little goings on in my hometown

[denobobeno]

The more people I meet and unexpectidly learn they also have an artificial I have pondered the state of our legal system and the effect it seems to have on Doctors caring for their patients.
I wonder if it is just an Abilene thing or if it goes on all over...
I received a 'certified letter' from my Cardiologist stating that he could no longer care for me because I was a noncompliant patient. I questioned him on a couple of times when they wanted to stop my coumadin for 2-3 days to get it down and then I needed a lovenox shot when I was 1.2 I only told him of my experience the last time I stopped my Coumadin and how I plummited down into another unsafe range.
My friend had also received a similar letter of Certification due to 'non-compliance'. She had just gotten out of the hospital and he basically did the same thing to her.
Is this a pattern ya'll are seeing elsewhere or just our slap happy Docs covering their butts? I dont' blame them sometimes it is necessary!
She also was recently taken off Coumadin for five days (artificial valve) for a simple tooth surgery. I couldnt' believe that they took her off. I reccommend she read this site and educate herself before she does anything else.
I had just had another friend in Abilene who was told by his Internist to stop for 5 days for a Colonoscopy. He called me after the procedure because he had stroke. Surprise, Surprise. He has some damage to his left side face, arm, and a little confusion. I begged him to come on to the website too. I explained the Lovenox bridge issue and he said it was never mentioned.
This is where I learn to have the guts to say what I need and fell confident about my decision.
Thanks to all for helping so many of us not make life threatening mistakes!
deana

 

[Ross]

It seldom ever happens. It's your Doctor and judging by the way he took care of you, your much better off without him. Find someone that is logical cause this guy wasn't.

 

[ALCapshaw2]

In my NON-professional opinion, it sounds like your Doctor is Way-Out-of-Date in the way he manages his Coumadin Patients undergoing simple invasive procedures and is doing a Legal CYA with those certified letters.

The Fact that one of his patients had a STROKE after a 5 day hold for a simple colonoscopy confirms this. Obviously he doesn't like his patients questioning his 'advice'. How old is he (i.e. how long has he been practicing)? Are there other Cardiologists you can go to in your home town?

'AL Capshaw'

 

[Karlynn]

I agree - good riddance. But it's very sad to read of your friend that had the stroke after a colonoscopy. And its extremely frustrating to read that your other friend was taken off for simple tooth surgery.

It sounds like your doctor is not very secure in his own abilities and wishes to get rid of patients who he is finding hard to manage.

Unfortunately your experience, and your friend's stroke experience are looked on by many doctors as just more reasons why they believe Coumadin is a bad drug. They don't connect it at all to their mismanagement and extreme lack of understanding.

I was just in for my "female" exam with my Family Physician. He mentioned that next year I'll be 50 and that he'll want to get a baseline colonoscopy on me. So I asked him what he'd do about my Coumadin for the procedure. He looked at me funny and said "Well, leave you on it." as if it was a silly question to ask. For me that was a sign that this FP (around 60 years of age) has chosen to keep up to date.

 

[warrenr]

dental procedures

dental procedures

The more people I meet and unexpectidly learn they also have an artificial I have pondered the state of our legal system and the effect it seems to have on Doctors caring for their patients.
I wonder if it is just an Abilene thing or if it goes on all over...
I received a 'certified letter' from my Cardiologist stating that he could no longer care for me because I was a noncompliant patient. I questioned him on a couple of times when they wanted to stop my coumadin for 2-3 days to get it down and then I needed a lovenox shot when I was 1.2 I only told him of my experience the last time I stopped my Coumadin and how I plummited down into another unsafe range.
My friend had also received a similar letter of Certification due to 'non-compliance'. She had just gotten out of the hospital and he basically did the same thing to her.
Is this a pattern ya'll are seeing elsewhere or just our slap happy Docs covering their butts? I dont' blame them sometimes it is necessary!
She also was recently taken off Coumadin for five days (artificial valve) for a simple tooth surgery. I couldnt' believe that they took her off. I reccommend she read this site and educate herself before she does anything else.
I had just had another friend in Abilene who was told by his Internist to stop for 5 days for a Colonoscopy. He called me after the procedure because he had stroke. Surprise, Surprise. He has some damage to his left side face, arm, and a little confusion. I begged him to come on to the website too. I explained the Lovenox bridge issue and he said it was never mentioned.
This is where I learn to have the guts to say what I need and fell confident about my decision.
Thanks to all for helping so many of us not make life threatening mistakes!
deana

Denobobeno,

Go to the following link and print this info for your friend
http://jada.ada.org/cgi/content/full/131/1/77

 

[lance]

Non-compliant, eh!

Non-compliant, eh!

Deana
How frustrating for you to receive that letter--"non-compliance" indeed. My ACT advisor, does not, will not advise a patient to deliberately drop warfarin for 1 day let alone 2. Others on this board do and quite successfully. I'm not trying to flame anyone it's just how my ACT is managed. If I deliberately dropped warfarin for 2 days without her knowledge she would probably tell me I'm non-compliant and be extremely annoyed with me. Maybe I'd receive a letter just like yours.
In Ontario the hospitals doing cardiac surgery have anti-coagulation clinics and you would do yourself a huge favour if you could find one in Abilene and have them monitor your ACT. This forum has many members who manage their ACT a lot better than your doctor has been.
He's protecting his posterior which is more important to him than well-managed ACT, has learned how dangerous warfarin can be and just wants out.

 

[Karlynn]

has learned how dangerous warfarin can be and just wants out.

I would say that he's learned how dangerous he can be when managing Coumadin.

I don't believe that Coumadin is a dangerous drug. It is a serious drug that needs to be managed correctly and can have dire consequences when mismanaged. But it is a life-saving drug. When managed correctly, I am not in any danger taking warfarin. Poorly educated medical personnel are dangerous when they attempt to manage a drug they don't understand - and this not only applies to Coumadin, but to many drugs.

Only the very youngest, oldest and most infirm diabetics don't manage their own insulin. Just about every diabetic on insulin is taught how to test and self-dose. The consequences of mismanaged insulin can be just as dire, and more immediate than warfarin. But because more people are diabetic the medical and insurance community is much more in-tune and up to date on the management of insulin.

 

[denobobeno]

You know what? I didn't make it clear that the doctors I'm talking about are two different Cardiologist. My friend that also got a non-compliant letter sees another Cardiologist here.
There are some good Cardiologist here, but once you see one in that group you can't switch. I have a Cardiologist in Fort Worth now who I really like.
The Gastro Doctor my friend used for his Colonoscopy told me the same thing this past Fall. I was due for a Colonoscopy, but I quickly canceled after the phone call that I had to get off Coumadin for 5 days.
I had read a post from Ross a while back that if your Gastro Doctor wants you to stop Coumadin for the procedure you probably need to see another Doctor that knows what he's doing. (sorry I don't much time to look it up)... Good advice, already had one stroke I don't need another!! I just wish my friend had known before all his mess! I also told him about this website.
Thanks for all your help!
Deana
ps thanks for the website warrenr

 

[Mary]

This just makes me mad reading it.

Noncompliant my ---

Smart is more like it.

I wish your friend would sue the hell out of his/her cardiologist.

 

[briansmom]

Wow, that is scary. I have been quietly trying to manage my son's coumadin, because I don't want to get into a pissing match with their coumadin manager. I am floored because I really love our cardiologist but Brian just had a 5.0 and they told him to hold for 3 days. I of course said no and had him hold for 1 day and his INR went down to 2.8. He had a reading of 3.1 yesterday and they were recommending that he hold a day!!! I just got done listening to my cardio tell my son how wonderful his manager was, it makes me lose a little confidence with my doc when they can endorse someone that makes these kind of recommendations. I would certainly be considered "Non Compliant".

 

[Lisa in Katy]

Deana - I agree with everyone else. He did you a favor, so good riddance. I had this conversation with my Coumadin manager several years ago, because when I held for 2 days, my INR was 1.0 and she was recommending that I hold for a day. After the discussion, we agreed that I would take half a dose and then drop 10%. It worked like a charm and she never recommended that I hold again.

To all of you who are recommending Coumadin clinics. I'm not sure exactly why, but I haven't been able to find one of these and I live in a suburb of Houston, so you'd think there would be at least a handful. It could be that Texas doesn't license them or that the managed care plans don't cover it. I'm not sure. Since I've been so stable lately, and my doctor's office seems competent, I haven't looked lately.

One more think Deana - I have relatives in Abilene and the surrounding areas. My mom's first cousin in Joe Allen, of Joe Allen's barbecue, who I think serves the best steaks anywhere.