6.5 Inr

[Lorraine]

I wrote all this Saturday night and that was when after i went to post, it said I wasn't logged on and I lost the thread that took me a half hour or so to write. So now I'll give a condensed version (if that's possible)

I had started by stating I lurk and try to log on when I can and respond to posts when I get a chance. I never usually have too many issue's of my own and when I do it's my INR.

Friday I went for my INR and it was 6.5. I've been under a lot of stress, my 15 year old cat KC has kidney disease. I found out about a month ago. I've been giving her IV's to keep her hydrated and trying to get her to eat. I've been so stressed knowing I'm probably going to have to put her down soon. I also found out Friday my sister-in-law in Alabama had a stroke on Tuesday and went brain dead after they tried to relief the pressure on the brain. They ended up pulling the plug on Friday, so I have a wake and funeral to go to today and tomorrow. THey brought her back to Chicago where she was originaly from. My brother is devastated to say the least.

Anyway back to the INR. I normally take 10mg on Monday and Friday and 8.5mg the rest of the week. Friday they had me drop to 5mg for Friday, Saturday and Sunday and come back in Monday. I ate my mexican salad with lots of cilantro and avacado on Sunday, but I know that didn't even figure into my reading yesterday. I went in and it had dropped to 1.9! So of course they upped my dose for Monday, Tuesday and Wednesday to 7.5 and want to retest me on Thursday. I think that's too low a dose considering what I was normally taking. I don't think it will go up that much especially since I ate that salad on Sunday.

I'm looking for opinions especially from home testers about what would they have done for dosing. I decided even if I can't get my insurance to pay for a machine, I'm going to get one. I have to see my cardio next Tuesday and I will demand he sign the papers and let him know it's not just for my convenience it's also to make sure I don't lose my job from taking off so much to go for INR's when it gets out of range like this. Once a month is no big deal but of course when he goes high and then too low I have to take off early from work, three times within the week.

Any inputs would be deeply apreciated. Thank you!

 

[Ross]

My first question is, when did you have the test before the high test? Was it normal and how long between tests? I'm thinking it was a bad result and should have tested a second time to verify before making any adjustments. Given that you dropped so low, I think it might well have been in range when it was all a bad result. the other thing is, I think they are testing you too soon. They should give it a full week between tests to let things stablize.

If it was indeed 6.5, then they lowered the dose by roughly 11% which seems feasible, but they are testing too soon to get the full picture.

 

[Karlynn]

Lorraine, first of all, I'm so sorry to read of all the things that are stressing you. You have my sympathy on the loss of your SIL.

If I had gotten a 6.5 I would have retested. A number that high, that requires some action like holding doses, so it needs to be varified with a recheck. So I'm thinking that the 6.5 may have been an error. You may still have been high, but not that high.

Is your INR range 3-4?

 

[Lorraine]

Ross, Karlynn

The thought did cross my mind about the 6.5 INR but not until after I went home. I should have said I wanted a retest to see if it was a bad reading. I do know she recalibrated the machine while I was sitting there before she tested me since she hadn't done it yet that day. Maybe she didn't calibrate it right. This year I have had more highs and lows since this new coumadin nurse assistant took over. My other nurse was a doll! If she was still there and it was 6.5 she automatically would have known not to have me hold but lower the dose some. If I came in Monday and it was 1.9 she would have just told me to go back to my normal dosing schedule. Then just come back in four weeks. It always worked out fine. I'm glad at least you two think they loweed it by the rtight percentage but do you think they really raised it enough yesterday to get a optimal reading in another three days? They insisited I had to come back this Thursday or they couldn't be held responsible. I said why can't I be retested on Tuesday when I have my cardio appt but they said that was too long. I actually didn't make an appt for Thursday yet, but I was thinking I shold bump my dose myself upto 8.5 since that was one of my normal doses.

BTW: Ross the INR a month ago was 3.7. They were concerend about that but I wasn't. I said 3.7 is fine. Remember I have two mechanical valves, not one. It was right after that appt, I took my cat to the vet for her appt. and found out about the kidney disease. My other concern is that I did eat my wonderful salad on Sunday and I know that did show in the reading on Monday because I had just had not even 20 hours before. So I don't think 7.5 for three days is going to help much!

Yes Karlynn my range is 3-4. So should I just not make the appt for Thursday and leave it for Tuesday? I'm going to be taking a trip on Wed-Sat next week though, so I'm concerned about it not being in range when I'm out of state if I wait until Tuesday of next week.

Thanks for your inputs and condolences.

 

[Karlynn]

Why would they be concerned about a 3.7 if your range is 3-4? Even if it was 2.5 - 3.5, they shouldn't have been concerned about a 3.7. Have you been on the same dose for a while, prior to this 6.5, or are they adjusting your dose around frequently?

I'm with you. I'd go to the 8.5.

Ask them to get a self-calibrating machine! My cardio just got an INRation free from Hemosense. They just have to buy the strips, which don't cost them any more than their last machine.

 

[Lorraine]

Karlynn,

Yeah, that was my take last month. I told them not to be concerned about 3.7, and that I would be fine. They said okay and left it at that. But see then when I came in this month it was 6.5 I'm sure i their eyes, it was like, see, we should have tried to bring you down some. They din;t say that, but I bet they were thinking that. I did tell them after my test on Friday that I was very stressed. A lot had been happening and I knew before they tested me it was probably high.

I had been oin the 10mg for two days and week and 8,5mg since about MAy. I was doing fine for the most part sometimes on the lower side but still within range which is why I think in May is when they licked it up to 10mg for the two days. Thanks for your opinion. I did take only 7.5mg yesterday but I will take the 8.5mg today and tomorrow. Nwo do I make the appt to be seen on Thursday or should I stick to my original thought of waiting until Tuesday when I have my cardio appt also. That would give me a few more days to get it in range in my opinion but of course I do't want to overide them too much or the cardio won't approve a machine for me. I'm just concerned with missing so much work when they are trying to get it back in range. Every three days of leaving early does not look good. My boss is understanding though. She's also my neighbor and one of my best friends. Thanks for your reply.

 

[Ross]

By testing you Thursday, your only going to have a total of 15+15+7.5=37.5mg, so your going to be way low and part of what you've taken from Tuesday and Wednesday isn't even going to show in the result, so it's going to be too low, yet slowly climbing.

 

[Karlynn]

Unless you are going to be too stressed over it remaining low. Then test Friday. Peace of mind is a good thing too.

I don't remember - have you tried to get a home monitor?

 

[LUVMyBirman]

Hi Lorraine,

So sorry to hear about your SIL....also KC. I know how much it hurts to lose a loved one.

On the INR. I would have only halved my dose for one day...retest in 3.
If you are trending up after your second test.....then a dose change would be in order.

I feel what they had you do was a drastic jerk. I would have bottomed out, no doubt about it. With me...my adjustments are small. 1 to 1.5 mgs over a weeks period usually brings me down. As such..I don't see why they are having you do 10MG on Mon...then Fri. 10MG sat/sun would make more sense. At that. I would try 8.5MG m-f and 9MG sat & sun. (If you are still high). If not 10MG Sat/Sun. It may take you a week+ to level out. But you will.

I take 6.5 M-F and 7.5 sat/sun. Took ME (not the MD) they had me all over the board.....a long time to find the correct combination. As most of us are aware...you have to be your best advocate. Most of the management is by the textbook. Generalized. As you are aware...Coumadin is not one dose fits all. Just wish more healthcare providers realize it!

 

[Guest]

A monkey throwing darts would probably have picked a method as good as that.