancing act: supplying Fio with enough coumadin that her blood will be thin enough that her valve won't clot vs. keeping it thick enough that the new surgery won't bleed out. For instance, when Fio had the facelift, the coumadin was resumed too enthusiastically so her INR shot up to 3.9, way too thin, and she had a lot of swelling.This wasn't a situation she wanted to repeat so she was pleased when she learned her INR would be regularly monitored as she started up the coumadin again after her hip surgery.
Now comes the drama. Fio's INR on Tuesday was something like 1.2 and she's been taking a larger than usual dose of coumadin since then. So, yesterday, ever mindful of that 3.9, she decided it was time to have her INR checked by the Home Health people . They were agreeable, but couldn't reach the coumadin nurse who was supposed to okay their trip to Fio' s bedside. Fio couldn't reach her either. A couple of hours later, Fio called the cardiologist's office and explained the situation. The coumadin nurse finally called Fio and said she hadn't been able to the cardiologist. Fio told her that she understood that the nurse herself could okay the INR. but the nurse insisted that the earliest the INR could be checked was Monday.
Fio gave up and prayed that her INR not explode over the weekend. An hour later, though, she got a call from the Home Health people saying they'd been authorized to come by this morning. God only knows what went on behind the scenes, but this morning Fiorella eagerly awaits the arrival of the finger-prickers.
First, a little background. Because she has an artificial heart valve, Fio takes coumadin, and her blood "thinness" level, or INR, is closely monitored so it stays between 2 and 3. In preparation for any surgery, though, she lays off the coumadin so her blood will be thicker and she will heal better. After the surgery, the coumadin is started up again, although it takes three days for each pill to register.
It's a balancing act: supplying Fio with enough coumadin that her blood will be thin enough that her valve won't clot vs. keeping it thick enough that the new surgery won't bleed out. For instance, when Fio had the facelift, the coumadin was resumed too enthusiastically so her INR shot up to 3.9, way too thin, and she had a lot of swelling.This wasn't a situation she wanted to repeat so she was pleased when she learned her INR would be regularly monitored as she started up the coumadin again after her hip surgery.
Now comes the drama. Fio's INR on Tuesday was something like 1.2 and she's been taking a larger than usual dose of coumadin since then. So, yesterday, ever mindful of that 3.9, she decided it was time to have her INR checked by the Home Health people . They were agreeable, but couldn't reach the coumadin nurse who was supposed to okay their trip to Fio' s bedside. Fio couldn't reach her either. A couple of hours later, Fio called the cardiologist's office and explained the situation. The coumadin nurse finally called Fio and said she hadn't been able to the cardiologist. Fio told her that she understood that the nurse herself could okay the INR. but the nurse insisted that the earliest the INR could be checked was Monday.
Fio gave up and prayed that her INR not explode over the weekend. An hour later, though, she got a call from the Home Health people saying they'd been authorized to come by this morning. God only knows what went on behind the scenes, but this morning Fiorella eagerly awaits the arrival of the finger-prickers.
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