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Old 11-13-2009, 09:50 PM   #21
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Sam, when the doc told you that you'd need to administer your own heparin injections, did you say "I'll give it a shot" ?

Hope you get better quickly.
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Old 11-13-2009, 09:53 PM   #22
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Sam, lloyds, sorry to hear about your problems. Best of luck, and thanks for posting - describing your symptoms and experiences for others to be aware of is a commendable thing to do.
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Old 11-13-2009, 11:07 PM   #23
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Originally Posted by samclem View Post
Rich,
Thanks for the good wishes. I gave myself the first shot tonight--I'd be a very skittish junkie.
Not to offer advice where none is sought, but... a few tips: don't put too much pressure on the injection site after administering it. That sometimes leads to a little extra lump under the skin. Just gently hold a bit of pressure for a minute or so. Wait for the alcohol to dry before injecting to reduce the sting. Nothing to it.

If you have prescription coverage (assuming it's Lovenox, Fragmin, et al) ask your doc about just sticking with the injections rather than switching to coumadin. It's just as effective or even a little better and will spare you numerous blood tests, dosage adjustments, etc. Once daily injections are pretty easy to get used to.
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Old 11-14-2009, 09:41 AM   #24
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I'm going to bet your insurance premiums over time have more than covered the amount the uninsured guy will be charged.
Right. Quicken tells me that we've spend $42,000 on health insurance premiums since 2001.
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Old 11-14-2009, 10:43 AM   #25
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(Apologies to all for the individual nature of the following. Included here rather than PM in case others find it useful)
Rich,
Thanks very much. I didn't get much info or instruction from the ER doc, and I heard two different versions of how much/often I'm supposed to be taking meds. Right now I'm doing Lovenox injections (.8mL) 2X per day and coumadin 2mG once per day. The pharmacist suggested I tactfully ask the folks in the "Coumadin Clinic" (really--the hospital has an office just for this stuff) if that was right. Anyway, it's a little disconcerting not being certain about the dosages--if I end up bleeding out due to a paper cut, you'll know why.

I'll ask about just staying with the heparin, though I gotta say I hate the needles. Also, the bruising around my waist that I'm experiencing already is going to ruin my bikini modeling biz for months. Thank goodness I thought ahead and developed this roll of fat subcutaneous injection site. If Lance Armstrong finds himself in this situation, he's SOL. If Lovenox might work better and be more predictable than coumadin that would make it worthwhile. I have insurance (Tricare), but if coumadin is cheaper, that's probably what they'll keep me on. They are cheap--right now I'm surprised they aren't giving me a pile of cow intestines and an instruction sheet on how to render my own heparin in the kitchen.

(Legal note: I am not interpreting Rich's comments as medical advice.)
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Old 11-14-2009, 11:21 AM   #26
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If the bruising is bugging you, you might try icing for a couple of minutes before the injection. (experience advice, rather than medical )

Good lucks guys and hope you are all better soon!
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Old 11-14-2009, 11:41 AM   #27
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[QUOTE=samclem;875286 If Lovenox might work better and be more predictable than coumadin that would make it worthwhile. I have insurance (Tricare), but if coumadin is cheaper, that's probably what they'll keep me on.[/QUOTE]

As I have mentioned a few times, I take 5MG of Warfarin (Generic version of Coumadin) daily -- have been for 6-7 years now. I have my Prothombine Time checked every 8 weeks and have not had any wide variations, certainly none outside of "normal" range. Of course, my diet doesn't vary much either.

I don't have any other choice but to continue taking an anti-coagulate for the rest of my life -- Atrial Fibrillation. Nevertheless, I have some concerns with the long-term effects of Warfarin/Coumadin use. So I am particularly interested in this:

Dabigatran - A Coumadin Substitute for Atrial Fibrillation?

Let me google that for you+

Perhaps, this is something you can get your PCP's advice on.
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Old 11-14-2009, 12:59 PM   #28
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Sam, the once-daily injection regimen uses different dosing which you doctor can easily calculate for you.

Generally the low molecular weight heparins have been proven useful for thromboembolic diseases like DVT and pulmonary embolism. Their place in atrial fibrillation is less clear, though they are used at times and it's logical.

Thanks for preempting my "not medical advice" disclaimer. Turns out to be particularly apt in this situation because of numerous variations case to case, cost and coverage issues, and the clinical details.

The "-atroban" type drugs are likely to see wider use and can be helpful, but the same basic issues apply.
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