Have you contacted the people that are taking care of your INR, your hematologists, your cardiovascular surgeon???
They are the ones you should be talking to.
They should had been involved from the begining.

My $0.02, get in touch with them ASAP!!!

Hey Chris,

Ok, first, OUCH. I know how much that hurts.

Second, kind of interesting. I think I would have done the same thing in your case, given you had no GP and the fear of infection. The risk of infection may have outweighed the risk of bleeding and that's why they just went for it.

My two cents is that you need a regular doctor in your life.

Hope you heal quickly!

You know, you are right, calling the coumadin clinic never even crossed my mind (clinic handles all the INR testing, dosing, etc. pulmonologist runs the clinic but doesn't get involved). I agree it's probably something they should be made aware of, and I do have a call into them now.

I also have "get a new GP" on my to-do list :) But the GP has nothing to do with my anti-coagulation. That's 100% pulm/clinic whom I see regularly. In fact, when I asked my pulmonologist to sign for the home machine, I asked what the protocol was and he said "just report it to me if things are out of range."

But in my experience to date, for every procedure I have to have done (cystoscopy, colonoscopy, etc), the pulm/clinic defer to the medical provider to make the call whether it's safe to be on coumadin or whether a bridge is needed. Or as with a colonoscopy, the risk/benefit of each way.

This was after hours on a Friday night, and I would bet a week's pay that had I paged him pulmonologist would have said go to ER/urgent care. That is what has happened in the past. The doc on duty was VERY concerned with the infection getting in my blood stream, but I don't think he weighed that against the risk of bleeding. I specifically asked the doc whether the procedure could be done while I was on coumadin, and he said yes. Took him at his word (which goes against my lately acquired distrust of docs generally.....) and he was correct. Certainly nothing I would have futzed with a bridge and consequent INR re-stabilization, etc. over.

But again, I do other "stupid stuff whilst on coumadin" like diving, riding a bike, trail running, ocean swimming, bodysurfing, etc. etc etc.

Chris

Turns out, the clinic could care less about the procedure.

They did care about the interaction between coumadin and the antibiotics and pain meds they gave me, which is actually something I DID check out, specifically asking the pharmacist whether there was any interaction, which she said no. Turns out, she was wrong, and there is a potential for increasing INR with all of them.

I guess we really have to do everything ourselves if we want accurate information. I will be telling CVS about this......

I have learned in the early stages of my DVT, that YOU have to be as inteligent as your doctor, if not more... (ok, maybe an exageration, but we need to educate ouselves on the topic)
We have to be our own LIFE advocates.

(not too bad, you are up to 4 cents in this thread...lol)

CJ...

Hope your leg heals up and you can get back to doing your thing again.

I don't want to turn the thread into a doctor bash because I think they deserve a lot of credit, but I too have been feeling quite disappointed with doctors and patient care. On the one hand, I am amazed at the advancement of medical technology and the things that can be treated and healed. Having said that, I just don't think many doctors have or take the time to really listen and spend time with their patients. Busy, busy, busy, In and out in 10 minutes. I have had several issues with my doctor and I am giving him one more chance to step up the quality of service.

It all leads to oversights and poor patient care. So we have to resort to the internet and forums to get answers.

Somewhat unfortunate symptom of today's times.

And possibly fire our doctors. My GP, and really, her staff, were just depressing to deal with and so bitchy about stuff and when I called for INR results, because god forbid they call me, you would have thought I was interupting an audience with the pope.

I switched doctors. I asked my GI for some names of a couple of internists (I love my GI doc) and then I called each of their offices, asking if they had warfarin patients who were young, how they managed INR testing, etc. Based on the responses, I picked a new doctor and he's the best. So wise and on top of things. Love him, love his staff, and I swear, I feel healthier for it.

cj, my $0.02 worth. I have cared for many people in critical care for open wounds that are on therapeutic doses of coumadin. Of course they aren't in the hospital for the wounds but usually for other reasons, in most cases the wounds were secondary. I can understand the doctors fear of allowing the infection to get into your blood stream, that's bad news. In my experience it didn't seem to me that the healing time was much different than a person who was not on coumadin. Also being on Coumadin doesn't mean your blood wont clot it merely means it takes longer for it to clot, since the doctor packed the wound it is like putting a pressure bandage on the wound so that in itself helps control any bleeding. If it were to ever get to the point that you were in jeopardy of severe bleeding a shot of vitamin K would rectify that. Then they could cover you with Lovenox. Just in case you were unaware of the difference between lovenox and coumadin. It generally takes 3-5 days for Coumadin to get out of your system and lovenox has a life of 12 hours. so generally for any major surgeries they will bridge you from Coumadin to lovenox over a period of 5 days, do the surgery and then bridge you back over to coumadin after the risks of severe bleeding stops.
Hope this information helps clarify a few things for you.
Heal well my friend
Hugs
Ferr

So, turns out my INR did jump a bit, to 3. Thanks to dero for the calling the clinic advice, as I would not have known there's an interaction (having been told otherwise).

Even then though the clinic isn't worried since I am only on the meds until Monday, they just told me to eat more greens (at least that will make my weife happy) rather than changing my dosage, and come back in a month. I think I'll call to go in sooner after I stop the meds to ensure it goes down. 3 isn't a big deal, but I like to keep mine down near 2.

As for docs, yes, it's made me change too. Previous to this, I wouldn't really question ocs, or put up with bad/poor service. Not anymore. If my GP didn't retire she was being fired, and I had one consultation and follow up phone call with a GI doc after which I told his office I wasn't comfortable having him perform any procedures on me, and I'd find a new one.

Then again, the ER doc that thought about PEs and diagnosed it may have saved my life.

Chris

My daughter had an open wound like yours. We poured sterile saline over the gauze as we were unpacking it to try to take some of the pain out of it. Seemed to help somewhat.

No prob Chris, just happy that everything is good for you. You will realise that everything affects your INR, things as simple as varying your water intake will make your level fluctuate.
The things is that you need to get your doctor to regulate your dosage according to YOUR diet, not you changing your diet to have your INR stable.
Here is another $0.02. lol

CJ, you can't believe that just because they are called Dr and have a piece of paper on their wall that we need to bow down to them, that was yesterday's way of thinking, these days, we are our best advocate, we have to be!!! (you know what I mean...)

Actually, my INR varies very little, on 7.5 mg for almost a year (in two spurts) and I am normally 2.0-2.4, I keep a pretty consistent diet, rarely drink, etc. So this was actually interesting to see something actually make a dent in the INR