I need to vent

[Robbyn]

I have to have a rather large cyst - 1" x 1" removed. When I called the surgeon for the date, his nurse automatically told me that I needed to completely stop my Coumadin 1 week before the date of my appointment in the hospital. This is without the doctor even seeing me first. I was shocked. I told her that was unacceptable and unless he made some other arrangements to accomodate my use of Coumadin I would be seeking a physician who would. I can't believe a surgeon (no less) would be automatically advising patients to stop their Coumadin for a week.

My INR at the moment is 1.9 and that's with 10 mgs of Coumadin, imagine if I stopped it. Thanks for listening.

 

[Karlynn]

It never ceases to amaze me. I honestly believe that the statistics for bleeding and clotting events would be much less than 3% if the medical field ever decided to really learn about the use of the drug.

Good for you!

At 10 mg/day and 1.9, I'm guessing you'd be at 1.0 in 2 days. I take 10 a day to and my INR drops really fast if a dose is skipped.

 

[geebee]

I sure would be shopping for another surgeon. I still find it hard to believe this crap is still happening with the "highly educated" medical professionals. Obviously they do not take refresher courses.

 

[ALCapshaw2]

I had an infected cyst lanced by a relatively young Surgeon who "gets it" about Stroke Risk vs. Bleeding Risk.

We both learned a bit about managing minor surgery on anti-coagulated patients, but we made it. I did mess up his lab coat (and examing table, and floor), BUT we got it stopped and it eventually healed nicely.

Remember to ask about using Pressure Bandages.
Regular tape and gause just don't get the job done!
Been There, Done That.

'AL Capshaw'

 

[JimL]

I've had several sebaceous cysts removed while I remained on coumadin -- but it was not easy to find a doctor who would do that. He did cauterize the incision quite a bit to reduce bleeding.

 

[Robbyn]

Jim, that is what I have to have removed. I am curious as so how big yours were. A 1" x 1" cyst seems so big to have removed in a ambulatory clinic. The last time (many years ago) I had it done it was in the doctors office but it was quite a bit smaller, it is my understanding if you don't get it all it comes back.

 

[lance]

Vent away

Vent away

Hi Robbyn

Vent to your heart's content--you have every reason to. Luckily you realized you were given "bad" advice". Did no one mention "bridging"?

I notice you are from Ontario too, and yes, it happened to me too. GRRR

Who manages your ACT?

 

[bvdr]

Robbyn, I just wouldn't do it. I'm hoping you can work something out with the surgeon. I recently had a cervical spinal fusion and was off anticoagulation with PTT and INR results the same as a patient who had never been anticoagulated. I still had a large amount of venous bleeding (not due to any anticoagulation issue ) during the decompression of the spinal cord but the surgeon used pieces of Avitene and Floseal to stop it. Ask your surgeon if he uses those products or others similar. I had lip surgery for cancer several years ago and my surgeon agreed to proceed without me holding coumadin. I did have more bleeding but my surgeon did not have any problem controlling it at all.

 

[ALCapshaw2]

Robbyn,

If your surgeon won't agree to excising your cyst (even at a reduced INR, say 2.0), FIND ANOTHER SURGEON.

As I said in my previous post, my (young) surgeon lanced my infected cyst with a 1 inch incision. There was some bleeding along the road which required additional cauterizing and one stitch, but it healed just fine.

Early on, a Pressure Bandage (applied at an Urgent Care facility) worked wonders. Regular tape on gause just doesn't give enough pressure to stop the bleeding.

'AL Capshaw'

 

[Robbyn]

Lance, the anti-coagulation clinic at Toronto General manages my Coumadin.

Al, I am waiting to hear back from the surgeons office, she was going to speak to the doctor about my situation. But I think I will just go ahead and get another doctor. I mean she didn't even ask why I was taking Coumadin and they have an appointment booked at the hospital in the clinic before even seeing me. The whole situation is really rubbing me the wrong way.

And thanks to you good people on this board that I even knew to tell the doctor that was unacceptable. What about the person who doesn't know and just blindly follows doctors orders?

 

[geebee]

And thanks to you good people on this board that I even knew to tell the doctor that was unacceptable. What about the person who doesn't know and just blindly follows doctors orders?

The sad part is this is why coumadin gets such a bad rap. Many people have problems because too many folks in the medical profession do not stay up to date on how to handle coumadin patients. In addition, many people choose to face multiple surgeries because they think (and may be right in many cases) that coumadin is just too much trouble when, in reality, if you have the right doctors, it is not a problem.

 

[PeggyM]

My God!!! I would notify the licensing board about that! That is nuts.

Thank goodness you knew better.

Always question "authority".

 

[lance]

Robbyn

You could not be in better hands than those at UHN in Toronto. Have you discussed this issue with the anti-coagulation nurses? They supervised bridging for me when I needed surgery two years ago. Everything went well.

It's too bad you need to see another doctor but I'm awfully glad you knew better than to follow the instreuctions you were given.

I belong to a forum where persons gather to discuss horse related activities. There was a thread questioning instructors/barn owners whether or not they would teach/instruct clients on "blood thinners". Well the idiocy that occurred would have choked a horse and came from persons (amongst others) claiming to be medical staff in ACT clinics. The worse one I recall was that the poster's grandfather lost his driver's licence because he was on "blood thinners" and could have a stroke behind the wheel. SHEESH

 

[Robbyn]

Lance you are right they are great at TGH. I think I am going to pass on this doctor completely. I live in a small town and deal with a local community hospital. I already just about died once in their hands, one strike your out. I think I will just go to the hospital in Toronto, which is what I should have done in the first place.

 

[catwoman]

Robbyn:

I suspect that what transpired is that the surgeon's office did an automatic "Discontinue your Coumadin" before surgery, since many people who take it can probably do so without risk or harm. I'm surprised the nurse didn't consult him/her about your particular history or when you voiced your concern.

Unanticoagulated, mitral valvers are at high risk for stroke. My gastroenterologist's office routinely tells people on Coumadin to go off before colonoscopies. HOWEVER, I was told to remain on warfarin because a mechanical mitral valve is involved.