Fourteen stitches and didn't "bleed out"

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Hi

epstns said:
... Those darned things would to 20-25 MPH. . . with NO brakes.
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Marcus made the chain drive and components himself on CNC gear ... he's had it up to something higher than that ... burned himself on the expansion chamber too.


have SuperDick. (NO off-color references intended, but. . . )
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is it a bird? .... is it a plane? ... no its

ok ok ... I'm outta here
 
dick0236 said:
Skigirl and Pellica....Not a bad idea but.......I am an old man and probably couldn't find a young lady to take pity on me.
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Look don't dismiss the idea out of hand Dick ... Rupert seems to manage it.

wendi-rupert--z.jpg
 
I had an interesting talk with my new electrophysiologist today. We were reviewing the interrogation report from my pacemaker, which showed one single incident of either tachycardia or afib, lasting about 4 1/2 hours. We determined the cause and wrote it off as a non-issue, but she was saying that if I continued to experience episodes this long, then we might have to consider long-term anti-coagulation threapy. She then mentioned Pradaxa and the other "magic" drugs, and was surprised when I told her that "Thank you very much, but if I need to move to anticoagulation meds, I would prefer to stay with good old warfarin. I told her that I understand a bit of how to manage the drug, what to look for and how to adjust, but I am not at all comfortable with the non-reversibility of the new meds. She thought this was a very sound viewpoint and was surprised to meet a patient who, although not now using ACT, knew enough about it to have a valid, informed opinion.

I'll argue both sides of the tissue versus mechanical valve issue, but I am strong in my opinion of "What's so bad about warfarin?"
 
epstns said:
I'll argue both sides of the tissue versus mechanical valve issue, but I am strong in my opinion of "What's so bad about warfarin?"
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especially if it stops you getting a stroke from a clot!

Stories from my mate whos a pharmacist about the other drugs bother me more than me accidentially taking an OD on warfarin.

Besides I can always get it cheap at the hardware shop in a pinch ;-)

as foghorn would say <I say thats a Joke Son>
 
epstns said:
I had an interesting talk with my new electrophysiologist today. We were reviewing the interrogation report from my pacemaker, which showed one single incident of either tachycardia or afib, lasting about 4 1/2 hours. We determined the cause and wrote it off as a non-issue, but she was saying that if I continued to experience episodes this long, then we might have to consider long-term anti-coagulation threapy. She then mentioned Pradaxa and the other "magic" drugs, and was surprised when I told her that "Thank you very much, but if I need to move to anticoagulation meds, I would prefer to stay with good old warfarin. I told her that I understand a bit of how to manage the drug, what to look for and how to adjust, but I am not at all comfortable with the non-reversibility of the new meds. She thought this was a very sound viewpoint and was surprised to meet a patient who, although not now using ACT, knew enough about it to have a valid, informed opinion.

I'll argue both sides of the tissue versus mechanical valve issue, but I am strong in my opinion of "What's so bad about warfarin?"
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Steve, I am curious as to what was the cause of your 4.5 hr tachy episode ?
 
Bina, when we checked the date and time of the major tachy episode, it coincided exactly with the time at which I suffered a pinched lumbar nerve. The nerve injury caused massive muscle cramping all up and down my back, slamming me face-first down onto the floor. I was in so much pain that I was unable to stand, sit, walk or do much of anything else. My wife had to help me to the car and take me to the ER, where they did X-rays and discovered some arthritis in my lower lumbar region. The arthritis caused formation of some bony spurs on my spine, which they believe pinched a nerve. By the time the diagnostics were completed and the muscle-relaxant and pain meds I was given kicked in, it was about 4 1/2 hours later - just about exactly when the tachy episode ended.

The doc at the ER said "There's good news and bad. The good news is that you will again be pain-free. The bad is that this will likely happen again." One day at a time.
 
Follow up to thread. Just had stitches removed. My doc thought the ER doc did a helluva job sewing me up. We can put this thread "to bed"......I wonder what I'll do next?

......man will I be glad when the temp gets above zero degrees. I'm going stir crazy just sitting in the house and looking at TV or Internet screens. I wish you Canadians would keep your cold weather inside your border and NOT let it drift south.
 
Hi Steve,

I've been gone awhile (about four years). Has there been a discussion on here about the differences between warfarin and the newer drugs (e.g., dabigatran) used for a-fib? I'm curious to learn more about that.

Thanks!
Michele
 
warfarin and the newer drugs (e.g., dabigatran)

warfarin and the newer drugs (e.g., dabigatran)

Hi
river-wear said:
Hi Steve,

I've been gone awhile (about four years). Has there been a discussion on here about the differences between warfarin and the newer drugs (e.g., dabigatran) used for a-fib? I'm curious to learn more about that.
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I'm not Steve but while waiting for him to get back to you:
  • not approved for aortic valves AFAIK
  • one dose fits all, no monitoring needed (or if any very reduced)
  • not easily reversable (think re-establishing coagulation)
  • no established protocols in ER units (unlike warfarin where its give oral VitK)
  • results of studies suggest that new durgs are about equal to warfarin (when warfarin is badly managed) in terms of Thombus and Bleeds. However if you consider warfarin when INR is well managed warfarin has the lead

that should be a good start discussion. Perhaps this deserves its own thread?

PS:

from http://www.pradaxapro.com/stroke-risk#/dabigatran-safety-experience

The safety and efficacy of PRADAXA in patients with bileaflet mechanical prosthetic heart valves (recently implanted or implanted more than 3 months prior to enrollment) was evaluated in the phase 2 RE-ALIGN trial. RE-ALIGN was terminated early because of significantly more thromboembolic events (valve thrombosis, stroke, transient ischemic attack, and myocardial infarction) and an excess of major bleeding (predominantly post-operative pericardial effusions requiring intervention for hemodynamic compromise) for PRADAXA vs warfarin. Therefore, the use of PRADAXA is contraindicated in patients with mechanical prosthetic valves.
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(my bolds)
 
Thanks, Pellicle -- I really cannot offer much more on Pradaxa or the other new meds. If Ross was still around, I'm sure he had it all documented. I have discussed anticoagulation with my EP doc, and she was surprised to hear that if I do need ACT for afib, I am not interested in Pradaxa, et. al. I have used warfarin, had my issues getting it regulated, and fear it not. It is a well-understood drug that does its job, and does it extremely well. It requires a modicum of patient knowledge and care, and can be patient-managed over the long term. It is the "gold standard" for anticoagulation for a reason.
 
The drug companies are no doubt making a very strong push to convince doctors (and the public who see their barrage of commercials) to use these new wonder drugs - which make them lots of money - instead of Warfarin/Coumadin, which no longer does. This means that the drug companies send reps (which they call 'detail persons') to visit doctors and push the (relatively small) advantages of these high priced patented drugs, while also minimizing the potentially lethal side effects of their drugs if they're not taken correctly, and also accentuating the relatively small risks of warfarin).

It's about money. The doctors probably get free dinners to learn about these new drugs, all kinds of gifts, and whatever the drug companies can do for the doctors to convince them to start prescribing their drug.

For me, at a dime a day, having a pretty well understood, easily monitored (ouch -- I stuck my finger), and usually well managed once the initial dosing is worked out, drug versus these many dollar a day medications is a no brainer. And, as has been noted, these aren't approved for mechanical valves so, for me, the issue is moot anyway.
 
Thank you for the info, Pellicle and Steve. I had been wondering about the reasons why the new drug wasn't appropriate for valve patients. My speculation had been that perhaps the therapeutic level was higher than for a-fib and so the dangers of overdose would be higher. Based on the study Pellicle found, it appears to have more to do with how the drug works.

Thanks again! You'll probably find me here much more often after I see my surgeon on Tuesday... unless this is another "misunderstanding." :wink2:
 
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