Side and back Pain from coumadin

[Gary Miller]

Hello everyone,
I haven't posted for a couple of months as things have been going pretty well. But like most of our posters, when we have questions or bumps we always find our way back to the best support site on the net. It’s been 7 months since the AVR and other than a fight with my INR things have been progressing well. I joined the gym after 5 yrs of sitting out, and have gone from walking 4 miles a day to 35min on the elliptical trainer at level 10 and 90rpms and weight training. I feel good/normal at least 50% of the time. The problem I'm having is this nagging side pain/ back pain/ upset stomach. That is where the Coumadin dosage comes in. After surgery I maintained 2.1 INR for 3 weeks on 55mg a week. Than it went up to 65.5 for 7 weeks and I was down to 1.8 at times. I started getting back to my normal life (working on the Maverick, fixing things around the house, and walking 4 miles every other day and gained 20lbs) and my INR was all over the place. Once it was down to 1.3 and I would increase 15% for 2 days as instructed and it would get up to 1.8./2.1 at times, and this went on for 10 weeks. I home test and compared my CoaguCheckXS to two clinics here and it was right on. I finally took the ball from my nurse and stabilized my intake to 77.5 mg a week and have maintained 2.5/2.6 for the last 6 weeks. I know everyone says that we are all different and you have to dose to the individuals needs. I have always been concerned about having to take so much Coumadin. Everything I can find about Coumadin says that over 105mg a week is Coumadin resistant! If this 77.5mg holds now I'm not the only one who has had to use that much to maintain. But again my concern is these nagging side/back/stomach pains. They started about the same time my dosage went over 70mg per week. I read on my hospital release Medication Warnings that if you experience this side/back/stomach pains you are suppose to call your doctor right away. He is away for the holidays until Tuesday next week. His nurse told me to continue on with the same dosage until he gets back. I cannot find any Coumadin users that complain of this type of pain or what it is effecting (kidneys/bladder/stomach/liver) and if you can continue to use Coumadin if it persists. I didn't think that Coumadin had that many serious side effects. Has anyone ever had this pain and what did you do?? I can't stop ACT with a mechanical valve so I pretty stressed out right now. Thanks again for listening and any help will be greatly appreciated.

 

[lance]

Hello Gary
Increased activity results in needing more warfarin. In other words whatever puts more blood through your liver where warfarin is metabolized will require an increase in warfarin dose. For the past two weeks I have been taking 77 mgs a week with test results of 3.5 and 3.3 and I'm not nearly as active as you are. The Mayo Clinic does not mention your symptoms as being relevant to warfarin.
If you are taking other medications I would check for warfarin's reaction to them. Also if you take supplements I'd check that too.
A little while ago I had a major problem with Taro warfarin. Dose response to test results were bizarre. Everything returned to normal when I switched to brand name.

 

[catwoman]

What other meds are you taking? What are your normal eating habits like?
Your warfarin dosage is whatever it takes for you to be in range. Some people do have to take 12-15mg/daily.
Your pain could be connected to muscle spasms, activity, possible GI problems that are unrelated to warfarin.

 

[mainframe]

I only take 52 mg. a week and I've had pain in my side/back since my second surgery. It comes and goes and is only on the right side. My 1 kidney is on the right side. It's usually not to bad, but I'm unable to lay on that side at all in bed. It comes and goes over a 2 - 3 month period. I haven't been able to figure it out and I've mentioned more than once to my GP and cardio, both kind have kind of brushed it off. Wish I knew what it was.

Chris

 

[Fundy]

I'm not a coumadin user, but did suffer pains often that started either in rib sections of lower back or chest. Then would be both areas, then strong discomfort to all of ribs. Movement was always sore and lying down was painful. Eventually it cycled, showing up for a day or two then gone for 4 or 5 days, then seemed to repeat. This began at 5 weeks after(first two weeks it was persistant though) and stayed that way until about 7 months. Then it slowed to about once a month for a few months.

Now it seems to mostly be gone. I have no idea why. ER doctor, family doctor, and cardiologist all just say its probably muscles. Nothing showed up bad in a CT scan.

 

[catwoman]

I'm not a coumadin user, but did suffer pains often that started either in rib sections of lower back or chest. Then would be both areas, then strong discomfort to all of ribs. Movement was always sore and lying down was painful. Eventually it cycled, showing up for a day or two then gone for 4 or 5 days, then seemed to repeat. This began at 5 weeks after(first two weeks it was persistant though) and stayed that way until about 7 months. Then it slowed to about once a month for a few months.

Now it seems to mostly be gone. I have no idea why. ER doctor, family doctor, and cardiologist all just say its probably muscles. Nothing showed up bad in a CT scan.

I've had a similar pain, and it started before my MVR. It usually manifested itself as I was bathing a cat in our kitchen sink, so perhaps it was due to how I was standing.
I've had it several times recently, once 3 weeks ago when I was at a St. Louis mall with my sister, her daughter & twin granddaughters. It almost crippled me. Had to sit down for a while. I took some Alleve and after about 2 hours, it was gone.
Perhaps it's how I handle my luggage, how I sit at work, who knows?
Whatever it is, I do not attribute it to warfarin.

 

[Protimenow]

I've had some really rough days the past few days - and the reason that I even mention this is that a doctor prescribed a medication that slows the elimination of warfarin from the system. As a result, my INR may have increased. (A few hours ago it was 'only' 4.1, according to my InRatio 2).

I've been suffering with an abscessed tooth and need a root canal, and am carrying around a golfball sized lump in my cheek, and lots of infection in my gums. No doctors were open yesterday (Thanksgiving in the U.S.) and it seems that all are closed for the same reason. One doctor prescribed Metronidazole (generic Flaxyl), and aside from prohibiting me from anything with alcohol in it, it also can raise the INR. Although the pharmacist didn't know of any interactions with warfarin when I asked him, and the doctor didn't seem to, either, I discontinued this after I read the information about it -- and the doctor agreed with my action.

I've developed a sharp muscular pain, bilaterally, above both hips. I have to be careful how I move so that I don't aggravate it. It's probably muscular (possibly renal?), and may be related to the fact that, with this tooth problem, I sleep on my side more than I usually do. BUT - with increased effectiveness of Warfarin - perhaps this is the same kind of issue that you're having,

Although I don't think that I've read or heard anywhere about this kind of reaction to warfarin, who knows? I'm taking 4 Ibuprofen at a time and will know in a few hours if it helps with the mouth or back pain -- and will know tomorrow - when I retest my INR if it's changed because of residual effects from the Metronidazole, the Amoxicillin that I currently take, or the relatively high doses of Ibuprofen.

 

[Fundy]

The ibuprofen shouldn't affect INR levels but it does increase the bleeding risk similar in fashion to taking aspirin. From what I've read ibuprofen use with warfarin is usually discouraged becuse of the high bleed risk.

 

[ski girl]

Protime BIG RED FLAGS are going up for me reading about your gum infection. I had to have an emergency AVR redo (with 30% chance of living to and then through the op) due to endocarditis caused by mouth bacteria. People with artificial valves are more likely to get endocarditis and if I ever get an infection in my gum I'll be straight on to my cardio - if I can't get hold of him I'll be straight into the ER.

Endocarditis is nasty and it can kill you. I'd get this abcess/infection checked out!

 

[Lynlw]

I've had some really rough days the past few days - and the reason that I even mention this is that a doctor prescribed a medication that slows the elimination of warfarin from the system. As a result, my INR may have increased. (A few hours ago it was 'only' 4.1, according to my InRatio 2).

I've been suffering with an abscessed tooth and need a root canal, and am carrying around a golfball sized lump in my cheek, and lots of infection in my gums. No doctors were open yesterday (Thanksgiving in the U.S.) and it seems that all are closed for the same reason. One doctor prescribed Metronidazole (generic Flaxyl), and aside from prohibiting me from anything with alcohol in it, it also can raise the INR. Although the pharmacist didn't know of any interactions with warfarin when I asked him, and the doctor didn't seem to, either, I discontinued this after I read the information about it -- and the doctor agreed with my action.

I've developed a sharp muscular pain, bilaterally, above both hips. I have to be careful how I move so that I don't aggravate it. It's probably muscular (possibly renal?), and may be related to the fact that, with this tooth problem, I sleep on my side more than I usually do. BUT - with increased effectiveness of Warfarin - perhaps this is the same kind of issue that you're having,

Although I don't think that I've read or heard anywhere about this kind of reaction to warfarin, who knows? I'm taking 4 Ibuprofen at a time and will know in a few hours if it helps with the mouth or back pain -- and will know tomorrow - when I retest my INR if it's changed because of residual effects from the Metronidazole, the Amoxicillin that I currently take, or the relatively high doses of Ibuprofen.

So you have a large infection in your mouth/tooth/gums and stopped the antibiotic you were given is that correct? k I see you switched to Amoxaciallin, I'm not sure why they gave that specific antibiotic for a tooth and yes many antibiotics including Amoxacillian can mess with your INR, but I'd probably be even more worried about being a valve patient and having this large infection in your mouth. and spreading.

 

[Protimenow]

No. I have not ignored it. At the first twinge of discomfort, I saw a dentist. He didn't seem too concerned about endocarditis from this, but I did say those words, and told him that I WAS.
On Monday night, I had a strange event - my body was acting as if I had chills - muscles were continually tensing up - and I went to the Emergency Room. They thought it was from dehydration and fever. I got rehydrated and an IV drip of clindamycin, and left with a prescription for clindamycin.
The next day, I saw an endodontist. I was not in pain. I was taking the antibiotics. He wanted more money than I had and, being pain free, I thought I could stick it out until December 1, when I would have more money.
The pain and infection started on Thanksgiving morning. EVERYTHING WAS CLOSED. I spoke to one dentist, who said that Clindamycin was good for oral infections. I finally got in touch with the endodontist who wanted to charge more than I had - but I got a loan to cover his services. He told me to stop the Clindamycin, and instead wanted me to take Amoxicillin and Flagyl. I found a pharmacy that was open, and started both meds immediately. For a few hours, this seemed to help a lot. I asked the pharmacist about interactions with Warfarin, and he said that both were safe.
After my second dose of Flagyl, I checked the printout that came with it and saw that it DOES interact with Warfarin. I didn't take a third dose.

This morning, I spoke to the Endodontist and told him about the interaction. He told me to discontinue the medication (I already stopped it, and I reduced my dose of warfarin). My INR on the InRatio was 4.1 -- probably a lab's 3.9.
I am not taking this lightly.
I called 20 endodontists until I found one whose office actually answered the phone. I will get the infection taken care of first thing Saturday morning. If possible, he'll also do the root canal. He told me to DOUBLE UP on my amoxicillin.

I am aware that Amoxicillin can cause the INR to increase. I have some Vitamin K pills that I can take if my meter shows any large increases. I will test daily, for a while, and have reduced my dose of Warfarin.

At this point, I appreciate the concern that some of you have shown. I am extremely grateful to have found a dentist who cares enough to see me on Saturday and who knew enough to have me double my Amoxicillin dose.

I am hoping that my consulting will turn into a real job, with real medical and dental benefits so I can have an actual cardiologist and dentist. For now, I will continue monitoring my INR, and if it gets beyond my control will seek help.

Thanks again for spotting the red flags -- I saw them before they first appeared.

 

[ski girl]

Glad to hear you've found a good dentist! Those chills were something I had too and they're also a sign of systemic infection; did the hospital do any blood cultures to find out what bacteria you have? That will greatly impact on what antibiotic they give you, if you have something amoxicillin resistant then it's doing you no good.

I'm not a doctor, but in this situation I wouldn't worry too much about INR going too high (just stay away from sharp knives ) I'd be bashing the bejesus out of those bacteria with antibiotics!!!

GOOOOOOOD luck from down under!

 

[Protimenow]

I didn't mean to hijack this thread -- but I DID want to comment on the back pain and warfarin issue.

The hospital DID do a culture on the blood -- but their quick culture didn't find anything. (In fairness, my abscess didn't develop until two days after I left the hospital. It's possible that the clindamycin may have knocked out something ELSE that was cooking inside of me and the abscess happened later, and was completely resistant to clindamycin). Following my NEW dentist's advice, I've doubled the dose of amoxicillin - 1 gram (two 500 mg pills) three times a day, and it seems to be knocking the infection down pretty well. I'm not about to stop the antibiotics just because of my INR, but that Flagyl did concern me quite a bit.

Thanks for the good wishes. By this time tomorrow, I should be mostly infection-free. I may have had the root canal (maybe not), and should be back almost to my usual abnormal state.

 

[Protimenow]

I went to what I have to say was an extremely good dentist this morning. He came in to help me, even though his daughter was competing in an athletic event 150 miles South. He told me, briefly, that dentists and physicians have been debating over tooth problems and endocarditis and the argument was that everyone gets infections every day -- how is a dental problem any more infectious than a small cut or other injury? Isn't the bacteria still getting into the body? I didn't want to argue with him, but this highlighted the debate. That said, he gave me a prescription for 20 amoxicillin and multiple refills for any dental procedure. It's still probably much better to be safe than sorry.

He did what he called a 'mini root canal.' - he removed most of the dead pulp and nerves in my tooth and put antibiotic into the nerve root. I'm continuing on the amoxicillin that I have left, and will see him later in the week so he can finish the job. I haven't checked my INR yet, but took 1/2 dose last night. I'll check my INR again before tonight's dose.

If any of you are in Southern California (more specifically, the San Fernando Valley, and need a dentist, send me a message and I'll give you his name).

It's been a terribly rough few days. My mouth still hurts. I have a pocket of infection that I've got to get out. I am working to get my strength back. I think that I'm out of the woods.

If ANY of you plan to have health problems - try not to do it during a holiday like Thanksgiving, when the country shuts down for four days. (As if ANY of us plan to get sick).

Thanks again for caring.