For Older People with Sense
Comments
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Getting a little frustrated-----wrong about pulmicort, not a combo drug --it's a straight corticosteroid-meaning a steroid . Usually used for asthma. problem with withdrawing it is you could go into bronchospasm b/c steroids need to be weaned---I didn't know you had asthma. If they were using in the hospital post aneasthesia(usually stirs things up even if there isn't a lung history). It would be Ventolin/proventil/ albuterol---same drug different names but not steroids.. So, why were you on pulmicort.
Put in Blaxk box warning coumadin then warfarin-----brought up everything but the Black box.
Chrissy who is managing your medical care-----surgeon or medical doc important need to Know info. If surgeon you need to ask for a medical doc to manage medical care------that includes all drugs. Here only foolish docs want to manage medical care if they are surgeons. There is too much to know. Once they get into their specialties, it's hard enough keeping up on their speciality let alone others.
Watch your skin daily, make pen marks around areas that are retreating.-----no retreat no pen marks. Try to do a visiual daily or twice daily inspection in same high light as in the bathroom. if you are not on bedrest. Steroids on skin are a good choice , but if you are still taking an offending agent you will not see a response. But if it's b/c of laundry --unless offending laumdry is removed you also will not see a response. So, previous missive about laundry still stands. You must force all around you to be detectives. Otherwise wrong choices can be made. The laundry must be changed b/c it interferes with detrmining a drug reaction. Your body wide reaction as I said was serious please pay attention to each thing I said. Again look at it as if you are a detective.
What happenned when you came back in with the DVT b/c you told them about your DD problem , they tried to use that as a smoke screen that you weren't discharged with an anti coagulant-blood thinner. You thought that seemed reasonable b/c DD had a problem. Took them off the hook until you were able to say "why wasn't I d/c'd (discharged) with an anti coagulant if that is the standard of care". Then they knew , you knew they screwed up. Now you are having a drug or laundry reaction. They withdrew pulmicort a --steroid. Put you on oral steroids and a vream--------no sense.---------I don't rememver you being asthmatic.-----------so, I don't think this fufills our Sherlock -Holmes approach. OH dear Chrissy I hope I have given you enough words to work with. It Obviously causes me a great deal of concern. It also cuses me a cocern b/c my typings off b/c I can't see. Even the spell checker can't pick up some of my misspellings.
Love tou my dear friend------I put an intentiion in our on going novena right now. I hope there aren't to many misspellings in this. Was going to say it's hetting better till I spent at least multiple seconds finding a key. So this long missive was 3 x's as long as usual---L&H&P's sheila
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Shiela I would always want you on my team!
Ginger
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Just popping in to say I am still around. Will have to catch up on all the post later. I am too tired tonight so I am off to bed.
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Ginger so sweet-thank you.
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Sheila, I have asthma that is induced by hay fever but not normally at other times. When I was admitted they were looking for a Pulmonary Embolism and that is why I was put on the Pulmicort as the doc was hearing a definite wheeze. The doc handling my case is a Physician and has been very thorough with his investigations. Some of this was bought on by my lack of memory. I now remember that 15 years ago I was on pulmicort and penicillin at the same time and suffered an almost identical rash. My doc at that time deduced that I was allergic to penicillin. I haven't had it since that time and neither have I had pulmicort until now and have found out that that has been the culprit all along and not the penicillin. With the addition of the prednisolone and the cortisole cream, the rash is starting to be not so itchy and on the finer areas, is beginning to loose some of it's angry red color but the back of my leg still looks like chopped liver. Thankfully the weeping seems to have really slowed down so I'm thinking we are beginning to fight back. I know I have a while to go before it is totally gone so I just need to take care of it day by day until it recedes.
My INF came back at 2.7 today and if I'm close to that tomorrow, Moday looks like release day..........Yahooo!!!! but I'll wait and see and keep my excitememnt totally under control until I see the reality.........lol.........too many false days have been given.
Sheila please don't worry about type O's as I can read and understand what you have written and I really love your concern......thank you.
Elisimo! Great to see you! We don't see you enough...............I sure hope that you are not overdoing thing so you are exhausted!
Girls I hope you are all having good days and enjoying the spring weather as it slowly creeps over the large USA!
Love n hugs all. Chrissy
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Chrissy Retreat retreat >>.yeah>>yes it dies sound like you are on track. Now one last thing >>>get those sheets changed to the Burn sheets or hypoallergenic sheets>>In your case your skin is hupersensitive right now. You can't believe the chemicals used to wash hospital bedclothes and washcloths/towels. The reaction to the sheets is a fairly common problem if patiemts skin is damp b/c of sweat. You dear sweet Chrissy are rare. When you said the back of your leg looks like chopped liber. You are reacting to the drug and the sheets>>>>>burn sheet/hypoallergenic sheets.>>> weeping means skin is not intact, potentioal for infection>>>>burn/hypoallergenic sheets>>>> about this time I can hear you say Okay---okay I'll do it. Burn /hypoallergenic>>>burn /hypoallergenic. Now I hear you saying "stop already" burn/ hupoallergenic
What is the genetic test you are having?
Still confused by pulmicort being the offending agent------must be something in with the steroid i.e a perservative for example. if rash in retreat and it's the only drug that has been removed, perhaps Hmmmm.
Here we have a program where the pharmacist comes and does the discharge teaching on Coumadin/warfarin. It's very nice. It's the only drug that is taught by the pharmacist. It does indicate the "power" of the drug(couldn't think of another word). Ask if they have a similar program. If not ask the nurse for the usual discharge reading material on c/w so you can study before dc.Then all your questions can be answered. One of the most significant changes in recent years is the discussion re: grean leafy vegetables Things that have high vitamin K which can influence how c/w works. The previous teaching was to avoid all items high in vitamin K. It was then realized that many of these items had other nutrients that were very healthy. After study, it was determined that these items with vitamin K could be eaten, but the key was they had to be eaten regularly. So, if you are going to have a salad , have one every day. Have a list of foods with vitamon K and eat them "evenly throughout the week and your pt/inr will stay even too. Hope that made sense. Let me know what your literature says re: this and what your doc advises.
Mac glad your cough is better
. They can be so irritating and wear you out.
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My sister has rhe genetic blood clot thing and has to be on coumodin for life. My neice has it too, me not. They tested before I could take tamoxifen. Sending hugd,
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Good Morning Ladies, it is spring here is the NE USA. It is a little rainy today, but that is good since it has been too dry. I am appreciating everyday.
3jays, we don't know what caused my lung issue. At this point it seems the dr is just treating it to see if it will get better without long term complications. I am sure the rads (and all the other stuff my body has been through lately) irritated them. Just taking it slow.
Sas, my cough is better. I am coming off the prednisone and using the new flovent inhaler.I am to use the inhaler for a few weeks and then stop for a week before seeing the dr again. My body just feels so weird, tho. I know I am giving my lungs time to heal, but this is coming along very slowly. I have never had asthama or allergies. I am just so tired and have no energy right now, yet feel shaky and nervous. I make small goals for myself everyday and accomplish what I can.
Glad to have you all to talk to.
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I can tell the notes I send from my tablet...all the wrong letters...oops...
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"One-third of patients receiving warfarin metabolize it quite differently than expected. Research has shown that some of the unexpected response to warfarin depends on a patient's variants of the genes CYP2C9 and VKORC1. "
above quote from
FDA Approves Genetic Testing Labeling For Blood-Thinning Drug ScienceDaily (Aug. 17, 2007) - looking for more stuff-- be backAlthough a variety of factors influence a patient's ideal dose of warfarin, the genetic variations in the CYP2C9 and VKORC1 genes reported by 23andMe play an important part. In January 2010 the FDA updated warfarin's label to say that information on these variants can assist physicians in selecting a starting dose of the drug. The agency also provided initial dosage recommendations for patients with different variant combinations. The FDA does not, however, require that genetic testing be done before prescribing warfarin.Versions of the CYP2C9 gene known as *2 and *3 can slow down the body's ability to break down warfarin. This causes the drug's concentration in the bloodstream to decrease more slowly, so the patient needs a lower dose to begin with. Each T at rs1799853 indicates a copy of CYP2C9*2. Each C at rs1057910 indicates a copy of CYP2C9*3.The normally functioning version of CYP2C9 is called *1.Warfarin exerts its anti-clotting effects by inhibiting a gene called VKORC1 that is involved in vitamin K recycling. This in turn reduces the body's vitamin K levels, which translates into less clotting because many of the proteins involved in the clotting process depend on vitamin K in order to function.Some people have a version of the VKORC1 gene that reduces its function even in the absence of warfarin. Like those with the CYP2C9 *2 and *3 variants, these people may also need less warfarin than people who do not carry this variation. Each T at rs9923231 increases a person's sensitivity to warfarin.The variations in CYP2C9 and VKORC1 reported here are present at different frequencies in different populations. For example, about 20% of people with European ancestry have at least one copy of CYP2C9*2, but this version is rarely found in people with Asian or African ancestry. These prevalence differences at least partially explain why the ideal warfarin dose tends to vary by ethnicity.A small number of people whose data indicates that they have CYP2C9*1 may in fact have a different version of CYP2C9. Some of these different versions may affect the body's ability to break down warfarin in the same way that CYP2C9*2 and CYP2C9*3 do.TooK out bibliography --just way too long.
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Sorry about the big print it's just the way it cut and pasted. I know it's way more than you ever cared to know about the test. Basically, the test is telling you if the gene is present or not. The result explains how the liver is going to metabolize the drug. Didn't recognize what you were saying at first. But now that I know what your talking about I could bore you for hours, I won't. I know you are thankful for that.
Socalisa--------you take the most beautiful pictures. AND are those beautiful plants from your qwn garden?
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Question
Warfarin diet: What foods should I avoid?
Can you tell me what I should eat while I am taking warfarin (Coumadin)? What foods should I avoid?
Answer
from Sheldon G. Sheps, M.D.
Warfarin is a blood-thinning medication that helps treat and prevent blood clots. There is no specific warfarin (Coumadin) diet. However, certain foods and beverages can make it so warfarin doesn't effectively prevent blood clots. It's important to pay attention to what you eat while taking warfarin.
One nutrient that can lessen warfarin's effectiveness is vitamin K. It's important to be consistent in how much vitamin K you get daily. The average daily allowance of vitamin K for adult men is 120 micrograms (mcg). For adult women, it's 90 mcg. While eating small amounts of foods that are rich in vitamin K shouldn't cause a problem, avoid eating or drinking large amounts of:
- Kale
- Spinach
- Brussels sprouts
- Parsley
- Collard greens
- Mustard greens
- Chard
- Green tea
Certain drinks can increase the effect of warfarin, leading to bleeding problems. Avoid or drink only small amounts of these drinks when taking warfarin:
- Cranberry juice
- Alcohol
Talk to your doctor before making any major changes in your diet and before starting any over-the-counter medications, vitamins or herbal supplements. If you are unable to eat for several days or have ongoing stomach upset, diarrhea or fever, consult your doctor. These signs and symptoms may mean you need a different dose of warfarin.
Next questionBlood thinners: Can I still get blood clots?
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Section Focus- Warfarin side effects: Watch for interactions
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- deAssis MC, et al. Improved oral anticoagulation after a dietary vitamin K-guided strategy: A randomized controlled trial. Circulation. 2009;120:1115.
- Sconce EA, et al. Vitamin K epoxide reductase complex subunit 1 (VKORC1) polymorphism influences the anticoagulation response subsequent to vitamin K intake: A pilot study. Journal of Thrombosis and Haemostasis. 2008;6:1226.
- Ford SK, et al. Vitamin K supplementation to decrease variability of international normalized ratio in patients on vitamin K antagonists: A literature review. Current Opinion in Hematology. 2008;15:504.
- Valentine KA, et al. Outpatient management of oral anticoagulation. http://www.uptodate.com/home/index.html. Accessed March 24, 2010.
- Ansell J, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008;130:160S.
- Coumadin and vitamin K. National Institutes of Health. http://www.cc.nih.gov/ccc/patient_education/drug_nutrient/coumadin1.pdf. Accessed March 24, 2010.
- Vitamin K. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed March 24, 2010.
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Mac _sorry memory issues>>.nervousness and anxiety are b/c of the prednisone , if they didn't tell you. So,anywhere from 12 -24 hrs after last dose >>they should be gone Namaste sheila
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thanks, shelia for all the info
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Chrissy,
I do hope you are out on Monday. What a roller coaster. I'm glad the rash is disappearing and it sounds like issues are being resolved. Hate for this to be happening to you!
Love,
Lane
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Chrissy, I hope you'll be sprung Monday too! I know the hospital's getting old now, but at least you're seeing some improvement and I hope everything's on the way up from here.
I've been all by myself this weekend, well, me and the dog, while DH is in the mountains on one of his beloved fishing trips. Mind you, not that I've ever seen any fish returning with him! He and some friends do the mountain trip this time of year, and an Outer Banks one in the fall, and they camp out. I understand their "facilities" at this campsite consist of a porta-john, and I know from experience they'll come back grungy and DH's first thing at home will be a shower!
DS and DIL are going to put DGS in daycare next month. Yes!!! It'll be 3 days a week and DH and I will have him 2 days which will be fine. We'll be able to take some long weekends and travel a bit, and DGS will be around other children and have a lot more structure than he gets here, so it's to everybody's benefit. I do apologize to those of you who don't have the opportunity to see your grandchidren and I do love mine dearly, but keeping him 5 days a week for almost 3 years and dealing with bc at the same time has been hard. I want him to feel that coming to see us is a special thing, not his routine, and this is a start.
Hugs to all of you-
Kathy
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Mac - flovent inhalers can make you feel shaky and nervous also. When I was on it I felt like someone had wound a spring inside me up too tight and any minute it was going to go booooing! I was switched to Xopenex (?sp) and it does not make me feel that way. Tell your dr about the shaky nervous feeling.
Chrissy - do hope you can go back to DD's on Monday. I know you are truly ready to be out of the hospital. I pray that they are taking the best possible care of you while you are stuck there. You are a very special lady and are loved by so many, esp. me.
I had planned today to pay bills and fill out a mound of paperwork I have to do today, but DH sidetracked me into going to look for flowers and I would up spending the majority of the day planting flowers in all the various pots I have. Then I took a long nap and woke up with a sunburned face. DH says it is not a bad burn, but then he does not feel how hot my skin is and pink to him is red to the rest of the world. He was even calling some orange flowers pink! Oh well, tomorrow is another day that I have to wake up facing the mound of papers and bills. :-(
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ellisimo: i had to switch to xeponex also.. and i use it in the nebulizer, and the inhaler in the summer.. allergic asthma is my dx.. so, ck it out, mac.. it really does make a difference..
been a crazy weekend, and its not over yet...
we did get all our plants potted, and moved. Nearly killed mur.. i've been up tonight, in the middle of everything, i picked up my glasses, and they FLEW out of their holder.. finally, after working with an old pair all day, i found them BEHIND my BED!!!no way i looked there, first.
every box we had packed, (and there's enough for 2 families, still.. they have to be opened.. every drawer, every closet, etc.. tommorrow will be another crazy day...
i was so caught up in the insanity, i forgot TODAY is our 21st wedding anniversary.. i really feel like a dog, forgetting it.. but, sure as rain, Murray showed up with two dozen yellow roses, tipped in red, this morning.. and here i was, fussing he was gone so long.. i really feel so guilty. im so glad he's so patient with me.. im one lucky girl.. and, when not taking the prednisone, i KNOW it!!!!
we're going to ahotel on sunday, so i'll be on the sythyroid, and prednisone.. they come together for me.. i just hope i can balance it with Zanax, and be decent to him.. all of this chaos is killing me!! i'll be glad to get away for 3 or 4 days!!!
then, they start tearing the kitchen cabinets apart.. but i told the guy, im taking advantage of all this, and getting the house finally in order, before im doing anything else!!!!
i hope you're well enough to leave monday, chrissy. will you be staying at DDs' for a day or two, to make sure?????...3jays
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QCA Kathy, I completely understand. 5 days a week would exhaust me. DD DSIL and DGD 20 months old were here for about 8 hrs today and we were just knocked out when they left. I watch DGD Monday late afternoon and early evening and that, with a weekend day, plus lunch once in the week is really good. I would be on my face five days a week. I love her so very very much and if it was necessary of course I would do it, who of us wouldn't? Right now she still hollers out GaMa! when she sees me and I love that. As she is able to reason I think I could easily spend more time with her but at this age I must watch her every second and that is tiring.
I also have two grands in Arizona and one in Illinois. I would love to see all of them more often.
Hugs Ginger
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Elisimo, Buying plants sounds like a lot more fun to me than paying bills and doing paperwork. I bought some lily of the valley yesterday to plant after we get that tree taken out, which should be soon. I already have lily of the valley in front, but it was easier to buy a few new plants than to dig it up and I know it will spread.
Chrissy, I have been on warfarin (coumadin until it went generic) for a long long time....I was trying to think how long.....7 or 8 yrs perhaps. I doubt that I have that gene, but do know I get blood clots every time I go off of it for some sort of procedure which is why I am always happy when they decide I can put off anything that involves stopping it....got it after bunions, cataracts, even when I had the colonoscopy and endoscopy this Spring. The reason I have to take it is because of that mexoma I have lodged in my pulmonary artery, which believe me it a royal PIA. You would think they would always put me on the lovenox or arixtra, but they don't even though I always ask when I go off the warfarin. Fortunately mine have been superficial for the most part and I only had a DVT twice and then once the PE when the atrial myxoma lst broke loose. You may end up with one of those little coagucheck machines like I have so that you can check your own INR at home. This past week I was 2.8. I did not ever alter my diet, although I do watch the alcohol comsumption. My doctor told me that I did not need to change my diet since I told him I love veggies and salad, he said the medication would adjust to me. Anyway, I know we are all different when it comes to this, just like the way we respond to treatment and I certainly hope they get you straightened out soon and that you get back home and can start concentrating on strengthening your new knee. The Didn't have Penicillin allergy written on your records?....that is a bad oversight.
3jays....sounds as if you are doing a lot, hope you aren't overdoing. Hopefully the hotel has cable and you can just relax and catch up with all your shows. I am assuming the dogs get to go with you.
One time the GP had me use an inhaler...it was that one in the purple container that you would turn to the day and then get a poof from.....after two days, my voice started going away and I quit taking it. Now the ins co is always questioning me about asthma and I keep telling them I do not have asthma and never did. I was having a problem due to plaster dust or something at the time and do have allergies, but do not have asthma.
Today I am going to actually do some things since yesterday I did nothing.....was just really tired and I think the Adriamycin is catching up with me. But it is working so it is worth it.
Have a good day everyone. Temp has really dropped here, but at least it's not raining. Marybe
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WOW...it's good to be back from vacation, although it was awesome! I had no access to a computer for the last 10 days, so lots of catching up to do.
Chrissy...so sorry you had to go back into the hospital, but thank goodness you went right away to the doctor when something didn't feel right. I tell you, medicine is a crap shoot...they just experiment with us until they find what works:( Having such a bad rash can't be fun at all, but hopefully they have finally found the cause and will fix it.
3jays: Glad you re going to get some R & R! Kathy...I understand your plight with the DGS... if I keep mine for a day, it feels like a month, although I love every minute of it. They are just little bundles of energy and never let up. You have to watch them every minute!
Maca: so glad your cough is getting better...what a challenge you've had. Now time to rest and get your energy levels back to near normal. I think the rads, plus all the other drugs take a toll. I was spared, since I didn't do rads, but still had a challenge with energy levels that I feel are just now getting back to normal. I still have those darn hot flashes now and then from the tamoxifen, but I can put up with them, and I know they are triggered by what I eat and drink, so if I indulge, I do so at my own expense:(
As I said, vacation to Nevada and Scottsdale Az was great...good food, shopping, golf, and great people! It was near perfect. It was my first time playing 18 holes in two years, and I did well, so well, that I hit a shot out of bunker and it rolled right into the hole! Pure luck...trust me...lol. One crazy story...we were leaving for dinner and my boyfriend couldn't find his keys. We looked everywhere. I suggested he look in his golf bag which he had some difficulty with when bringing it up the stairs to the condo where we were staying. He suggested I was an idiot for even thinking that it could have fallen into the golf bag! Well after another half hour of searching everywhere, and my repeated suggestions that he turn the golf bag upside down and just see if maybe they had fallen in...guess what....that's where they were!! I said nothing...he apologized...we went to dinner. Some thing are better just left as they are.
It's good to be back...I'll catch up with everyone later!
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Welcome home, Kaara
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Kaara, glad your vaca was spectacular!
It is a very rainy Sunday here. My body feels like a lead weight. I move from the couch, to the chair, back to bed and then back to the couch. I had no idea I was so talented at sleeping.
Happy Anniversary 3jays and have fun in the hotel.
Let those who need rest, get rest and those that need energy be energized!
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You are a wise woman Kaara! 0
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Just finished my rest, waiting for energy!
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Hi 3jays, and happy anniversary! 2 dozen yellow roses (my favorite) sounds spectacular to me! Hope you can enjoy your stay in the motel and you won't have too much chaos when you get home.
Kaara, how about you, a hole in one! Intentional or not, that's great! Love the story about the keys and the golf bag, too. Sometimes it's best to keep one's own counsel, and I'm sure he got the point!
Thanks for understanding Ginger. DH is sad about this, but even he can see that it's for the best.
Hope everybody has a good week!
Kathy
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Kathy, doing that much babysitting for grandkids would be amazing for me to do. My patience and pep are not up to it anymore..
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Up early today...anticipating my eye injection:( No anti anxiety meds this time around...they put me in la la land before, so I'll go it cold turkey today since I already know what will happen...a poke in the eye then lots of burning for the rest of the day. Only a cold compressed helped the last time.
I got all of my unpacking and laundry done as well as grocery shopping yesterday...must have been working on borrowed energy with the change in time zones. Right now it feels like it's 4:00 AM here, and it's really 7:00!
Looking forward to seeing my grands this week....I missed them so much! Wish I could take them all on vacation with me, but then I would have to have a vacation to rest up after....lol! I see a trip to Disney in my future...just want to make sure they are old enough to enjoy it because there is so much to see and do, and they don't understand waiting in lines.
3jays: Happy anniversary to you! The roses sound beautiful....I much prefer yellow over red.
chrissy: Hope you're feeling better today and can head home.
Have a great day everyone...I'll check in later.
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Hi girls! Nope not home yet but I'm holding onto maybe tomorrow again..............man those tomorrows just keep on rolling around! ...............lol
INR read was good again this morning so if I get another good one tomorrow that will make three in a row so good things happening there. The rash is starting to dry, heal and fade in the lightest areas but the leg still looks yuk although it no longer weeps or bleeds so that also is starting to mend. The anti hystermine is working and is keeping the itch well under control so that is truly a good thing as I was just about driven crazy with it for a few days.
Kaara so glad you enjoyed your break and yes we do tend to miss the grands when we don't see them for some time. By the time you read this you will have had your next injection but I'm hoping it all went well without too much trauma to you or your eye.
Nancy hope that cough has stopped or is almost gone and you are feeling so much better. Spring sunshine sure does make a person want to get outside and sit in it for a while.
Kathy you will appreciate the time you spend with the grands even more when you don't have to look after them all the time and I know you will appreciate the 'me' time that not having them five days will mean.
Lisa your flowers always cheer me when ever I see them.................you are so good at capturing their beauty.
3jays, I sure hope you ended up having a wonderful anniversary and your stay at the motel is not too hard on you.
Well girls, gotta go the nurses are around again for obs............you know what it's like!
Love n hug all. Chrissy
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chrissy: Glad you are doing better....sending you lots of prayers and healing energy!
My eye feels better today...and the drug is working...that's the best news. It's all doable, particularly when you consider the alternative of losing your vision.
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