Coumadin and Antibiotic


When taking any form of antibiotic while on coumadin, it is important to closely monitor PT/INR. While antibiotics eradicates bacteria in the guts, Vitamin K2 is produced by the synthesis of vitamin K by the bacteria present in the colon. Washing off the bacteria in the colon depletes vitamin K source. Coumadin is then well absorbed and INR level will readily increase or double. Taking antibiotics due to infection can not be avoided. I would suggest more frequent lab draw for PT/INR.

1. Vitamin K – Wikipedia, the free encyclopedia
2. Microbial Fermentation


Chest Pain


Identifying Ischemic Chest Pain through the P Q R S T Method

P…what PROVOKES the onset of Pain..
– What was the patient doing when the pain started?
– What did he do to relieve the pain?
– What makes the pain worse?(movement..,deep breathing.. coughing… exertion?)

Q…What is the QUALITY of the Pain?
– a description of the pain, what was it like?..(burning..,pressure..,sharp..,excruciating..,stabbing?)

R…Does the Pain RADIATES to other parts of the body?
– does it radiate to..(neck.., left shoulder/arm..,jaw..?)

S…How SEVERE is the Pain?
– Gauging the intensity of pain with 0-10 scale
– Or through facial expression when patient is unable to express d/t dementia or unable to talk because of severe pain

T…What was the TIMING of the onset of Pain?
– When did the pain start?
– Is it a new pain? or a usual pain?
– Has the pain changed or has it progressed/more intense and longer?

Analysis and Important Points:
Knowing what provokes or precipitate pain would make you think of other kind of chest pain aside from Ischemic heart pain. PLEURETIC chest pain which is worse with inspiration, coughing and deep breathing secondary to inflammation of the pleura or lungs are described as sharp and stabbing pain. This is usually caused by an infection or irritant that invaded the lungs. eg.. pleurisy, PE(a clot obstructing the exchange of 02 and C02),viral or bacterial infection of the lungs or even malignancy. A chest pain reproduced by palpation of the chest could be referred as muscle pain. Ischemic chest pain is caused by lack of oxygen to the myocardium caused by insufficient and or obstruction of blood flow that supplies oxygen to the cardiac muscle. Pain can be described as pressure, stabbing, excruciating or sharp. It is usually accompanied by diaphoresis, nausea, and shortness of breath which could be secondary to severe anxiety caused by the fear of doom and the body systems reaction to an abnormality. The radiation to the proximal part of the body from the point or origin of pain is an evidence of ischemia spreading to the nearby tissue. The severity of pain becomes alarming when it becomes prolonged and unrelieved denoting high possibility of infarction or death of the cardiac muscle. The timing and onset of pain is significant for the successful intervention and maintenance of life. Immediate identification of a myocardial infarction from the time the patient presented to ER is crucial for a successful PCI and preservation of life.

1. Marianne Chulay,Suzanne M. Burns. Assessment of chest pain. AACN Essentials of Critical Care 2nd ed.
2. Pleuritic Chest Pain – Symptoms, Causes and Treatment
3. Assessment of Pain: Questions to Consider during Assessment of ……/assessment-pain-questions-consider-during-assessment..

The Floaters


I thought it was just an add on
With different colors,style and shape
But no.. it works like the original life vest on.
Such a bright idea,a credit to the inventor.

It boost confidence
It made parents comfortable,
proud and calm as those tinny arms paddles
with their short kicks they float
and make their progress in the blue waters.

It is safe, stylish and reasonable
An amazing gadget, a parents partner
In teaching kids how to swim and float.

At the beginning of summer
On our way home from a friends swim invitation,
My son, Timothy said,”Mom,I can’t believe I don’t know how to swim.”
My first time to see his face full of disappointment
Sadness engulfed his bright eyes
Now forming wells of unforgettable tears.

My heart sank and felt my son’s desires,
But how will I teach him? I myself don’t know how!
I plan to enroll him to learn the basics at least
But a friend recommended a floater would help.
He used a floater before but that was a year or two…

A simple arm floaters indeed was the trick!
My son flipped, floated and explored
But Yuri played with his floaters
Now its torn and cannot be restored
An expense I have to endure,
But my son reassured me, “Mom, I don’t need a floater anymore.”
I was skeptical and did not believe at first
Unable to find one I let him be himself.

Amazed, happy and mesmerized
He surprised me with the skill he displayed
He floated, flipped and dipped
To the pool not a trace of fear
But courage and confidence..
A freedom and independence learned..

My son.. I’m so proud of you!!
For the inventors of floaters..
Thank you so much..

n.b.. with or with out floaters parents/adults are advised to be with their children always.


BE E D U C A T E D on every medication that you take.. prescription, over the counter or herbal supplements and vitamins.

Recently,young once active yahoo man lone protester of a drug he took to stop his falling hair but crippled his manhood. Doctors may not have mentioned one of its side effect but it is also our responsibility to know what we ingest and what effect it would do to our body system. Being wise and curious could save us from any unwanted harm and long term effects. Technology is within our reach.. maximize its certainly makes a difference knowing what you don’t know.

My daughter was prescribed an adult post- operative dose of narcotic pain killers. It did not surprise me because after all my daughter’s built is almost like mine. But I did not follow what the doctor ordered, instead I opt and gave her a mild non narcotic pain medicine to start with but even then my daughter herself did not like to take any. She rather would eat Popsicle to sooth her throat after her tonsils were removed.

Many Antihypertensive medications can slow you down, let alone impotency, being unable to sustain an erection. If you are young and active, ask your doctor other options that will not affect your sexual drive. E.g…. Lisinopril.. Metoprolol are one of those that can slow you down. Think about your partner and discuss other options available in the market.

Fenasteride(Proscar, Propecia)- a drug used for benign prostatic hypertrophy for older men and Propecia to treat baldness have a side effect which include sexual dysfunction. I wish the yahoo man have read his prescription, or when he felt something was wrong patient are usually advised to call their primary doctor or go back and initiate a discussion.

Red yeast rice is a Chinese remedy for lowering cholesterol but its component are comparable with that of a statin. For this reason liver enzymes need to be checked periodically. How many knew that it can affect the Liver since its a natural remedy but the US FDA made a research that it’s considered and actually a drug? In most Asian countries, we use yeast rice to ferment and produce rice wines. Little did we know that this can be damaging to the liver!! with continued, prolonged and abuse intake of rice wine?

Those who have known Renal dysfunction and liver dysfunction are considered very vulnerable to harm because most drugs are metabolized in the liver and excreted through the kidneys. e.g.. a person who have a history of renal insufficiency was prescribed Bactrim, it further affected his kidneys by not drinking enough fluid. Now he was admitted for Acute renal failure with a GFR of 6 with a high probability of hemodialysis treatment.

Tylenol is one of the most abused over the counter pain killers that can damage the liver with overdose and prolonged consistent high dose.

Oxycodone and Hydrocodone are the most abused narcotic pain medication in North Carolina. Now a campaign to educate prescribing Doctors are being launched. Yes educate the MD’s and innocent people who are dragged to the physical and psychological dependence brought about by this supposedly pain killers.

Antidepressants are supposed to help uplift your mood to become human again but look at the back of the prescription.. it says warning.. patient may become suicidal???????

n.b…Please do your research before you trust Thanks to my readers.

Know the Drugs You Take Before it Harms You

A Wake Up Call For The Non- Compliant Patient


Patient C thinks he is doing well. It has been 3 weeks since he was admitted. He is in the road to recovery but because of some complications his stay was longer than expected. He became irritable because of not being able to do what he wants, he wants to get up but disappointed because of extreme weakness while doing so. His will power is strong but his body is weak. His mind is narrowed by his desire to shortcut the course but the body does not think that way. Our body is amazingly and intricately created to undergo processes that only those gifted with wisdom will understand. The body has its own healing power that is mandated by the immune system with the life giving power of the blood that goes around every corner of our body tissues. With the help of medicine this power is sometimes enhanced but failure may take place if the body senses it’s inappropriate and dangerous. A sound and understanding mind is also essential and plays an important role with the healing process. Educating ourselves and respecting those who studied them should guide us to a speedy recovery but averting the process with stupidity and immature control will only delay the whole picture of a smooth and healthy expectations.

Patient C realized the mistake he did, the following night his behavior changed, was more cooperative and patient. But he still needs continued education as his case is unique and extremely delicate. I thought I should have been more insistent and assertive but things happen this way so the one concerned will learn in a way.

Understanding C- Diff


Clostridium difficile (c. diff)- is an anaerobic, Gram-positive bacteria, a spore-forming bacilli(rods) that is most seriously caused by antibiotic-associated diarrhea. It is important to know that among the many hundreds of normal gut flora, c- diff is among them. Because it is resistant to most antibiotics like Cipro, levaquin, clindamycin, cephalosporins and beta- lactamase inhibitors, this antibiotics wipes out other normal gut flora but notorious c-diff remains. Its proliferation and overpopulation in the gut causes this bacteria to release toxins that is responsible for the severe diarrhea, inflammation and bloating. Nosocomial infection by accidental ingestion of c-diff can also lead to overgrowth of this bacteria in the gut. If not detected early and treated accordingly may lead to pseudomembranus colitis and toxic megacolon. Metronidazole is the first line of treatment. Vancomycin is used when treatment is unsuccessful with Metronidazole. Spores of C- diff may live for long periods of time outside the body. Only disinfectant containing bleach can eradicate the bacteria. for this reason pt positive for C- diff are on contact isolation and hand washing with soap and water is advised. Alcohol based hand rubs does not destroy the bacteria.

Why do practitioners need to bridge anticoagulation with Heparin while initiating Coumadin?


Heparin is a fast acting anticoagulant where you can achieve anticoagulation with in 24 hours. Whereas coumadin will take at least 3-5 days before achieving a therapeutic level. During hospitalization, depending upon the reason for anticoagulation, most clinician prefers to initiate coumadin and discharge pt once INR is therapeutic. During the days when INR still subtherapeutic, Heparin is used to bridge the gap. Of note, Heparin does not affect PT/INR but PTT.