Another roller coaster

[Rich]

I havn't posted for a while, because I'm still trying to get to the bottom(no pun intended) of the little internal problem I have been suffering with that I talked about some weeks back.
Trying to get to the source of this I stopped taking Nexium on April 9th.
Because Nexium had a very strong effect on my INR, now I'm back on the old roller coaster. Currently I take 5mg on MWF and 2.5 the other four days, for a total of 25mg/week.My range is 2.5 to 3.5.
April 14th INR 2.6
April 22nd INR 2.4
May 8th INR 2.4
May 15th INR 2.1 Too low for my comfort zone so I upped my weekly dosage by 2.5mg
May 27th INR 3.6 Cardio is upset and says hold one day, then go back to my original schedule described above.
June 3rd INR 2.0 !!
He says keep everything the same and test again in a week.
I don't agree, what do you guys think?
I plan to speak with him personally tommorow instead of the staff.
He gets a little upset if I make my own adjustments, but as many of you know, we are the only ones who fully understand our diet, activity level, etc.
No doctor can keep track of that on a daily basis.
In the meantime I will go see my second gastro specialist for another visit on Thursday. Hope he has more ideas because nothing either guy came up with has worked yet.
After three and a half months it is definitely getting real old, real fast.
This story refers to my post some weeks ago called 'not heart related but'.
Rich

 

[dick0236]

I agree with what you did by bumping it 2.5mg. If they want you between 2.5-3.5, your numbers indicate a small increase to get you to +/- 3 is in order.

I just had almost the same situation with my INR trending down below 2.5. Probably due to increased activity (golf). SUGGESTED to my PCP that we bump me up 2.5mg per week (35 to 37.5) to get up to 3. He concurred. It helps that I have been on warfarin since he was in diapers.

 

[Rich]

Thanks Dick,
Because I knew my INR would drop when I stopped the Nexium, I purposely have avoided just about anything with vit K.
I think my plan will be to convince him of my proposal for a ten percent increase and also go back on a regular diet at the same time. This would include salads, cole slaw, etc.
I believe that would keep me in range with no problem.
I've only been doing this for close to twelve years now, so I certainly don't have all your experience, but I sure have learned a lot both on my own and from the great people on this site.
Rich

 

[Ross]

I don't know that a 10% increase will be needed with your normal diet, but hey, I don't know how you eat either. The rest seems right on to me.

 

[JimL]

Hi Rich, I stopped nexium a week ago, which didn't show up on last Thursday's test at all, but tomorrow may well be different. I had increased my weekly dosage 1 mg in anticipation of the effect stopping nexium would have, and had an INR last week of 3.9. My coumadin nurse wouldn't say I was perfect, like she usually does, sweet girl, but I didn't change my dosage at all. I'm really wet behind the years with only 6.5 years experience at this stuff.

 

[Bina]

Hi Rich, when you had the INR of 3.6 it was really not necessary to hold a dose; that caused the sudden drop.

 

[ALCapshaw2]

Hmmm... I was not aware of the interaction with Nexium.

I take the Generic Form of Prilosec for reasons of COST.

When my INR creeps up or down, my CRNP's and I have a discussion whether to change my Weekly Dose by 1 mg or 2 mg. Bottom Line: For ME, very SMALL changes pull me back in range.

One kind Nurse gave me a bottle of 1 mg tablets to 'make adjustments' with and / or use as 'backup' if/when I ran low on tablets.

FWIW, I also use 3 and 4 mg tablets, which allows me to change from 21 to 28 mg/week using only ONE Tablet per day simply by changing the weekly allocation in my 7 day pill box. That also minimizes my day-to-day variation (i.e. only 1 mg difference day to day) and costs the SAME as having only ONE dose tablet.

'AL Capshaw'

 

[ALCapshaw2]

Rich -

Do you have a copy of AL Lodwick's "Dosing Guide"?
If NOT, GET ONE ! It's only $5 and can be ordered from his website www.warfarinfo.com

Holding a dose for an INR of 3.6 means that your Doctor needs a Refresher Course in AntiCoagulation Management. (I'm being kind!) Most of us on this site would simply retest in a week to make sure your INR didn't continue to rise.

NO ONE on this site would hold for an INR under 4.0 and many (most?) of us would only go to 1/2 dose, and then probably not until an INR of 5.0

'AL Capshaw'

 

[Rich]

Thanks all,
I called my doctor's office this morning and told them to make sure he had ALL the facts.
They called a short time ago and he agreed with me. I will up my weekly dosage by our ten percent rule which in my case will add 2.5mg to my weekly dosage.
Jim I hope you get back on track as well, Nexium can have a very strong effect on one's INR. From now on I will use it if neccesary but only for the recommended time.
Bina I agree with my range being 2.5 to 3.5, a reading of 3.6 was no reason to hold.
Ross I'm just a regular meat and potatoes kind of guy. I know in today's world I won't get any sympathy, but I have tried to gain weight just about my entire life with no success. My weight has not varied more than two pounds one way or the other for over thirty years, no matter what or how much I eat, so I told my wife bring on the meatloaf!
Al I don't have Al's guide though he and I have 'talked' a number of times over the years.
Are you suggesting I buy it for me or some of the stupid doctors?

 

[hensylee]

glad for you, Rich. You did know best after all, didn't you? I read it this morning but didn't have anything to add, but wanted you to know I was thinking of you and hoping for the best for you. Blessins.........

 

[Rich]

Thanks so much Ann,
Rich

 

[tommy]

If you avoid Vit K for a while to counter the Nexium withdrawal, you'll be due for another change down the road when you resume regular Vit K. It's these types of changes that perpetuate the roller coaster (and knee-jerk dosage changes). As Ross has always said .............. Live and eat the way you want and adjust the dose. It may mean that you test more often for a while, but with patience, you can safely migrate to the new dose.

I'm on your dose +- 10% with change in exercise habits. My clinic bounced me around 7 years ago by over reacting. When I get slightly out of range, they have me test weekly, but not change the dose unless it goes nuts. Even then we ease back to the same dose eventually.

Best wishes!