Question about Coumadin

[alicia]

Since Ive agreed to St Judes valve and will have to be on Coumadin I have some questions for all my VR friends...

(1) How often do you have to get tested?
(2) What happens if you cut yourself?
(3) Do you have to stop Coumadin for dental work (Im going to need alot after I get over the surgery)

The cardiac surgeon told me it takes about a year to get over this surgery. Does that sound about right? It didnt take me long to get over my MVR in 2001.

Monday is the big day. Im trying to stay busy this w/e. Planning on watching all the playoffs this weekend. I think San Francisco and Oakland will make it to the superbowl. Oh well, Ive strayed from the subject of Coumadin.

Does a St Judes valve sound like a good option for me since Im only 42 years old? Any feedback would be appreciated.

Hugs to all

 

[JimL]

1. I get tested every other week. I think once a week is best, but some test once a month.
2. If I get cut, I heal up -- although I find I do use more bandaids than before.
3. There has been much discussion about stopping coumadin, the general conclusion being: Usually not.

 

[alicia]

Oh another thing my cardiac surgeon talked to us about...he said since I had problems after my MVR with afib its likely I will have that problem again and when and IF I do it will be addressed at that time. Anyone had problems with afib after cardiac surgery?
I was put on Amiodorene (spelling??) and it did help.

 

[EVELYN]

Hi Alicia

My husband, Tyce, had a St. Jude's implanted in June and as a result is on Coumadin/warfarin for the rest of his life. He's 59 and just as active as before his surgery. Coumadin is NOT an issue with us. We do test every week with our Protime machine---well worth the expense if your insurance does not pay---and do a diet adjustment first if he's out of range ie, lots of v8 or broccoli or cabbage. I do fax our results into our cardio if he's out of range, though, and he will call us if there's an adjustment to be made. He has had tooth work done without stopping the coumadin; he has also cut/scratched himself with no problem. To him, the thought of another surgery in 10-15 years was NOT viable.

We consider ourselves extremely lucky because our cardio is very pro home testing. I think if Tyce had to go to a lab or our cardio's office once a week it might be different, but the home testing is absolutely a dream. If your insurance doesn't pay for it, it is WELL worth purchasing it yourself.

As far as afib goes, it is a very common problem post op. Tyce had it and was put on Amiodarone for about 6 months post. He was just weaned off of it last month and is in nsr, so we're hoping he won't go into afib again. Our surgeon said it's the heart's way of saying...."I don't like being wrestled with!!"

I wish you the very best on Monday.....you will be in my prayers.

Evelyn

 

[Creed3]

Hi Alicia!
I have a St. Jude in the aortic position. I am 34 years old and am on coumadin for the rest of my life. You will probably get your INR tested once or twice a week in the beginning. Eventually as your INR increases and you become more stable with your levels you will go once every two weeks and then maybe eventually once every six weeks. If you have a home tester, which I do not yet, you will probably test once a week. Don't worry if your INR goes up and down in the beginning. Sometimes it takes awhile to get everything stable. Everyone is different.
There will be times that you cut yourself, such as shaving etc....I haven't really found that to be too big of a problem. You will bleed a little more and it will take a little longer to stop, but it hasn't been a big deal. Usually those kinds of cuts are superficial. Now if you were to get a deep cut, that is when you would want to go to the ER, if the bleeding doesn't stop in about ten minutes or so. You may or may not bruise easier.
I am waiting to hear from my doctor to see if he wants me to stop my coumadin when I go for my cleaning. My dentist won't even make me an appt. until my doctor gives him his opinion. If he wants me to stop coumadin, I think I will definately question that decision.
This will be a tough weekend, but do try to keep yourself busy. I will be thinking of you on Monday. Everything will go just fine. As you know from your first surgery, everyone's recovery is different, but it does take awhile for your body to completely recover. I am only 3 1/2 months post op and I still feel a little sore, itchy etc...But you will be feeling more like yourself by about 8 to 12 weeks post op, if not before that.

Good Luck & Take Care!
Gail

 

[alicia]

How do they test your levels? Do you get results right then or do they send blood to lab? Is it like diabetics checking their blood sugars? Lots to learn

 

[wlaldridge]

Hi, and good luck to you as you go forward.

Your recovery will likely be very similar to your previous one.

I got a St. Jude in aortic position on Sept 12 2002 and am on warfarin till something better is approved (which is expected within the next 5 to 10 years, I don't say Coumadin for life, therefore.)

I wanted a tissue valve but got what they gave me due to my particular phisiology. I hate needles, and they about wiped out all my veins in the hospital trying to get to me. I have problem veins. Thank goodness that I have had good phlebotomists at both of my labs and they are very careful to make the draw. Much better than the hospital folks.

I was tested every 4 days for a couple weeks after the hospital and then every one to two weeks, then three weeks now starting once per month. I am pretty much "in tune" with what I do and what I eat so my INR has finally gotten into range fo 2.0-3.0.

I have little or no interest in self testing at this point. I think I would drive myself crazy chasing the normal day to day changes. If I get concerned I can always run to the lab or my cardiologist for a quick test.

For me the fear of Coumadin and all of this has been worse than the actual events.

Due to the volume and velocity of blood across the aortic valve there is much less threat of clots and these new St. Judes have good hemodynamics. My surgeon says that some places in the world they don't anti-coagulate aortic valve patients and they have not had problems. It is an important safeguard, to my thinking.

Everyone is different and has differing reactions. I would bet you will do just fine and have a gentle recovery.

My best wishes to you and your family(I think it is harder for family than the patient, since the patient gets all the special care from the pros and family bears the stress.)

 

[EVELYN]

Hi A
On the Protime or Coagucheck machines the results are within a minute or two. Since our cardio has a coumadin clinic within his practice, we have never had to go to a hospital for a blood draw. The finger stick with the portable machines is much easier, with almost instantaneous results. As Gail said, it takes a bit post op for your coumadin level to come up, but your cardio will tell you the parameters you should be between. Tyce is between 2.5 and 3.5....his last check yesterday was 4.1, so he just had some salad and a v8 and we'll check again in a few days. Foods high in vitamin k are great to lower the inr....green leafies like broccoli, salads, cabbage, etc.

I remember when we were in the hospital and they gave us booklet after booklet on coumadin management....I thought we would NEVER get it figured out, NOT SO!! Al Lodwick, on this site, runs a coumadin clinic and is the coumadin guru who will always answer any questions you may have....he's a wonderful asset and a great person, too.

Evelyn

 

[wlaldridge]

Oh by the way, I bleed a little more from cuts and nicks. I don't seem to bruise easier tho. I ran into a countertop with the back of my hand and my full body weight (260 #) moving pretty quickly and it did not bruise at all. Did scrape the skin pretty good tho.

Again, individual differences cause us all to react in different ways.

I know I am not completely recovered from the surgery but I have gained weight and have almost as much energy as I had before.

Again, good luck

 

[Ross]

How do they test your levels? Do you get results right then or do they send blood to lab? Is it like diabetics checking their blood sugars? Lots to learn

The take blood from a vein in your arm.

Then, depending on the place you have to go to, they usually have a lab on premises. It takes about 20 minutes to get the results and meet with the Doc or Nurse.

They will adjust your dosages from there.

If you can get a home test unit, it's similiar to what diabetics have to use. A little different though.

 

[LA_Cruiser]

I was informed that.......

I was informed that.......

...first the dentist informs the card as to type and procedure of work required, THEN the card decides on coumadin stoppage etc.

That in my case I'd probably be instructed to stop coumadin 3-4 days and take antibiotics before dental work beforehand.

I would guess that every case would be different.

EVELYN, how much are those 'ProTime' machines? I was informed at coumadin lab that 'the good ones' are about $1,500.

Coumadin Dosage Calendar >>>>

God Bless all!

 

[EVELYN]

Hi Marco

We were very fortunate that both of our insurances covered the machine and all the necessary supplies---Tyce's until he retires from work and mine for the rest of our lives. I think they run about $2,000 give or take, you'd have to contact QAS for the figures. I also think they're willling to work with insurance companies as far as price goes. When we bought ours, coagucheck was not available for "private" purchase. I do believe they are now available for anyone, not just clinics and drs.

Our cardio's office likes the coagucheck better because they got it free and only have to purchase supplies. Debbie, the head vampire says she liked the coagucheck because the protime had a time limit from the stick to the insert and sometimes she gets busy talking with patients and loses time.

We are very pleased with the Protime. From helping us and telling us what info we needed for the insurance, to working with the insurance companies, QAS was wonderful. They even send extra cuvettes or tenderletts when we screw up. Lance was wonderful, as was the nurse who did our training with us.

I hope you are able to get a machine.....they're well worth the expense even if the insurance won't cover it.

Evelyn

 

[Rich]

Hi Alicia,
Good luck on your upcoming surgery.
I have had my St. Jude mechanical in the aortic position for about six and a half years now and it has been great.
The Coumadin has been no problem whatsoever.
I get tested at the hospital once every month and then my cardiologisit office calls me the next day with the results.
Our hospital has set-up a special lab just for people like us so there is no waiting, parking fees,etc. I'm in and out in minutes.
If I cut myself I do bleed a little longer and bruise easier but it's been no big deal.
I only stopped my Coumadin for an extraction but not for any other dental work.
I found recovery to be more like 8-10 weeks, most of that waiting for the breastbone to heal.
I think you are making the right choice and even if you need to replace that valve someday it might be thirty years or more from now and who knows what may be available by then.

 

[terry40]

Hi Alicia

Hi Alicia

Mine is pretty much like the others, if I nic myself I just bleed a little longer, nothing too scary, the bruises are a wee bit bigger, but I've always been on the clumpsy side, and bruises are common-place with me.

Right now I'm being tested every week, they will adjust your dose the first several weeks until you reach that therapeutic range 2.5 to 3.5 for a mechanical valve. at 2 months I finally got into that range at 3.0.

I had afib in the hospital, which panic the whole nursing staff, it was under control after 48 hours, I was forbidden from getting out of bed.
I have had a rapid heart rate since surgery, and throwing off several PVCs, I had this problem before surgery, but it was control by medication, the same meds only double the dose are not working, but I'm patient and I hate taking meds so if the doctors okay with it I okay with it!

My prayers will be with you on Monday,

Terry40

 

[MarkU]

Hi alicia,

(1) I get tested every six weeks at the anti-coag lab at my cardiologist's office. You will be tested more often at first until your INR is in range on a consistent basis.

(2) Thankfully I haven't had any major cuts or injuries since being on Coumadin. Smaller cuts or nicks do bleed a bit longer, but I'm not sure it would be enough to even notice if I didn't know I was on Coumadin and was alert for it.

(3) As far as dental procedures, you need to take a look at some of the recent posts over in the Coumadin section, and review the articles on Al Lodwick's web site. Discontinuing Coumadin therapy for any reason is very dangerous. While I think that Al is sometimes a little hard on doctors, I think that he is correct in his warnings that not all in the medical profession are looking at the big picture sometimes. Having some bleeding during a dental procedure is a relative minor problem as opposed to having a stroke because you went off Coumadin for several days.

Good luck with your surgery. It did take me nine months to a year to totally recover, but now two years down the road I feel better than I have in years.

I was 47 when I got my St. Jude aortic valve. I was always physically active, and I still am, running and working out at the gym five days a week. I'm having to cut back on some of the things I do, but it's more due to the fact that I'm pushing 50 and my joints are getting stiff and wearing out from age

Our thoughts and prayers will be with you.

Mark

 

[carbomedic]

Alicia,
My biggest problem with Coumadin has been trying to be consistant in diet, exercise. But as stated before, the anticipation of long term coumadin is much worst that reality. My cardio adjusted my levels when I changed my diet to primarly fruits and vegs. She said, " eat healthy, we'll adjust on our end". Works pretty good. Just an occasional bloody nose. No big deal.
Good luck tomorrow, I'll be pulling for you. What time are you scheduled for? ( your time zone)

carbo

 

[wlaldridge]

Just a note, when I posted earlier about bleeding a little more.

I bleed about as much as I did when I took asprin therapy (low dose) a few years back. It has not been a big deal at all.

 

[whalepassion]

support from a NC neighbor

support from a NC neighbor

Hi Alicia, I am saying several prayers for you and hope that your surgery goes well. We are neighbors and about the same age. I am 44 and had a mitral valve replacement in late May at Forsyth Memorial Hospital in Winston-Salem. I am recovering and should be able to answer any questions you might have related to your recovery. I am an elementary teacher and somewhat active!! My husband is always trying to slow me down. The only problem I seem to be having is with getting my blood regulated. My INR target is 2.5 but I have been in the range of 1.3 to 1.6 for months now, am really starting to worry. If you need an ear, I am a great listener and will be happy to help you through this.

 

[Blanche]

Your INR is dangerously low

Your INR is dangerously low

Welcome to the board. I'm sure you will enjoy the information and fellowship offered here. My husband received his mitral valve in October 1990. He's been on coumadin since. Sadly, he suffered a stroke in 2000 because his INR was too low and he threw a blood clot to the brain.

I'm very concerned that you state that your INR has been between 1.3 and 1.6 for months. The range for mitral valves is 2.5 to 3.5. You must contact your cardio or doctor right away. Does he/she realize how low you are and how long that has been so? What do they say when you have your protime tests? Hasn't your coumadin dose been increased? I know I'm coming on strong, but you are barely anticoagulated. A person without anticoagulation could test at 1.3. The problems you could face with low INR levels are life threatening. Please seek medical help as soon as possible. Perhaps you need a different doctor. I have never heard of an INR target expressed as one figure (2.5). INR is always stated as a range. Let us know how you are doing.
Kind regards,
Blanche, who was an elementary teacher too.

 

[whalepassion]

Low INR

Low INR

Blanche, Thank you for your concern. I had my pro-time checked yesterday and it came back at 2.6 today. The doctor and I were both happy. My ideal range is 2.5 to 3.5. Yes, they did increase my coumadin dosage 10mg one day and 12 the next. It is a high dosage but the doctor said it is not the dosage that matters, it is the numbers from the pro-time. Since I am new at this, I find it mind-boggling. I just can't seem to get regulated. The doctor said some people are just difficult to regulate. I was too thin for a long while and then too thick. The too thick was really starting to worry me. I went to Florida over x-mas and my doc had me get tested there. I came back at 1.3 so that's when they increased my doasage to 10. I don't drink or smoke and my diet is pretty consistent. I just can't figure it out. I know there has to be some rhyme and reason to this madness. I believe that I am doing pretty well since the surgery....it's just the little things...being tired, occasional dizziness and dealing with the stresses of a 3rd grade classroom. I had the surgery in late May, and another on June 7 (pericard. window) to get rid of fluid, and then was back at work Aug. 1. I have gone on and on, sorry....it's just nice having people to talk to who know what you're going through. Thanks!