Saturday, February 18, 2017

PAD: peripheral artery disease or SIntrom / Warfarina

I'll jump straight to the answer now that I know, but will leave all the other rambling below (which is what I was digging before I found out the answer).

It is not the point of this write up to explain what PAD is. Plenty of basic intros out there. But try to dive down as a family member seemed to be getting tired legs when walking... He had had surgery few months before and during the surgery had an arrhythmia so they put him on sintrom (a blood thinner also called warfarina). As such, our first suspect was that, but I couldn't find any relation (see below... I was not that smart). Doctor checked and said that he seemed to have weaker pulse in one of the legs, so, he said, he had a mild case of PAD. But over the months he was getting worse and worse. One year later (after many monthly checks of the sintrom dose in blood) he went for the annual check, and the doctor wonder how he could be so pale. Then he discovered it had a huge anemia and rush him to the ER where they transfuse him 5 bags of blood!! Bottom line, he was bleeding to death over all that time. All the checks so far have been unable to find where he was bleeding from. But hey, if you get tired after taking warfarina / sintrom, check your blood levels! After the transfusion, he can now walk like the first day!! DUH!!! Big round of applause for those morons that didn't listen...

I'll put it in Spanish in case somebody searches for it: si el paciente se cansa de las piernas cuando camina hasta el punto que se tiene que parar y esta tomando sintrom, puede que no sea enfermedad arterial periférica (EAP), sino una anemia/perdida de sangre interna! Un simple analisis lo deberia decir.

If you want to see some paper on the topic, check here


PS.: Here is all the other stuff...

The first line of treatment for PAD is daily exercise and a healthy diet
ankle-brachial-index, or ABI << Test he got? The procedure is really well explained here and should be doable by a layman except that one may have to use stethoscope or ultrasound Doppler. 

One suspicious is sintrom, But a first read doesn't seem to point clearly on that direction. Below some of the stuff I found. One important thing would be to simply ask the doctor to change medication or stop it for a short period of time.
Nice site on several blood thinner. Example
Vitamin K antagonist

It is hard to find side effects on tired with sintrom when looking in English. It may be because in US they use warfarina. Nevertheless, I found this link when looking under Spanish. People complaining about sintrom/tired legs

Alternativos: Dabigratran, Rivaroxaban, Apixaban, Aldocumar (warfarina)

Medications are also often used, including a statin to lower cholesterol, blood thinners, blood-pressure medications and a drug called Pletal that helps expand arteries and relieve leg pain.
angioplasty with stents

from here
i can help you with stabilizing your inr. i know how to do it. first of all you have to buy your own COAGU CHECK aparatus,from roche germany. find it on google,order it,pay it and have it. then learn to measure your inr youself. not difficult at all. aparatus i have cost me around 800 euro,and for measuring little films,i dont know how else to call them,every farmacy have them. they cost about 4 euros each. not expensive. then you are your own master re your inr. after that you can eat what you want. and measure your inr once in a forthnight. in the meanwhile,have in mind that on whatever day you ate more green stuff,find on google lists of content of vitamin k in foods,on such a day you should take one fourth of a sintrom tablet more than on days when you did not eat much of such foods that are full of vitamin k. as general rule,green leafy vegetables like lettuce and spinach parsley etc have much vitamin k in them. it is not a good idea that you stop eating these foods cos they contain folic acid that is nesessary for health. and omega 3. the one fourth of sintrom tabblet more on days you ate more green foods,and less on days you did not eat much of these foods,is my rule. for me it works. but you will say,who will decide how much sintrom daily i will have to take after having measured my inr. you will decide it. ill tell you how i do it. lets say my todays measurement of inr was 2,75. its a good finding. then ill decide to take three thirds or one whole tablet every day. we dont all react to the same dose equally. so in the beginning you will have to measure your inr more often so as to see how you react at one tablet or at three thirds. but you will have only you,only one patient to follow,while your doctor has many. one more thing. it makes sense to take sintrom in the evenings,cos in a public laboratory or you doctor they measure it in the morning lets say at nine o clock. so,nine in the evening is half time,12 hours in between.

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