any thoughts on this?

[jax]

okay so when my inr was down to 1.3 the doc had me double up twice. it went up to 1.7 in four days. they had me wait a week before going back to get it checked after doubling three doses that week. Well after all that i went back to get it checked yesterday and it is up to 2.03. The doc told me again to wait two weeks to get it checked and to take my regular dose of 4mg of coumadin until that time. i questioned the nurse twice on it because it just didn't seem right, since i will be taking a lower dose than what i was just to get it up to 2.03. They said that they don't want it going up too fast and that's why they want me on my normal dose. but now i have a funny feeling that after going back on my normal 4mg/day and waiting another two weeks that when i do go back in two weeks that my inr will be right back down again.

Does anyone have any thoughts on this. My doctor is leaving july 24th and a new doctor will be taking over my coumadin control. i guess i can only hope that she knows what she is doing a little better than this one does. because i don't want to stay on a roller coaster going from high to low because they are waiting too long to test.

 

[Bina]

I don't remember if you are on any other meds that will affect your INR.......are you working with 4mg pills only?

 

[KristyW]

Jax.

You are only 6-7 weeks out of surgery, right? You're INR went down to 1.3 while you were on your regular 4mg/day dose four weeks out of surgery? The Doc had you double 2 doses and you got to 1.7 at 4 weeks out, then they had you double three doses and you're only up to 2.03?

Hmmm...4 x 7 - 28mg/week = 1.3 INR
4,8,4,4,8,4,4 = 36mg/week = 1.7 INR = 29% Increase
4,8,4,8,4,8,4 = 40mg/week -= 2.03 INR = 12% Increase from prior week

And now they want you to go back to 4mg/day = 28mg/week?

If that's the case...they don't know what the hell they're doing!

You are going to continue to get more and more active, this alone will bring your INR down some (which is why you got the 1.3 to begin with).

I'm not a medical professional, but maybe you need to put it like I have it above...weekly dose = INR and ask again.

 

[jax]

i take nexium for gerd, still on 2.5 mg of linisopril, centrum multivitamin and my coumadin other than that i am not on anything else bina.

Kristy you make a whole lot of sense maybe when i go for my physical on friday i will have it written down and talk to her as i was going to ask her about it anyway it would help to have it written down that way she can tell me exactly why she knocked me right back down to 4 mg a day because it just doesn't make any sense to me. maybe my new doc will approve me for a coaguchek but i'll have to wait until i can see her after the 24th. all i know is i am going to be very upset when i go back in 2 weeks and i am right back where i started.

 

[Bina]

You need to be tested in another week.....!!!!
Your INR of 2.3 could drop and that would not be good, especially so early after your surgery.
If you are working with only 4 mg pills, try not to double dose.
By splitting some pills in half, you could take 6mg alternating with 4mg for a more even distribution.
Also, if your vitamins have vitamin K in them make sure to take it every day, avoid missing a day.

 

[jax]

thanks bina. i knew yesterday that the way the doc wanted to drop me down to 4 mg again just wasn't right. my centrum does have vitamin k in it and have not missed any doses. would it be better if i take that in the morning with my nexium and linisopril. as of right now i am taking it in the afternoon with my coumadin.

 

[Bina]

I don't think it matters when you take the vitamin, do whatever works for you.

 

[ALCapshaw2]

I would call back and INSIST that you be tested in No More than 1 Week. It might even make sense to be tested this Friday. I'm with you. It sounds like this Doc doesn't really know what s/he's doing. Is this your PCP or your Cardiologist?

If you are being managed by your PCP, then you may want to pass this through your Cardiologist and ask for his opinion / recommendation.

It sounds like the Sooner you can get on Home Testing, the Better for You!

You should also check your MultiVitamin to see if it contains Vitamin K which counteracts Coumadin. You can take Vitamin K (in moderate amounts) BUT you must remain Consistent in the amount so that your Coumadin can be adjusted accordingly.

'AL Capshaw'

 

[jax]

i have been fairly consistent throughout with my vitamin k. my vitamin has 13 % of daily recommended dosage and i haven't missed a dose. also have been consistent with my diet to make sure that i am getting roughly the same vitamin k per week.

it is my pcp unfortunately my cardiologist has moved back to ireland now and other people in his department have taken over the patients he had. when my inr was at 1.3 he was concerned she wanted to wait a week and insisted that i go back in the monday after i saw him which was on a friday and that was 4 days after i had it tested. that is when i went up to 1.7. but as far as what she told me to do he wasn't too concerned about that. i'm just not having any luck keeping doctors right now. i can call cleveland clinic and i am sure that one of the cardiologist's in his department will get back to me.

hopefully my new doc will have no problem with me getting a coaguchek. although who knows whether she will allow myself to self-dose. or atleast be better at dosing than my current pcp. as it was i had to stop in the doctor's office before they closed just to get my results and then they still had to call the hospital for my results as they still hadn't gotten them. it's getting aggravating for sure especially when i question what the doc says cuz it just doesn't sound right and yet they tell me they don't want it going up too fast but yet they put me right back on the dose that made me drop down as low as 1.3. i could do better than them especially with help from everyone on here.

 

[Ross]

Jax use the INR calculator that I have posted as a sticky at the top of this page. These people obviously do not know what to do or how to do it properly.
If Kristys on the money with your dosing, this should be your new dose, not 4mg daily.

 

[BigOwl]

I'm glad Ross posted the reminder about the dose calculator--it's really helpful in figuring out the ups and downs.

Jax, even if your multivitamin has a substantial amount of K in it, you're presumably taking it every day--can't get more consistent than that. What might change is the amount of green veg you ingest day to day, and the amount of exercise you're getting. Make sure your new doc has a good profile of your activities and your diet. You might want to show her the calculator, too. My clinic folks were really impressed by it--and it concurred completely with what they were doing.

All that said, it took me a couple of months to get stable, so don't be surprised if you're up and down (or down and up) for a bit.

 

[terodac]

I was on a roller coaster for a good year after my surgery, now almost three years later I do ok. I have my own machine now and my target is 3.0-3.5 I have been at 3.9 for the last month but have adjusted it by taking 7.5 for two days it fell to 3.0. My normal dose is 10mg. Order that chart as well it is very helpful, I also have a NP that thinks she is at the top of her class on INR. Not!

 

[Ross]

my target is 3.0-3.5

Good luck! If you can keep your INR in that range, your a better person then anyone here. Whoever said 3.0 to 3.5 doesn't know how Coumadin works. Be happy with anything between 2.0 and 4.0.

 

[jax]

thanks ross for the calculator i hadit bookmarked but my numbers came out a little different but i did it by day not by the week. i am definitely bringing it up on friday when i go see her. i don't especially mind if is above two i just know it's going to go back down. and i don't mind being on a roller coaster if i somehow feel that my doc knows what she is doing but it is just obvious that she does not have a clue.

 

[Ross]

thanks ross for the calculator i hadit bookmarked but my numbers came out a little different but i did it by day not by the week. i am definitely bringing it up on friday when i go see her. i don't especially mind if is above two i just know it's going to go back down. and i don't mind being on a roller coaster if i somehow feel that my doc knows what she is doing but it is just obvious that she does not have a clue.

INR is a roller coaster even when your doing everything perfect, but the huge hills become little when you know what your doing. In other words, there won't be huge swings and your right, this person is not even following guidelines, so they can't possibly know what they are doing. If they want to argue with the calculator, ask them to show you their dosing algorithm. Bet they don't have one other then the numbers they pull out of their head.

 

[jax]

well i was at the doctor's office today and i brought up the question of her wanting me on 4 mg. and what it boils down to is she wanted me to stay the same as last week but the nurse even though i questioned her about it twice before i left the office said to take your regular dose. so now i have to double today and sunday and will still be short by 4 mg. then next week i am going to split the pills and take 6 per day like the calculator said. i am glad i got that cleared up.

I also mentioned to the doc about home testing and she had no problem writing me a prescription for the home monitor and just said that don't go crazy testing yourself. yesterday i had gone on to QAS website and printed the details on the monitor and have someone calling me on tuesday. hopefully they can talk to the insurance company and get it approved. i'm sure it has to be cheaper than them having to always paying for me to go get tested at the hospital.