Arm Injury

I'm a fairly aggressive golfer with a big distance when i get it right.  Some of my shots resulted in hitting the ground, or not catching the call in the middle of the club, and this was bothering me a bit, causing some pain to run up the back of my wrist.  On a couple of occasions I was rubbing it for a minute or so because it hurt.  After the 3rd and final round of golf, it was giving me a bit of an ache throughout my forearm.

A couple of days later, when golf was left well behind and I was at the Ski resort, I chose not to ski on the first day due to my INR being 3.9.  I said to myself that 3.5 was the max to ski, not worth the risk.  My arm was bothering me a bit, but wasn't too bad.

The next day, day 2 of skiing, my arm was the reason not to ski.  It had progressively got worse, and was now keeping me awake.  Desperate to ski, i called a sports physiotherapist, who came to my hotel room.  He noticed the bruise and commented on it.... I hadn't even noticed anything up to this point.  There was indeed a very large bruise.  At this time I couldn't straighten my arm, and any slight jarring caused me to wince.  He diagnoses it as torn radialis muscle.  He can feel a 'golf ball' hematoma in the muscle at the joint, and that's what's stopping me straightening the arm.  A hematoma is a large pocket of blood that forms as a result of an injury, where it has nowhere else to run to.  I really can't straighten the arm, and the physio can't either - it's jammed at about 15 degrees open.

At this point my arm looked like this:

The next day, it was worse, and i went to hospital.  They X-Rayed it and confirmed it was not a fracture:

 Next day, its worse, and looks like this:

I then visited my usual sports physiotherapist at home who was quite shocked by the level of bruising and lack of mobility.  He was even more shocked when i could barely explain how it happened!  He decided to stick some physio tape to the bruised area to help it drain.  This seemed to work quite well, here's a picture of it after it was removed - the skin coloured areas where the tape was and the purple where it wasn't.  I'm almost liking it - tattoo style!

 
Its very clear this is warfarin at work, but to what extent was warfarin involved?  Clearly the warfarin made the bruise, but what about the actual injury?  I feel that the muscle pain would have happened anyway, but perhaps just brushed it off in a few days.  I think the warfarin made the problem a hundred times worse.  I barely did anything, i don't even recall any injury as such, just a number of little pains, nothing I haven't shaken off before.

I sit here writing this posting 14 days after the 'injury' and the bruising has mostly gone, but the rock hard hematoma is still alive and well.  Perhaps its gone down a bit, and perhaps i can get the arm open more, but the arm still won't straighten.  There's a ton less pain now, it only twinges when it gets close to straight.  I hope the hematoma will absorb back and behave, because the idea of having it surgically removed doesn't sound too nice at all.

Christmas Holiday High

Every year I go away for Christmas and New Year, and this will be the first one since the operation.  Typically holidays involve a change of everything - different exercise, diet, alcohol.

This year I'm going away with a friend for 4 days Golf, 5 days Skiing, and then meeting up with my Girlfriend in Thailand for 2 weeks.

Off kicked the golf holiday.  Playing a round every day, followed by lots of alcohol.  I caught a cold on the plane and in order to not ruin the holiday and still be able to play golf I took Beechams All-In-One which is Paracetomol based.  I was taking the max dose - 8 tablets per day, 2 every 4 hours or so.

INR climbed daily, despite reducing the dose of warfarin to 5 or even 4, hitting an eventual peak of 3.9.  Whether this was the alcohol, or the paracetomol, or other ingredients in Beechams, or both, i'm not sure.  Probably all of the above!

I nearly had it under control the whole time, it just slipped away from me a bit, but then was back under control a day later.  God knows what would happen without my drastic dose adjustments!

Here are the results and doses:

Another Pharmacy Appointment

This one made me laugh... I attended the pharmacy as usual.

I have no doubt that I'm quite memorable - probably one of the youngest, if not THE youngest, warfarin case at the pharmacy.  I'm always greeted with a friendly smile.

As usual I said that i'd forgotten my warfarin book, the easiest lie to avoid showing all my test results.  She then started the test and asked me how I was getting on.  I said that things had been stable and it's all fine.  The test was in range and fine, and she is now under the impression that I'm a stable patient and the dose is spot on.  She has no idea that i'm constantly testing and altering my dose to keep it that way!

Then, the bit that made me laugh - she said "I think you've calmed down on the testing now and can see how stable warfarin is if you just leave it alone and don't react too fast to problems."

What a load of nonsense.  However, I'm sure it's just what she's been taught - not her fault.

INR Low for No Reason

After being stable for a while, my INR tested at 1.7.  Again, no change in diet, drinking, exercise, and not feeling unwell.  I decided to self-fix the problem rather than gain heparin cover, aware that this could be unwise, but I had good results last time this happened so i will stick with it.

I took 10mg and 2mg next morning to make a total of 12mg dose for the period.

Next day tested at 1.9 and then 2.5 the next day.

This is further proof that it's an unstable drug, and can swing in either direction without warning.  At least my testing picks up on it very quickly and lets me take action.  I can only assume that other "stable" patients who are not self testing are going up and down all the time and mostly not realising it.

INR High for no reason - Again

INR shot up to 3.7 after being normal and stable for ages.  Again, absolutely no idea - no change in drinking, diet, exercise, or anything.

More proof that it's just an unstable drug.

This has happened on several occasions since this post, clearly not that unusual.

Here are the results and doses:

Oxford University Study on Self Monitoring

I agreed to take part in the Oxford University self monitoring study.  I hope that my contribution will help improve the ridiculous system we currently have in the UK.

http://madox.org/projects/monitoring/inr

So far i've had to send my results in once, and have had a telephone interview.  They are very nice and friendly and I have chosen to tell them the truth about everything rather than hold it back as I do for other professionals.

Unfortunately it's not always easy to find the time to complete a telephone questionnaire, I would perfer to have done it online.  Perhaps there's a reason - like the need for detailed explanations or interpretation of answers.

Stomach Bug

I had a bit of a stomach bug which included some Diarrhea - not terrible by any means, just a bit.

My warfarin was an obvious concern, so i monitored it every couple of days.  Everything seemed OK, and I fully recovered.  I then tested 2 days later and it had plummeted to the lowest ever - 1.8.

I was very concerned about this, and was considering going to hospital to get some Heparin cover whilst the warfarin was inaffective, but decided against.  It was only a little under acceptable, so i decided to take a high dose instead.  I took 9.0 and topped it up with 2.0 the next morning, effectively an 11.0 dose.

By the next day it had climbed to 2.1, then 2 days later to 2.8.  Back under control, thank goodness.

Here are the results and doses:

Amoxicillin for 7 days

I had previously cut my finger quite badly, with a flap of skin.  I'd done the usual, including antiseptic clean, but unfortunately a few days after it properly healed it started really hurting.  It then started to swell and get bigger.  I ended up seeing the doctor who diagnosed Cellulitis in the finger, and put me on a 7 day course of Amoxicillin Antibiotics.

Due to previous dental experiences of antibiotics, I was aware of its ability to lower the INR.  I jacked my usual average dose of around 7.5 up to 8.5 or even 9.0 and managed to keep my INR just about in range, but right at the bottom of the acceptable level.

Here are the results and doses:

Holidays and Timezone Changes

I always test and dose at 9pm every day.  Going on holiday or business trips has enough capacity to disrupt warfarin without forgetting a dose, so I decided to timezone adjust my dose to keep it at 9pm.

On this occasion I'm going to Bangkok, and i'm taking something around 8mg daily.  Bangkok is 7 hours ahead of home, so I worked out my dose assuming 8mg is over 24 hours like this:

8/24 = 0.333  x 17 = 5.66.  So I need a 5.6 dose instead of 8.

Then when I return I do the opposite:

8/24 = 0.333  x 31 = 10.3.  So I need a 10.3 dose instead of 8.

Here's an example, results and doses:

INR High for no reason

Things have been pretty stable for a while now.  Just the odd subtle dose change to handle a trending high or low.

Suddenly, for no reason, a test came back at 3.8.  And I mean no reason.  I felt fine, diet was normal, exercise was normal.

I adjusted the dose to cope with it a little, ate lots of green food, and problem went away.  This was the first in a number of lessons that warfarin is not a stable drug. It can just change on a whim.  If I hadn't been self testing - presumably it would have just gone high... perhaps come down on its own after a while.  Hopefully i would have avoided any major problems, but who knows.  One bit of bad luck, as sods law often dishes out, and I would have had a big problem.

Wrist Injury

Whilst standing on a step ladder, i slipped and fell and landed fairly heavily on my wrist.  It was the sort of thing that's happened before, and will happen again - nothing too major.  Wrist hurt a bit, i was sure it would be fine the next day.

Unfortunately, due to my girlfriend being away, my diet had changed and my INR was up around 4.0.  So it decided to make a meal out of the injury.

It swelled up and turned purple in a really bad bruise.  I went to see the sports physio who checked it out and concluded it wasn't broken or fractured, and I should keep an eye on it.  7 days later it was on the road to recovery.

This shows how a minor injury, blunt force trauma type, mixed with high INR, can cause havoc.

Highest INR to date - 4.2

My girlfriend went off on holiday for 2 weeks and left me home alone.  This changed quite a few lifestyle factors that would affect warfarin.  I drank more alcohol in the evenings, either alone with the TV or out with friends ... and I ate much less vegetables.

The INR started climbing almost immediately, and sods law says that I had a pharmacy test 4 days in.   Just long enough for INR to get too high, and not long enough for me to have got it back under control.

The pharmacy had no record of the real history because they only record their own tests, and I keep mine secret anyway.  They looked up the algorithm of what to do in the situation where INR > 4.  The algorithm was quite different whether my range was "2.0 - 3.0" or "2.5 - 3.5".  Remember my range is a bit custom at 2.5 - 3.0.  She decided to go with the algorithm of "2.5 - 3.5" which recommended simply a small dose cut and wait it out.  The alternative algorithm for "2.0 - 3.0" recommended skipping a dose and then reducing the dose 10%.  I was sent home and told to reduce 10% and not to skip a dose.  I ignored this, skipped the dose.

On the next evening's test the 4.2 had dropped to 2.3 which was a tad low, but proves the algorithm had worked as it should.  I then pretty much left my dose as it was before and tried to eat a bit more greens!  At this point i'm typically consuming somewhere around 7mg or 8mg mark.

This shows the test results and dosages for the period, the worst period of time to date:

The Pharmacy and P.A.M.S.

Since the initial appointment with the hospital I had been promised that the administration of my warfarin could eventually be handed to the local chemist, under the administration of Boots Chemists, so that I don't need to travel to hospital.  I was told this could only happen once I was stable.

I filled in all the paperwork, and then phoned and chased to get it put through.  Nobody had any idea about it, then the paperwork was apparently lost.  I filled it in again, and this time was told I needed 3 stable tests to be put through. At this point, 1 more test to go.

Upon having that final test, I still heard nothing, then heard that they didn't use the process with Valve Replacements so I was stuck with going to the hospital.  This is a big deal because it's typically taking 90 minutes, plus travel of 30 minutes, at a time I have no control over - and this will be eating into work time once i'm back at work.

Then, out of the blue, i got a letter saying i'm accepted and should attend my local pharmacy!  Not sure where that came from, but I later learned that they had only just started accepting valve replacement cases.  My local pharmacy is less than 5 minutes away, and they can see me at 9am each time, so this is great.

On my first attendance, I immediately realised that this was a world apart from the hospital, so much better.  A more individual approach to each patient.  However, it was equally clear that the computer ruled the roost - all calculations were issued by the computer based on the test results entered.  As a result, it needed a bit of fudging, especially as it didn't accept my slightly custom INR range of 2.5-3.0.

Alcohol

I have little doubt that this will be the first of many posts that include alcohol discussion.  Before the operation I used to drink a fair amount - perhaps an average week would include a couple of glasses of wine 3 days per week, and a big binge on Friday... and possibly Saturday too.

I've already had up to 1 glass of wine in the evening a couple of times and seen no warfarin affect.

So, i have a wedding and the night after to drink.  I ended up drinking the most I had since the operation, somewhat reassured by my ability to self-test and fix the problem myself.  However, I don't really know how big the problem will be.

I drank a lot.  I felt really quite drunk on the way home.  Hard to know how much, over the whole (long) evening, perhaps 4 beers, 5 glasses of wine - something like that.

Turns out that the warfarin climbed from 2.5 back to 3.1 as a result of the nights drinking.  A test another day later saw it still at 3.1.  So, no real problem here then - i've proved that a night on the lash isn't a big issue.

Here are the test results and doses for the antibiotics and alcohol episode:

Antibiotics

I had to attend a dental checkup and hygienist appointment and this required preventative antibiotics to be taken 1 hour before the procedure.  This was 3g Amoxicillin in a sachet mixed with water.

I was nervous about how this would affect the warfarin, and it turns out it took a dive from 3.2 to 2.5 - certainly not a major issue, but could be a problem if i'm ever on it for longer.

Anyway, I've got 2 nights of slight alcohol abuse coming up with a wedding, so I suspect this could swing it the other way...

Repeat Prescription

Not really running low, but I wanted to test the water and build up a stock pile of both warfarin and the test strips.  So I trotted to the doctor and asked the receptionist how to do a repeat prescription.  She gave me the form which already had all my prescriptions listed on it, i just needed to tick which ones I needed.

Except... the Coagucheck XS test strips were not listed.  So, I ticked all the warfarins (5,3,1,0.5mg) and then hand wrote "Coagucheck XS Strips".

Next morning, i popped around, and the prescription was written, and it included the strips (2 packs).

Why this nonsense?  Because the GP has to pay for the prescriptions, and when he prescribes he sees the cost on his screen - £120 each.  2 packs of those at £240 is quite a hit.

Second Hospital Test

Due to me missing the vital information of the next test on the posted slip, I ended up having no test for 2 weeks.... well, no official test, anyway!

On reattendance they made me wait, and then were planning on taking a full vial of blood for the test.  Still anemic, and now knowing the test to be utterly pointless due to my own testing, I spun them a story of me being scared of it, and would be unable to drive home after!  My creative nonsense amazes even me sometimes.  The stone-faced nurses immediately melted and became extremely caring!  They made a special exception and lined me up to see the specialist and take a finger-prick test instead.  Turns out they have the same brand of machine that I use at home, just a bigger version that holds data for multiple patients.

In a moment of letting my guard down, I showed all my results and dosages to the specialist.  She was not happy at all, and gave me a thorough telling off.  I was to stick to the prescribed doses at all times, and can only test myself to spot check and cannot react to tests at all.  After this I decided that all my results will be kept completely secret.

GP Appointment

A GP Appointment was necessary to get me on my regular repeat prescriptions for Warfarin, so I attended.  He duly prescribed a selection of 5,3,1 and 0.5 tablets.

I then started to discuss the self testing.  He said "I have never heard of such a thing" and "it doesn't sound a good idea to me".  After much pleading and negotiating, I eventually got through to him when I said that I make regular trips abroad (for a month at a time in some cases) and on these trips I would be unable to test.  He agreed to write me a prescription for the test scripts for use on holiday ONLY.  He reaffirmed that I should never alter my own dosage, and its pointless to test myself because the hospital will manage it.  What a load of nonsense, I'm not sure he spoke a true or accurate word.

Anyway, i got all the tablets, plus 2 boxes of the Coagucheck strips, priced at a cool £120 a pack.

First hospital test

After 2 weeks of independence, time to go to the hospital.

I'm still very anemic, and feeling light headed and cold most of the time.  Still suffering from terrible night sweating and other issues, so the last thing I want to do is leave the house.  Regardless, I have to travel a distance to the hospital.

On arrival at the warfarin clinic, the enormity of the warfarin problem in this country becomes evident.  There are literally hundreds of, mostly 60+ year olds, queuing up for their appointment.

After the obligatory 30 minute wait, i get called up, and receive a full test tube blood draw.  In the context of my finger tester, this seems a fragrant waste of my precious blood.

I then get sent home.  No test results?  How odd.

Results don't arrive in the post for 2 days on an old fashioned "pay slip" type letter which also contains your dosage change and next appointment time.  I noticed the first two... and missed the next appointment time.  What a poorly designed document!

It said that I should adjust my dose to 8.5 based on a single test snapshot of 3.1 and the fact they believe my range should be 2.5 to 3.5 instead of the correct 2.5 to 3.0.  This is because their computer system didn't have a setting for 2.5 to 3.0.  So... they sent me home with a dose that was almost certain to send me on an INR high within only a few days.  However, they didn't want me back for another test for 2 weeks.

First 2 Weeks

Due to some administrative screw-ups, i went for the first 2 weeks without anyone on my case.  Eventually the hospital caught up with me and issued me a warrant to go to their blood testing department!

During these 2 weeks I was managing my own dose. Due to massive changes in my metabolism, energy levels, exercise, and drugs - the INR was going all over the place, and went up to 3.4 for a couple of days.  Not critical, but too high nonetheless.  I was of course finding my feet with drug adjustments and working out how quickly they take affect.

By the end of the 2 weeks, it was not a bad result, only out of range for 2 days, and that was only 3.4 - never low.  I have already learned one teaching to be false - they said that it takes 7 days for a dose change to take affect.... and this is clearly not the case, its reacting much faster than that - some possible reaction the immediate next day, and some definite reaction the day after that.  I now understand that most literature talks about 3 days, but I was told seven!

Here are the results and doses for the period:

Leaving Hospital

Just before leaving hospital, it's time for a consult with the pharmacist.  She's sending me home with a bagful of drugs to stop sickness, constipation, headaches and all manner of other ailments i'm feeling, but more importantly the Warfarin drug itself, and pack of information.

We chatted through how things will work and she told me that I will need to check in to my local hospital for blood tests.  These are likely to be weekly at first, and once stable move to 3 weekly, or even longer.  What a pain in the neck this feels.

I discussed with her my self testing and she was completely dismissive.  She said "You won't need that", and was rather patronising about my efforts towards independence.  Once stable, she said, I won't need a test more often than every few weeks, and the drug just stays in balance.

I chose to smile and not discuss any further :)

First time using Coagucheck

My first time using the coagucheck was just 6 days after the operation at home.  I'm somewhat disabled and I've got a pounding headache, so this isn't the best recipe for concentrating!

This is how it works:

1. Insert strip.  It gives you a 3 digit number to confirm.  It must be the same number as on the side of the strips packet.  You confirm it.
2. Wait around 20 seconds for it to warm up.
3. It beeps and starts counting down from 180 seconds.  This is how long you have to draw blood.
4. Prick your finger, squeeze out blood, get it onto the right place on the strip
5. Wait 30 seconds for the result.

Sounds simple? Well in the first few days I wasted 10 strips.  The most common mistake was not getting enough blood, the guidelines in the manual were very vague on this.  Turns out you need a ladybird sized blob.  Second mistake was missing the strip and getting blood everywhere else!  The technique I later found is that you should sort of wipe the strip across the finger, picking up the blood.

After a week i was getting a near to 100% success rate, with just the occasional mistake.

Surgeon's Opinion

Now my brain is back to normal working order, it's time for a consult with the surgeon.

My surgeon is Christopher Young of London St Thomas' or London Bridge hospital.  From the moment I met him I have had nothing but respect and admiration for him, his style, his knowledge, and his caring approach to me as an individual.  Unlike others I met he's interested in me, my lifestyle, my skill set, and used this individual information to formulate a plan to fit in with my life.

I told him about the self testing and he said it was "The only way to go".  How often should I test?  He said every 2 days if it was him, and acknowledged that most others would disagree with him on this point!

Starting on Warfarin

The day after surgery, the Warfarin starts.  They started me on 8mg in the belief that this level of the drug should be higher than my regular dose will settle at, and should bump start the therapy.

INR is the measure used to state how quickly the blood clots, and it can be tested either in a hospital lab or on a 'finger prick' machine like the one I own.  My target INR is between 2.5 and 3.0 and needs to stay in this range.   If too low I have a risk of stroking, and if too high of bleeding and being very susceptible to bruising, and worse.

The first three days continued at 8mg, and then they decided to cut it back to 5mg.  Immediately following this the rise in INR stopped and fell back.  The next day they realised the mistake and fixed it by going to 9mg for a day then back to 8mg.  This meant that my warfarin didn't get "Into Range" for 8 days which is disappointing!

Here are my test results, and doses, for the first few days:

My own self tester

I've decided to spend £299 and buy a Roche Coagucheck XS machine.  The consumable strips for this machine are available on prescription (at the GP's discretion) making them affordable.  The alternative would be £120 for 24 tests, which is damn expensive!

The machine has arrived and looks good, simple enough to use by the looks of things.  Time to leave it in the box until after the operation.

How to manage my drugs?

In the run-up to the surgery I have read everything I can about Warfarin on the internet, and have started thinking about how I will deal with it.

I'm not the sort of person to just sit back and trust health professionals.  I always back up what they say with my own research and I'm not afraid to ask questions and challenge what i'm told.  The older I get, the more I notice inconsistencies, and the more I feel I need to watch my own back.

One other factor of relevance is that I travel quite a lot.  I'm impatient, hate hospitals, hate waiting around, and don't want to feel like a patient, I just want to get on with my life.

In summary, it's clear that I need to be independent, and need to control my own drug.  This means I need to own my own self testing machine.

The antiquated law in the UK is that I am allowed to test my own blood, but I'm not allowed to adjust my own dose.  In addition, there's nobody I can phone for advice, and nobody I could give my results to in order that they adjust my dose.  Even if I could, they wouldn't be allowed to take my result as meaning anything unless they did it themselves.  Pretty useless then!

Even before being on the drug I've already made the decision that I will take all of this with a pinch of salt, and just manage my own dosing.  This will obviously require lying to the faces of professionals, which is uncomfortable, but necessary.

About INR

INR is the measure of how quickly your blood clots.  It naturally varies amongst different people but a normal person will have an INR around about 1.0.  If you take anti-coagulation, then your INR will get higher so that if, for example, it is 2.0 then your blood will clot precisely twice as slowly as a normal person.

My INR target is slightly lower than other mechanical valve owners due to my surgeon having confidence in the natural anti-clotting properties of the On-X valve that has been installed.  I'm recommended to stay between 2.5 and 3.0.  I should never allow it to fall below 2.0.

If INR goes low, say below 2.0, then I run the risk of a blood clot forming somewhere around the valve and shooting up into my brain.  This would cause a TIA or even a full stroke - causing partial paralysis and all measure of other horrible things.  This is not good AT ALL.

If INR goes high, say over 4.0, then I run the risk of bleeding events.  Simplest of these might be seeing blood on the toothbrush, and more complex ones could be bleeding from rectum or if very high, even in the brain.  In addition, when high, I'm essentially more vulnerable to injury particularly from Blunt Force Trauma, which can lead to unexpected or exaggerated bruising, or even worse hematomas (like bubbles of blood forming inside a muscle, etc).

In summary, it's MUCH worse to have a low INR than a high one, so if in doubt, aim high.

About Warfarin

In the knowledge that I'm going to be on the drug for the rest of my life, its time to research the drug.  Here's my understanding:

Warfarin is often called a blood thinner, which is a ridiculous misnomer.   No matter how much you take, your blood stays exactly the same consistency, looks the same, and largely acts the same.  This concept is very misleading and has caused patients to make incorrect decisions through fear of the drug.

I thought that I would have to be more careful with knives after being on the drug, because if I cut myself i would keep bleeding longer than before.  Mostly nonsense!  I can report that cutting myself heals in more or less the same time as anyone else.

Quite simply, Warfarin inhibits the clotting of the blood.  It does this by slowing the Liver's production of an enzyme that clots the blood.  It's sort of "antodote" is vitamin K.  This means that the drug takes time to work - if you take a dose now, it will be several days before it's done much.

The thing is... the blood actually has more than one technique up its sleeve for repairing damage.  One is called "Platelets".  I think of these as little sticking plasters in the blood.  These only work when shown oxygen - essentially if you cut yourself these little guys patch up the hole.  This differs to the clotting that Warfarin inhibits, which doesn't require outside exposure.

This means that when on Warfarin you are more vulnerable to internal injury, bruising, hematomas, and that kind of thing - much more so than cuts.

Welcome to the Blog!

Since age 6 I have been diagnosed with Aortic Stenosis, a condition that causes narrowing of the aortic valve and means the heart has to work harder than usual to shift blood.  I always knew I'd need the operation eventually.  I've been largely symptom free, but after age 30 I started to occasionally notice that I was out of breath after doing only a small thing.  I was also suffering with regular visual migraines, but wasn't sure if this was related or not at the time.

In March 2011 during an regular checkup, the cardiologist announced that it was about time to have the operation.... this was quite a shock!  He said "No rush, you can do it any time in the next couple of months".  Sounds like a rush to me!  This somewhat destabilised me and caused me to write my will!

In this time I was lucky enough to be put in touch with a girl who had a very similar operation a couple of years ago.  I had many long emails with her discussing everything from the surgery, recovery and the warfarin.  Amongst other things, she helped me to initially develop a watchful mistrust for "believing everything you read" about Warfarin.  She also helped me form my own strategy for dealing with the drug long term.

2 Months later, I had an OnX mechanical AVR (Aortic Valve Replacement) and Dacron Aortic Graft.  The operation was a complete success.  This means I'm on anticoagulants for the rest of my life. Until something better comes along this means Warfarin (Or Coumadin Brand in many countries).

This blog charts my experience on the drug, and attempts to expose the nonsense that exists amongst medical professionals.  As I write this I firmly believe that the whole system is wrong, professionals are trained incorrectly, patients are given bad advice, and generally the drug is misunderstood.  This leads to problems ranging from seriously inconvenient through to life threatening.

To tell you the truth, I'm actually writing this in January 2012 after I have already gained lots of experience and feel I have something to share.... I am writing this in Diary form in this blog.