A Wheelie Walker, Wooden Leg And Warfarin
Taking warfarin can be risky for people who are prone to falling. People on warfarin are twice as likely to suffer from bleeding on the brain after a fall than people not taking warfarin. That is the dilemma facing doctors everyday. Doctors are constantly having to calculate what has the least impact on a patient’s health. There is a real risk of falling or risk of a blood clot going to the heart, brain, lung which may cause permanent damage or even death.
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Blood is a fascinating part of the body. It has many functions to keep us alive. One of those jobs is to stop us losing our entire blood volume by forming a clot. Blood vessels tear all the time. It happens everyday. But nothing happens to us because blood acts like putty and repairs the leaks. A bit like a plumber repairing a broken pipe… but faster.
So what does warfarin do?
Warfarin is an anticoagulant medication to “thin the blood”. Its job is to slow down the process of blood sticking together that forms a clot: the “putty”. Warfarin in high doses is poisonous to the body. It needs to be carefully monitored by a medical officer with regular blood testing to keep the level of warfarin in the body at a safe level. The other side of the coin is if not enough warfarin given. The blood will clot too quickly and cause an embolism (floating putty ball) to find a home in a small vessel, usually a major organ. That is what may lead to serious injury or death.
Mrs Cunningham lived in a unit on her own in a residential retirement village. Her Left leg was amputated below the knee seven years ago following a long struggle with an ankle bone infection. To make matters worse during the rehabilitation phase, due her recent operation and prolonged bed rest, Mrs Cunningham developed a clot in her good leg (right). Also known as a DVT (deep vein thrombosis)*. Just like what happens when people travel on planes for along time or in a car. Part of the treatment Mrs Cunningham received was warfarin. Now the writing was on the wall.
Mrs Cunningham was well controlled with warfarin for seven years before her crisis point would be realised. Mrs Cunningham was walking with the wheelie walker in the lounge room when her wooden leg gave way and she came crashing to the floor and unable to move. The carpet had cushioned some of the force, but Mrs Cunningham still hit her head very hard. Unable to move because of the pain in her neck and back she pressed the emergency call buzzer for assistance. The ambulance brought her into the emergency department and described the injuries as pain in the neck and back and large orange size lump to right forehead that was still bleeding.
What a Mess!!
The bump on the head was still bleeding and her face was difficult to see through the blood. Being on warfarin caused the job of stopping the ever growing lump more difficult. The bleeding was eventually ceased with compression dressing and a lot of time. The neck pain also was a major concern. Anyone who has neck pain after a fall should have alarm bells ringing that a serious problem has occurred. A CT scan* showed Mrs Cunningham had broken her neck in 3 places and could not support her head. If Mrs cunningham moved the slightest bit she would have been paralysed. The silver lining in this crisis was no sign of bleeding in the brain or spine around the broken neck. If bleeding was in the brain Mrs Cunningham would had a severe disability or even died.
Thankfully Mrs Cunningham went to the ward to continue her recovery.
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P.s Are you a carer with similar experience? Tell me your story . Please leave a comment for me.
DVT: Deep vein thrombosis. A blood clot that is stuck to the blood vessel wall.
CT: computer tomography scan. Detailed X-Ray image taken in a large machine that looks like a donut.
1. Use of Anticoagulation in Elderly Patients with Atrial Fibrillation Who Are at Risk for Falls 2008