Outrageous Advice

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Karlynn

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A current thread in this forum made me think that it might be worthwhile to post Al Lodwick's page from his site that lists some of the outrageous advice that people have relayed to him. Sure, for those of us that have been educated by Al, we know these to be sadly funny and makes us shake our heads. But I think it also is worth a read for those who are new to warfarin use to get an idea of how they really need to be wary of what some "so-called" medical experts are saying. It demonstrates the need to educate ourselves about warfarin use and not just assume our medical professionals know the information.

For those of you who haven't been to Al's site please bookmark it and spend some time reading through it. Also look to see if he's giving a seminar in your area and encourage your ACT manager to attend. www.warfarinfo.com

http://www.warfarinfo.com/outrageous.htm

THE MOST OUTRAGEOUS PIECES OF ADVICE GIVEN TO WARFARIN PATIENTS

I was off warfarin for surgery. When I left the hospital I was started on Lovenox and told to continue it until my INR was 2.0 and then switch to warfarin. First, Lovenox does not influence the INR. Second, it is designed to keep you protected from a clot for the 5 to 7 days that it usually takes for warfarin to get the INR back up to 2.0. Following your doctor's advice will keep you from getting a clot for however long you are on Lovenox and then put you back at risk for as long as it takes for the warfarin to get the INR back up to 2.0. You are supposed to start the Lovenox and warfarin at the same time, then stop the Lovenox when the INR gets to 2.0. This could have been a simple misunderstanding on the part of the patient except that I saw the written discharge instructions.

I thought that this case was so ridiculous that it must have been made up but the writer swears that it is true. I fractured both legs in an accident. I have a fracture of the tibia plateau and a spiral fracture. My orthopaedic surgeon did a reduction with implants and screws. On my checkup 8 days after surgery, he saw that my leg was swollen and I told him I had slept for 30 hours. He said he suspected a clot. I went the next day for a doppler, and they discovered a large hematoma and a DVT. He originally told me I would have to be admitted to the hospital. He instead called in Lovenox and Coumandin. I have never injected myself nor do I know how. He started me on 10 mg of Coumandin and 80 mg of Lovenox.My family doctor said I should not take these medications without a baseline being established. I was to go to a cardiologist the next day, but they called and said they could not take my case because it was work related. My case manager said for me to go to the hospital, so I did. I was in for 1 day and sent home because they didn't know what to do. To date, the treating doctor has not found a doctor to monitor my INR and PT's. I have been going to have my blood drawn regularly for the last month, but I have no idea if I am where I need to be. My doctor now informs me he has to take the hardware out of my leg (another surgery), and that I have to stop taking Coumandin for 7 days prior to surgery. Does this sound right to you? I am confused and a little frightened. Truth can indeed be stranger than fiction.

International Travel News has an article about a woman who was having some bleeding from around her gums. She called her doctor and asked about an interaction with warfarin and cranberry juice. Her doctor was unaware of such an interaction but soon found out that it could happen and told her to hold her warfarin for five days. One has to wonder if she would not have been better off if her doctor had remained unaware of the interaction. What is the danger from bleeding gums? A little inconvenience that might have been corrected by simply having her take 1/2 of her usual dose for a day or two. Instead her doctor decided to put her at risk of a stroke or a blood clot in the lungs. While a five day hold might be justified in preparation for major surgery it could never be justified for bleeding gums without some monitoring along the way. If you receive a piece of advice such as this RUN, do not walk, out of that doctor's office.

My INR was 3.8 today. My range is 2.5 to 3.5. I was told to hold my warfarin for for two days and decrease my daily dose. The worst part is that this person also said that they had switched doctors because the previous one was not doing a good job of managing warfarin.

I went to a chiropractor yesterday. So, I get there, fill out all the paperwork including a list of medications I'm taking - warfarin being at the top of the list. Because I'm still experiencing some significant incision pain, he recommended some enzymes to help reduce the inflammation. His words to me were, "This won't interfere with your warfarin." So, I buy the stuff ($32.86). Normal dosage is 2 pills, but because he wants to get the inflammation down, he tells me to take 20 pills each day for 2 days & then 10 pills for 3 more days. So, taking him at his word that it was safe, I downed all 20 pills. Then I decided to research the ingredients. The first place I went was to Al's site... there I found that one of the major ingredients, Papain, was on the no-no list. Looked at a few other trusted health sites, Papain on the no-no list. Can cause uncontrollable bleeding! May interfere with INR. Went to the manufacturer's site. It said that this supplement should probably not be used on patient taking warfarin.

I was started on warfarin last week. I was to take 7.5 mg the first day. My doctor tested my INR after the first dose and it was 1.2. My instructions were to continue 7.5 mg and have my INR checked the next day. The second day it was 2.2 and the comment was that it was in the range, so I was to take 10 mg the next day. But after reading some things about warfarin, I was afraid to take that much. So, I only took 5 mg. The next day my INR was 6.6. I presented this situation to my receptionist She has worked in the medical field for only one year, but she knew that an INR of 2.2 after two doses is heading for disaster and that 10 mg was going to be way too much. I think that you need to shop around for someone else to manage your warfarin

Fingerstick INR machines are new and are not as accurate as hospital or commercial laboratory testers. This came from a physician who supervises doctors in training. I mention this because these doctors have an obligation to stay up to date on the latest developments and teach these things to the young doctors. There were some inaccurate machines in the early days of fingerstick testing. These have been removed from the market more than five years ago. There has not been a medical journal article in the past five years that showed that the currently used testers are anything but comparable to the larger models. It is a shame that this "leader" has chosen to retire his/her brain, and stay in a position of responsibility.

Your INR will stay in range better if you use Coumadin instead of generic warfarin. I hear this one over and over and it never ceases to amaze me. There has never been a study that showed that this was true. Think about how many things can affect the INR - food, vitamins, other drugs, exercise, missing a dose, taking an extra dose, alcohol consumption and on and on and on. When DuPont owned the trademark for Coumadin they lost a huge lawsuit and had to give refunds to people because they had the sales reps saying this. I would be worried about putting my life in the hands of any doctor who believes this old rubbish.

Subsequent to my MVR surgery, I was taken off of Coumadin and spent four additional days in the hospital on heparin. The doctors were mistakenly waiting for my INR to decrease so that they could remove the G-Tube from my stomach. Funny thing, removing a G-Tube takes about 10 seconds (or less) and there is virtually no bleeding. I easily could have been released from the hospital four days earlier and there was no reason to take me off of Coumadin. This shows how little many physicians know about warfarin. They were willing to do the procedure while he was on heparin which carries just as much risk of bleeding as warfarin. The real surprise is that the insurance company paid for this.

You cannot eat green vegetables while taking warfarin. Does this person think that no vegetarian ever took warfarin. The more vegetables you eat, the higher your warfarin dose will need to be because you will be taking in more vitamin K which is the antagonist of warfarin, but so what. Don't you need to eat a healthy diet?

You cannot eat anything green -- not even green Jell-o or jelly beans. Millions of kids would be dancing in the streets if Jell-o and jelly beans were suddenly declared vegetables.

You need to stop warfarin for (some amount of time) before getting your teeth cleaned because you might bleed to death. Do you really think that getting your teeth cleaned will cause more bleeding than a gunshot wound?

My dentist wants me to stop my warfarin for a week before a dental procedure. My INR is supposed to be less than 1.0. This dentist must have made an amazing discovery that will extract clotting factors from your blood. The INR for a person who has never taken warfarin. The definition of having no warfarin in your body is an INR of 1.0.

You might as well stop taking warfarin because after all of these years you are probably allergic to it. It would be impossible to run fast enough to get out of this doctor's office.

An elderly man was told to stop warfarin for three weeks before he had a circumcision. This surgeon lacks any understanding of pharmacology. The man was put at high risk for a stroke for no other reason than the surgeon was afraid of a little bleeding.

A woman was given vitamin K 10 mg every day for four days before a minor surgical procedure. If the patient had suffered a stroke because of this, would she have had any quality of life to enjoy the correction made by the surgery?

A police officer was barred from duty standing along a parade route in New York because he was taking warfarin. This was after September 11, 2001 when so many of New York's finest lost their lives in the World Trade Center.

Of course you will feel cold when you take warfarin, it is a blood thinner. Warfarin does not thin the blood, it slows the ability of the blood to form a clot. While everyone calls it a blood thinner this is an unfortunate name because it is not what warfarin does.

You have to stop your warfarin to have a Pap Smear. Another one of those "you might bleed to death" fears. Some women might liken this to a gunshot wound, but only the most incompetent doctor could cause that much bleeding by taking a swab.

Carry cayenne pepper with you at all times to put on a cut that won't stop bleeding. When will you decide that a cut won't stop bleeding? Just before you lose consciousness - maybe? If you get a cut that is going to require stitches you are better off heading for the nearest emergency department that you are dumping something like hot pepper on it. I don't know if the cayenne pepper would actually harm the area around the cut, but I hope nobody ever finds out. If you keep your INR under 5.0, you are not likely to have a cut that won't stop bleeding.

Anything can happen, that stuff is rat poison. This was the response one reader got every time a question was asked of the primary care doctor.

The reason that you get more accurate results on an INR done by a venous stick rather than by a finger stick is that the sample size is larger. This was given by a doctor when asked why there was a difference between two readings. He probably thinks that you get less drunk from shots of whiskey than you do from big glasses of beer because the glasses are smaller.

Your INR must be 1.0 to have an ingrown toenail removed or you could bleed to death. I have asked a lot of trauma surgeons, ER nurses and Anticoagulation clinic people if they have ever seen anyone bleed to death from a cut to the arm, leg or torso. The answer has always been, "No." How big of a gash is that doc planning on ripping in the toe?

Your INR is 6.0. You are in danger of bleeding. Don't go out of your house. We are trying to get in contact with your doctor. The harm done by causing this person to worry excessively is likely greater than the risk of bleeding. It illustrates why warfarin should be managed by professionals using fingerstick testing to get instant results

Stop Warfarin before Flu Shot ?
I'm gonna get my Flu shot. My cardio said stop the med for few days to lower INR to 1.5. And after the shot, do not apply pressure.
 

Rich

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Karlynn,
That is a good idea especially for patients new to Coumadin.
It is some of the reason I started the thread a few weeks ago.
It can be very frustrating.
When someone on the street says 'oh your'e on a blood thinner', I just yeah I am. But when a medical professional says something like that and BELIEVES IT, then I have a problem with them.
Some examples I've run into are as follows:
I'm making an appt for the old colon check-up. She says now you must stop your Coumadin for three days prior because we don't want your blood to be too thin.
I was investigating a tooth implant(which thankfully I don't need) the periodontist says we can do the procedure while you are on Coumadin, you just make sure your INR stays EXACTLY at 2.0 for at least three days.
My nieghbor who is elderly was going for a colon check-up. His doctor tells him to hold his Coumadin for a minimum of five days prior, and five days after.
The list just goes on and on.
I have printed out a few things from Al's site and when I hear these things from a 'professional' I will stick it in front of their face.
Rich
 
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