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.
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.
Very good explanation WhyNot, but I do have some slight nitpicks.
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.
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)
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
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:
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.
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?
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?
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.
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.
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. 
My best friend said this hospital doesn’t have a very good reputation but so far we’re impressed.
Thank you! I mean that sincerely.
I’ve never seen it IV, either, but my drug book indicates that it is produced that way (2010 Nursing Spectrum Drug Handbook).
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.
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.
happy wiggle
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.
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.
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.
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.
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.
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 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 – 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.
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). 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 around the house and in the car in case of accident.
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.
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.