3.1 to 2.4 to 4.0 to 3.7

[Ross]

Laurie sometimes that's just the way it is. At the beginning of the month, I was doing the samething. I reduced dose and was still high. Reduced again and came out way low and now I'm back to the same dose that I started with. This is why I think people are nuts to test only once a month. There are too many swings in that time.

 

[AgilityDog]

Bless you, Ross. It's good to hear I'm not totally nuts. I know I'm not the most stable of patients with my INR, but normally there is a reason for the blip. This time I can't find one.
Love the frog, btw.

 

[Karlynn]

Laurie - as you found out - your INR has little to do with what you eat and drink regularly. You changed those things and no difference. Unless you were ingesting nutrition drinks with high K and then stopped, my guess is that's it's because the moon had an eclipse.

I used to refer to myself as having an unstable INR. Now for me anything between 2 and 5 is stable, but probably some within the range requires a little tweaking. Some people take the same dose of Coumadin their entire lives. But very very few. I had to come to accept that I will be one that needs to adjust my dose occasionally. Much like a diabetic has to adjust their insulin dose, I have to play with my warfarin dose (not nearly to the extent of a diabetic and insulin - but I hope you get my drift). For most reasons unknown to me, my dose need increases and decreases.

One of the reasons I started self-dosing (which has actually made me more "stable") was that I got tired of hearing my doctor get frustrated over, once again, having to change my dose and wonder what was up. It's just me, it's just the way I am. I have gone 16 years without incident (knock wood) and I give little thought to an INR that causes me to tweak my dose. It's just a fact of life.

It took me quite a few years (mostly due to Coumadin myth) before I became comfortable with my INR trends. But I give it little thought - other than when I'm helping people out here.

 

[catwoman]

Laurie:

When did you start WeightWatchers?
If you have reduced your fat/oil intake significantly, you will see a rise in your INR because oils/fats contain vitamin K.
I noticed this when I started WeightWatchers in June 2004. Despite an increase in my activity levels, my INR was increasing. After looking through information about warfarin & vitamin K, I realized my INR increase was due to the change in diet. I adjusted my dosage just a tad and my INR went down.

What is your dosage?
I take 6mg daily in the winter, usually 6.5 in the summer.
I occasionally will hit 4.5-5.0 on my INR and do nothing about it. If I get several high INRs in a row, I adjust my dosage.
It's been a very long time since I have held a dose. I just adjust it downward because it's easier to stabilize than if I hold a dose.
When I need to retest, I wait 3-4 days to get a more accurate reflection of the change.

 

[AgilityDog]

I started WW in July of 2006, before OHS. I was sick AND fat, and at least I could do something about the fat part. I've lost a bit over 40 lbs, and have been maintaining nearly a year.
I'm pretty good about the fat intake, get my 2 good oil/day, or a tad more. I make my own lunches and pretty much eat the same thing, or variations thereof.
I'm just particularly frustrated about the INR because Tank and I have our first agility trial this weekend since my v-tach and bionics upgrade at Christmas. We've missed so much practice and several trials ($$$ entry fees gone bye-bye) because of the "no-running, don't move your arm for 6 weeks" bit after changing out the pacemaker.
Tank only needs 2 more Qs to finish a master title, he's getting too old to trial at this level much longer, and now I have to worry about messing up a front cross, joining the "kiss the dirt club" and hitting my head or something stupid. I refused to front cross my puppy, Jet, in class the other day for the same reason, besides which she's really fast and really green/clumsy, and we crash into each other all the time.
I just want my life back to "normal." The v-tach and surgery were such a disappointment after 14 months of no problems after OHS, and now this extra bit of worry on a stubborn high INR. I know that's the main reason it bugs me so much. I should have something more important to whine about.

 

[AgilityDog]

Oh, my dosage has been 4mg Monday and Thursday, 3.5 mg the rest of the time. We seem to alternate several weeks at a time between 3.5 mg on Thursdays and 4 mg on Thursdays. Sometimes I trend too low and we add it in if I keep dropping, then a month or so later I'll trend up too high for a couple of weeks (but never this high), and we take out the extra .5 mg if I keep climbing. I don't worry about a 3.7 or a 3.9 but creeping up toward 5 or down to 2 bugs me, especially with the clutzy furball, and my history of 2 cardiac events on the highway-let's not have a crash. I was 3.7 last week, 3.2 the week before, and had been in range with no Rx changes since after surgery.

 

[Guest]

Today's Count

Today's Count

My INR is 3.0, retest in 2 weeks. No change in my dosage, remain at 32.5 mg over 7 days.

 

[Bina]

Louise, that is great!

 

[Ross]

Oh, my dosage has been 4mg Monday and Thursday, 3.5 mg the rest of the time. We seem to alternate several weeks at a time between 3.5 mg on Thursdays and 4 mg on Thursdays. Sometimes I trend too low and we add it in if I keep dropping, then a month or so later I'll trend up too high for a couple of weeks (but never this high), and we take out the extra .5 mg if I keep climbing. I don't worry about a 3.7 or a 3.9 but creeping up toward 5 or down to 2 bugs me, especially with the clutzy furball, and my history of 2 cardiac events on the highway-let's not have a crash. I was 3.7 last week, 3.2 the week before, and had been in range with no Rx changes since after surgery.

Well even you were 5.0, the likelyhood of something that traumatic happening is miniscule. You still aren't going to bleed to death from furballs.

 

[Guest]

My INR is 3.0, retest in 2 weeks. No change in my dosage, remain at 32.5 mg over 7 days.

I had to go in for an INR today, and show the coumadin clinic nurse that I could stick myself with the best of them as long as I had my trusty Coagucheck XS, I had to sign a form also. I tested myself on the 23rd when the monitor was delivered and my INR was 3.0, same as the clinic results posted above.

Today's INR was 1.9, she said to increase my dose 2.5 mg to 5mg on Friday and I would now take 5mg daily for the next seven days. I didn't tell her that I switched the 2.5 mg day to Mondays.

I don't see how 2.5 mg added this Friday, or next Monday since I changed the 2.5 mg day, is going to get my INR back in range anytime soon, so I added the 2.5 to tonight's 5 mg and will remain at 5 mg until next Wednesday when I test at home and call in my INR.

Should I test earlier than next Wednesday? I have plenty of strips so stick away?

 

[Ross]

I had to go in for an INR today, and show the coumadin clinic nurse that I could stick myself with the best of them as long as I had my trusty Coagucheck XS, I had to sign a form also. I tested myself on the 23rd when the monitor was delivered and my INR was 3.0, same as the clinic results posted above.

Today's INR was 1.9, she said to increase my dose 2.5 mg to 5mg on Friday and I would now take 5mg daily for the next seven days. I didn't tell her that I switched the 2.5 mg day to Mondays.

I don't see how 2.5 mg added this Friday, or next Monday since I changed the 2.5 mg day, is going to get my INR back in range anytime soon, so I added the 2.5 to tonight's 5 mg and will remain at 5 mg until next Wednesday when I test at home and call in my INR.

Should I test earlier than next Wednesday? I have plenty of strips so stick away?

I'm easily confused, what was your total weekly dose before and now?

 

[Bina]

Ross, I'll give this a shot:

The dose was 5mg daily with 2.5 on Friday (total 32.5)

Clinic has now recommended 5mg daily for a total of 35mg
An increase of 7% for the coming week.

Louise upped yesterdays dose to 7.5 and the next 6 days will be 5mg (37.5)
This is now an overall increase of 15% over last week.

I would take advantage of the freedom to test again on the weekend

 

[Guest]

I'm easily confused, what was your total weekly dose before and now?

My weekly dose before was 32.5, they want me to increase to 35 over 7 days. By adding last nights 2.5 to the 5 and taking 5 the next 6 days, Bina is correct, I'll be at 37.5 mg.

My dosing this past week from Sun to this Sat would have been 5, 2.5, 5, 5, 5, 5, 5. I figured by adding the 2.5 last night, I caught up on this past Monday's dose, making it a 5 rather than just 2.5. That would give me a 35 mg dose over 7 days.

I'm messing up aren't I?

 

[Karlynn]

I'm messing up aren't I?

You're learning. Coumadin doses should be adjusted by percentages of the weekly dose total. This is why we ask what your weekly total is. Adjustments are usually from 10-20%, depending on how far out of range the INR is. You will come to know how your body reacts to %'s and the 10 - 20% adjustment is just a starting point. Many of us know that a simple 5% works well for small changes.

Once you arrive at a weekly total - you then divide by 7 to come up with your daily dose. Most often you then need to do a little simple rearranging to get your total daily doses to equal your needed weekly total using the pill sizes you have on hand. I have 3's and 5's and take 10 total some days and 12 others for a weekly total of 76.

 

[Guest]

2.0

2.0

I tested this a.m. I was actually nervous because it was my first time without a nurse watching me.

I'm at 2.0, entry to my range. I will continue the 5 mg daily, test on Wednesday and see where I am.

Thanks for all of your support.

 

[Ross]

If your still that low on the next test, bump up 10% for the week and check again.

 

[Guest]

If your still that low on the next test, bump up 10% for the week and check again.

When I tested last Wednesday morning I was still at 2.0, I called in my INR and when the nurse called back she was reluctant to increase my dose. I told her that my illness threw everything out of whack and I wanted to increase at least 10%, (meanwhile I was already at 37.5 for the week ) She said go ahead and take 7.5 that evening and then 7.5 on Saturday, 5 the rest of the week. This would take me up to 40 for the week. She said to retest in 10 days to make sure I wasn't going too high.

With Good Friday tomorrow, some businesses will be closed. I tested this morning and I'm at 2.7. No dose adjustments and retest in a week.

 

[Bina]

2.7 that is super! It must feel good to be in control and understand what is going on.

 

[Karlynn]

Sounds good!

 

[Ross]

Now don't go freaking out if you test a little less or a little more. Sit tight on this awhile and make sure you've found the sweet spot.