Neary PAA

What effects does my medication have on my life? 

A Top 100 radio station played softly in my ears as I tried to focus on the music instead of the blaring noises filling my head. I was losing feeling in my limbs as I tried to stay perfectly still, just like the doctor had asked. The IV was pulling on my skin though, and my view of a grey ceiling five inches from my face wasn’t helping my boredom. Then the music stopped, and the voice of the MRI technician blared in my ears.

“Okay Jessica, now I need you to hold your breath until I say stop okay?”

I wasn’t sure if they could hear my reply, but I said “Okay” just in case.

I held my breath over and over again as the machine beeped and buzzed loudly, taking pictures of my heart. After the first few times, I began focusing on the specific noise pattern, knowing which beeps go off before I could relax. My eyes would water, and my lungs begged for air as I lay in that cramped space. The worst, however, was yet to come.

Suddenly the voice came on again. “Alright Jessica now we’re going to do the stress test.”

All I could do was nod, even though they couldn’t see it. Soon I felt a rush of cold as the drug as it filled my veins, spread up my arm, and to the rest of my body. My heart began beating faster, even though I should have had a resting heart rate. As the last strain of ice left my hand, my chest rose and fell in short breaths and I could hear the thump of my pulse in my eardrums. It was highly uncomfortable, the idea of panting without even lifting a finger was strange, and my longing to be done with the test increased tenfold. I wanted to get out of the MRI machine. I pleaded in my head for the people behind the glass to make it stop. I didn’t want to hold my breath anymore, I didn’t want to be poked and prodded with needles. After two hours, I felt the tug of my shallow bed slowly being pulled out into the iridescent lights of the hospital room, and the technicians helped me sit up. As I gingerly walked out of the room, my mom was waiting for me. I wanted so badly to leave the hospital, but I knew I still had three more tests to do. So instead, I hugged her and we made our way back to the cardiology unit.

I was ten years old when I had my first MRI, and I have done that test every year since along with various others, all recording how healthy my heart is.

When I was ten months old, I was diagnosed with Kawasaki’s disease, a very rare heart disease that usually affects children from one to five years old. The disease caused four aneurisms to form on the coronary arteries of my heart. Today, two still can potentially affect me if I do not take daily medication of Coumadin and aspirin. Coumadin is an anticoagulant, or blood thinner, so my blood does not clot and cause me to have a heart attack.

Doctor Minich was the pediatric cardiologist who correctly diagnosed me in Salt Lake City, Utah, after I had already been on life support and taken off without a real treatment. She saved my life. After visits every three months for the first two years of my life, Doctor Minich told my parents that I should be able to live a normal and happy life, free of limitations concerning physical activity and virtually any other aspect. She said I didn’t have any physical restrictions, but that I should gauge it myself on a case-by-case basis. Today, physical exercise can sometimes be brutal simply because I can’t continue more than a certain amount of time without catching my breath.

In high school, I played varsity volleyball, but every time there was a conditioning workout, I’d fall behind. If I stopped to catch my breath, my heart was pounding and I sounded like I was hyperventilating. The other girls would look down on me, thinking I was making an excuse to get out of a difficult practice, and I was always ashamed of not being able to perform as an equal. In college, I prefer working out alone, taking my time and making sure I never have to explain myself and slow others down in the process.

I had an idea of why this happened, that I couldn’t get oxygen into my system as fast as someone with a healthy heart could. An article on WebMD.com, however, gave me a more specific answer, that this could be caused by something called “Ischemia.” It occurs is when my heart doesn’t get enough oxygen-rich blood. “Ischemia is most commonly experienced during: exercise or exertion, eating, excitement or stress, or exposure to cold.” When I read the different reasons, I immediately understood why I hated running in the cold, or when I started to have chest pains when I was lying in bed stressing about a test the next day.

When I went in for my annual checkup when I was sixteen, Doctor Minich told me I would need to take certain steps if I ever decided to get pregnant down the road, and that drugs and alcohol could be dangerous. At sixteen, none of this bothered me and when I was eighteen, I said goodbye for the last time, needing an adult cardiologist. Although these warnings rang true, I had no idea the enormity that her words meant.

I have been taking Coumadin every day for nineteen years. My mom would bring me the pills every night before bed with a glass of water and whenever I went to a camp, I had a pillbox that she would give to the camp counselor. One of the necessary steps with taking this drug is monthly blood draws, to monitor the amount in my system and make sure it’s balanced. If I’m taking too small of a dose, my blood will grow thick and increase the risk of blood clots. If the dose is too big, my blood would get extremely thin and the risk of excessive bleeding becomes much higher.

It was only when I left for college that I finally had to start taking my medication by myself regularly, and going to Curry for my monthly blood draw. This responsibility made me realize how much I didn’t know about this drug and what it can do to me. According to the FDA Medication Guide, I’m not supposed to drink alcohol, eat “leafy greens” due to the large amount of vitamin K that can reduce the effectiveness of the drug, and even cranberry juice could be potentially hurtful. Serious side effects include the death of skin tissue. On top of that, the article states, “Coumadin can cause death or birth defects to an unborn baby. Use effective birth control if you can get pregnant.” Coumadin can also cause bleeding to a child if they are breastfeeding, and shouldn’t be taken for the serious risks or carefully monitored.

I had no idea the medication I took could cause serious damage to the fetus of my child if I was ever to get pregnant, or potentially give me a heart attack from taking in too much vitamin K. The pregnancy warning scared me the most however.

I take birth control, but what happens if there was a slip up someday and I did indeed get pregnant and didn’t know it? After doing research, according to heart-disease.emedtv.com, the FDA also says that I could potentially have a miscarriage or stillbirth, while the fetus could have severe problems such as birth defects, blindness, mental retardation, brain or spinal problems, prematurity, and excessive bleeding (in both fetus and the mother). The site goes on to say, “The risks appear to be greatest when Coumadin is taken early in the pregnancy (weeks six through nine), although exposure at any time during pregnancy could lead to devastating outcomes.”

As I read the document listing all of the things Coumadin could do to a child, I was stunned. The thought of causing such pain and unfair treatment to an unborn child was unthinkable, and I didn’t want any part of it. On top of that, as I said before, Coumadin is a blood thinner, and doctors take extreme precautions for any type of medical procedure to make sure I don’t bleed too much. When I was fourteen, I had a surgery to get my adenoids out in my nose. I was in the hospital for two days after to make sure I didn’t have any unforeseen bleeding. Two weeks prior to this “walk-out” procedure, I had to start giving myself twice-daily shots as a replacement to the Coumadin. I cried every time I stuck the needle in my side, not because I hated needles, but because the aching pain the meds left after I was done.

This all comes before the actual birth, in which my life would also be at risk with the potential of bleeding to death, or the amount of exertion on my heart that could potentially lead to a heart attack.

So even if I was going to get pregnant at some point in my life, would I be giving myself shots twice every day for nine months? The other possibility would be to have heart surgery, take out the two remaining aneurisms, and be done with the Coumadin all together. It was never discussed with my pediatric cardiologist simply because I was stable, there was no need to take me off the medication when I was doing so well.

Would this make be a consideration in the abortion debate? According to Roe v. Wade, I am not, although many conservatives still disagree. The Roe v. Wade case was brought on by a pregnant single woman (Roe), who challenged Texas’ criminal abortion laws. She won, and allowed legal abortion for women. Before this case, there were exceptions for women whose life would be in danger, and I still fall into that category (Cornell).

Sadly, there are people in the world who can’t see past their simplistic view of the world in that a fetus is a living human being and should have the rights as such no matter what. I do see their point, but where is the humanity in bring a child into a world where they are practically ostracized because of a birth defect, or mentally handicapped because their mother didn’t know they were pregnant. My dad had four brothers, each with their own unique characteristics but one, my Uncle John, had a spinal defect and gave him a humped back. Everywhere the family went, people stared at Uncle John because he was different and he was treated his whole life as someone to avoid, even though he was an intelligent and kind man. My dad would never wish that life upon anyone, and I agree with him.

A major part of college experience is centered around alcohol, but the FDA warns against me drinking. When I was in high school, my parents understood that when I got to college, there was the possibility that I would go out and drink. So, they let me drink with them at parties and on vacation, just so the urge to go out and get wasted wasn’t such a draw to me when I was out on my own. After two drinks, I’m tipsy. Three, I’m drunk. But this makes sense when you think about the Blood Alcohol Content (BAC) tests given by the police. BAC means the amount of alcohol in your bloodstream, so when my blood is more susceptible by being thinner than most, alcohol affects my system more quickly (LMU).

I never realized how much Coumadin could affect my life. It is something I have taken every day for as long as I can remember, but what are the long-term effects? Livestrong.com had a synopsis of the drug, which told me a lot of information I had already found out, but it did mention the fact that the longer Coumadin is taken, the higher the risk of excessive bleeding. I have never been worried about cutting myself and bleeding to death, nor has there been any instance where it has been an issue, but what about thirty years down the road? I don’t know where my life will take me, and what decisions I make concerning the affects of the Kawasaki disease. But if I’m still on Coumadin, will I be so fragile that I can’t live a normal life without worrying if I’ll bleed too much from a paper cut? 

I wanted to know what alternatives I could take to Coumadin, mainly for the pregnancy risks, but also for my diet and the consumption of alcohol that might be safer. Recently, there was a new drug released called Pradaxa that is also an anticoagulant, but does not work with vitamin K (which is needed for blood to clot) like Coumadin. Instead, it directly inhibits the thrombin protein to stop clots from forming. Merriam Webster defines it as “a proteolytic enzyme that is formed from prothrombin and facilitates the clotting of blood by catalyzing conversion of fibrinogen to fibrin.” This basically means that it facilitates blood clotting. The Pradaxa site does warn against getting off the drug in case of a medical or dental procedure, but does not include pregnancy.

If medications will truly affect my life down the road, however, the next option could be surgery. A New York Times article gave a description of what would happen during heart bypass surgery. After the general anesthesia, my breastbone would be separated, and I would be connected to a heart-lung bypass machine. My heart would be stopped and this machine would do the work for me. An alternative to this would be off-pump coronary artery bypass, or OPCAB if there were potential problems using the machine.

During surgery, “the doctor takes a vein or artery from another part of your body and uses it to make a detour (or graft) around the blocked area in your artery.” I remember my mom explaining some of this to me when I was still in high school, and this article backs up her statement that this graft could be from my leg. After the graft is created, my breastbone will be brought back together with wire, that will stay there for the rest of my life and the cut down my chest will be closed with stiches.

The risks include “blood clots that may travel to the lungs, breathing problems, infection, including in the lungs, urinary tract, and chest, and blood loss.” Those were only for regular surgeries. The risks of coronary bypass surgery went on to say possible risks of chest would infection, heart attack or stroke, heart rhytm problems, kindey or lung failure, low fever and chest pain, memory loss, loss of mental clarity, or “fuzzy thinking.” 

Great. Bypass surgery sounds wonderful. If at all possible, after reading what the surgery could possible do to my body, if it all possible I want to stay on medication unless it’s necessary. All of the risks that go with bypass surgery seemed inconsequential when it’s about somebody else. But when you’re the one they are about to crack open and stop your heart, suddenly it sounds like a scary and possibly fatal ordeal that I would rather avoid.

Now, I get it. I understand what my condition is and what I can do for a lot of different scenarios. I will stay on the lookout for new drugs that could replace Coumadin that are less dangerous, maybe a stronger birth control, and if all else fails, heart surgery to get rid of the problem permanently. My condition had always loomed in the background and something I thought I understood, but now, I realize how wrong I was. I wish I had done this sooner in my life, but now that I know, I can go forward into the adult world ready for anything that comes my way.

Work Cited

"Blood Alcohol Content." Loyola Marymount University. Web. 19 Apr. 2012.

<http://www.lmu.edu/Page25066.aspx>.

"Coronary Artery Disease: Causes, Symptoms, Treatments." WebMD. WebMD, 11 Jan.

00.        Web. 19 Apr. 2012. <http://www.webmd.com/heart-disease/guide/heart-

disease-coronary-artery-disease>.

"Coumadin and Pregnancy." Heart Disease Home Page. Web. 13 Apr. 2012.

<http://heart-disease.emedtv.com/coumadin/coumadin-and-pregnancy.html>.

"Coumadin Long-Term Side Effects." LIVESTRONG.COM. Web. 19 Apr. 2012.

<http://www.livestrong.com/article/257226-coumadin-long-term-side-effects/>.

"Health Guide." Heart Bypass Surgery. New York Times. Web. 19 Apr. 2012.

<http://health.nytimes.com/health/guides/surgery/heart-bypass-

surgery/overview.html>.

Medication Guide: Coumadin Tablets. Federal Drug Administration. PDF.

"PRADAXA SAFETY INFORMATION." PRADAXA. Web. 17 Apr. 2012.

<http://www.pradaxa.com/pradaxa-safety-profile.jsp>.

"Roe v. Wade." LII. Cornell University, 13 Dec. 1971. Web. 17 Apr. 2012.

<http://www.law.cornell.edu/supct/html/historics/USSC_CR_0410_0113_ZS.html>.

"Thrombin." Merriam-Webster. Merriam-Webster. Web. 17 Apr. 2012.

<http://www.merriam-webster.com/dictionary/thrombin>.