Tag Archives: Coumadin

Ding Dong! The Rat Poison is Gone.

You should have “Ding dong! The witch is dead” stuck in your head now.  You’re welcome.  Just like the Munchkins in the Wizard of Oz, I am thrilled that my personal wicked witch is gone.  I got the best news ever from my doctor.  My DVT is gone, and I no longer need to take Coumadin, the human life saving, rat killing blood thinner.

When I first started taking Coumadin, I thought for sure it would kill me.  This is because I Googled it as soon as it was prescribed.  Big mistake.  Go ahead.  Just for fun, do a search for “Coumadin.”  What do you see?  Um, I’m going to guess there’s a bunch of stuff about gastrointestinal hemorrhaging. Trust me; you haven’t lived until you’ve spent at least three months being on high alert for signs of this.  I will spare you the details.  You’re welcome again.

In your Internet search, you probably also found a little background information on Coumadin.  Yes, it really is rat poison – a comforting little fact that kept me on edge for the past three months.  Because it is a poison, Coumadin requires constant monitoring.  Blood levels have to be kept in a therapeutic range.  If the level is too high, you get that hemorrhaging you see online.  If it’s too low, your blood clots.  To make things super challenging, just about everything interacts with Coumadin.  So, I spent three months avoiding green vegetables (Vitamin K counteracts Coumadin) and ibuprofen, and seriously limiting my alcohol and green tea intake. While the children in Iraq aren’t exactly weeping for me, it was challenging.  As you can imagine, I am super glad to be done with Coumadin.  As with any life experience, positive or negative, I did learn a few things.

  • If you drink enough water and strong black tea, you can get rid of a headache without ibuprofen.
  • Canola oil has a load of vitamin K in it and it is in just about EVERYTHING fried or baked.
  • Canola is NOT USED to make fries at Five Guys.  Peanut oil is used instead, which was wonderful news for me, not so much for all of the people who are allergic to peanuts.  I would hate to be on Coumadin and allergic to peanuts.  I only got fries from Five Guys once while on Coumadin, but it was wonderful.
  • Red wine really does have blood-thinning properties.  I intend to use it medicinally from now on.

    It's medicine.
    It’s medicine.
  • There are a lot of green veggies in Chinese and Italian food.
  • Green tea tastes really good when you haven’t had it for three months.
  • There are thousands of people who have to take Coumadin for life due to genetic blood disorders, mechanical valves, or certain heart issues.  I don’t know how they do it.
  • Tylenol is only useful in larger doses.  Taking large doses of Tylenol is dangerous.
  • Color-coding is a great tool.  Since my dosage of Coumadin needed to change periodically, I had three different varieties of pills.  The pharmaceutical industry realizes that it could be easy to confuse the different pills, so they are colored differently, depending on the strength.  The five-milligram pills are peach, the two milligrams are blue, and the one-milligram pills are pink.  The other varieties are also different colors, but I only had fives, twos, and ones.

So, this will be my last Coumadin/DVT related blog.  I will now go back to writing about John Stamos, kittens, jeans, and whatever else irks or amuses me. You know, the serious things in life.

Five Flat-out Awesome Things About Having a DVT

This is how I operate when bad things happen.  I freak-out, I curl in a ball and cry, and I throw myself the mother of all pity parties.  Then, I stop all of that and get on with life.  In order to get to that getting on with life part, I HAVE to find the good part of the bad thing.  To be cliché, I HAVE to make lemonade out of lemons.  It is a big coping mechanism for me, along with sarcasm, writing, and macaroni and cheese.  So, without even thinking that hard, here are the five positive things that happened because I had a life-threatening blood clot in my leg.

 I learned to really pay attention to what I put in my body, for real this time.  The “gold standard” medication for blood clots is Coumadin (Warfarin).  It is an OLD drug that was once used as rat poison.  Ah, yes.  That does make me feel super comfortable about taking it.  Anyway, in addition to the whole rat poison thing, Coumadin is very unstable and it can be difficult to keep it at a therapeutic blood level.  EVERYTHING interacts with it, including vitamin K, NSAIDS, and alcohol.  In other words, my previous diet.  : )  So, I have to monitor the amount of vitamin K I eat to keep it consistent week to week.  Who does that?  Who measures portions of green veggies?  I think they are usually “free” on all weight loss plans. I have also had to limit alcohol to three glasses of wine per week.  This isn’t so bad, but still who does that?  If I have pain, I can take Tylenol in limited amounts and that’s about it.  I can’t take aspirin, ibuprofen, or any NSAIDS.  Up until now, I thought Tylenol was a placebo.  

 I am a friggin’ subject matter expert after all of the research I have done.  I use friggin’ here because “subject matter expert” alone is just not enough, but I try to avoid using other F words in my blog because my boss has been known to read it some times.  Anyway,  being the anxious nerd that I am, I research everything, especially things that could possibly kill me.  My doctor both loves and hates this about me.  I know this because she said, “On the bright side, you’re a very good patient.”  I love that I have a number of tools to add to my knowledge. In addition to my old pal Google, I also have two iPhone applications that relate to my medical condition.  On is a Vitamin K app.  Since Vitamin K does not play nice with Coumadin, I look up anything green that I eat or drink to determine if it is safe.  The other app I have is Comadin dosing app.  I do follow my doctor’s orders with all dosage changes, and there are many, but it is still interesting to understand the why behind moving from 6 milligrams to 7.

 I learned the BEAUTY of compression hosiery.  Before all of this started, I used to giggle at Spanx.  I never wanted to compress any part of me. In fact, I tried to avoid tight clothing as it tended to make me claustrophobic.  I’m more of a loose clothing person.  This changed when I was told to wear compression hosiery because of the DVT. Compression helps prevent long-term damage like swelling and pain after a clot, and it also helps to prevent new clots by improving circulation.  I wear compression hosiery, in the form of socks or tights, every day now.  It does wonderful things for my chubby ankles.  I have even considered getting an ankle bracelet.

 My empathy received a kick-start.  I can be hard on people.  I have survived a lot of crazy things in my life, so I usually just tell people to buck-up and deal with whatever they are upset about.  I am glad I decided to NOT major in Psychology as I had originally planned.  I would have made a terrible therapist.  Anyway, after having many meltdowns over the past month or so, I have come to the shocking conclusion that it is OK to be upset sometimes.  It is normal, and it causes less damage than trying to hold everything in all of the time. 

 I learned to be more selfish. I didn’t want to ruin Christmas for my family, so I waited a week to see a doctor about my mysterious calf pain.  That could have killed me.  A lot of people put the needs of their families before their own needs.  While I will still strive to be a good mother and wife, I will no longer put my health on the back burner.  It is just too dangerous.  I’ve learned to stop and rest, and to seek medical care when needed. 

 I still have my days where I’m pretty sure having a DVT is the worst thing ever.  I still get grossed out when I think about blood thinners and the clot, but I’m positive for the most part.  I hate PT/INR test days (once or twice per week) as they are usually not in the correct range.  The good news is I only have to deal with this for a few more months.  There are people who have life-long health conditions.  I don’t know how they are sane, but I hope they blog and eat a lot of mac and cheese.

Constant Dosage Changes
Constant Dosage Changes

Sheldon Cooper and Grown-up Tantrums

The ER doctor walkedMy Journal into the room and said, “You have a clot,” as though he was saying something like “The cafeteria has flavored coffee today.” He stood next to the rail of the hospital bed I was in, and looked at me. I started shaking a little, and I was trying so hard to keep it together. Like my favorite fake boyfriend, Sheldon, I am not big on emotional outbursts.

I looked up at his tired, expressionless face, and my stomach instantly tensed. I replied, “I do?” I kind of knew that this would be the diagnosis, but I was still in denial. I had been hoping the doctor would tell me that I did not have a clot, and that I was just a crazy hypochondriac who needed nothing more than muscle relaxers and a heating pad. I had calf pain for the previous five days. It hurt so bad to stand on my left leg that I was brushing my teeth in a flamingo pose, keeping all of my weight on my right leg. I was trying to tell myself that I was just having muscular pain after being in a walking cast for a tendon injury for the past month, but somehow I knew it was more than that. Also, I had seen the sonogram technician’s face.

Technicians aren’t doctors, and they are not allowed to give you a diagnosis, but they do a lot of exams and they know when something is wrong. I saw it in her face. The sonogram technician started with my thigh and spent about two seconds there. She had a sort of normal “just doing my job” look to her face. Then, she moved to the back of my calf and she slowed down when she got to the back of my knee. Her faced changed. Chris, my husband, was looking over her shoulder at the monitor. He started to look concerned, too, even though he has no sonogram experience. I turned and looked away from both of them to avoid getting more stressed. I did not want to cry in the ER. I heard a lot of clicks, and I felt some pressure and tenderness behind my knee. I felt nauseated. I was hoping I was wrong, but I knew that I had a DVT.

So, when the doctor came back in to deliver the news, I wasn’t shocked; I was disappointed. The doctor asked if I had a local doctor. I explained that I am originally from South Florida, but I currently live in Ohio. So, I had no doctors in Port St. Lucie, where we had been visiting my in-laws. At this point, the doctor wasn’t sure whether to admit me to the hospital or let me leave with medication. He left for thirty minutes to “consult with colleagues.”

The doctor finally came back and told me that they would be letting me go home, or back to the hotel in my case. He let me know that I could just give myself shots in the stomach and then take Coumadin pills, with the same flavored coffee in the cafeteria tone. WHAT? I started shaking A LOT then.

“Shots in the stomach? There has to be a better way.” I got teary-eyed then.

He ignored my tears, and said, “Trust me. You don’t want us to keep you here on IV’s. You don’t have a local doctor. It just doesn’t make sense to keep you here.” I know now that he was right, but this doctor had the bedside manner of a Taco Bell employee. It was like giving myself shots to the stomach would be as easy as adding guacamole to a burrito. The doctor left the room again.

The nurse came in to give me my first of five, which later turned in to ten, Lovenox injections. That’s when I cried. I cried over having to give myself shots in the stomach, and also because I would have to take Coumadin. My cousin died from falling while on Coumadin. She bled out in her abdomen. I could not stop shaking and crying. I apologized to the nurse for my melt down. I despised myself for having one. I hated that I could not control my emotions.

The next morning, my husband went to the pharmacy near our hotel to pick up my pre-filled Lovenox syringes and Coumadin. While he was gone, I sat on the hotel bed and had a toddler tantrum. I cried so hard I thought I would puke. While I was crying, I texted my son, who was two hours south of me with his father and step-mother, a nurse. I asked him to ask his step-mother to give me these shots. We were headed to South Florida later that day. Due to her work schedule, she could not give me the shot at the time I needed to receive it. The injections are supposed to be given twenty-four hours apart. I thanked my son for asking, and her for being willing to do this, and I put down my phone and went back to my toddler fit.

My husband came back to a blubbering version of his sarcastic, micro-managerial wife. “I can’t do this. I don’t want to give myself shots or take Coumadin. How do people live like this?” I kept saying, between nose blows. I knew that LOTS of people, including some of my friends and family, had given themselves injections, but I had no clue how I would do this. “We have to just go to a clinic, like the nurse said. I can’t do this.” I cried more and grabbed more tissue. Then, my husband made everything a little better.

“I think I can do it,” he said.

“What?” I pulled my face out of a hotel grade Kleenex.

“I can do the shots. I watched the nurse, and it didn’t look that hard,” he said. He went on to tell me about a diabetic friend he had when he was a kid. She had told him that she had to learn to give herself shots by jabbing an orange. Chris remembers odd things like this; I’m glad. So, he had an idea of how much pressure to use. I was relieved that I wouldn’t have to do it myself, but still upset that it had to be done and that I had to take blood thinners at all. I was terrified of bleeding out like my cousin. I still felt really queasy about everything, but at least I would not have to go all Pulp Fiction on myself.

My husband and I spent another 3 days in Florida, visiting with my mom. We also stopped by to see my aunt, cousin, and my cousin’s daughter. It wasn’t the best visit ever because I was constantly preoccupied with blood thinners and the clot in my leg. Chris gave me the shots every night, and he did a good job. The shots stung, but they weren’t as painful as I thought they would be. The pain in my leg got better a little every day. So physically, I was getting better, mentally I was still anxious. Between friends on Facebook telling me horror stories about Coumadin, and thinking of my cousin, I was a nervous wreck.

I had another meltdown once we got home. I had to see the nurse at my doctor’s office for a PT INR test. I will have these regularly while I am on Coumadin. Basically, they are a finger prick blood test to be sure you are in the therapeutic range for Coumadin, which is between 2.0 and 3.0 for me. My doctor was out of the office that day, so I asked the nurse if it was OK to ask her some questions. She, of course, agreed to help.

So, before she even did the test, I dug out my plastic baggy of medications from my purse. Coumadin interacts with nearly EVERYTHING, or so it seems. I already knew that I could not take my birth control pills or eat a lot of green vegetables, and I knew that aspirin and ibuprofen were out of the picture, but I wasn’t sure about acetaminophen or my assorted IBS medications. As I started to talk to the nurse, I started crying again. Holy instability, Batman. This was getting old. As I cried to the nurse, I apologized for crying. She tried to comfort me, and she told me that what happened to my cousin was very rare. She also told me that it was OK to take Tylenol and my IBS meds as needed. So, I stopped crying and let her do the test. My result was 1.5, which meant I would need more Lovenox shots. Ugh!

I saw my doctor the next day, and told her about my cousin and asked her was there no other treatment that I could possibly do. Dr. R. said that this was the best one for me, explained why, and offered to send me to a hematologist if I wanted another opinion. I really just want to stay with MY doctor. I’ve only been her patient for six months, but she has a way of calming all of my anxieties and explaining medical things in real people terms. I’m quite sure if celebrities found out about her, Dr. R. could be a super rich doctor to the stars.

Dr. R. spent about thirty minutes talking to Chris and me. She assured me that I would not bleed out from shaving my legs, or most things that could possibly happen. She assured me that we would be keeping me in the therapeutic range. She also told me that I would only need to take Coumadin for six months, not for life. Since my clot was “provoked” by the cast, the original injury, and the birth control pills, it was probably not caused by a medical issue. Dr. R. also said that she would order blood work for me at the end of all of the Coumadin to make sure that everything was normal.

I’m still not thrilled about taking Coumadin, or that one more injection I have coming my way this evening. I can’t have Cosmopolitans, red wine, or any alcohol until July, when I am off of the medication. I also have to pay attention to how much spinach, broccoli and other vitamin K rich foods I eat. If I get a headache, I can take Tylenol, not Motrin. Plus, there will be regular PT INR tests. So, it’s not how I saw myself spending the first half of 2013, but I suppose it could be worse.

Every night, for the past few nights, I have been writing in my journal, which has a famous anti-suicide quote on the cover. I have been listing everything good that happens each day. I’m always amazed at how MANY things I can list. They are the little things like “got to have Chinese food today” or “chatted with Alli and Pam today.” Then, there are the bigger things like, “My son is home from Florida” and “I got to spend the whole day with Chris.” Good things happen every day. Like many people, I sometimes forget that.

The Six Ways I Almost Died this Holiday Season

Until recently, Deep Vein Thrombosis (DVT) was one of the many things that happened to other people.  It never crossed my mind that it could ever happen to me.  I don’t take super long flights.  I’m only 41, but 27 in my own imaginary world.  I’m not thin, but I’m not obese.  Sure, I was always a birth control pill user, but I have never smoked, other than that time in seventh grade in the band practice room, which caused me to vomit.  Anyway, I’m not the most likely candidate for a DVT.  So, when I got calf pain this holiday season, I ignored it.  Now, that I KNOW what was causing the pain, I need two hands to count the ways I almost died.

  1. I ignored the pain for five days.  I first noticed the calf pain on Christmas Eve, a Monday.  It hurt A LOT, bIMG_0841ut I assumed it was due to the walking boot cast.  Plus, we had plans to go to a Christmas Eve party at our good friends’ house.  I really like this family, and I wanted to go. So, I ignored the pain. The next day, Christmas, it hurt so bad that I almost cried.  I thought maybe I should go to the ER, just to get it checked, but we were supposed to leave the next day to visit our parents in Florida.  I didn’t want to ruin our visit.  I was really convinced that it HAD to be muscular.  At this point, blood clots were still on that list of things that happened to other people.
  2. I relied on the Internet instead of seeing a real health professional during those five days.   My well-meaning Facebook friends told me to get Biofreeze or Bengay when I asked for help with muscular leg pain.  Google searches led me to sites detailing how to deal with muscular calf pain after a cast.  Apparently, this is a common issue.  These same sites also told me that my skin would be hot and red if I had a clot.  My skin was never and still isn’t hot or red.
  3. I rubbed my leg.  A lot.  I figured I could massage that knotted muscle back to being normal. My husband and I even considered going to a massage therapist.  Since I didn’t know this before I had a clot, I’m assuming that you don’t know.  RUBBING OR MASSAGING A CLOT CAN KILL YOU. When you have a clot, you don’t want it to move to your heart, lungs or brain.  So, you don’t want to loosen it up and HELP IT MOVE at all.
  4. The doctor’s office took 8 hours to call back. I finally called the orthopedist’s office to ask about the post cast pain at 9:00 AM on Friday.  When they still hadn’t called back when we were about to eat dinner, I was going to turn off my ringer and deal with it when I got home.  When the nurse finally called back and told me to get a DVT test, I panicked, and I almost lied to my husband and told him it was nothing.  After all, I didn’t want to ruin the holidays, and I really didn’t want to face reality.
  5. I was almost given an overdose of a blood thinner. Doctors have messy writing, and ER doctors don’t sleep much.  With this combination, it was no surprise that the pharmacist was confused by the way the doctor wrote my prescription for the Lovenox injections, the first medication for DVT’s.  The doctor wrote it for prefilled syrIMG_0872inges, but needed me to take a lower dose.  So, he wrote unclear instructions about shooting some of the medicine out before injecting it.  Lucky for me, instead of worrying about being politically correct, the pharmacist asked my husband, “Is your wife a big lady?”  My husband said no and told him my height and weight, and the pharmacist was able to decipher the dosage with that information.
  6. I let fear cloud my judgment.  I have taken the birth control pill to regulate my menstrual cycle most of my adult life.  I will spare you the gory details, but I will tell you that my monthly visits are a little slice of hell.  Of course, the ER doctor told me to stop taking the birth control pill immediately.  I didn’t listen. I took it for two IMG_0874more days because I figured since I was taking blood thinners and quitting the pill mid cycle, I was setting myself up for more hell WHILE TRAVELING.  My husband finally talked sense in to me and put my pills in the “sharps” container. Since my husband has to give me the Lovenox shots, we have our very own sharps container.

My son goIMG_0875t me a pink leather bracelet with “Seek Wisdom” on it for my 40th birthday.  I have been wearing that as a reminder to seek out professional help when I need it. As of today, I’m still alive.  I’m following the doctor’s orders, and I hope to be off of all of this blood thinner medication soon.  I hope anyone reading this will share it, just to educate others.  A lot of people have heard of blood clots, but who really thinks they will get one?