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Re: Ten Days Post Op.....

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Hi

I was also concerned about the “rat poison†blood thinner I was

administered. I’m afraid this is health care applying ‘one size fits all’

rules regarding DVT (deep vein thrombosis). I researched this after I was

prescribed Warfain to reduce the rate of coagulation of my blood. Blood

thinners are administered until the patient reaches an acceptable INR

(International Normalcy Rate) of usually between 1.5 and 2.5. That means that

your blood has to coagulate 1.5 to 2.5 times slower than that of a non-operated

person. Once you reach this range you can leave the hospital (or discharge

yourself, as I did, earlier than that) and should stay within that range for up

to 3 weeks from the op date.

There appear to be 5 ways of dealing with DVT:

1. Anti-coagulant taken orally (Warfarin is one and is indeed a component

used in rat poisons as it induces internal bleeding leading to death; that’s

why your INR is monitored and if/when you exceed 2.5 the dosage in mg gets

reduced as it could become lethal if it reaches 4)

2. Anti-coagulant administered via a subcutaneous injection usually into

your tummy (Heparin is one such)

3. Aspirin

4. TEDS stocking

5. Nothing at all

Studies appear to show no significant difference between the 5 methods.

Pulmonary embolism appears to have been no more prevalent in people he had no

blood thinning agents administered.

This leads me to the biggest folly – resurfacing patients in the main do not

require blood thinning agents. THR patients generally do as they lay stationary

much longer. Resurfacing patients are generally encouraged to start walking on

day 1. Throughout the first 3 weeks patients exercise so regularly that it

would be a miracle if a clot were to form. But, hey, who wants a law suit on

their hands. So, it’s cheaper, even if it may be not necessary at all, to

prescribe an agent to a patient.

Here, there was my tupence worth…

Dan

dan.milosevic@...

_____

From: aleksblaise1

Sent: 14 May 2004 20:02

To: surfacehippy

Subject: Ten Days Post Op.....

I would like to thank all of you for helping me get to ten days post

op. Special thanks to my new found friend and hip borther Dave.

Dave was kind enough to provide me with a wealth of information

along the way, not to mention he called me in the hospital two days

after surgery to provide encouragement. I can't imagine what it was

like going through this five or six years ago with little knowledge

or support. I hope to give back any way I can.

In my estimation this is as much a mental and emotional game as it

is one of physical perseverence. DON, I feel your mental pain over

this and it is not something to be taken lightly. You are doing the

right thing getting help for the mental aspects of this. Hang in

there. I had a bad crash at the world championships in Japan

several years ago. I was told I would never walk normally again. I

had four torn legiments in my knee and a compound fracture of my

tibia plateau. I was flown back to the US for surgery by a miracle

working OS and our team doctor. Since then I won two US national

titles in skiing and ran 15 marathons 2:35-2:45 as a recreational

runner. I was prepared for surgery, understood career ending

disappointment and the mental challenges of surgery and rehab. This

does not come easily to many who have never had to go through

anything like this. I mention this not to talk about myself as I am

fully aware at 40 I am a washed up athlete with modest objectives.

Keeping up with my two young athletic boys is my main objective

these days. I believe a large percentage of getting through this

successfully is related to ones mental well being and ability to

take on this type of challenge and win, regardless of how that is

defined.

My staples required removal today on day ten. I walked three miles

to the hospital, had them removed and then walked home. I carried

the crutches under my arms because I made a promise to my doctor and

I had bone grafts during my surgery so I am playing by most of the

rules. My objective was 10k in ten days. It is an amazing thing to

no longer feel the pain in the joint itself when I walk. I was

smiling the entire way home.

I had an interesting conversation with a well respected OS who told

me that I needed bilateral THR four years ago at age 36. He

attended a recent presentation by Dr. Amstutz and he was very

impressed and spoke highly of the procedure. He also stated, and I

observed during my due diligence, that on the East Coast of the US

the OS community is very " dogmatic, " and reluctant to anything new.

Particularly when THR has a " sufficient " track record. I am sorry

but I was not looking for sufficient. His words were encouraging

and he was more than happy to provide me with any required follow up

considering the distance I live from LA.

My advice, for anyone new and for what it is worth. Do your own

research and get comfortable that this is right for you. Get in the

best physical and mental shape you can given your own limitations

prior to surgery and you will recover that much faster.

On another note, what is up with this Coumadin? I really don't like

the idea of dumping rat poison into my body. If I plead my case are

there any issues related to getting off this stuff any earlier than

three weeks?

I also have plenty of " clunking. " My guess is that it is the two

sides getting to know eachother. I assume this improves as the hip

capsule heals. I will continue to read the related posts on this.

Thanks again for the support and best of luck to anyone new joining

the group.

C+ Dr. Amstutz 5/04/04

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> On another note, what is up with this Coumadin? I really don't like

> the idea of dumping rat poison into my body. If I plead my case are

> there any issues related to getting off this stuff any earlier than

> three weeks?

,

If you throw a clot, it could end up in your pulmonary artery or in

your brain and *kill* you. You'll have a really hard time playing with

your kids from the inside of a pine box, if you know what I mean.

I wasn't exactly nuts about ingesting rat poison for 3 weeks, either,

but I figured that some of the (admittedly unlikely) alternatives were

a hell of a lot worse.

It's only 11 more days. Patience, dude.

Steve (bilateral C+ 4/20/04, Amstutz)

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> On another note, what is up with this Coumadin? I really don't like

> the idea of dumping rat poison into my body. If I plead my case are

> there any issues related to getting off this stuff any earlier than

> three weeks?

,

If you throw a clot, it could end up in your pulmonary artery or in

your brain and *kill* you. You'll have a really hard time playing with

your kids from the inside of a pine box, if you know what I mean.

I wasn't exactly nuts about ingesting rat poison for 3 weeks, either,

but I figured that some of the (admittedly unlikely) alternatives were

a hell of a lot worse.

It's only 11 more days. Patience, dude.

Steve (bilateral C+ 4/20/04, Amstutz)

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> On another note, what is up with this Coumadin? I really don't like

> the idea of dumping rat poison into my body. If I plead my case are

> there any issues related to getting off this stuff any earlier than

> three weeks?

,

If you throw a clot, it could end up in your pulmonary artery or in

your brain and *kill* you. You'll have a really hard time playing with

your kids from the inside of a pine box, if you know what I mean.

I wasn't exactly nuts about ingesting rat poison for 3 weeks, either,

but I figured that some of the (admittedly unlikely) alternatives were

a hell of a lot worse.

It's only 11 more days. Patience, dude.

Steve (bilateral C+ 4/20/04, Amstutz)

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>

> > On another note, what is up with this Coumadin? I really don't

like

> > the idea of dumping rat poison into my body. If I plead my case

are

> > there any issues related to getting off this stuff any earlier

than

> > three weeks?

>

> ,

>

> If you throw a clot, it could end up in your pulmonary artery or in

> your brain and *kill* you. You'll have a really hard time playing

with

> your kids from the inside of a pine box, if you know what I mean.

>

> I wasn't exactly nuts about ingesting rat poison for 3 weeks,

either,

> but I figured that some of the (admittedly unlikely) alternatives

were

> a hell of a lot worse.

>

> It's only 11 more days. Patience, dude.

>

> Steve (bilateral C+ 4/20/04, Amstutz)

Hi Guys,

Take it easy. Coumadin is a widely used drug. It is very safe when

used in apppropriate fashion. I prescribe it to my own patients all

of the time. Coumadin is a blood thinner and is necessary to

decrease your risk of deep vein thrombosis (clots). Steve is right

and wrong - Right, in that yes a clot forming in your operated leg

can move to your heart and lungs (pulmonary emoblism) and can be

fatal (kill you). Wrong, in that the clots from the veins in the leg

can not move to the brain. Any surgery on the lower extremities

where activity is restricted after surgery puts patients at risk for

clots to develop in the leg. That is why Coumadin or Fragmin (LMW

Heparin) is used. So enjoy the short-term use of the blood-thinner

knowing that you do not have stay on it for very long and be thankful

it is available to keep you healthy and alive. However, you also

must realize that it can cause bleeding in the tissues if one falls

or suffers trauma to the body. So be careful! Just a FYI. I hope

it helps ease your concerns.

Regards,

Dr. Mark

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> Steve is right

> and wrong - Right, in that yes a clot forming in your operated leg

> can move to your heart and lungs (pulmonary emoblism) and can be

> fatal (kill you). Wrong, in that the clots from the veins in the leg

> can not move to the brain.

I don't know where I picked up that bit of misinformation. Thanks for

setting me straight, Mark!

It just seems to me that, even if the probability is low, the

consequences of DVT can be so bad that it's just not worth the risk of

dropping the Coumadin early. It's not a race, after all.

Steve (bilat C+ 4/20/04, Amstutz)

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> > Steve is right

> > and wrong - Right, in that yes a clot forming in your operated leg

> > can move to your heart and lungs (pulmonary emoblism) and can be

> > fatal (kill you). Wrong, in that the clots from the veins in the leg

> > can not move to the brain.

This seems so obvious now that I think about the way the plumbing's

hooked up.

How embarrassing

Steve

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