To all you who hate going to the doctor...

[congodwarf]

A little background:
My boyfriend detests going to the doctor. He especially hates going to the ER. In all the years I've known him (11.5), he has been to the ER 3 times. One of those times I forced him to go.
The first time I took him was because he woke me up in the middle of the night and asked me to take him. He ended up having back surgery.
The second time I took him was the time I forced him. He felt that having both eyes swollen shut and oozing pus was not important enough for a trip to the ER. He had a massive eye infection which his eye doc later told him could have blinded him.


Today was the third time I took him to the ER.

He spent the entire day yesterday working on his jeep so he was very sore when he went to bed. This morning, he was going to Home Depot to buy supplies and woke me up before he left. I decided at the last minute to go with him. When we got to the store, he started complaining that his arm hurt. We both assumed it was from all the work he did yesterday. As we walked through the store, he kept complaining about it (which is odd for him). While looking at soldering irons, I stretched his arm for him and he said it helped but then a minute later the pain was back and his hand started going numb. I looked him straight in the eyes and said, "Are you having a heart attack?" He said he wasn't and that it was just from the car work. We paid for our stuff and left. As we got in the car, he said that his whole arm was going numb. Not numb and tingly, just numb. We got about 10 minutes down the road and he said, "Can you please take me to the ER?"

I nearly drove off the road in shock just from him asking that question. He said that his arm was completely numb and he had tightness in his chest. He was also lightheaded and hot. Of course, I panicked. He was somehow oblivious to what his symptoms indicated, he just knew he felt really bad. Of course at that point, we were closer to the small hospital in our town than to all the huge hospitals in Worcester so we continued to our town.

We walked into the ER and all I said to the triage nurse was, "chest tightness, right arm pain and numbness." In about 30 seconds, he was in a johnny and being hooked up to machines.

They gave him and EKG and took some blood. While waiting for the blood work to come back, they sent him for a head CT and a chest x-ray. Almost right after we got back to his room, the doctor came back and said that his EKG was normal (thank god) and that his brain was fine (double thank god*). BUT, she said that one of his blood tests indicated a very small possibility of a blood clot so she was sending him back to Radiology for a chest CT with contrast. After that we spent about an hour waiting in his room. We assumed everything was ok because they didn't hook him up to anything when we got back to the room.

The doc finally came back and started listening to his lungs, feeling his arm, asking him strange questions (any long trips lately, any injuries lately). She also hooked him back up to all his monitors (something I have NEVER seen a doctor do). Then she said, "You have a blood clot in your lung and I have no idea why."

We could tell from the look on her face and the way she said it that she definitely was shocked at the news. I think she assumed he was having a panic attack or something.


So.....


My boyfriend is spending at least 1 night in the hospital for extensive testing. He will not be allowed to leave unless they're confident he's not in danger. He also has to be able to give himself Coumadin shots in the chest before they'll let him leave. If he can't give himself the shot, he'll have to stay for 3 days while the pills take effect.




THE POINT TO THIS STORY (and I bet you thought there wasn't one) is that he could have passed it off as being out of shape and sore from working on his Jeep. He chose to go to the ER just in case. While waiting for his results, he kept saying he felt like a fool for going to the ER. If he had followed his natural course of refusing to go to the doctor, that blood clot in his lung could have killed him.

IF YOU THINK YOU MIGHT BE HAVING A HEART ATTACK GO TO THE ER!!!!!!!!!. Even if you aren't having one, there could be another cause to the symptoms you're having.

My boyfriend keeps apologizing for being a pest. I keep telling him that today he made the best decision he's ever made in his entire life and I will be eternally grateful to him for it. He had a valid reason for having a sore arm. He has asthma so he had a valid reason for chest discomfort. We could have passed this off as asthma and hard work related.




* At the beginning of the summer his boss went to the hospital thinking he was having stress related problems. He left the hospital with a baseball-sized glioblastoma and a 6-month death sentence. When we heard head CT, we both got a little queasy.

[The Vorlon]

Congo, it is Lovenox shots into belly fat. Coumadin is another beast that works differently, but produces the same result in a few days. Lovenox just went generic. If insurance is a issue, WalMart has it for the least. You can expect fun with Coumadin---it is a art getting dialed in with the dose, not a science.

Hope blood tests don't freak him out much, he's gonna get quite a few for a while.

Why don't you give him the shots? After all, this will hopefuly be your only chance to stab him over a few days and not be talking to the boys in blue........


The Vorlon (who picked up $6763.99 of generic Lovenox today for Mrs. Vorlon...)

[It's Not Rocket Surgery!]

This is seriously one of the reasons men have shorter lifespans than women - we are socialized to think that if we don't work through the pain, we are less macho.

[congodwarf]

The Vorlon: Oh. I wasn't there when they talked to him about what the shots were. I was told the shot was Coumadin. This is why I am almost always with him for important stuff. If I'm not there I will later on ask why they said, followed by his answer, then followed by me going :confused: and asking, "are you sure they said that?" They must have meant that he's on the Lovenox for the 3 days it will take the Coumadin to kick in. Not sure. I hate trusting him with this stuff. He is a very intelligent guy but I think he's medically dyslexic (he always gets medical shit backwards or inverted).

:D

I had run home because we put the puppies in the crate assuming we'd be gone about an hour. I had to let them out. By the time I got back about 45 minutes later, his parents and brother were there, he had been moved to his room from the ER, he had seen the doctor and nurse, had eaten his dinner, had been given a talk about the shots.



Another thing he told me (and his mother backed it up - she's more reliable) is that the doc said that if HE can't give the shot himself, he's not allowed to leave. It would be easier if I could do it. Hell, my best friend is a medical assistant and a nursing student. Part of her job is giving these injections so she said she could come out once a day to do them but if he needs more than that, we're on our own. I'll double check with the doc tomorrow. He's really not happy about giving himself the shot.


Blood work is only an issue for him because his veins are not very good. The lab lady took 10 vials at once today and needed 3 veins to do it. Even with her skill, it took her about 10 minutes to find a vein she was happy with sticking. I am so glad I don't have shitty veins. Anyway, he's used to it. He has Hashimoto hypothyroidism. He spent about 4 years having blood work every 1-2 months and then having his medication adjusted. After all that time, his doctor FINALLY gave up and referred him to an endocrinologist. What do you know, it only took about 6 months to regulate him when he had a specialist doing it. :rolleyes:

[Gleena]

Happened to me in a more spectacular fashion - and I almost didn't go to the ER either, and would have died driving to work.

Good on your bf for asking you to take him!

[congodwarf]

and would have died driving to work.


It makes me queasy to think of what would have happened if I had stayed home to do my homework, causing him to have been driving (and alone) when it hit.


When you went to the ER, did you feel like you had dodged a bullet?

[Lanzy]

I hate going to the Dr, hell I hate going to the barber, but if I need to go I go.

[Gleena]

and would have died driving to work.


It makes me queasy to think of what would have happened if I had stayed home to do my homework, causing him to have been driving (and alone) when it hit.


When you went to the ER, did you feel like you had dodged a bullet?

Not really, that was much later. I was a lot sicker (from the sounds of it) than your bf. I spent several days in intensive care.

It was only very much after the fact that I realised my decision to turn around halfway to work very much allowed me to dodge a bullet, since I finally passed out not six feet away from the ER doors.

Plus, when I was in the ER they didn't tell me exactly how sick I was. Later I found out they told my husband to "prepare for the worst". That's reasonably scary.

[Khadaji]

Quite an adventure! Sending out a wish for a speedy and full recovery.

[WhyNot]

The doc finally came back and started listening to his lungs, feeling his arm, asking him strange questions (any long trips lately, any injuries lately).
These strange question were to find out if he's at risk for a blot clot. When you take a long trip, you tend to be sitting still for long periods of time, which can cause the blood to pool in your legs and lower abdomen. When blood pools, it has a chance to clot. When you're injured, lots of blood rushes to the spot of the injury and, again, has a chance to clot.
The Vorlon: Oh. I wasn't there when they talked to him about what the shots were. I was told the shot was Coumadin.
Ok, let's see if I can help.

Coumadin, sometimes called Warfarin, is an antiplatelet drug. It's often called a "blood thinner", but what it actually does is inhibit platelet formation by messing up clotting factors related to Vitamin K, which makes it harder for your blood to clot. It takes a few days for it to build up to a therapeutic (working) level in your bloodstream. Coumadin is usually taken orally, as a pill, but it can also be given intravenously (through an IV catheter placed in your vein). It is not, as far as I know and according to my drug book, available in a shot into the skin, subcutaneous tissue or muscle.

Heparin, or Lovenox, is another antiplatelet drug which interferes with other clotting chemicals (not the same ones as Coumadin/Warfarin). It is either injected subcutaneously (a needle just under the skin and fat layer in your abdomen or the back of your upper arm) or intraveneously. Heparin/Lovenox works much faster than Coumadin/Warfarin, but it has more side effects and is a pain (literally) to use, so we try not to keep you on it for longer than we have to.

So the general course of action is to put a patient on Heparin/Lovenox and Coumadin/Warfarin at the same time. While the Coumadin/Warfarin is building in the system, the Heparin/Lovenox is already working. Once the Coumadin/Warfarin levels are high enough to be protective, you can generally stop the Heparin/Lovenox, unless you have a really severe clotting disorder that requires both groups of clotting factors to be reduced.

While on Coumadin/Warfarin, he's going to need frequent bloodtests to check how his blood is clotting. We don't want it to clot as fast as yours and mine does, but we don't want it to take too long for it to clot, either, or he could start bleeding and not stop. So he needs a test to see how long it's taking his blood to clot. This test used to be called the PT. Then, because different PT tests were giving different results, the labs started standardizing their results, and called the new and improved test procedure the PT/INR. Nowadays, a lot of people are shorthanding the name and calling it simply an INR. So if you hear "PT", "PT/INR" or "INR", it's all the same test, for your purposes. (And why so many nurses never tell patients this is beyond me. I've had patients thinking they needed three different blood sticks every month for three different tests!)

His doctor will determine what his INR level should be, based on his health and history. Very generally speaking, we like to see it over 1.5 (that is, it takes him one and a half times longer to clot than a healthy person who's not on Coumadin) and less than 3 (takes him three times as long to clot as a healthy person who's not on Coumadin), but that's a pretty big range, so the doctor can tell you his specific range.

The INR is a fairly inexpensive test, ranging from $8 to $20, depending on where you live. They'll probably want them one a week until they find the right level of Coumadin for him, and then once a month after that for as long as he's taking the Coumadin.

The PTT (two T) test is a slightly different clotting test to see if the Heparin/Lovenox is working well, but I doubt they're going to order that if he's only on it for three days. They may, but it won't be a recurring one unless they keep him on the Heparin long term.

Let me know if you have any other questions. Of course, I can't answer specifics about your SO's case because I'm not HIS nurse, but I can maybe help with the general stuff.

Oh, and yeah - if you have numbness down an arm, GO TO THE ER! There's simply no reason for that that's healthy, none at all. Overwork or exercise causes soreness, not numbness!

[congodwarf]

Thanks WhyNot! That was awesome. I actually understood all of that, mostly because you explained it so well, but slightly because I've been working on my transcription class for so long. I recognize all the tests and the drug names but why they're specifically used isn't so important as long as I know they're relevant to the condition being treated.

Once we found out why she was asking those questions, the reason behind them became very clear. They were strange at that moment because we were expecting her to walk in and say the CT scan was clear. Instead she came in and started asking about his travel time (he spends about 45 minutes each way getting to work, plus a lot of driving to shoots).

[Mean Mr. Mustard]

Here's a hint to distinguish between PT & PTT.

PT is related to Coumadin (Warfarin).

PTT, to heparin (Lovenox).

To keep this straight, imagine the two (lower case) t's in PTT forming an H. There's your heparin test.


mmm

[CrazyCatLady]

I think you're addressing this to the wrong crowd. It should be "To all you who refuse to go to the doctor." Like a lot of people who hate going to the doctor, I go. I may growl and bitch every damn step of the way, but I go. Not often enough to suit my mom who wants me to have every viral sniffle no one can do anything about checked out, but definitely when it seems medically advisable.

My dad, though. Jeebus, my dad. He hid chest pains and shortness of breath for a day and a half because they were intermittent and he didn't want to ruin Christmas for everybody by scaring us all half to death over nothing. We went to the ER Christmas night when the pains got worse, and the tests revealed that not only was he having a heart attack, he'd been having mini-heart attacks for probably 6-8 months judging by the scarring and dead tissue. And never said word one to anybody, even though he knew the warning signs because his dad, grandfather and uncle had all died of heart attacks and even though he knew he was at high risk due to family history, diet, and 3 packs of Camels a day.

He got a lot better about going to the doctor after the bypass (and after Mom got done chewing on him about hiding symptoms from us for all that time), but as the "OMG, I almost died" feeling has faded he's slowly become more mulish about it all. At this point he's still better than he originally was, but he's gotten way worse than I've ever thought about being.

[UncleRojelio]

My dad probably hadn't seen a doctor in 15 years. He hates going. But he got a bug bite on his hand that swelled up and didn't go away after a few days so my mom made him go to the doctor. One thing lead to another and about three weeks later he was having quadruple bypass surgery. He is feeling much better now. Myself, I don't like doctors much either but I've vowed to start actually getting the annual physicals that my insurance plan allows and doing as the doctor says.

(Yeah, I know, the bug bite has nothing to do with the story other than an excuse for my mom to make my dad go.)

[Angel of Doubt]

Glad things are under control for now and hope for a great outcome!

Not to nitpick, but I don't think a hospital can make a patient stay for treatment unless it's a mental health issue - anyone shed light on this? Assuming you meant it in the sense they would force him to stay until he's in the clear,and assuming you're in the U.S. I'm just asing for clarification from somebody. Boy that would piss me off if I were a patient.

[WhyNot]

Thanks WhyNot! That was awesome. I actually understood all of that, mostly because you explained it so well...

Yay! I really love the patient education part of nursing most of all. I really want to be good at it, not least because I've been in the hospital as a patient or family member feeling really clueless and powerless because no one had the time or skill to explain things in a way I could understand. Thanks for letting me practice my skills on you - I know this isn't academic for you in the least bit, but still, you're helping to educate a novice nurse while you're going through some pretty big stuff yourself right now, so I thank you! :)

(he spends about 45 minutes each way getting to work, plus a lot of driving to shoots).
That's actually really good to hear. It may indeed be a problem, but at least he's not one of those patients with no risk factors who develops a clot and we're all WTF? His doctor (or nurse) might have some tips for him about how to reduce the risk of those long drives, like breaking them up into smaller legs with a short brisk walk at a way point to keep the blood moving. There are also some leg exercises he can do while sitting, especially if he's in the passenger seat.

Not to nitpick, but I don't think a hospital can make a patient stay for treatment unless it's a mental health issue - anyone shed light on this? Assuming you meant it in the sense they would force him to stay until he's in the clear,and assuming you're in the U.S. I'm just asing for clarification from somebody. Boy that would piss me off if I were a patient.
The hospital won't discharge him through the normal process until he's stable enough to leave and can demonstrate an ability to do the things he needs to in order to follow the therapeutic plan, but yes, you can always leave AMA (Against Medical Advice) unless you're mentally incompetent...or a child. (In some areas, a parent cannot sign a child out AMA.)

[Angel of Doubt]

My fiance gets so freaked out by doctors/hospitals, he freezes up and I can't guide him (he's blind). His bloodpressure gets out of control. The solution came in the form of a concierge plan - he can call his doctor anytime, even at night, or email him, longer personalized appointments, very detailed reports - it's eased his mind.

Oh, ok thanks WhyNot

[Mean Mr. Mustard]

Glad things are under control for now and hope for a great outcome!

Not to nitpick, but I don't think a hospital can make a patient stay for treatment unless it's a mental health issue - anyone shed light on this? Assuming you meant it in the sense they would force him to stay until he's in the clear,and assuming you're in the U.S. I'm just asing for clarification from somebody. Boy that would piss me off if I were a patient.

You are correct. A patient may refuse admission and leave AMA (against medical advice). A parent or guardian can sign their minor out AMA as well (but if the child were in serious danger social work would get involved and papers would be filed to prevent this).

As for psych issues, a patient may be held against their will if they are considered a danger to themselves or others for a maximum of 3 (?) days. Again, paperwork is involved.

This applies in the U.S. (maybe differs by state?)

mmm

[The Vorlon]

If you need a PTT, do not go to Quest---they managed to frack up Mrs. Vorlon's test 4 times---it took a hospitalization to get the test done correctly. The MD was quite eloquent and descriptve in ripping them a new one over their lack of talent.

[Rubik]

I last went to the doctor ten years ago. I tell ya, she had a face of scorn when she realised all I had was a chesty cough and not the dreaded lurgy from yonder.

[MLS]

Oh, yeah. I know of two people who ended up with problems after ignoring the signs of a stroke. One was my MIL ("I didn't want to bother anybody") and the other is a guy somewhat younger than I who wanted to tough it out. He nearly died, and ended up with (only) very serious disability.

Every doctor I've ever heard speak of such matters says they'd much rather you come in and find out you aren't that sick after all than the reverse.

[sisu]

This is seriously one of the reasons men have shorter lifespans than women - we are socialized to think that if we don't work through the pain, we are less macho.

Yeah he needs to harden up!

I do not liek going to the ER but have on 3 occasions in my life and all were false alarms, not so for my dad.

If you are feeling bad then get yeself to a dr ASAP.

[Hirka T'Bawa]

Very good explanation WhyNot, but I do have some slight nitpicks.


Coumadin is usually taken orally, as a pill, but it can also be given intravenously (through an IV catheter placed in your vein). It is not, as far as I know and according to my drug book, available in a shot into the skin, subcutaneous tissue or muscle.

I have never seen Warfarin (Coumadin) given through the IV route, and I checked a couple of my sources to double check, is only available through the Oral route.

Heparin, or Lovenox, is another antiplatelet drug which interferes with other clotting chemicals

Lovenox isn't the same thing as heparin. It isn't a matter of brand/generic like Coumadin and Warfarin is. The generic name of Lovenox is Enoxaparin. Enoxaparin is a low-molecular-weight-heparin (LMWH), which while it does come from heparin, is greatly different (It's like the 2nd generation heparin)


Very generally speaking, we like to see it over 1.5 (that is, it takes him one and a half times longer to clot than a healthy person who's not on Coumadin) and less than 3 (takes him three times as long to clot as a healthy person who's not on Coumadin), but that's a pretty big range, so the doctor can tell you his specific range.


According to the guidlines, the goal INR for prevention of normal blood clots (DVT and PE), and most other conditions, is 2-3. The goal when having mechanical heart valves (not something I think the OP has to deal with) is 2.5-3.5.

Besides those very slight nitpicks, you pretty much said everything I would tell someone when I have to council them. During the last month of my advanced clinical pharmacy rotation at the big local hospital, I've been responsible for giving the counseling to patients being discharged on Lovenox bridging therapy. You did very well WhyNot.

To the OP, getting a PE (Pulmonary Embolism) is a very serious thing, and has a very high mortality rate. Your boyfriend was very lucky. Make sure he keeps taking his medication as prescribed, over the last few weeks I've see way too many people admitted to the hospital due to complications from PE's, and it is always because they stopped taking their warfarin.

On a lighter note, here is a youtube video that you and your boyfriend can watch that will tell you all you need to know about coumadin, in a rap song! http://www.youtube.com/watch?v=Mfk05IFfW48

[Nava]

...BUT, she said that one of his blood tests indicated a very small possibility of a blood clot...
The doc finally came back and started listening to his lungs, feeling his arm, asking him strange questions (any long trips lately, any injuries lately)...

Both are possible causes of blood clots. Due to a variety of blood conditions in my family's oldsters (my paternal grandma died at 86, maternal grandma still kicking at 96, maternal grandpa died at 95, so they had time to collect a variety of ailments) I know more about blood thinners and thickeners than I ever wanted to.



Two wednesdays ago (today is a Monday), one of my coworkers woke up startled and hit his elbow against the corner of the bed table. For several days he complained that it hurt and was kind of stiff, but instead of going to the doctor (we have a medical center onsite at work) or keeping the arm as still as possible, he would keep exercising it. He finally went to the doctor the following Monday, and refused a referral to go for an X-Ray; the doctor bandaged the arm and told him to move it as little as possible. His wife dragged him to their own family doctor last Saturday (and had to resort to the ultimate threat, "I will call your mother"); turns out he has a small fissure. Now he has the arm in a cast... and he's still trying to exercise it! I swear I don't smack him because his wife and mother have dibs on that :mad:

[congodwarf]

He's still at the hospital. They wanted to make sure he's really comfortable with giving himself the shot so they wanted him to stay for another night and at least 2 more shots. He said he had no problem with the first one and it actually hurt less when he gave it to himself. The poor guy. His stomach is covered in huge bruises and is so sensitive that even a slight touch is painful.

He had his ultrasound Sunday morning and it confirmed that his legs are clear. He doesn't want to be in the hospital any more and he misses his puppies. He said it's very hard to be in the hospital when you don't feel sick (he hasn't felt sick since before he left the ER). But, he has no intention of leaving AMA and even if he did, I wouldn't pick him up (and I have his wallet).

He certainly isn't going to work today and we're not sure when he's going back. This is definitely not a good time for him to be out of work but they're just going to have to deal with it.

His job is odd. He can have days where he spends 8 hours sitting at his bench fixing things and then he has days where he spends 20 hours lugging equipment back and forth, running into the venue to fix broken equipment, sitting for 5 minutes and then getting back up to do it all again. His biggest concern with work is that his job is completely based on his hands. His hands are moving all day every day. He works with a lot of heavy metal and plastic equipment which has a lot of sharp edges. He gets cut every day. He's really concerned about the bleeding.

[congodwarf]

$6763.99 of generic Lovenox

When I first read this, I thought you meant that was the total value of the drugs and not the copay. But, the discharge coordinator just told us that for 6 doses of generic lovenox, his copay will be over $500! Six doses! That's 3 days worth! Thank god he's not going to keep taking it after that and hopefully coumadin is his normal $20 copay. Please tell me that $6763.99 wasn't your copay and if it is, how do you manage that?

[The Vorlon]

Hy thee to Walmart! The brides dose should be 160mg, she was getting 120mg/2x daily, but for the 12 days we did not have drugs or coverage they sold us 150mg doses for only $99 each.

The 6763.99 is retail for 60 120mg doses from Stop & Shop (co-pay counts to gas points), co-pay is $12.50. Commonwealth Care saves our butts.

Of course, the 90 day pharmacy called, telling us they had shipped---another 180 doses, co-pay $25.

Your SO should be on a lower dose than Mrs. Vorlon, so Wal-Mart may come in below $500--call and ask them.

Is your heat behaveing itself in this cold snap?

[congodwarf]

I just turned the heat on last night to make sure it was working. We had to replace the burner on an emergency call last week and this was the first time it was turned on. It works so well. I had the heat on 66 last night and it was too hot in the living room and bathroom. I slept on the couch last night so I don't know how the bedrooms were. I also noticed that the furnace didn't kick on nearly as often as it did with the old burner.


Unfortunately my boyfriend doesn't have Commonwealth Care. He has Aetna through his employer and there have been a lot of complaints from him about the quality of the coverage. The pharmacist just called him to make sure he was aware how much this is going to cost him because she didn't want him to be shocked when he gets there. We're going to see if we can get them one day at a time since he'll be in here getting blood drawn every day. If his coumadin levels reach whatever they're aiming for, he wont need to finish all 6 doses.

[Little Nemo]

A co-worker once told me that he had lost vision in one of his eyes a few hours earlier. I told him I was going to call an ambulance. He didn't want me to - he said he wanted to see if it got better on its own. I told him that with something like a headache or a stomachache you might wait and see. But if you were going blind you had a serious problem and needed medical attention. I finally had to call in our boss and have her order him to go to the hospital.

[congodwarf]

I feel the need to say that I love this hospital. It's very attractive, the furniture is comfortable, the food is incredible, and the staff (medical and support) are all exceedingly friendly. Oh, the medical care seems to be very good too. :D

My best friend said this hospital doesn't have a very good reputation but so far we're impressed.

[WhyNot]

Very good explanation WhyNot, but I do have some slight nitpicks.
Thank you! I mean that sincerely.

I have never seen Warfarin (Coumadin) given through the IV route, and I checked a couple of my sources to double check, is only available through the Oral route.
I've never seen it IV, either, but my drug book indicates that it is produced that way (2010 Nursing Spectrum Drug Handbook).

Lovenox isn't the same thing as heparin. It isn't a matter of brand/generic like Coumadin and Warfarin is. The generic name of Lovenox is Enoxaparin. Enoxaparin is a low-molecular-weight-heparin (LMWH), which while it does come from heparin, is greatly different (It's like the 2nd generation heparin)
Oh, I know, I know! I got into an argument with my teacher about this once, actually. Her professional opinion was that trying to explain the difference between heparin and low-molecular weight heparin to a patient is more information than they really need to know and there's too much risk of information overload with no real payoff in understanding. So we were told just to call Lovenox "heparin" instead of "low molecular weight heparin". I wasn't entirely happy with her advice, but, well, y'know. Teacher and all. I'll try to come up with another way to explain it that isn't confusing but makes the distinction clear. Thanks for the feedback.

According to the guidlines, the goal INR for prevention of normal blood clots (DVT and PE), and most other conditions, is 2-3. The goal when having mechanical heart valves (not something I think the OP has to deal with) is 2.5-3.5.
And another thanks! My book says 2-3, my last few patients' docs were happy at 1.7 or 1.8, so to be honest, I wasn't sure who to believe. I'll stick with the 2-3 for patient education, with the caveat that your particular doctor may have another number in mind.
You did very well WhyNot.
*happy wiggle* :D

Hy thee to Walmart!
Indeed! Coumadin is one of Walmart's $4 prescriptions. Target, too. I think K-Mart is $5. If your copay is more than that, just tell them you don't want to put it on your insurance; they'll let you pay out of pocket instead.

[The Vorlon]

Wal-Mart tends to be better on most drugs. Due to changeing from Mass Health to Commonwealth Care we were between carriers for a month. 150mg/1 ml doses at WM=99.00
Next cheapest was Stop & Shop, 132.99. For the same thing. It pays to shop around.

[Markxxx]

I'd love to go to the doctor I have about five urgent things that should've been look at 12 months ago, anyone want to pay for it?

I can hardly wait till I get a job with insurance, so I can get some things fixed and not have to deal with the crap day to day.

[chizzuk]

Back when he was a freshman, my cousin started suddenly having annoying chest pain after a college track meet. He thought he might have pulled a muscle or something, but his parents were worried and insisted on taking him to the ER. The doctors were pretty sure a healthy 19-year-old wasn't having a heart attack, but they took an x-ray and discovered that his right lung had collapsed.

He wound up stuck in the hospital for 2 days with a chest tube. Then right after he was released, his left lung decided to collapse. Before it was all over, he'd had four episodes of lungs collapsing, needed major surgery to fuse the linings of his lungs together, and spent a month in the hospital with tubes and a morphine drip (apparently chest tubes really suck). He'll be 30 soon and is back to running marathons, but to this day they have absolutely no idea why all that happened to him. Just one of Those Things, I suppose.

Never ignore chest pain.

[congodwarf]

Is your cousin very tall and thin? I once knew a young man who had the same thing happen, about the same age. He was 6'3" or 6'4" and weighed about 120 or 130.

Even this weekend, one of the nurses commented on very tall, thin men having issues with lungs collapsing for no apparent reason. We got on the subject because of the fact that my boyfriend is not a likely candidate for a pulmonary edema - other than having a 45 minute commute. Sometimes, things that have no reason to happen do happen.

I wanted to smack the nurse who was getting his discharge ready. She mentioned that he still had blood work out and that it might give an indication why it happened. She said that sometimes they find that people with pulmonary edema for no apparent reason end up having Lupus.

My first inclination was to tell her that it's never Lupus but after seeing the horror on my poor boyfriend's face, I just wanted to smack her.

[ptr2void]

Make sure they test for antiphospholipid antibodies. I have a similar story, although the clot started in my leg and went to my lungs; it turns out I have anticardiolipin antibodies (http://www.lupus.org/webmodules/webarticlesnet/templates/new_aboutaffects.aspx?articleid=82&zoneid=17) which make my blood "sticky" and therefore more likely to clot.

In my case, the ER to which I went was ready to discharge me with a torn muscle from a basketball game a couple of days prior. I was thankfully well aware of the symptoms of DVT (http://www.nlm.nih.gov/medlineplus/ency/article/000156.htm) -- having done tests for them in a previous job -- and knew what the real diagnosis was; in fact, I told my wife what I had on the way to the hospital. In retrospect I should have related that directly to the doctor, but felt that wasn't really my job...instead I simply said, sorry, but a torn muscle does not make one's leg hard and purple. After multiple consults with multiple attending physicians, they finally brought in the Chief Resident who came up with the appropriate diagnosis (telling my wife they may need to amputate my leg!) and I spent 9 days laid up in a hospital bed waiting for my blood to thin up. I will spend the remainder of my life on Coumadin therapy as a result.

Interestingly, the very first indication of the underlying condition was a false-positive RPR (test for syphilis) that was conducted as part of my marriage blood tests. I was worked up for Lupus, but was found to be negative and never thought anything more about it (except that I could no longer donate blood which is annoying...I have O- blood, so it's valuable) until I related it to the hematologist I saw in the hospital.

[pravnik]

I can sympathize with your boyfriend, congodwarf. I had a week long stay in the hospital a few months ago for deep vein thrombosis and pulmonary embolism (and even started a thread about it (http://boards.straightdope.com/sdmb/showthread.php?t=560121)). I'm also on Coumadin/Warfarin, probably for life, since mine turned out to be genetic. I've adjusted pretty well to the Warfarin, generally breathing a lot easier and feeling much, much better. The clots in my lungs were causing some shortness of breath and heart palpitations that I wasn't completely aware of - now that I'm feeling good I realize how bad I felt before.

If your husband is worried about cuts he might want to look into Kevlar lined cut-resistant work gloves, as well as some "liquid bandage" medical glues based on cyanoacrylate, the same sort of stuff they make Super Glue out of (I've heard of people actually using plain old Super Glue, but I'd feel better using something medical grade myself). He might also want to think about keeping a couple of QuikClot Sponges (http://www.amazon.com/Quikclot-Advanceed-Clotting-Bleeding-Packages/dp/B001BCNTHC) around the house and in the car in case of accident.

[congodwarf]

He's also having issues with shortness of breath but we always assumed it was due to his asthma. He's been using the inhaler a lot more frequently lately.

I appreciate the suggestions. I know he has work gloves but I don't know what kind they are.

[ptr2void]

Regular, everyday cuts are far less of an issue than internal bleeding, from what I understand, as long as your platelets are in good working order.