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Guest
I can't break out the data to study this, but I think that the biggest lifestyle changes after vacations, is having house guests. I hear so many people say, "Well I got out of my routine because my ... and family were staying at my house."
Routine is the key to warfarin management. Yet, we all need some variety or life gets pretty dull.
The bottom line is that few people are harmed by an INR that gets elevated, maybe even to as high as 8, as long as they do not stay there for very long. Serious bleeding (requiring 2 units of blood or causing a life-threatening event) almost never occurs at an INR below 5.
One patient that I have has been forced to retire on disability because of lupus. When she first came to the clinic she had a headache which had persisted for 2 months to the point that she vomited if she opened her eyes. She lives alone and is very independent. She hated the fact that her mother had to drive her everywhere that she went. She also had been in the hospital repeatedly for blood clots in her legs. It took us months to get her INR under control but eventually her headache subsided and the vomiting stopped. However, her nose bleeds - a lot. She goes to so many doctors that she keeps a diary. She writes down what you tell her right while she is sitting in the office. In out data gathering we found that she reported 122 nose bleeds. This was 13% of the nosebleeds reported by over 800 patients. However, she has stayed out of the hospital and is happy. She says, "At least I'm the best at something."
I can't imagine tolerating that many nose bleeds, but I guess it is just a matter of putting things in perspective.
Routine is the key to warfarin management. Yet, we all need some variety or life gets pretty dull.
The bottom line is that few people are harmed by an INR that gets elevated, maybe even to as high as 8, as long as they do not stay there for very long. Serious bleeding (requiring 2 units of blood or causing a life-threatening event) almost never occurs at an INR below 5.
One patient that I have has been forced to retire on disability because of lupus. When she first came to the clinic she had a headache which had persisted for 2 months to the point that she vomited if she opened her eyes. She lives alone and is very independent. She hated the fact that her mother had to drive her everywhere that she went. She also had been in the hospital repeatedly for blood clots in her legs. It took us months to get her INR under control but eventually her headache subsided and the vomiting stopped. However, her nose bleeds - a lot. She goes to so many doctors that she keeps a diary. She writes down what you tell her right while she is sitting in the office. In out data gathering we found that she reported 122 nose bleeds. This was 13% of the nosebleeds reported by over 800 patients. However, she has stayed out of the hospital and is happy. She says, "At least I'm the best at something."
I can't imagine tolerating that many nose bleeds, but I guess it is just a matter of putting things in perspective.
