AVR need to do my 1st Colonoscopy, freaking out.

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flex131

Active member
Joined
Nov 17, 2011
Messages
42
Location
Miami, FL
Hello

I just turned 50 in Nov and my primary told me it's time for a colonoscopy. I had an AVR St Jude Valve back in 1996. He started explaining all the steps, to stop taking Coumadin and inject enoxaparin etc etc... I was so overwhelmed and worried since I have done both extremes of getting clots and bleeding for taking my meds incorrectly when was I a youngster (you think you are invincible). I am going to run this by my cardiologist just to be safe. What are your experience with this? I not feeling comfortable, even to the point of just doing the poop sample knowing is not 100%

Thank you
Farid
 
Hi Farid(Flex131). Glad to hear from you again. I have read a number of Posts on this Forum where folks have had a colonoscopy without withholding Coumadin. I guess I was lucky in not having a doctor press me to have a colonoscopy and I was not going to "kick a sleeping dog" by asking for one. Do a search and I think you will find many posters who have gone thru the procedure with minimal difficulty. BTW, I am still counting on you to be in the bunch of "Valvers" that blows thru my record......but it is getting close to 57 years now:cool:.
 
dick0236 said:
Hi Farid(Flex131). Glad to hear from you again. I have read a number of Posts on this Forum where folks have had a colonoscopy without withholding Coumadin. I guess I was lucky in not having a doctor press me to have a colonoscopy and I was not going to "kick a sleeping dog" by asking for one. Do a search and I think you will find many posters who have gone thru the procedure with minimal difficulty. BTW, I am still counting on you to be in the bunch of "Valvers" that blows thru my record......but it is getting close to 57 years now:cool:.
Click to expand...
Hey Dick
Been a while, always happy to hear from you. I will search and see what others have to say. I guess he just told me since it's the standard, not because I have any issues. Well, I am glad to see you are still setting the bar for everyone. It's good for everyone to read everything will be ok for many years to come. I am not too shabby myself 28 years :) and on Coumadin doing everything.

Thank you bud
 
JWalters said:
My primary care Dr presented me data from studies that concluded if someone does annual poop tests, then the ability to detect colon cancer is just as good as colonoscopy. So I'm doing this plan ! I could try to dig out the studies if you want.
Click to expand...
Hello Walter

Very interesting, this is awesome news. I'll try to google search to see if I can find it.

Thank you
 
Personally, I opted for the Cologuard instead of the colonscopy. Given no family history of colon cancer and that I had no special risk factors, other than age, this seemed to make the most sense for me. I will get another one soon. If one opts to go this direction, instead of colonoscopy, it is important to get them done more frequently than would be done with a colonoscopy. Probably every 1-3 years.
 
flex131 said:
Hello

I just turned 50 in Nov and my primary told me it's time for a colonoscopy. I had an AVR St Jude Valve back in 1996. He started explaining all the steps, to stop taking Coumadin and inject enoxaparin etc etc... I was so overwhelmed and worried since I have done both extremes of getting clots and bleeding for taking my meds incorrectly when was I a youngster (you think you are invincible). I am going to run this by my cardiologist just to be safe. What are your experience with this? I not feeling comfortable, even to the point of just doing the poop sample knowing is not 100%

Thank you
Farid
Click to expand...
Farid, my MVR was in June 2003. My range is 2.5-3.5 and I have home-tested since November 2003. My mother and her mother were colon cancer survivors and I had 2 polyps removed during my first colonoscopy, which was before my MVR. Post-MVR, I have had 1 small polyp removed (August 2023); the site was cauterized and I had no bleeding.
My first gastroenterologist did not require me to go off warfarin; instead, he wanted my INR at 2.0-2.5. My cardiologist approved. When he retired 6+ years ago, one of his colleagues took over. She and my cardiologist agreed to continue the previous protocol of reducing my warfarin dosage to get to an INR of 2.0-2.5.
When you restart anticoagulation after a procedure or surgery for which you have bridged, you are doubling your risk of a bleed. Most people do not have a problem.
However, I have a history of bleeds, resulting in hematomas, while restarting warfarin while giving myself enoxaparin injections. The first time was 11 years ago and I was rehospitalized for 15 days. Nausea from 1 dose of Augmentin triggered a huge bleed. I fainted at home and required 2 transfusions. The second time was in April 2023; I had to go to the surgeon's office 3-4 times in one week.
 
Chuck C said:
Personally, I opted for the Cologuard instead of the colonscopy. Given no family history of colon cancer and that I had no special risk factors, other than age, this seemed to make the most sense for me. I will get another one soon. If one opts to go this direction, instead of colonoscopy, it is important to get them done more frequently than would be done with a colonoscopy. Probably every 1-3 years.
Click to expand...
People who have a personal history of polyps or family history of colon cancer are generally not candidates for Cologuard. My GI doctors and PCPs have also said no since I am on warfarin -- just to be on the safe side. I do have hematuria, as do many people who take warfarin, but I don't know if the GI tract is affected in that way too.
 
catwoman said:
My first gastroenterologist did not require me to go off warfarin; instead, he wanted my INR at 2.0-2.5. My cardiologist approved
Click to expand...
Lowering INR, instead of bridging, is gaining more and more support. I have shared how my INR was lowered to just under 1.5 for a thyroid procedure that I had.

catwoman said:
When you restart anticoagulation after a procedure or surgery for which you have bridged, you are doubling your risk of a bleed.
Click to expand...
That's correct. The period of time for which you are on both warfarin and bridging with heparin, you are at risk for bleeding. This is one of the main reasons why lowering your INR can make more sense for some procedures, instead of bridging.

The below linked paper from the Cleveland Clinic Journal of Medicine has a good discussion about the topic.

They indicate that surgery is usually safe if INR is brought below 1.5, as was the strategy for me with my thyroid procedure. It depends on what type of surgery and the individual patient. The strategy could vary, depending on whether the patient has a history of thromboembolism or bleeds.

https://www.ccjm.org/content/ccjom/70/11/973.full.pdf
 
catwoman said:
People who have a personal history of polyps or family history of colon cancer are generally not candidates for Cologuard. My GI doctors and PCPs have also said no since I am on warfarin -- just to be on the safe side. I do have hematuria, as do many people who take warfarin, but I don't know if the GI tract is affected in that way too.
Click to expand...
No family history, its just my age. Thank you for all the info.
 
dick0236 said:
Hi Farid(Flex131). Glad to hear from you again. I have read a number of Posts on this Forum where folks have had a colonoscopy without withholding Coumadin. I guess I was lucky in not having a doctor press me to have a colonoscopy and I was not going to "kick a sleeping dog" by asking for one. Do a search and I think you will find many posters who have gone thru the procedure with minimal difficulty. BTW, I am still counting on you to be in the bunch of "Valvers" that blows thru my record......but it is getting close to 57 years now:cool:.
Click to expand...
On "kick the sleeping dog" my mother died relatively young because she didn't want to do routine colonoscopies. She ended up in the hospital vomiting poo, she had one at that point and they discovered metastasized cancer. Her husband still did not get one himself into his late 60's. I lost contact with him after he remarried. A colonoscopy is psychologically invasive and more so to some people aside from the preparation however it is a walk in the park compared to colon cancer. In my mother's case I suspect her reluctance was related to sexual abuse when she was a young girl. I have had several. CC runs on both sides of my family. It began with my parent's generation. It helps to consider they have you covered up and you are just another butt among hundreds processed per week.
 
Last edited:
flex131 said:
Hello

I just turned 50 in Nov and my primary told me it's time for a colonoscopy. I had an AVR St Jude Valve back in 1996. He started explaining all the steps, to stop taking Coumadin and inject enoxaparin etc etc... I was so overwhelmed and worried since I have done both extremes of getting clots and bleeding for taking my meds incorrectly when was I a youngster (you think you are invincible). I am going to run this by my cardiologist just to be safe. What are your experience with this? I not feeling comfortable, even to the point of just doing the poop sample knowing is not 100%

Thank you
Farid
Click to expand...
Hi Farid,

I wouldn’t be too worried about bridging. A couple of years after I had my mechanical valve surgery, my doctor wanted me to have colonoscopy done after I had about a diverticulitis, to make sure nothing else was going on. I was 46 at the time. I was apprehensive myself about going off of my meds and giving myself a shot. I even had my wife standing next to me in the bathroom, in case I couldn’t go through with jabbing myself with a needle. I managed to do myself, and the only side effect I had was a little bit of bruising at the injection site. After my procedure, I was able to get myself back into my range of 2.5–3.5 rather quickly.

The only other time I had to bridge was last year, that was prior to a procedure I had to have done to my esophagus. Once again, I had no issues with bridging, although it did take me longer to get back into my therapeutic range. All I had to do for that was continue with the shots of a little bit longer than planned. Aside from that, no side effects.

I hope this helps, and I wish you the best in the future

Regards,
Marc
 
Hi
flex131 said:
I was so overwhelmed and worried since I have done both extremes of getting clots and bleeding for taking my meds incorrectly when was I a youngster (you think you are invincible). I am going to run this by my cardiologist just to be safe. What are your experience with this? ...What are your experience with this? I not feeling comfortable, even to the point of just doing the poop sample knowing is not 100%
Click to expand...
a bit late to the party, but there is an amount published on this. I would definitely run what I have put in this blog post past your cardiologist (including and perhaps of paramount importance the actual journal article I cite in my 2017 blog post

https://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html

importantly the journal says things like:

Summary
Click to expand...
The perioperative management of patients on long-term warfarin therapy poses particular problems. This situation is exacerbated by the absence of randomised trials. The strategy used is based on the assessment of each patient's thromboembolic and bleeding risks. These determine the need for withholding warfarin and switching to heparin. Most patients having minor procedures can continue to take warfarin, provided that they are closely monitored and local measures are used to ensure adequate haemostasis
Click to expand...

What does closely monitored mean? Well to me it means daily testing and forearmed with actual knowledge of what your INR responce is. You will only get that knowledge by self testing.


@Chuck C above mentioned his experiences and that he'd shared them here, as it happens I collaborated a little on that and wrote up his experience here in a 2022 blog post where he took "closely monitored" to a whole new level:

https://cjeastwd.blogspot.com/2022/05/rapid-dust-off-inr-management.html

To do this you need to be:
  1. self testing
  2. documenting carefully and rigorously
  3. know your self

HTH
 
@flex131, Bridging isn't too hard/bad, it's something we need to do sometimes. It's not a big deal bridging. I'd rather have that extra protection and peace of mind when something else is going on.

Last year was my first colonoscopy since being on Warfarin. It was my 3rd one and the 2nd one, where they took polyps out. Now, I get the joy of going every 5 years now. The challenge I had was getting back into my therapeutic range. To give my wounds extra time to heal, my doctor took it slow bringing me into range.

Giving the injections isn't fun. The first one was the hardest, by the end, it wasn't hard at all! It gave me a new respect for my daughter-in-law who was diagnose as a Type-one diabetic 4 years ago. Made me happy with taking my Warfarin each day, easy!

The one tip I have: take the pills instead of any drinking stuff! I've used 3 different types of medicine for my "cleaning out" and the last one, using the pills, made it so much better!! In the future, I won't use anything else! The "cleaning out" is way worse than bridging!
 
Beach77 said:
It gave me a new respect for my daughter-in-law who was diagnose as a Type-one diabetic 4 years ago. Made me happy with taking my Warfarin each day, easy!
Click to expand...

an under rated observation from all those who make an ado about being on blood thinners.
  • one pill per day
  • one measurement per week
what the heck is all the fuss about?
 
You can do a colonoscopy without holding warfarin, but if they find anything that needs removal, they will not do it and you’ll have to prep for another colonoscopy and deal with stopping warfarin and however else the doc wants to do it at a later date. That’s what I’ve been told when they wanted me to do a colonoscopy after I was in chronic a-fib.
So, I’ve gotten the okay to do Cologard twice, now. I’d have to be hospitalised and put on heparin if I absolutely had to do a colonoscopy at this point. No thanks! (My 1st colonoscopy was clear at age 52).
Also, a GI doc said the pill method of prepping is hard on the kidneys so I would research that before using them.
 
I had a colonoscopy years ago while on warfarin. I’ve also had a second heart surgery while on warfarin. Gallbladder and appendix removed. Elbow fracture. Broken thumb. Vasectomy. Etc.

Sometimes I bridged. Sometimes they just took me below 2.0 INR with no bridging. I guess being a lifer heart patient, I just roll with the punches. I don’t fret too much about any of it. Wouldn’t do any good if I did. If/when get another colonoscopy, we’ll come up with a plan and get it done. Life goes on. Until it doesn’t.
 
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