7.2! Yikes!

[Gnusgal]

Okay, so I've let my INR get away from me... But I didn't think it would be THAT bad!

Here's the situation (and I know I'm going to get a lot of fingers being wagged at me, but oh, well): Back in early October I changed insurances. Around that same time I was down to my last two test thingies (can't think of what they are called at the moment) for my Protime. I went to take my INR and it came up with an error message. I think that time it was an air bubble. So I had to use my last one sooner than I thought (I know, I should have already ordered more, but with them in the fridge I didn't really think about it). And wouldn't you know it, I got an error message on THAT one too!!! And I hadn't done anything about finding out if my new insurance would pay for testing supplies or not, so I just let it go for awhile. Then I got sick and was worried about getting better. Then I just got busy... Okay, so I don't have a real good excuse. Suffice it to say, it's been about two months since I've actually tested my INR. (Please don't throw things at me, my INR is in a dangerous place right now!) I finally decided I should just go in and get it tested at my doctor's office like a good girl. I figured I'd probably be out of range. But I was being pretty consistant with my diet and whatnot, so I didn't think it would be too far off. Maybe in the 4's. When it came back 7.2 I was in complete shock. I have no significant bruises to speak of at the moment, have had no problems what-so-ever.

I've been instructed to hold my coumadin for two days and come back to test on Wednesday. I just hope this doesn't put me in a yo-yo act again... It's my own fault I suppose. I should have stayed on top of things. But I really didn't think it would get that far off!

 

[Ross]

Being that long since you tested, it's hard to say. I still don't like lab tests. Just to much variance for me. Hold the two and get checked Wednesday. I'd rather it be Thursday to give it three full days and you'll still be dropping some then, but whatever. As long as your not bleeding etc. your o.k..

 

[lyneebee]

7.2 Inr

7.2 Inr

You are lucky, you don't have symptons, unlike me I had bleeding at 7 INR. no protime in 2 weeks (see 3 mos post up). Just watched for symptoms and go for PT in 3 days.

Lynneebee

 

[Ross]

We've had people much much higher that had no problems. It's one of those individual things.

 

[Karlynn]

It's anybody's guess how long you've been that high. Did they redo the test, just to see if it was a false reading?

Before I started hometesting I was VERY bad about going to the lab for my tests. Over 11 years (I've hometested for 3 now) I had many times that I'd go over 6 weeks for testing. Particularly when my kids were small, who had the time to go and wait for an hour in a lab to get tested (that was a pretty usual wait time). I know when I'd get an off reading (many too low) I'd panick and worry what was going to happen to me!!! Then I'd stop and think that ignorance is bliss, because who knows how long the INR was that reading? I know that I've been just darned lucky during those irrisponsible years.

I'm sure you'll be fine.

I'd wait until Thursday too, particularly if you take your meds at night, but test in the a.m.

 

[Guest]

Gail,

Bleeding with an INR below 8 is unusual. My guess is that you will be OK. With the holidays, I have scheduled lots of people for 2 months between checks. I usually do not bring people back in 2 or 3 days for INRs under 8. I just have them hold a day or two and then lower the dose a little and recheck in 2 weeks or so. If I were a bettin' man, I'd put big money on you being OK.

 

[Gnusgal]

Oh, I didn't figure I'd be on death's door or anything. It just surprised me is all. I'm not planning on placing myself in a plastic bubble or anything... Though the nurse at the doc's office said it would be a good excuse to make someone else cook and do the dishes!

I guess I don't feel so bad going so long without testing now that Al's said he sometimes schedules people that far apart... Good to know. I do wonder, though, how long I've been so high... Karlynn, you're right. Ignorance IS bliss.

 

[Guest]

You weren't even on the same street as death, let alone at the door.

In the UK it is common to test only once every three months.

 

[terryj]

My husband normally gets tested once a month. He did go six weeks one time because of our vacation and his work schedule. We don't worry too much about it if he can't test at exactly 4 weeks everytime. If he is high or low he retests in 2 weeks. This has only happened about 5 times in 4 years.

 

[catwoman]

In the UK it is common to test only once every three months.

Al:
For people who are very consistent in habits ("couch potatoes," you might say), this would be OK, as you have said in previous posts.
But what about people who are active? Have you seen any stats from the UK on how many have clots, strokes, bleeds, etc.?

 

[Gnusgal]

Yea! I'm so glad I can stop feeling guilty over neglecting to get tested for so long. It's just such an inconvenience when I don't have my own supplies. And I guess I'm a little gun shy with insurance companies right now, since we're battling it out with my old insurance over my ICD and subsequent hematoma and infection (they have ruled it "experimental" and won't pay for any of it, and are asking for money back on bills they'd already paid!). Also, getting my land legs in my new job has taken up quite a bit of time... Calling insurance companies just isn't something I have time for these days!

Thanks everyone for making me feel better!

 

[Granbonny]

For Al

For Al

Not to highjack..Niki's thread...What if someone in the UK or others here..that do not test but every 4-6 weeks....when they do test..their INR is low?How would they know that their INR has been lower..than what they should be in their range..and for how long?......I am to stay within 2.5-3.5..always there..But, what if I should test one day and see my INR at 2.0?..And it had been 3 weeks since I last tested?.....Would I have been at a risk for a stroke?....The reason I'm asking..Dentist wants me to hold my coumadin again for 2 days..for 2 more extractions next Monday.and start doseage right back up.... I figure doing that..my INR will drop to about 2.0..so, what is the difference.. NOT knowing what your INR is..for 4-6 weeks?....Geez..hope I'm making a point. ..sorry again..Niki ..for hijacking your thread.......B/T/W..teeth are coming out..because both showed infection in them..by x-ray.. ..Soon, I will be a real toothless Redneck. Bonnie

 

[Ross]

2.0 you should be fine for a while. Even unanticoagulated you should be fine for a little while, but not for great lengths of time nor if your one predisposed to clotting to start with.

 

[Guest]

Today we were scheduling people for the weeks with dates in the 20s in January. My complication rates are

1 minor bleed for every 1.5 patient-years
1 major bleed for every 33 patient-years
1 clot for every 100 patient-years

I don't know the exact answers to Bonny's questions but the outcomes data shows that my method works. I have put these up against many other clinics and they are close to each other.

I have 550 active patients under my care and have done in excess of 30,000 patient visits.

 

[Gnusgal]

And the fun just keeps on coming!

So I went in to test today, and came back with a 1.3! This after only two days. Glad I didn't take Ross's advice and wait until tomorrow .

The new plan is to take lovenox tonight, in the morning, and tomorrow evening (I have some left over from awhile back) along with my usual 10 mg of coumadin every day for the next week, except Friday and Monday, when I'll take 5 mg. I'm to retest on Thursday of next week. Don't ask me the logic. I'm just following their orders. This just confirms, though, that I really need to get my own supplies again. I had a feeling this kind of thing would happen...

 

[Karlynn]

Sounds like they should have done another test to confirm the 7.2. If I remember Al's info - INR drops by roughly 1/2 when a dose is skipped. The bigger dose you take, the quicker it drops. I've found that to be true after taking only 3 of my 9 mg. one evening and having my INR read 1.4 3 days later.

 

[Granbonny]

Karlynn

Karlynn

Thanks for the tidbit about Al's saying that one's INR drops by 1/2 a day.when missing a dose..that means..if I am at 3.0 Friday and skip 2 doses..Mine should be 2.0 Monday morning when I go to dentist..If mine is higher than 3.0..will have to tweak down a tad Friday night..Then, skip 2 doses.....Hometesting is the Best. Bonnie

 

[bvdr]

Thanks for the tidbit about Al's saying that one's INR drops by 1/2 a day.when missing a dose..that means..if I am at 3.0 Friday and skip 2 doses..Mine should be 2.0 Monday morning when I go to dentist..If mine is higher than 3.0..will have to tweak down a tad Friday night..Then, skip 2 doses.....Hometesting is the Best. Bonnie

Bonnie, I think it would mean that it would be 1.5 on Monday and then .75 the next day. Remember this is only a rough rule of thumb.

Niki, I hope you get your supplies soon and get back to home testing. How have you been doing other than this INR business?

 

[Karlynn]

Thanks for the tidbit about Al's saying that one's INR drops by 1/2 a day.when missing a dose..that means..if I am at 3.0 Friday and skip 2 doses..Mine should be 2.0 Monday morning when I go to dentist..If mine is higher than 3.0..will have to tweak down a tad Friday night..Then, skip 2 doses.....Hometesting is the Best. Bonnie

I could be getting this all wrong too, so please wait for Al to weigh in. (It's the Christmas season and my work hours as music director have doubled - I'm finding my mind to be really scattered at times. It's a bi-product of the season. I go through it every year.)

He may have said that it drops by 1/2 after 2 missed doses. Don't trust the over-worked music director!!!!!!

 

[Gnusgal]

How have you been doing other than this INR business?

Well, up until this week I'd say I've been doing pretty decently. I have considerably less stress in my new job, simply due to less hours (no more after school rehearsals until 6:30 at night!), and no grading papers when I come home. I don't think I'm cut out for elementary, but I'm hanging in there...

Unfortunately, I seem to have picked up another bug of some sort. I started getting an ugly headache last night, and it's lasted into today and this evening. Also, this morning I woke up with a sore throat on one side. Now my whole throat hurts and it's painful to swallow. I have early release on Friday, so I think I'm going to go ahead and make a doctor's appointment for that afternoon. I need to be well for when my family comes to town! Not to mention I need to clean the house before that happens. And finish making all my Christmas presents! (what was I saying about less stress???)

I did have something strange happen the last two days. Yesterday I was sitting at lunch and suddenly got VERY dizzy and light headed. It only lasted about 45 seconds or so. I had to look at a wall and focus to keep from feeling like I was going to throw up, though. Then the same thing, to a lesser degree happened again this afternoon when I was sitting and working on making some puzzles for the kindergarten students... Very strange... I didn't notice anything else unusual, though. So I didn't bother mentioning it to anyone and had actually forgotten about it until just now.

Hee, hee. I bet you didn't expect such a long and involved answer to your simple question, did you?