Emergency surgery

shop deals on amazon
Advertise with us
Shop deals on ebay
Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
catwoman

catwoman

VR.org Supporter
Supporting Member
Joined
Sep 23, 2003
Messages
6,024
Location
near Fort Worth TX
If you are on warfarin, consider the chance that you might face emergency surgery some day.
I went through that last weekend.
I had a colonoscopy June 7. Became nauseated during prep night before, vomited for 6 hours, developed pain. When I reported for c-scope (my 3rd), I mentioned the 6 hours of nausea and the pain and didn't think they should do the c-scope, and was told they'd tell the staff. All the GI doctor was told was that I had been nauseated.
Scope report was good. But I didn't feel well. Slept 4 hours. Took temp and I had a fever, plus the pain the right side. Called the phone # on the discharge papers and was told to go to the hospital ER for a CT scan, that I probably had an infection.
After nearly 6 hours at the ER, I was told I had appendicitis (at 62???????) and needed surgery ASAP. They started calling surgeons and then worked to get my INR down to 1.5. My INR had been 2.3 when I tested Thursday. Had soups (my choice) Wednesday, clear fluids Thursday, no foods or drink Friday, so my INR was up to 3.4 on a blood draw late Friday. Got shot of vitamin K, 4 units of fresh frozen plasma.

They got my INR down to 1.5 and I went into surgery at 10AM Saturday.
Unlike elective surgery, I had no say in how to handle reversing anticoagulation. My GI doc had approved doing the c-scope with INR in range.

I told every RN and doctor who saw me that (1) I had my own INR monitor and (2) adjusted my own dosage, using an evidence-based algorithm chart. Gave them my dosing regimen. We discussed how to restart the warfarin (by then I had been on some heparin and then Lovenox shots).

I had never used low molecular-weight heparin. Before leaving the hospital, I asked my RN to let me give myself the last in-hospital shot, and he gave me 105 on the "test." The shots have been a breeze, no pain, no bruising whatsoever.

Because the appendix had ruptured, I was on IVs of antibiotics in the hospital and am on antibiotics at home for 1 week. I am quite upset at the endoscopy center staff for allowing the procedure to continue as scheduled and will discuss that with my family doctor Tuesday.

Would I have chosen a mechanical valve 10 years ago knowing an emergency like this would occur? You bet!! This is a small price to pay compared to knowing that I would probably undergo another MVR in my lifetime. I was 52 at the time of my MVR. My grandmothers were 99.5 and 96 when they died and my parents are now 84 and 86. In all likelihood, I would have required a re-op had I gone tissue. This isn't to say I won't with a mechanical, but the likelihood is very much reduced.

Those who have chosen tissue valves made that decision for various reasons. I respect their decision.

I am happy with mine. AND I LOVE MY HOME MONITOR!!!! I kept telling medical professionals, "I am so glad I have my own INR machine!!"
 
Marsha: It's good to see that you've come out of this okay. It's good to see that the doctors knew how to get your INR down for surgery.
I'm also surprised that the colonoscopy center didn't do at least a quick exam pre-colonoscopy in response to your complaints.

I completely agree with your assessment of mechanical valve versus tissue valve -- with the doctors demonstrating that they can quickly bring the INR down for emergency surgery, should ANY of us on warfarin really worry much about it?

It's good to know that you've got your own meter -- with the antibiotics that you're probably still taking making your INR spike, it'll be good that you'll be able to test as often as necessary to make sure that your INR stays within limits.
 
OMG my dear. That's awful. On another note: thank g*d you were on warfarin and not one of these newfangled anticoagulants that have no way to reverse them except time. You didn't HAVE much time!!!
Bless your heart. and bless that home monitor. Nothing like being able to deal with the antibiotics. Last time I was on them for more than just dental work (bronchitis last fall) I consulted my manager (I love her). She said to start back up on my regular warfarin dosage the last day I took the antibiotics, because when you stop taking the antibiotics the interaction elevating your INR stops pretty quickly, and your INR will drop back. She was right (and my knowing when to consult is why my cardio doesn't quibble with me self manage).
 
Hi

firstly so very glad to hear you are recovering. Quite a scare. My mum nearly died from a ruptured appendix

catwoman said:
If you are on warfarin, consider the chance that you might face emergency surgery some day.
I went through that last weekend.
...Got shot of vitamin K, 4 units of fresh frozen plasma.

...They got my INR down to 1.5 and I went into surgery at 10AM Saturday.
Click to expand...

which probably couldn't have happened if your were on pradaxa, as there is no way to rapidly reverse this if I understood this properly. Dialysis may be required.


I had never used low molecular-weight heparin.
Click to expand...

seems to be the norm here in Australia. Works well

Would I have chosen a mechanical valve 10 years ago knowing an emergency like this would occur? You bet!! This is a small price to pay compared to knowing that I would probably undergo another MVR in my lifetime.
Click to expand...

and even happier to be using old tech warfarin rather than bleeding edge pradaxa too I guess. This video is well worth watching:

http://vimeo.com/24204720

for the non technical please just listen and note the words like: "untested" "unknown" "guesswork" "speculation" in relation to dabigatran (or pradaxa). As the point is made about renal (kidneys) clearning the drug from the system, and the clearance rate being 24 hours in a healthy person, note that if you were in a car accident it would be quite likely that you would have kidney damage. Making the clearance rate longer.

So in the ER, warfarin is just so much simpler.

Anyway, Marsha, best wishes for a safe recovery
 
Cat woman, so happy to see you survived an ordeal which could have very easily have had another outcome. I chose my bovine tissue valve based on many things, including my lifestyle. I received my AVR in what for years has been ranked the nation's, if not the world's, top heart hospital, Cleveland Clinic. And my surgeon I believe is probably the leading surgeon at that facility. When he looked me in the eye and told me the chances I would receive my "replacement" valve someday percutaneously at close to 99%, I believe him.
 
Mass General Hospital, which is always in the top five heart centers in the U.S., heart surgeons say the same as reported above is said at Cleveland Clinic. I also believe them.

VERY happy your surgery went well and you are on the mend. That must have been a very frightening circumstance. So sorry you had to experience all that.

Wishing you a speedy, smooth recovery.
 
That was too close, Marsha! We're glad that you're still here to tell of it, but it is a scary notion to think that people are taking "those other drugs" instead of warfarin, thinking they are better. If you had been on one of those. . .
 
you are one of the lucky ones who can test tnere own inr i had a mech.valve and hated everything about it warfarin scares the hell out of me. but like you said it's what wotks for you any way glad you are ok
 
Virginian777 -- luck probably didn't have a lot to do with Marsha having her own meter. They're becoming increasingly available, and SOME doctors are becoming increasingly enlightened about the ability of many patients to self-test. Having the ability to self-test - and, for some of us, either a good doctor, nurse, clinic or dosing chart, should take the terror factor out of using Warfarin.

I realize that ACQUIRING a meter can be a challenge for people with limited financial resources and no insurance - but it CAN be done (I know - I've done it many times). Being able to test weekly, and being conservative about dosing changes (unless there's a major change from one test to the next), helps to assure that you are in range. There's really little reason that taking warfarin should 'scare the hell' out of you. Understanding it, and taking control of it, should make it a lot less scary.
 
Update

Update

The day after I was discharged for the emergency appendectomy, I was very sick from taking Augmentin -- vomited several hours. (It has joined erthromycin as to drugs I can't tolerate in any dosage.) Surgeon notified, switched me to cipro & Flagyl.
Two days later I was back in the ER, complaining of severe pain on the left side. Got 2 boluses of morphine, but still hurting. Nothing abnormal on CT or labwork. Sent home with Zofran RX. ER doc did NOT call my surgeon (that's what my surgeon told me later).
Four days later I returned to the ER at 5AM, complaining again of severe pain on left side. In fact, I think I was crying and screaming. Different ER doc on duty, called my surgeon, who advised on what types of CT to order. Labwork showed hemoglobin of 13, CT scan showed a hematoma 12 X 5.7 X 4.4 cm (my family doc converted this to about 6X2X2" for me) in the left rectus abdominus muscle.
I was relieved that I was NOT imagining my pain. BTW, INR was 2.9 in lab draw. I retested when I got home on my INRatio and also got 2.9.
I was advised to make appt with surgeon in 2 days and I was discharged in time to make a 2:10PM appt with my family doctor and we discussed the CT scan report I was given. My PCP copied it for his records.
The next morning (Wed June 19), I became clammy and queasy & collapsed at home. I thought it was from the pain. Friend texted me to call surgeon. Surgeon said to get to the ER & I would be admitted. He alerted the ER department I was on my way.
Same ER doc as day before worked on me. Hemoglobin down to 10. I was told I would be in the hospital about 1 week.
Because my own cardio is in a practice owned by a competing hospital system, he could not see patients where I was being admitted. So another cardio was brought in to attend to me, and I liked him very much. I plan to switch to him, in fact. He said I would be in the hospital "at least" 1 week.
I was taken off warfarin. Got 2 units of FFP.
Hemoglobin started dropping more, got down to 7.8. Got 2 blood transfusions Friday. Moved to much better quarters Saturday night in a newer building on a transplant ward. Room more like a LaQuinta room, had a mini-fridge.
Doctors started me on heparin drip, hoping to move me back to warfarin. However, a day later new CT found a small active bleed and I underwent embolization via catheterization in a radiology lab.
Labwork monitored, particularly the hemoglobin levels. I was off warfarin about 7-8 days total.
On Sunday June 30, CT scan showed no new bleed, so cardio restarted me on heparin and I got 5mg of warfarin that night. My INR was 1.2 at that point.
INR was 1.3, I think, on Monday pm, then 1.4 on Tuesday PM. It was 1.5 Wednesday (July 3).
The goal was to get it to 1.8 and I could go home, with instructions to continue home-testing and call results to cardio.
I had mentioned several times to the cardio that my wedding anniversary is July 3.
On Wednesday afternoon, cardio came in and said, "Happy Anniversary. How would you like to go home? Or do you want to stay until tomorrow?" I was willing to leave at 1.5INR. Having my own INR monitor sure helped in getting me out of there a day or two early!!!!!!!!!!!
My INR was up to 1.8 ths morning, showing 3 full days' worth of warfarin.
Game plan is to keep INR about 2.0-2.5 for about 1 month, then gradually move up to 2.5-3.5, hopefully staying around 2.5-3.0.

One of my breakfast buddies & his wife came to visit on Monday or Tuesday. Gary is a retired pediatric orthpedic surgeon and I told him about the hematoma and having vomited pretty strenuously on Wednesday June 12. He said it's possible that factored in, with the Lovenox shots & warfarin.

For a number of days, I had what I called a "size 20 muffin top" on my left side. Painful to get up out of bed, from chair, had to hold my abdomen when walking. I did not want narcotics for pain, so they used a Lidaderm patch on the area + extra strength tylenol. I had had morphine when I was hospitalized for the appendectomy, and it depressed my BP, caused nightmares, nosebleeds and constipation.

As with my MVR recovery, I am having appetite/hunger issues, sleep issues and lack of energy. Takes very little to wipe out my energy. I did some walks at the hospital, but I'm unsteady on my feet and don't want to walk at home unless someone is with me.
In addition, I have some problems from IVs -- an embolus in the left forearm due to an IV in the crease of the arm (dumb ER nurse!!!) and a smaller one in the right forearm. Left arm was tagged to prevent any shots, IVs or BP checks.


I am off work at least 2 weeks, then will go back for 2 weeks at 20 hours/week. I would like to be off 3 weeks, then 2 weeks part-time. May see if doctors will alter the FMLA/STD paperwork accordingly.

It will take several months for the hematoma to be fully resorbed by the body.

Doctors have told me I had drawn the black bean, that even patients not on warfarin or Lovenox can suffer hematomas post-op.

Whatever, I am determined to regain my strength and get back to "normal" (whatever that is).

I owe my life to several people -- an ER doc who told me Tuesday June 18: "I WILL find out what's wrong with you. You do not deserve to suffer this"; my friend who texted me to call the surgeon on Wed June 19; the cardio & surgeon; and the wonderful nurses and nurse techs who pampered me AND my husband. One nurse tech found him extra dinner trays, brought us cups of Blue Bell ice cream in the afternoon, always asked if she could do anything for him, when she checked in on me.
And, of course, my husband.

This was just a fluke. Many have had surgery and used Lovenox while returning to warfarin w/out problems. I was told I had the "perfect storm."

I have been advised to avoid coughing bouts and vomiting. Coughing bouts frequently turn into vomiting for me. I had one such incident while in the hospital.

I had a lot of time -- 15 days during the latest hospitalization -- to rethink my choice of valve 10 years ago. And decided that, yes, I would still go with a mechanical.

BTW, I spent my 10th valversary having a CT scan and the embolization procedure.

I will have to take things easy, avoid overtaxing my energy -- not unlike what I went through 10 years ago after my MVR. I will be using the little motor scooters at stores for several weeks. Do not want to drive for another week (my choice).
 
Wow. What a nightmare that must have been.
It sounded like all the vomiting may have contributed to the issue with the abdominal muscle. For myself, I know that some long bouts of coughing or sneezing can do a job on those muscles -- it makes it painful to do those things, but hasn't caused any bleeding yet.

One of the many things that you have no control over - or knowledge of - is the way your body is treated when you're transferred from bed to gurney to operating table, back to gurney, to bed, etc. While you're still under anesthesia, and basically just a lump of meat, it may be possible that a bit of mishandling may have put a bit of extra strain on an abdominal muscle. Who knows?

In any case, it's good to hear that you've survived this and that you're on your way back to full health.
 
A friend of mine -- who is an attorney for the state of Louisiana -- told me she had searched online for appendicitis cases related to colonoscopies and hit pay dirt.

When folks have OHS -- whether it's CABG, valve repair or replacement, heart transplant or other procedures -- there are others who have been there, done that, who can tell them, yes, that's normal, that's not normal, you'll get through this, consult your doctor, etc.
I didn't have this. It was a wait-and-see pattern.
My doctors said they had not seen cases like mine. The cardio did have one patient whose hematoma was on the back, don't remember the details.

BTW -- the cardio seemed confident I would be OK without warfarin for several days, but didn't want to go beyond about 1 week. Reasons: 1. My valve was 10 years old; clot formation greatest within several months of valve implantation; 2. My valve is very crisp-sounding. He related one patient who, for whatever reason, had gone TWICE without warfarin for 8 months and had had no negative incidents.
Being in a hospital, if I had suffered something without warfarin, I know it would have been immediately tackled. At home, not. I remember hearing Code Blue calls to CVICU and prayed for the patients.
 
If I was to have a stroke, I wouldn't feel much safer if I was in a hospital than I would at home. (In fact, I had a TIA at home, and immediately took two aspirin - which is apparently what they'll do at a hospital). My mother-in-law had a stroke in a hospital. My wife witnessed it. She immediately went to the nursing station, which ignored her. Twenty minutes later, the nurse sauntered in and said, 'gee, you were right.' If the damage has been done - if the brain cells die - there's not a lot that can be done - inside or or away from a hospital.

I wouldn't be comfortable below 2.0 for any more than a day or two. The new 'range' that some are promoting for AVRs is an invitation for disaster -- 2.0 - 3.0. With meters (and, I guess, labs) having acceptable margins of error of .5, this could put you far below 2.0 without ringing any bells.

It's probably okay to be without warfarin for a few days, as long as your INR doesn't stay below 2.0 for very long--but this is only my opinion.
 
And what would you have done in my shoes? Stay on warfarin and continue bleeding? I hope you never have to make that decision for your doctor.

It was damned hard accepting that to stop the bleed, we had to stop anticoagulation. I had to go on gut instincts (excuse the pun) that this would work. There was no other option.
 
You must log in or register to reply here.

Latest posts

Back
Top