Derek, you old geezer, you.

Well now, it appears that Derek's docs have been confabbing, as doctors are often wont to do.

The date of hospitalization is all set for March 4-9 and oh yes, they would like Derek on Coumadin.

*MULTIPLE sighings and gnashing of teeth*

I understand. Really, I do. After all, Loren was on it for 10 or 11 years. It's standard practice for someone in atrial fibrillation. Sustained a-fib.

We've gotten by with baby aspirin until now, but what with the in-hospital start of Sotalol and particularly the possibility of a cardio-conversion at the end, it is thought that the anti-coagulant will be good to start and keep in place for a short time.

If at the end of that week Derek is not in sinus rhythm, then he'll be put to sleep for a wee bit and shocked back into normal rhythm. It is then hoped that the Sotalol will keep him in a stable sinus rhythm, and that it will be self-sustaining, similar to many of the executive boards of high-end companies.

It is also standard practice to keep one on Coumadin for several weeks after a cardio-version. Then MAYBE, Derek can discontinue the rat poison...er...blood thinner.

(yes I KNOW "blood-thinner" is a misnomer. It doesn't actually thin the blood, but lessens the blood's ability to coagulate as fast. But for us mere mortals--non-medicos--the terminology of "blood thinning" will suffice)

The problem of taking this medicine is that it has rather narrow parameters of safety. If the blood clots too quickly, you run the risk of a clot in the heart or the brain. If the blood clots too slowly you could theoretically fall down and have nasty looking bruises or even a brain bleed.

In general, I think they are more concerned with the possibilities of excessive bleeding.

But the reason for all of this is the atrial fibrillation. With the upper chambers of the heart goofing around like that (just picture a coupla hoods leaning up against a building, taking a smoke and razzing helpless passersby) there is the chance for blood to pool and cause a problem.

I believe the technical term is "throwing a clot."

So while aspirin is also an anti-coagulant, it does not have the capacity to give the doctors precise bits and pieces they can measure in the blood, such as Coumadin.

Also, the fact that baby aspirin tastes good and is easy to ingest does not bode well.

There IS however, a nifty test that must be given to all who take Coumadin. It is called INR which can stand for the Indian Rupee. But in this case we are talkin' International Normalized Ratio. A more common name is Pro-time, which is short for Prothrombin Time.

The INR was developed so that a standardized method of measurement could be achieved. In essence, this means that a person could get a pro-time test done in...say....North Dakota, wait several days and then cross the state line to rob a bank in South Dakota, stop by a clinic on the way to Minnesota, get arrested in Iowa, and then become incarcerated in a federal penitentiary, where he (like, how many female bank robbers have you ever heard of?) could still receive the INR testing procedure and be assured of consistent results and proper dosing, which would no doubt cause great peace of mind while waiting out his 25-year prison term.

There is another term involved, the Prothrombin Ratio. I believe all three of these names, INR, PT, and PR came into existence because doctors discovered patients were coming dangerously close to understanding what was going on, and so added the extra acronyms in an attempt to perpetuate their professional air of superiority over the patient.

(on a side note, one of the most aggravating effects of today's technology is the development of the Internet, and the alarming propensity of some patients to research various aspects of their conditions and whether or not they have in fact been temporarily abducted by aliens for nefarious and otherworldly experimentation)

ANYWAY, going back to the Greek, thrombosis means "a clumping or curdling" and thrombos means "clot, curd, lump." So when you get right down to it, getting a Pro-time could simply be the medical profession's attempt at finding new sources of cottage cheese.

Or, it is a refined test to measure the pathway of coagulation. Enzymes and plasma protein and other things....and suddenly that whole alien abduction theory doesn't look so far out any more.

But seriously, the testing keeps track of how fast the blood coagulates and then the Coumadin dosage is adjusted accordingly.

Derek will be taking the generic form, called Warfarin. Just as good as the name brand, but without the little gold "Gucci" labels.

And no, I wasn't kidding about the rat poison business. Look on the box of rodent killing stuff the next time you go to Wal-Mart. They now make poison for "Warfarin resistant" rats.

In the short term, Derek will have to be tested every 3 or 4 days. Thankfully, our usual clinic now has the finger prick method :-) so that part will be easier.

And one more thing....we'll have to watch what he eats, so that he does not overdo on the foods rich in Vitamin K, a known substance that can cause clotting. Not that he'd suddenly develop a clot, but it can wreak havoc with the pro-time results. No need to take more of the anti-coagulant than necessary.

Well, I could go on and on for hours, the subject of young people taking old-peoples' medicine is so fascinating....

{5:320 pm edit} Just so there's no mistake, we have great respect for Derek's doctors. Besides being terribly smart, they are real human beings, fully capable of layman-friendly speech and even humor. The ones we work with (both for Loren and Derek) actually care about people. It's the surgeons that are sometimes less "people-skills savvy." :-p

I had earlier used the word "overdue" in connection with Vitamin K-rich foods. This was in no way meant to be a slur against vitamin K-rich foods. I was not implying they had overdue library books, owed fines or anything of the kind.

 

Tweet