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BBB is in the hospital

 
 
Pemerson
 
  1  
Reply Thu 7 Jan, 2010 03:29 pm
Glad to see BBB is posting again - and, exercising, losing weight too! My husband is doing the coumadin thing with pacemaker. We just keep moving, working, gardening, trying to never quit.
Also good to hear you, Butrfly, didn't get the flu or whatever - just a cold. Yeah, the doggies help, don't they?
0 Replies
 
Butrflynet
 
  1  
Reply Wed 13 Jan, 2010 04:06 pm
Been busy taking care of my mom. She was doing better for awhile after coming home from the hospital, but her hip has gone out on her after doing some brief walking in the grocery store's produce section so she's immobile and on pain killers again. Physical therapy is now on hold. We're trying to find out if it is safe for her to receive another cortisone injection so soon after she had so many in the last few months, and if it is safe for her to get one while on blood thinners. We're also investigating hip replacement surgery and whether she's in good enough condition to survive and recover from it.

The nurses have said that she'd have to come off the blood thinners a week before an injection or surgery. We've got an appointment on the 19th with an orthopedic surgeon to evaluate the situation.

I found this article that warns about the dangers of coming off blood thinners before surgery and it gives us a lot of concern too. It's a catch 22.

http://www.lifeclinic.com/fullpage.aspx?prid=512576&type=1

A Warning on Stopping Blood Thinners Before Surgery
4/3/2003

THURSDAY, April 4 (HealthScoutNews) -- Conventional wisdom dictates that patients taking the blood-thinning drug warfarin discontinue its use up to one week prior to any type of surgery, even dental work.

But a new study turns that well-accepted tenet on its head, with evidence that, for some patients, doing so could dramatically increase their risk of stroke.

"What this study does is raise some serious questions about the application of current guidelines that recommend stopping anti-clot medications prior to invasive procedures," says study author Dr. Stanley Cohen. "And hopefully [it] will shed some light on other ways to manage treatment for these patients if and when they require some type of surgical procedure."

Cohen, director of the Stroke Program at Cedars-Sinai Medical Center in Los Angeles, presented his findings Thursday at the annual meeting of the American Academy of Neurology in Honolulu.

The study focused on a sub-group of stroke patients with a cardiac condition known as "atrial fibrillation." This is a type of heart-rhythm disturbance that affects more than 2 million people, and it dramatically increases the risk of blood clot formation, and, ultimately, stroke.

While all types of strokes can be devastating, the type that occurs because of atrial fibrillation "can yield the greatest amount of damage and disability," Cohen says.

One way that warfarin reduces that risk is by thinning the blood, keeping clots from forming. But that also increases the risk of hemorrhage, should any type of bleeding occur. This is one reason why doctors routinely tell patients to stop taking this drug up to seven days before surgery, says Cohen.

However, many types of surgeries -- including dental work, skin biopsies, mole removals, and even colonoscopies (without polyp removal) -- carry a slight risk of major bleeding, he says.

"When this is the case, the risk of stroke is far greater than the risk of hemorrhage," says Cohen, who adds that stopping the drug could have dire consequences.

Proving that, he says, was the point of the new study.

The researchers examined the medical records of more than 650 patients admitted to Cedars-Sinai Medical Center for treatment of stroke. From this group, they identified 178 patients who had been previously diagnosed with atrial fibrillation and were taking warfarin for stroke prevention.

The researchers then identified 14 patients who had discontinued warfarin up to seven days before some type of elective surgery.

"All 14 -- 7 percent of the total group -- had strokes within the seven days prior to surgery when they were not on warfarin, or within one to three days afterwards, " says Cohen. Nine of the 14 were seriously disabled as a result of those strokes.

The study conclusion: "Our findings indicate that a good deal of the atrial fibrillation-related strokes can be prevented if patients do not discontinue the use of anti-clotting medications for a prolonged period of time prior to surgery," says Cohen.

It's a conclusion that neurologist Dr. Keith Siller says is important and accurate.

"This gives us some evidence of what many stroke experts have known for a long time -- there is a better way to treat these patients, and the conventional wisdom of discontinuing ant-clot medication before surgery is not always the right thing to do," says Siller, medical director of the New York University Comprehensive Stroke Care Center.

One of these "better ways" is to weigh the odds of bleeding from the procedure, against the odds of having a stroke, before deciding if and when to stop warfarin therapy, Cohen and Siller say.

But there's another alternative, according to Cohen. Two different forms of the drug heparin -- another blood-thinning treatment -- are available and can be used in place of warfarin prior to surgery.

With both treatments, there's a decreased risk of bleeding similar to that which occurs with warfarin, without increasing the risk of stroke.

However, both forms of heparin are expensive -- one requires intravenous administration in a hospital setting for a week prior to surgery. As a result, insurance-company spending limits often keep patients from learning all their options.

"I think any patient with atrial fibrillation who is taking warfarin has the right to know that stopping their medication could put their life at risk, and that they don't have to take that risk because there are other treatments that can help," says Cohen.

Siller agrees: "Patients should be told -- they need to know all their options. And hopefully, this study will help spread the word that there is a better way."

More information

To learn more about atrial fibrillation as well as stroke, visit the American Heart Association. For a checklist of important information you should know if you're taking warfarin, click here.

SOURCES: Stanley Cohen, M.D., senior investigator, director of the Stroke Program in the Division of Neurology at Cedars-Sinai Medical Center, Los Angeles; Keith Siller, M.D., medical director, New York University Comprehensive Stroke Care Center, New York City; April 3, 2003, presentation, American Academy of Neurology annual meeting, Honolulu
Walter Hinteler
 
  1  
Reply Wed 13 Jan, 2010 04:21 pm
When mother got her hip replaced - which was done with an emergency opreation - she's stopped her blood thinners just a couple of hours before.

Same happened before the following two operations she'd had during her eight weeks in hospital ...

However, the surgeons didn't replace the hip (last operation) as they actually wanted ... due to her condition.
ossobuco
 
  1  
Reply Wed 13 Jan, 2010 04:38 pm
@Butrflynet,
Thanks for the info the Cedars people and the NYU study (I have a soft spot for Cedars, and, vicariously, for NYU) - useful for people to know about in a situation like your mother is dealing with and the decisions to face.
0 Replies
 
Butrflynet
 
  1  
Reply Wed 13 Jan, 2010 04:42 pm
@Walter Hinteler,
Due to her chronic diarrhea, BBB sometimes has an atrial fibrillation condition due to low potassium. She's on prescription strength potassium to counter that.

That's why this study about the dangers of coming off it is concerning to me.

It's reassuring to hear that surgeries can still be safely done while they are on blood thinners. Other than her skeletal structure problems and atrophied muscles, BBB is in remarkably good condition for her age. Part of the problem is that she's really resisting the idea of another painful surgery and painful recovery. She's already been through so many of them in her life and so many of them have been botched and had negative results.

She's hoping that another cortisone injection will again temporarily relieve the pain. After that, we'll have to figure out how to get her moving again to prevent additional clots from forming so she can eventually get off the Coumadin.

I'm thinking that compression cuffs for the legs might help, but don't know if that would also cause internal bruising and bleeding while on the blood thinners.

Looking forward to the consultation with the ortho doc to get some expert advice on all this.
0 Replies
 
ossobuco
 
  1  
Reply Wed 13 Jan, 2010 04:44 pm
@Butrflynet,
Butryfly has also been busy - well, today - helping me: she took me to my eye clinic where I got more good news, even surprising good news.
Wishing the same, good news soon, for BBB.
Butrflynet
 
  1  
Reply Wed 13 Jan, 2010 05:49 pm
@ossobuco,
Be sure you share the good news with everyone on your eye surgery thread!
0 Replies
 
Reyn
 
  1  
Reply Wed 13 Jan, 2010 09:21 pm
@Butrflynet,
Butrflynet wrote:

Been busy taking care of my mom. She was doing better for awhile after coming home from the hospital, but her hip has gone out on her after doing some brief walking in the grocery store's produce section [...]

I'm sorry to read that your mom is still having such a tough go, health-wise.

I wish for better days ahead - for both of you!

Here's hoping for some recovery!
0 Replies
 
Butrflynet
 
  2  
Reply Tue 19 Jan, 2010 04:59 pm
We had the appointment with the orthopedic doctor today. Pretty discouraging...

They don't want to even think about doing anything (including further cortisone injections in any of BBB's joints or hip surgery for what is currently causing her extreme pain) for at least six more months until they are assured the blood clots are stabilized. He basically said she's in a catch-22 right now and that pain killers will have to be her friend for awhile. She's not to do any additional physical therapy and the only walking she's to do is back and forth to her bathroom from her bed or recliner. Anything more strenuous and she's to use her mobility chair or the transport chair.

The only way they'd consider doing the hip surgery now is if she were to break it and need emergency surgery for it. He says in that case, they can give her drugs to immediately reverse the effects of the blood thinners and be able to do surgery within a day. It's a matter of assessing the risk/benefit.

All this means that when the cortisone injections she's had in her spine, knee and shoulder wear off, she's not going to be able to get further ones for at least six months and will have to temporarily come off the blood thinners before they can give them to her.

Her hip pain threshold has already gone from a 3 immediately after the blood clot incident to a constant 7 or 8 on a scale of 10. The pain killers relieve it down to a 6 or 7. She's been in so much pain that it had her in tears the other day.

It's hard to watch and I feel rather helpless...
edgarblythe
 
  1  
Reply Tue 19 Jan, 2010 05:15 pm
BBB is in my constant thoughts. May she come through the ordeal, stronger and feisty as ever.
0 Replies
 
realjohnboy
 
  1  
Reply Tue 19 Jan, 2010 05:16 pm
@Butrflynet,
So sorry to hear that report, Butrflynet.
0 Replies
 
TTH
 
  1  
Reply Tue 19 Jan, 2010 05:22 pm
@Butrflynet,
Really sorry to hear this Butrflynet. Please tell BBB I said hi and am thinking about the 2 of you. I hope she can get some relief soon.
0 Replies
 
littlek
 
  1  
Reply Tue 19 Jan, 2010 05:24 pm
Sitting and waiting with you.
0 Replies
 
Eva
 
  1  
Reply Tue 19 Jan, 2010 05:50 pm
You're a good person, Butrflynet, and an even better daughter. BBB is so lucky to have you!

Please tell her she will be in my prayers.
0 Replies
 
JPB
 
  1  
Reply Tue 19 Jan, 2010 05:51 pm
I'm very sorry to hear that she's still suffering. I know this is hard on both of you. Gentle hugs all around.
0 Replies
 
Roberta
 
  1  
Reply Wed 20 Jan, 2010 12:53 pm
Sorry to hear this. I'm hoping for a good outcome. In fact I'm putting my hoper into high gear.
0 Replies
 
ossobuco
 
  1  
Reply Wed 20 Jan, 2010 01:39 pm
That is discouraging, very hard. (((BBB))), and hugs to you too, Butrfly.
0 Replies
 
Izzie
 
  1  
Reply Wed 20 Jan, 2010 05:05 pm
@Butrflynet,
Oh Butrflynet...

:shock had not seen this latest report Sad so very sorry everything is so discouraging right now.

thinking of you and your Mom... I know you're taking care of her, please take care of yourself too - or let someone else give you a little rest. You must take care of yourself Burtflynet... ok.

hugs and love to you both

Iz xx
0 Replies
 
msolga
 
  1  
Reply Wed 20 Jan, 2010 05:35 pm
@Butrflynet,
I'm very sorry to hear of these latest developments, butrflynet. A very tough situation for both of you. Please pass on my best wishes to BBB. And as for you, I just wish things weren't so hard on you, so demanding.
0 Replies
 
jespah
 
  1  
Reply Thu 21 Jan, 2010 07:27 am
@Butrflynet,
Sweetheart, you are doing an awesome job. I know you may feel helpless and like you're not doing anything, but you are phenomenal. We all know this.

Best to you both.
0 Replies
 
 

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