Once Again Into The Breech…

One more time a doctor’s checkup ends in a stay at the hospital (Hospital visit #5 in year 2011).

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Why am I going into the breech (aka hospital) again???

My legs are swelling and even though the swelling is going down most of the time, there is an area on the backs of my thighs that are often “hard”. That, as you might guess, is not a good thing. Blood clots were suspected.

The doctor prescribed a sonogram (Venous Doppler) of both legs and the area of the filter.

NOTE: A Venous Doppler ultrasound is often the procedure of choice for detecting deep vein thrombosis (DVT). This test uses reflected sound waves to show doctors how blood is flowing through veins and arteries. It is very effective in detecting clots.

I’ve had many sonograms in this room, so it’s nothing new.

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On one visit, John from s/v MUSIC helped me understand the doppler images (in the States John trains medical professionals in the use of this equipment).

Thank you, Hospital San Javier for allowing John to accompany me during one of my sonogram session.

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Result? Blood clots confirmed.
Also, the clots appear to be more mature than one would expect. Not good. The blood has little way to return to my heart and therefore it is pooling in my legs when I stand up or in any other way have my feet down.

That might also be some of the cause and effect for why I sometimes get a bit light headed and have some “tired” aches (mostly) and pains (infrequently) in my legs.

The sonogram results indicate the need for a CATscan or two. First the “regular” scan. Next is the scan with “contrast”.

This is also a place I’m extremely familiar with…

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They can now see the extent of the clots; and, they are huge. They extend from my filter (which is clogged and without which I would once again have been dead by now) all the way nearly to my knees in both legs with the right leg being the worst.

Please Note, I am not a doctor, nor do I play one on TV, I am simply telling you my experience. The most likely cause of the blood clots was taking the prescribed drug Paradaxa as a blood thinner to prevent blood clots. Paradaxa was recommended by our vascular surgeon in San Diego, CA as well as two doctors in Puerto Vallarta, MX.

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Although the drug had not been approved by the FDA as an anticoagulant for DVT (blood clots) the drug has been approved for AF (atrial-fibrillation) sufferers (they need anticoagulants too). Our San Diego specialist assured us it would be approved in a few months.

In my case Paradaxa failed to prevent blood clots.

After the CAT scan we sat down with the doctors at Hospital San Javier and talked about things and what we can do next. They tell me that there is not much more that can be done. However, there is a chance that the clots are not so mature that they might be removed through surgery. The same doctors that installed the filter do that sort of thing with cardiac patients and it might work with me.

As you might guess, I’m up for it. I know the doctors and I trust them to do a good job. The only problem is the equipment to do that procedure is not here in Puerto Vallarta. It has to be brought in from somewhere and might take a couple days.

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It took less than one day. You can color me shocked and surprised with the rapidity of the delivery. They must have had perfect timing with someone coming this way.

The floor head nurse preps me for surgery. You would not believe how much area she shaved for a small incision in the groin area. I thought she went a bit overboard. However, in the end, she knew exactly what she was doing. Then a few minutes later, I climbed on the gurney with my IV and away we went to the operating room.

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As they wheeled me into the sterile area, I recognized one of the nurses even though she was masked. I’ve been in the hospital way too long!

As surgery began, they gave me a local anesthetic and kept asking if I felt this or that. I could feel the pressure and once in a while I could feel a bit more than that when a sharp “something” was produced. As time went on, I began to feel very hot and then a bit nauseous. They turned up the air conditioning.

One time I saw one of the doctors squirt a syringe full of blood into something and then turn back to me. I thought that maybe it was working after all and they were getting the clots out. I relaxed a bit then and felt my head beginning to become a bit “light”.

The next thing I remember, they were telling me that it was over and, unfortunately, they were not successful. The clots were so mature that they could not penetrate the area between the clot and the vein wall to admit even the thinnest of wires they needed to guide their surgical instruments to remove them. This comes as a blow to me since I’m used to having things go “right,” Not this time though.

After I am back in the hospital room with a sandbag on the groin incision to keep it from bleeding, we all sat down and discuss what has happened and where we go from here. I found out that there is nothing more that they can offer me in the way of removing those clots. The room was a bit quiet.

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My body might dissolve the blood clots over time or they might be there as long as I live. It can go either way. I will be on anticoagulant medication for the rest of my life. This is necessary so the blood doesn’t have a chance to start clotting in my legs or anywhere else. (They cannot put in a filter in those other places.)

BLOOD ANTICOAGULANT (THINNING) MEDICATION CHOICES

I have my choice of medications. Each has their pros and cons.

CLEXANE 80mg
INJECTIONS: Two 80mg syringes per day
Cost: Approx $3,000.00 USD monthly ($100 to $120 USD per day)

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CLEXANE

PRO:
Fewer food and drug interactions when compared to Coumadin.

CON:
I would self inject into my abdomen 80 mg of Clexane twice a day .
The lowest price was at a local pharmacy. The cost is between $50 to $60 USD per syringe. Two 80mg syringes per day is $100 to $120 USD.

COMMENT:
I have learned to be comfortable with self-injections of Clexane, but after a while my abdomen becomes a bit tender from the twice-daily injections. And the injections would be for a lifetime.

Yes, we have some insurance but we have to up-front the cash and then wait for reimbursement. Reimbursement can take several months.

PARADAXA 150mg
Tablet twice daily
COST: $140 USD monthly

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PARADAXA

PRO:
Fewer food and drug interactions when compared to Coumadin/Warfarin
Paradaxa cost p/month nearly equal to the daily cost of Clexane.

CON:
Cannot test blood coagulation levels
Not approved by FDA for use as a blood thinner
Paradaxa costs $140 USD p/month compared to Coumadin/Warfarin costs about $17 USD p/month.

COMMENT:
In August, 2011 we went to San Diego for a second opinion on my medical condition. Our Vascular Surgeon near San Diego, CA told us the FDA will likely be approving Paradaxa for the prevention of blood clots within a few months.

For me, Paradaxa did not prevent blood clots.

COUMADIN/WARFARIN

Dosage adjusted as needed
Tablet once daily
COST: About $17 USD monthly depending on dosage needed

COUMADIN

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PRO:
Coumadin has proven to prevent blood clots for me.
The least expensive of the three medications.

CON:
Regular blood tests are required to determine how “thick” or “thin” my blood is.

Dosage is adjusted depending on blood tests results.

A large variety of foods and a number of drugs interact with Coumadin

COMMENT:

Certain foods, such as spinach, are loaded with Vitamin K. Vitamin K increases the blood’s ability to clot (thickens blood).

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A large number of drugs interact with Coumadin. Aspirin and anti-inflammatory drugs, such as, Ibuprofen are a couple examples of common drugs that decrease the blood’s ability to clot (blood thins) which can cause excessive bleeding.

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The Coumadin dosage is adjusted as needed. Blood too “thick”? Increase Coumadin. Blood too “thin”? Decrease Coumadin. Although Coumadin is available in a wide variety of dosages in the United States, it is only available in two dosages in Puerto Vallarta (2.5mg and 5.0mg).

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Yes, I’m going back on Coumadin. Coumadin has a proven track record for preventing blood clots in my body.

I will obtain the home blood test kit that allows me to test my own blood on the boat. This test kit allows me to test my blood thickness no matter where we are.

I’ll have to be more careful about what medications I take as well as what I eat and drink. The cost of Coumadin is reasonable and with the home test kit I will be able to test and determine just how “thin” or “thick” my blood is. So, there really isn’t any real choice in the matter.

Until I have the home test kit, I will have my blood tested at Hospital San Javier.

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Why did this happen?
I’ve been described as the perfect patient. I always follow orders, exercise and take my medication as directed. I took my prescribed Paradaxa medication daily within minutes of the exact schedule prescribed.

There are many possibilities I suppose. The one that I believe is likely is that the company that produces Pradaxa published all the good test results and not the bad results. When our doctors did their research they found that Pradaxa was better than Coumadin.

The drug company said it didn’t interact with what you eat and drink or other medications such as anti-inflammatory drugs. There was no need for blood tests and, of course, none of the bleeding issues that Coumadin has. These were compelling reasons to take Paradaxa.

It was a “no brainer” for me to switch to Pradaxa. I agreed, although I was a bit worried about not having to test and not knowing what Pradaxa was doing until “something” happened, but the odds of that “something” were small according to the published test result data.

After the previous episode #4 hospital stay, with my back issue and the resulting clots, the doctor doubled the amount of Pradaxa so that I was taking it twice a day at 12-hour intervals. The increased dosage didn’t help. As I and my doctors now know, Pradaxa didn’t work for me.

During my #5 hospital stay, I spoke with one of my other doctors here in Mexico. He is a cardiologist and is treating some patients for “AF” (a heart issue that Pradaxa is approved for in the U.S.) and some of those patients are developing blood clots when they are not supposed to.

To me this all sounds like the manufacturer knew there was a problem with this medication and pushed it through the FDA in the U.S. There are many stories concerning drug companies that have “hidden” the results of all or most of the “bad” test results from those that need it.

The patients use it and bet their lives on it as well as the doctors that prescribe it. I’m certain that the results I achieved here in Mexico were no different than I would have achieved in the U.S. had I been there. In fact, one of my U.S. doctors (a venous specialist) consulted with my Mexican doctors and wholeheartedly concurred with the treatment I was being given here in Mexico.

So, where does this leave us?
Well, we will be going to San Diego, CA for “second opinions” on several things. Hopefully, I’ll be able to have something done to stabilize my back.

While in San Diego, I’ve got an appointment with a Hematologist to see if we can track down what part of my genetic makeup is responsible for the blood clots. We’ll make the results available to all those in my family that are remotely susceptible to blood clots happening to them. Perhaps if they know, they can take the necessary precautions to prevent blood clots or treat them quickly if they do happen to form. Who knows?

The Bottom Line
I guess the real bottom line is we are in La Cruz de Huanacaxtle and it is nice here. We want to go South this year to be in El Salvador by early March; but I’d give us less than a 5% chance of doing that.

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Instead, we’ll likely stay here and get stronger, rest, and do boat work slowly so that next year we have a better chance of making it out of here. In the meantime, we’ll be able to go for daysails as I get better. Bandaras Bay is very large and we are protected from hurricanes. We could do a lot worse.

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Mark and Gail on s/v MANGAREVA loaned us their copy of Sailing Grace, by John Otterbacher. It was inspiring to read John’s account of how he overcame arterial blood clots and continued sailing. My experience was so similar to John’s story. I could have written the first part of the book. His story of overcoming blood clots has encouraged both of us and gave us a ray of hope.

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FAST FORWARD 3 MONTHS: Here is LA VITA returning to her slip after her survey haul out. Wow, it felt so wonderful to be underway, even if for a brief time.

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To view the photo album for this post, click on the camera,

21 Responses to “Once Again Into The Breech…”

  1. Jeff on s/v Beatrix on May 3rd, 2012 at 8:42 am

    Hi Rick,

    What a story! I wonder why you didn’t go on Plavex; somethin well known. I hope somehow this all works out and you can get some sailing in. I wish you and Lynn all the best.

    You seem to be making thi best of a very bad deal.

    Hang in there.

    Jeff

  2. Lynn on May 4th, 2012 at 9:34 am

    Hi Jeff,
    I asked Rick about Plavex. He does not know why that drug was not even mentioned. One thing for sure, he’s unwilling to switch drugs again. Yes, it’s been a rough patch. Rick inspires me everyday with his get-up-and-go spirit.
    Fair winds and save passage.
    Lynn & Rick

  3. Chris and Sharon Meeler S/V Bright Star on May 6th, 2012 at 8:26 am

    Lynn and Rick,

    Wow, what a beautiful job on the website! Okay, I have looked into these issues because of my mom, who was on Coumadin. I found a substance called Nattokinase that is derived from fermented soybeans. Please do some research on this. I will send some to you from the States if you cannot obtain it. There are many reviews on this wonderful substance. It is not expensive and works beautifully. Are you willing to try it? You cannot use both Coumadin and Nattokinase. Nattokinase removes blood clots. It is a natural and safe substance. Please let me know, okay? We love you guys! Check it out!!

  4. Lynn on May 6th, 2012 at 9:14 am

    Hi Sharon & Chris,
    The Nattokinase sounds interesting. Do you know if it is GMO soybeans or natural soybeans. We will check it out. Not sure if is readily available in Mexico. Also, until Rick’s home INR test kit is functioning reliability he will reluctant to switch medications. When the blood clots matured while on Pradaxa we’ve become very cautious. Still we are open and welcome suggestions!

    Thank you for your input and lots of folks read our posts, so other may benefit learning about Nattokinase. Often, natural sources are better than medication.

  5. Mark and Gail Strong on May 6th, 2012 at 8:39 am

    Thanks for the update. Hang in there. We’re back home and enjoying spring. Let’s keep in touch. Hope to see you out there next season.

  6. Lynn on May 6th, 2012 at 9:18 am

    Hi Mark & Gail,
    Hey, good to hear from you! Thank you again for loaning us your copy of SAILING GRACE. We’ll sea ya along the way. Fair winds & safe harbors!

  7. Mike Latta on May 6th, 2012 at 12:07 pm

    You guys are both troopers of the highest order. I send you my best wishes for the proverbial speedy recovery. However, I have no better suggestion for making your body and lives richer…other than this proven oddity.

    Spam.

    Yes, Spam. I give credit to my having weathered 76 years of cigarettes,booze, unsavory women, 2 marriages, cancer, the Marine Corps chow line and the multiple hurricanes of a misspent life…to Spam.

    Es verdad! I am convinced that the heavy concentration of industrial effluents, unknown carcinogens, anti-vermin additives and pork grease has fortified and ultimately inured my entire cardiovascular system to anything potentially unhealthy, known or unknown by so-called modern medical science. And it will also help to repel pesky mosquitoes.

    Yes, Spam. The single-handers friend. I recommend a minimum of 2 small cans per week.

    Yours in health. Happy sails, Mike.

    PS: to really get your mind off stupid stuff, check out my sailor book on michaellattanovels.com

  8. Lynn on May 6th, 2012 at 3:20 pm

    Hi Mike,
    We can always count on you for a bit of fun and unique twist on any subject. Keep writing!
    Hugs, Lynn & Rick

  9. Julie Azhadi on May 6th, 2012 at 3:38 pm

    Wow. There you go again, having all the adventures!
    Someone should make you the “Ombudsman of Mexican Medicine”… There’s no end to the best wishes, hopes and prayers that will be heading your way as you ‘traverse’ this continuing hurdle! We’ve known a few people who did well on Coumadin it’s been around forever so they know a couple things about it!
    Fair Winds back to you both!!!
    Julie

  10. Lynn on May 6th, 2012 at 8:21 pm

    Hi Julie,
    Rick is really an Ombudsman of the Mexican Medicine. He has dozens of nurses that know him by name. Each week Rick goes to the hospital to get his blood tested. The nurses address him by name and give him hugs! Even the security guards say, “Welcome back!” No hugs from the guys!

  11. dick tripp on May 6th, 2012 at 7:47 pm

    hey guys keep moving forward. my mom was on Coumadin for several years. it worked for her to keep blood regulated, although she has since passed due to other age related issues. Hopefully everything starts to come together & work out. thoughts & prayers are with you both. dt

  12. Lynn on May 6th, 2012 at 8:24 pm

    Hi Dick,
    Yes, Coumadin is older than dirt. We are going through a steep learning curve while we balance diet with medication. Rick is very accurate with his meds, so I know it will work out. In the meantime, he spends several hours recaulking the decks and replacing bungs. These projects give us hope for the future!

  13. John & Gayle Crowley on May 7th, 2012 at 10:20 am

    Thanks so much for sending us your updates & keeping us informed with how things are going! Our thoughts & prayers that Rick is on the road to recovery now! We are currently at the dock in Washington, NC working on boat projects before we start our trek North. Take care both of you!!

  14. Lynn on May 7th, 2012 at 7:26 pm

    It wonderful to know m/v SirensCall has carried you to wonderful places and invited you to experience new sights and cultures. Have a fantastic time on the East coast.
    Cheers, Lynn & Rick

  15. Sloflite Too The Spencers on May 7th, 2012 at 2:29 pm

    What a story, you both are in our thoughts and prayers. We wish for you a speedy recovery and answers to your unknowns. Hope your travels will begin soon and that you grow stronger and healthier every day. Norm and Luetta Spencer
    M/V Slo Flite Too

  16. Lynn on May 7th, 2012 at 7:22 pm

    Hi Norm and Luetta,
    Next week we are sailing to Opequimar boatyard. We are getting the bottom painted. It’s about 1.5 hrs. from here. It will be sooo good to sail in the bay. Thank you for prayers and answers to our unknowns. That means a lot.
    Hugs, Lynn & Rick

  17. Sheri on May 10th, 2012 at 9:52 am

    Hola Lynn and Rick,
    Wow! What a story. Rick really is the most positive guy I have ever heard. I so enjoy your updates but am sorry that Ricks’ health as been so volital.
    My Rick and I are still stuck in San Diego and love to hear what’s going on down south. It looks like we might be able to go back to Tigger this coming cruising season and can’t wait to get back on the boat and catch up will everyone. I hope we can connect if we do get back to the boat. Our prayers are with you and we hope to see you if/when we get back down there.
    Sheri & Rick
    S/V Tigger

  18. Lynn on May 15th, 2012 at 3:20 pm

    Hi Sheri & Rick,
    We hope you’re able to get back to Tigger, too. It’s a great life style, that’s for sure. We love La Cruz and there an excellent chance we’ll be here to welcome you!
    Thanks for staying in touch.
    Lynn & Rick

  19. Mike Brown on May 19th, 2012 at 1:10 am

    Scary stuff good to hear that things seem to be stable right now. I read all the med post with interest because I have AF and my doc has said that in a few years he wants to put me on a stronger blood thinner than a full strength Bayer. We are home right now and I am just beginning my yearly round of doctor visits You both are in our thoughts and prayers. Oh thanks for the info on what you were told to do on the accounting problem at marina mazatlan, we are one of the boats they are trying to hit up so far we have found all except one of the receipts for the months they are questioning. This after having checked us out of the marina in March and stating we were all paid up. -s/v Antipodes-

  20. Rick on May 19th, 2012 at 5:29 am

    Hi Mike,
    For those that don’t read the South Bound list, there appears to be an accounting problem at Marina Mazatlan, MX.

    Some boat owners are being asked to provide proof of rent payment.

    We spoke with Mrs. Kelly Trainer, the US Consulate in Puerto Vallarta, regarding this issue. The US Consulate suggested contacting an attorney or Profeco. And go as a group. Profeco is the Mexican Better Business Bureau.

    To visit the Profeco Web site, click here:

      Profeco

    Here is Profeco’s Mission statement:
    Promote and protect consumer rights, promote smart consumption and seek fairness and legal certainty in relations between suppliers and consumers.

    On the Profeco’s Home page, you can select English.

    We wish you the very best of luck with both issues. Getting credit for past rent payments and your AF.

    Please feel free to send us an email if we can answer any questions.

  21. David Edwards on June 8th, 2012 at 10:47 pm

    Hi Rick, Thanks for your missive, it does sound as if you have been through the medical mill!

    Shame you have not made it to our side of the pond yet, I just hope you don’t find it dull after spending so long in more exotic places/hospitals.

    As to the rising costs in European boating, our basic marina charges in the Med were €5,000 + per annum, plus all the other usual expenses, for a 10mt berth. Added to the diminishing anchorages and weighed against the cost of running a campervan, the van won easily! Besides, there are still so many places in Europe we have not seen yet.

    Lat summer we managed Denmark, Sweden, Germany, Holland, Belgium, France and Spain but that still leaves a whole swathe of the more Eastern countries to go. I also have a to get my lumber spine “fused” somewhere along the line but having survived an aortic aneurism repair that should be a piece of cake.

    All the best for your future cruising, keep the dry side up,

    David (catamaran LYNX)

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