Colonoscopy

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Mister_James

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Tom in MO

Your arguement is the just a mirror of those who say I will take a tissue valve and have a redo in a few years because I don't like warfarin.

Why would you want 2 colonoscopies? Any procedure carries risks. The scope could perforate the colon and...

You go into a colonoscopy to explore, find, snip and probe. All at once. You want to have a whole nother low fiber for days, clear liquids for a day, purging concoctions all over again?

If you have been coagulated properly for a while, you can go off warfarin for 5 days and restart without major problems. Yes I chickened but I still held off lovenox for 24 hours with an INR of 1.5.

Clots on valves take a while to form. It is a reasonable risk to take once than to chance and compound risks.
 

Sheenas7

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Bridging is only needed if they take remove tissue (e.g. polyps, samples, etc.). Most colonoscopies do not include those activities. So you can have a colonoscopy on warfarin. If they find things they want to sample or things they want to surgically remove, you'll need a second colonoscopy w/o warfarin. So you bet right, one and done, no risk of stroke from being off warfarin. If you bet wrong, two colonoscopies within a couple of weeks. The second one being off warfarin.
Hi Tom. So if I understand you correctly you do the first on Warfarin and hope they find nothing?
 

pellicle

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I agree with everything you say, but just wanted to add something here:

Clots on valves take a while to form. It is a reasonable risk to take once than to chance and compound risks.
another issue which is covered by AC Therapy is the triggering of thrombosis caused by pressure jets on valve opening and valve closing. These triggered micro clots will then move along the direction of the pipe (the Aorta) and may lodge in places not desired >if not broken down before they get there<

One of the purposes of AC Therapy is to slow down the formation and give additional time for that normal body process (of breaking them down).

I believe that the number of Dynes needed will mean you're doing exersize (probably fitness training or event levels) to trigger this. I would guess that a sedentary period would not be high risk.


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the interested may research: Fluid Mechanics of Heart Valves by Yognathan (et al)

the usual disclaimer applies
1617833506583.png
 
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dwhist

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Elmhurst, IL
My 2 cents worth. Bridge for the colonoscopy and get it done in one shot if needed.

As to clotting, I had knee replaced last November. Stopped warfarin on Sunday. Started lovenox shots Tuesday, but held Wed evening shot on advice from doc. Surgery Thursday morning and tested at an INR of 1.06. Much lower than I would have liked. Given usual does of warfarin that evening. Doc decided due to bleeding in knee they would hold the heparin for a few days.

Next day, Friday, I had a stroke in early afternoon. I do not remember anything and woke up Sat morning in ICU. Doc came in and said they felt a blood clot had formed on valve and let loose causing the stroke. They had given me the stroke buster shot, TBA and it worked. Saw doc notes and they did 3 CT scans day of stroke. Was in until following Thursday and they put me on heparin and wanted me over 2.0 INR before they released me. Cardiologist said I was extra sensitive and there will be more planning next time I bridge. No after affects from stroke as they caught it fast and shot worked. Interesting as hospital bill showed shot cost $29,000. I am sure insurance paid alot less.

In 2018 I bridged 3 times for 2 tests and 1 surgery with no issues. I think they started me one day too early for bridging this time and I would have liked to be closer to an INR of 1.5 day of surgery. Not sure what surgeon would have wanted this time, but past tests and surgery I was told 1.5 was ok
 

dwhist

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Thanks Pellicle,

They did testing before I was released and feel I have no lasting effects. I have noticed nothing different. I was lucky it happened in the hospital and nurse figured it out quickly and got a doctor in who called a stroke alert. A team including a neurologist showed up and took great care of me leading to shot being given within time it works best.
 

pellicle

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as a PS
I was lucky it happened in the hospital and nurse figured it out quickly and got a doctor in who called a stroke alert.
for what its worth my Uncle (a fit and strong grazier without any heart conditions) died days after a back fusion surgery from a stroke. He was released from hospital and died suddenly one evening (in front of his wife (my Aunt)).

I sometimes think that some of these bone surgeries are riskier than heart surgery.

(PPS: turns out its yes , other)
 

Mister_James

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Updates:
I had my colonoscopy with my INR at 1.7. I withheld Lovenox for 24 hours prior to the procedure on Tuesday morning. They removed two small polyps and used clips.

When I got home Tuesday evening, I restarted Warfarin and Lovenox, I continued Lovenox on Wednesday morning and I noticed significant bleeding. I was advised to stop Lovenox and my INR was 2.0

Thursday was better. I cant say less blood but it is there. INR 2.0 no Lovenox.

Friday looks more less like Thursday with only difference that I have been eating food for 3 days without getting too detailed the difference is in the consistency of what comes out not the color.

Since I am not having any other symptoms, I am monitoring with hope that if I don't get my INR too high we will have progress. I notice the blood with bowel movement.

I don't want ER visit on a weekend but if it becomes serious enough there is no choice and that is where we are at.

My surprise is that my INR did not drop fast, I thought I would be below 1.5 but I did not get there.
 

tom in MO

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Tom in MO

Your arguement is the just a mirror of those who say I will take a tissue valve and have a redo in a few years because I don't like warfarin.

Why would you want 2 colonoscopies? Any procedure carries risks. The scope could perforate the colon and...

You go into a colonoscopy to explore, find, snip and probe. All at once. You want to have a whole nother low fiber for days, clear liquids for a day, purging concoctions all over again?

If you have been coagulated properly for a while, you can go off warfarin for 5 days and restart without major problems. Yes I chickened but I still held off lovenox for 24 hours with an INR of 1.5.

Clots on valves take a while to form. It is a reasonable risk to take once than to chance and compound risks.
It is not "my argument." It's a clinical choice for me, the patient, provided by the colonoscopy expert, my colorectal surgeon. Nobody wants even 1 colonoscopy, but nobody wants to throw a clot either. Due to bowel problems that led to a 6" colectomy I have had numerous colonoscopies and sigmoidoscopies and they have never "snipped" or "probed" or taken samples. They drove the snake through and watched. I would rather risk a second colonoscopy and have one on warfarin then risk throwing a clot to avoid a second colonoscopy. There is no risk with the just a colonoscopy to your valve. There is risk if they take samples, remove polyps or bridge.

By the way, you don't have to have low fiber for days or purging concoctions for a colonoscopy. All you need is to skip dinner the night before, don't eat, drink clear liquids, and have back to back enemas at home a few hours before the colonoscopy. However, most people think enemas are distasteful so it's not a choice given by many doctors who perform colonoscopies. I found out about the enema option by complaining abut the drug-induced purge.

Hi Tom. So if I understand you correctly you do the first on Warfarin and hope they find nothing?
Yes. The colonoscopy is just on Warfarin. Since I had prior bowel troubles and hemorrhoids, before my valve surgery, I had a consultation with my colorectal surgeon about warfarin and the impacts for someone with my pre-existing problems. I had a colonoscopy before surgery so I could check it out and push back the next one 10 years.
 

Sheenas7

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Messages
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Va, Fairfax County
It is not "my argument." It's a clinical choice for me, the patient, provided by the colonoscopy expert, my colorectal surgeon. Nobody wants even 1 colonoscopy, but nobody wants to throw a clot either. Due to bowel problems that led to a 6" colectomy I have had numerous colonoscopies and sigmoidoscopies and they have never "snipped" or "probed" or taken samples. They drove the snake through and watched. I would rather risk a second colonoscopy and have one on warfarin then risk throwing a clot to avoid a second colonoscopy. There is no risk with the just a colonoscopy to your valve. There is risk if they take samples, remove polyps or bridge.

By the way, you don't have to have low fiber for days or purging concoctions for a colonoscopy. All you need is to skip dinner the night before, don't eat, drink clear liquids, and have back to back enemas at home a few hours before the colonoscopy. However, most people think enemas are distasteful so it's not a choice given by many doctors who perform colonoscopies. I found out about the enema option by complaining abut the drug-induced purge.



Yes. The colonoscopy is just on Warfarin. Since I had prior bowel troubles and hemorrhoids, before my valve surgery, I had a consultation with my colorectal surgeon about warfarin and the impacts for someone with my pre-existing problems. I had a colonoscopy before surgery so I could check it out and push back the next one 10 years.
I have done colonoscopy off warfarin and on warfarin. They have never found a polyp so my last two have been on warfarin. My doctor said he plans on only doing one more because I am now over 70 and never had a polyp. Surprised me because my brother and cousin had colon cancer.
 
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