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User Topic: Prayers and med advice
knightsbff
♀ Member
Member # 36853
Default  Posted: 2:45 PM, August 11th (Monday), 2014View ProfileEdit MessagePrivate MessageHomepage

We got back from our FL vacay, had one day of recovery and mom showed up at my house in the AM and woke me up to look at her leg (she drove herself of course). Her entitle left leg was swollen and kind of purple. She wanted to know if she "should go to the urgent care" .

Amazingly they didn't find it on the first u/s, but positive d-dimmer and MRI show massive DVT (femoral, iliac, and great saph).

She's inpatient on Heparin. Admitting doc mentioned Xarelto, DH hasn't used it because he does emergency medicine. He is reluctant because it's new and the "other shoe" hasn't had time to fall yet.

We need prayers and info on management of massive proximal DVT. I have read everything available on uptodate, I would like to hear anyone's irl experience. And thoughts on xarelto or maybe we should do lovenox?

Help.

Dr PJ? Tushnurse? Anyone?


FWW 40's
D-day August 27, 2012
3 kids and 2 dogs

I edit often because I make a lot of typos. ☺️


Posts: 1511 | Registered: Sep 2012 | From: Deep South, USA
Pentup
♀ Member
Member # 20563
Default  Posted: 3:06 PM, August 11th (Monday), 2014View ProfileEdit MessagePrivate MessageHomepage

Friend had this, not quite so massive, but big. Have they already put in a screen? Has she seen an interventionalist?

I don't know that med. lovenox for my friend. Long term issues because she waited to late and they could not restore flow to the main vein that was impacted.

Sending prayers for healing!


Me- BS
Him- FWS (I hope- F)

Posts: 6679 | Registered: Aug 2008 | From: Not Oz
knightsbff
♀ Member
Member # 36853
Default  Posted: 3:12 PM, August 11th (Monday), 2014View ProfileEdit MessagePrivate MessageHomepage

No filter. No interventional rad in our tiny community. Wondering if we should be considering transfer to higher level of care but not sure if it would fly for DVT???


FWW 40's
D-day August 27, 2012
3 kids and 2 dogs

I edit often because I make a lot of typos. ☺️


Posts: 1511 | Registered: Sep 2012 | From: Deep South, USA
lieshurt
♀ Member
Member # 14003
Default  Posted: 3:19 PM, August 11th (Monday), 2014View ProfileEdit MessagePrivate MessageHomepage

Sending prayers hun


A relationship without trust is like a car without gas. You can stay in it all you want, but it won't go anywhere.

Posts: 13841 | Registered: Mar 2007 | From: Houston
Pentup
♀ Member
Member # 20563
Default  Posted: 3:34 PM, August 11th (Monday), 2014View ProfileEdit MessagePrivate MessageHomepage

I would transfer. If an interventionist can get that opened up, huge difference I quality of life down the road.

Also, no filter to protect lungs, etc.

If it were my parent, I would be asking for a transfer.

[This message edited by Pentup at 3:35 PM, August 11th (Monday)]


Me- BS
Him- FWS (I hope- F)

Posts: 6679 | Registered: Aug 2008 | From: Not Oz
purplejacket4
♀ Member
Member # 34262
Default  Posted: 8:50 AM, August 12th (Tuesday), 2014View ProfileEdit MessagePrivate MessageHomepage

Xeralto is fine. I've used it on several patients. It's no more risky than coumadin but with no constant INR checks. You also don't have the accidental OD problem.


Me: BS 45
Her: fWS 48 (same sex partner)
Together: 18 years now (both MDs)
OW: meh so what 40s PhD
DD1: 10/30/11EA; DD2: 11/10/11 Had ONS; TT until 12/26/11; broke NC 6/12; NC again 7/12; R-ish

Posts: 2311 | Registered: Dec 2011 | From: Great Southwest
nowiknow23
♀ Guide
Member # 33226
Default  Posted: 8:56 AM, August 12th (Tuesday), 2014View ProfileEdit MessagePrivate MessageHomepage

((((hugs)))) Keeping you all in my thoughts.


You can call me NIK

"Keep your face always toward the sunshine - and shadows will fall behind you."
-Walt Whitman


Posts: 26209 | Registered: Aug 2011
tushnurse
♀ Member
Member # 21101
Default  Posted: 10:57 AM, August 12th (Tuesday), 2014View ProfileEdit MessagePrivate MessageHomepage

Yah, I'm going against PJ here on this one.
Xarelto is like Plavix in the fact that you don't know how well it is or isn't working, and there is NO quick reverse for it. With Coumadin a wallop of Vitamin K and a if needed a few FFP and good as new. It may be the old nurse in me, but I had a couple of patients that scared me and went through quite a bit of product from taking Plavix back when it was new.
With your H being an MD, and I would encourage him to talk with the PharmD he works with, and Cardiology to get their input on the thoughts on treatment.
I am a fan of the filters too. Not a big deal to place, and solves some worries. If you have an IC team there (interventional cardiology) they should also be able to place it.
Coumadin is not recommended for long term therapy for DVT's anymore though depending on size and location. If cause is known and some other factors.


Me: FBS
Him: FWS
Kids: 15 & 17
Married for 22 years now, was 16 at the time. .
D-Day Sept 26 2008
Fully R'd, and Happy Happy Happy

Posts: 8798 | Registered: Oct 2008 | From: St. Louis
sisoon
♂ Member
Member # 31240
Default  Posted: 1:34 PM, August 13th (Wednesday), 2014View ProfileEdit MessagePrivate MessageHomepage

(((hugs & best wishes)))


fBH (me) - 70 (22 in my head), fWW (plainsong) - 65+, Married 45+, together since 1965
DDay - 12/2010
Recovered, not yet fully R'ed
I share my own experience because it's the only experience I know, not because I'm a good model.

Posts: 10582 | Registered: Feb 2011 | From: Chicago area
Edith
♀ Member
Member # 38337
Default  Posted: 1:40 PM, August 13th (Wednesday), 2014View ProfileEdit MessagePrivate MessageHomepage

My DD32 had a massive embolism in her mesenteric vein 6 yrs ago, was on Lovenox at first (expensive/injections), then Coumadin (constant INR checks), and finally I mentioned to her hematologist Pradaxa. He switched her, and she is doing MUCH better. No dietary restrictions like Coumadin. I would check with insurance carrier, as I believe this is still an off-label use for Xarelto, as it is for Pradaxa. They are mostly intended for A-fib patients.

Prayers for your mom. By the grace of God, I still have my DD.

E.


Lies are manipulations. Always.

Posts: 401 | Registered: Feb 2013
jo2love
♀ Moderator
Member # 31528
Default  Posted: 4:02 PM, August 13th (Wednesday), 2014View ProfileEdit MessagePrivate MessageHomepage

Sending prayers and good thoughts.

Posts: 36492 | Registered: Mar 2011
knightsbff
♀ Member
Member # 36853
Default  Posted: 6:21 PM, August 13th (Wednesday), 2014View ProfileEdit MessagePrivate MessageHomepage

Thank you all. She refused Coumadin at first but is started on it now. I too had concerns about the ability to reverse if needed. We have no (real) IC here and our one cardiologist does procedures whether they are needed or not. (He put a internal pacer in a 19 yo who was hypokalemic...)

Her DVT is massive and proximal plus idiopathic...so a candidate for long term therapy. She will follow up with vascular guy in a decent sized city an hour from us after d/c.

We appreciate the prayers and the voices of experience. I have been loosing my mind researching all this stuff and Knight has been overwhelmed at work. He's talked to everyone available here has been trying to keep his head above water at work at the same time.

She's still doing well and is in pretty good spirits. We have had some drama that I haven't had the strength to post about yet with her NPD/sociopath husband and his crackhead harem. I'm just trying to keep my focus on my mom and my family right now (kids started back to school this week).

I cancelled scouts and meetings with the church auxiliary I am heading up. I'm in survival mode at the minute and will make apologies to everyone later....


FWW 40's
D-day August 27, 2012
3 kids and 2 dogs

I edit often because I make a lot of typos. ☺️


Posts: 1511 | Registered: Sep 2012 | From: Deep South, USA
Kajem
♀ Member
Member # 36134
Default  Posted: 8:18 AM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

((((((((Knightsbff)))))))))


I trust you is a better compliment than I love you, because you may not trust the person you love, but you can always love the person you trust. - Unknown
Relationships are like sharing a book, it doesn't work if you're not on the same page.

Posts: 5551 | Registered: Jul 2012 | From: Florida
Schadenfreude
♂ Member
Member # 43075
Angry  Posted: 9:08 AM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

Coumadin patient here. Other than the fact that my dose is constantly for reasons I don't understand it's no big deal. I had 9 or 10 clots in my leg and that was the only time my nephrologist got real excited. Usually he was Dr Cool, but he told me stat exam via ultrasound and gave me the option, thankfully, of immediate hospitalization or self injection with Lovenox. Ouch. But I sure didn't want to be in the hospital.

The benefit, such admit is, of dialysis,,is that blood draws are absolutely painless. They are done through a lead in the tubing leading to the machine.

I can't take Xeralto.

The lesson: it goes away. At least she didn't develop pulmonary embolism or have a stroke.

Has she seen cardiology? Atrial fibrillation, a form of irregular heartbeat, can cause blood clots. That's what happened to me. A fib is often treated with drugs.

Or maybe she was sitting too long. Any long car trips or airplane rides for her?


Posts: 892 | Registered: Apr 2014 | From: Midwest
booger bear
♀ Member
Member # 26584
Default  Posted: 5:20 PM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

Xarelto is great "new" drug. The doc I work Rx's it quite a bit, as a long term management therapy. The big risk with it is bleeding, if pt is prone to bleeding, has some sort of diagnosis, then Xarelto is prolly not the best choice. Because it can't be reversed, coumadin apparently can be reversed as far as excessive bleeding goes. But barring her having a diagnosis as such or being in some sort of accident that would cause extensive blood loss, it is a great drug. PT's love it cause they don't have to have the finger checks all the time and the dosage adjusted.

There are at home testing machines for those on coumadin but they are a bitch to get approved through ins. Home health can come out and do her PT/INR checks in the home as long as she stays home health qualified.

I don't know much about inpatient treatment - They may start discuss placing a filter, there has been some recent controversy over one of the filters that are used, and I believe it is the one in the area of her DVT, but I'm not sure.

An internal medicine doc would be my choice for her PCP and a cardi doc who specializes in DVT's and clots ect ...

(((hugs)))


I am fiercely independent and I won’t apologize for it. I'd rather be single than settled.

Posts: 18823 | Registered: Dec 2009 | From: OK - Hot as hell here !!!!!!
purplejacket4
♀ Member
Member # 34262
Default  Posted: 5:29 PM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

Xeralto IS FDA approved to treat DVTs. With Pradaxa it is off label.

Believe me if someone has insurance we use Xeralto. Yes it has bleeding risks but I've had several people DIE because they fell or were in a car wreck and they bled out too fast to give them Fresh frozen plasma (which reverses coumadin immediately) or vitamin K that takes days. But hey don't trust me I'm just a physician who practices actual hospital medicine and just spent the last two weeks treating this VERY thing. And I'm pissy too.


Me: BS 45
Her: fWS 48 (same sex partner)
Together: 18 years now (both MDs)
OW: meh so what 40s PhD
DD1: 10/30/11EA; DD2: 11/10/11 Had ONS; TT until 12/26/11; broke NC 6/12; NC again 7/12; R-ish

Posts: 2311 | Registered: Dec 2011 | From: Great Southwest
booger bear
♀ Member
Member # 26584
Default  Posted: 6:06 PM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

Well alrighty then ....... the Dr. has spoken and I will quietly go back in my LPN hole.

Hugs and prayers to you and yours, I really hope they find what works best for her and quick resolution.((()))


I am fiercely independent and I won’t apologize for it. I'd rather be single than settled.

Posts: 18823 | Registered: Dec 2009 | From: OK - Hot as hell here !!!!!!
purplejacket4
♀ Member
Member # 34262
Default  Posted: 6:32 PM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

Sorry Booger Bear. I just figured out a forgot to take my celexa last night. Boy am I a bitch today.


Me: BS 45
Her: fWS 48 (same sex partner)
Together: 18 years now (both MDs)
OW: meh so what 40s PhD
DD1: 10/30/11EA; DD2: 11/10/11 Had ONS; TT until 12/26/11; broke NC 6/12; NC again 7/12; R-ish

Posts: 2311 | Registered: Dec 2011 | From: Great Southwest
inconnu
♀ Member
Member # 24518
Default  Posted: 9:49 PM, August 16th (Saturday), 2014View ProfileEdit MessagePrivate MessageHomepage

(((knightsbff))) can only offer hugs, not advice. but know I'm keeping y'all in my thoughts.


Say what you wanna say and let the words fall out...honestly
I wanna see you be brave

Pretty pretty please, don't you ever ever feel
Like you're less than, less than perfect


Posts: 12172 | Registered: Jun 2009 | From: DeepInTheHeartOf, TX
knightsbff
♀ Member
Member # 36853
Default  Posted: 3:09 PM, August 18th (Monday), 2014View ProfileEdit MessagePrivate MessageHomepage

She was discharged from the hospital Saturday and is staying with me for a while. We follow up with her MD on Thursday and I think he plans to refer her to a vascular surgeon.

The swelling in her leg has gone down some but now it's starting to be uncomfortable at the sight of the clot and she's having pins and needles sensation in the leg and foot. Before it was just numb. She also says she's happy she can feel the floor under her foot again. Hope these are good signs...

Thank you for the prayers, advice, positive thoughts, and hugs.

Dr. PJ, I think he may change her to Xeralto after 3 months... We will discuss it with him when we see him.

I'm working on menu planning right now...for a diabetic, on Coumadin, with hyperlipidemia. Any dietitians with two weeks of meals planned out for someone with these dietary needs?


FWW 40's
D-day August 27, 2012
3 kids and 2 dogs

I edit often because I make a lot of typos. ☺️


Posts: 1511 | Registered: Sep 2012 | From: Deep South, USA
Topic Posts: 20

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