What's the difference between internal and external bleeding?

[baradonai]

This may be a stupid question...but here goes.

I have noticed that when I cut myself, my bleeding is not much different than before coumadin therapy. I bleed for a minute or two and then it stops, just like always.

But when discussing minor surgery, most don't even want to attempt it because of the risk of bleeding. ( I have a kidney stone and the Doc said removing it wasn't really an option unless I absolutely could not pass it. This was because of the coumadin.)

Now if I stop bleeding at a respectable rate externally, why are Docs worried about internal bleeding? Do you bleed more internally?

Thanks

 

[RandyL]

I think the problems lies with the fact that you don't know you are bleeding internally till there is a major emergency.

 

[Ross]

This may be a stupid question...but here goes.

I have noticed that when I cut myself, my bleeding is not much different than before coumadin therapy. I bleed for a minute or two and then it stops, just like always.

But when discussing minor surgery, most don't even want to attempt it because of the risk of bleeding. ( I have a kidney stone and the Doc said removing it wasn't really an option unless I absolutely could not pass it. This was because of the coumadin.)

Now if I stop bleeding at a respectable rate externally, why are Docs worried about internal bleeding? Do you bleed more internally?

Thanks

It's time to find a new Doctor! Whomever this one is reciting stoneage Coumadin doomsday material. Does your Cardiologist understand Coumadin? If so, he may want to educate this Urology guy.

All they would need to do is provide bridging, take you off Coumadin, Stop the bridge just before the procedure, start it again afterwards and start your Coumadin back up and continue bridging until your back in range. Honestly, if you can pass the stone, it's going to more then likely cause more damage then if they went in and took it out or better yet, can't they blast it with ultrasound?

 

[baradonai]

It's time to find a new Doctor! Whomever this one is reciting stoneage Coumadin doomsday material. Does your Cardiologist understand Coumadin? If so, he may want to educate this Urology guy.

All they would need to do is provide bridging, take you off Coumadin, Stop the bridge just before the procedure, start it again afterwards and start your Coumadin back up and continue bridging until your back in range. Honestly, if you can pass the stone, it's going to more then likely cause more damage then if they went in and took it out or better yet, can't they blast it with ultrasound?

He said that even with lithotripsy there would be bleeding involved and he didn't want to risk it.

How long does a bridging take? couple of days? Since coumadin takes about 3 days to absorb, then three days?

The reason I ask is I had once long ago considered some elective surgery. It would have been outpatient procedure. The I figured that no Dr. would want to perform anything little like that on someone on Coumadin and I could no longer consider anything like that.

{By the way Ross, the new look is great! Didju install it?}

 

[Ross]

Figure a week to ten days total on bridging including procedure. 3 to 5 to get your INR down and then at least that to get it back up.

This is all they would have to do, if they even have to do that.

Someone is telling you a bunch of garbage because they don't want to deal with it.

Nope, the people at QAS are responsible for the site improvements, not I or Hank.

 

[tobagotwo]

Many doctors are squeamish about Coumadin, envisioning a patient bleeding out on them from some very minor procedure. Mostly that's just scare stories from older doctors, left over from days before the INR scale and accurate testing were introduced. Your clotting and bleeding can be nuch better monitored and controlled now. With bridging, it can be controlled with incredible accuracy and speed. And most surgical tools and procedures these days minimize bleeding greatly.

I agree that you should get a different doctor to do your surgery, if this one's clucking. You could retain him as a doctor if you like him. Just get someone else to do the actual cutting.

Coumadin may mean you have to look harder to find someone to do elective surgery on you, but it doesn't mean you can't have it.

Best wishes,

 

[Guest]

Normal childbirth results in a loss of about a quart and a half of blood and the woman walks out the next day carrying her baby. But death will result if you have your teeth cleaned while on warfarin!!!!!

 

[traumahob]

Get a new urologist!

 

[PJmomrunner]

Oh, I see...it's okay to scare the bejeebers out of pregnant women but not coumadin users??? NORMAL bloodloss after childbirth is about a pint (according to the World Health Organization) and since the pregnant woman's blood volume has been drastically increased during the course of nine months, for a pregnant woman to lose a pint is an entirely different story than for the average non-pregnant person. A quart would be considered postpartum hemorrhage, although she still may not require transfusion. Losing a quart and a half probably would require transfusion, but if her insurance company has anything to say about it she still would probably go home with the bouncing bundle the next day!

 

[Guest]

I was in a meeting with an obstetrics professor in June. He said that the amount of bleeding has been grossly underestimated for years. They had done a study where they weighed all of the cleaning materials before and after the blood was wiped up and it came out to about a quart and a half.

The discrepancy fits the model of doctors (people) underestimating bleeding when they witness it and overestimating it when they are trying to avoid it.

 

[sue943]

Honestly, if you can pass the stone, it's going to more then likely cause more damage then if they went in and took it out or better yet, can't they blast it with ultrasound?

After my experience with lithotripsy you won't get me EVER going that route again. I wasn't on warfarin and I passed lots of bloody urine for days AND it gave me endocarditis.

When it was thought that I still had kidney stones last year, after my OHS, they were going to put me on bridging therapy then 'go up and crush the stones and insert a stent', then bring my INR up again.

I had an ultrasound this week and my stones have not reformed so hopefully I won't have to consider having treatment for that again. (Edited to add that despite being told by the radiologist that I have no stones, I passed a 3mm stone this morning plus lots of 'sand').

If you have treatment for kidney stones I suggest you ensure you get antibiotic cover.

 

[baradonai]

Thanks Sue

Thanks Sue

That's great advice.

I was just reading your events from December 2004 to June 2005. Sounds very familiar. I think I got my endocarditis from a teeth cleaning in November. Stroke New Year's eve. Dick Clark and I had something in common that night.

 

[DrAllan]

First some definitions: internal is within the body and external is on the surface of the body. Clinically the difference besides the fact that external can be seen and internal cannot is that almost all external bleeding, even if you were to slit your throat with a knife and cut the carotid artery, can be controlled with application of external pressure. Obviously, without surgically opening the area that is bleeding within the body, this cannot be done. When the area is opened the applying pressure again will often control the bleeding.

The real surgical question is the extent to which surgery or trauma will cause damage that cannot easily be controlled or where the bleeding itself is dangerous. For example, bleeding a tablespoon of blood into the brain may result in permanent neurological damage. Bleeding 1 quart of blood into the sift tissue around your hip with a hip fracture would probably not be significant.

Surgery for kidney stones presents its own set of problems. Lithotripsy in which a shock wave is directed at the kidney, which pulverizes the stone. However, this ?Beating? of the kidney and the hard sharp stone can cause damage locally, which can bleed. In non-anticoagulated patients the bleeding usually stops within several day. On Coumadin, it may not stop. Thus while on Coumadin the procedure involves passing an endoscope up to the stone and either mechanically crushing it, fragmenting it with a laser, and/or grasping it with an instrument and withdrawing it if it will pass thru the lower narrow areas. Bridging for lithotripsy is not easily done because of the several days of bleeding that can go on. From a physiologic point of view, lithotripsy for a valve patient is not an option.

The signs and symptoms of internal bleeding vary on location, amount, duration, and speed of the bleeding. Pain, changes in blood pressure, palpable swelling and other signs will appear before the ?Major emergency? term used by Randy occurs. This is usually shock from blood loss anywhere, or unconsciousness or change in mentation if within the brain.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

 

[tobagotwo]

Lithotripsy is plainly not the procedure of choice for people on ACT. However, I didn't get the impression from your posts that it was your initial plan. While many helpful surgeries are needlessly avoided due to warfarin usage, this use of intense sonics doesn't qualify as surgery. As DrAllen suggests, it carries a higher risk than other methods that are available.

There is at least one other method, which DrAllen mentioned. I would still look to another doctor if you wish to pursue a course other than trying to pass the stone naturally. Be aware of risks as you do so.

Best wishes,

 

[Ross]

I wasn't aware that lithotripsy was not an option obviously or I wouldn't have asked about it. It still is something that can be dealt with while on Coumadin though. It's not like the poor guy has to suffer through passing it if it's that big. Laser or mechanical removal are still options.

 

[Guest]

When I had my lithotripsy, it took 3 months before I quit passing chunks.

Having a stone fall into your bladder in Charlotte just as you walk onto a plane to Denver with a window seat is not the most fun thing in the world.

 

[baradonai]

Thanks to everyone for your replies

Thanks to everyone for your replies

I've learned a good bit of what's going on.

I was told my stone was on the large size but I should be able to pass it. Funny thing is, I haven't "heard" from it for almost 2 months. I'm hoping the darn thing is gone.

 

[Karlynn]

I've learned a good bit of what's going on.

I was told my stone was on the large size but I should be able to pass it. Funny thing is, I haven't "heard" from it for almost 2 months. I'm hoping the darn thing is gone.

I'm glad you haven't heard from it. I haven't experienced it myself, but I've heard that passing a stone can be excruciating.

 

[Guest]

Sometimes you hardly know that you passed one. The one I got in Charlotte finally passed in Castle Rock, Colorado. What happens to me is that the flow of urine stops for half a second and you hear a "ding" as it hits the porcelain. Obviously jagged ones hurt more than smooth ones. If you haven't heard from it in two months it probably passed.

 

[DrAllan]

Just a slight clarification regarding kidney stones. Typically passing a stone is from the kidney down the ureter into the bladder. This causes pain. A typical ureter is about 3mm in diameter. Expelling a stone from the bladder through the urethra is much simpler and usually without pain because the urethra is larger in diameter than the ureters.