Hi everyone,
A few weeks ago I became more of a lurker than a participant here on the boards. I've been following though and am trying to stay abreast of how everyone is doing. I'm glad the surgeries and recoveries sound very successful.
Some of you know that I haven't felt the best for the last several weeks and that hasn't really changed. Last year at this time I was in the hospital with what was diagnosed as a embolus (presumed from my mitral valve) causing transient ischemia resulting in ulcerative colitis. It has never really returned to normal but I actually get along just fine. My suggested range for my INR was increased from the usual 2.5 to 3.5 to a slightly higher 3.0 to 4.0....with an aspirin a day.
Now I find myself in a bit of a predicament. A week or so ago (Dec.26th) I started with gastro-intestinal bleeding. Not a few drops of bright red blood but rather melena. This lasted for about 4 days but is now gone. I know that for that to occur there has to be close to 200cc of blood and that it usually originates in the upper GI tract in the stomach or the duodenum. My usual hemoglobin is above 16 and when checked at my PCPs office it was still at a pretty healthy 13 and my INR was 3.7. I don't know if last year's problems are connected to what is going on now or not.
Several months ago my INR was holding within range on a dose of 7mg per day. I have had to slowly taper my dose since then and then finally stablized at 4mg a day. As you know, vitamin K is produced by healthy bacteria in your gut and the amount of vitamin K present is a very real factor in determining what dose of coumadin will be required. Antibiotics that destroy the healthy bacteria sometimes cause a temporary rise in the INR.
What a delicate balance! We decided it was safe for me to go home since my hemoglobin was so good and since they knew I would return if things began to worsen or failed to improve. I was put on a PREV-PAK which is a collection of pills to treat an upper GI ulcer. It contains two different types of antibiotics and also prevacid. I am seeing my gastroenterologist on the 12th (or sooner if this occurs again). I'm not sure where the real problem is occuring. I was NOT taken off my coumadin but was told to take what amounts to less than a 10% reduction in my weekly dose. I also was taken off aspirin. I expected my INR to actually go higher with the introduction of so many antibiotics but I tested it a little while ago and it was 1.9. I have never had an INR that low.
I am so glad that I home test but have found that coumadin therapy is more complicated when you have digestive track problems. I also found out an interesting tidbit: A hemoglobin of 10 requires twice the cardiac output to nourish the body than a hemoglobin of 16.
I think I'm doing alright but life sure is complex! Sorry that this ended up so long.
A few weeks ago I became more of a lurker than a participant here on the boards. I've been following though and am trying to stay abreast of how everyone is doing. I'm glad the surgeries and recoveries sound very successful.
Some of you know that I haven't felt the best for the last several weeks and that hasn't really changed. Last year at this time I was in the hospital with what was diagnosed as a embolus (presumed from my mitral valve) causing transient ischemia resulting in ulcerative colitis. It has never really returned to normal but I actually get along just fine. My suggested range for my INR was increased from the usual 2.5 to 3.5 to a slightly higher 3.0 to 4.0....with an aspirin a day.
Now I find myself in a bit of a predicament. A week or so ago (Dec.26th) I started with gastro-intestinal bleeding. Not a few drops of bright red blood but rather melena. This lasted for about 4 days but is now gone. I know that for that to occur there has to be close to 200cc of blood and that it usually originates in the upper GI tract in the stomach or the duodenum. My usual hemoglobin is above 16 and when checked at my PCPs office it was still at a pretty healthy 13 and my INR was 3.7. I don't know if last year's problems are connected to what is going on now or not.
Several months ago my INR was holding within range on a dose of 7mg per day. I have had to slowly taper my dose since then and then finally stablized at 4mg a day. As you know, vitamin K is produced by healthy bacteria in your gut and the amount of vitamin K present is a very real factor in determining what dose of coumadin will be required. Antibiotics that destroy the healthy bacteria sometimes cause a temporary rise in the INR.
What a delicate balance! We decided it was safe for me to go home since my hemoglobin was so good and since they knew I would return if things began to worsen or failed to improve. I was put on a PREV-PAK which is a collection of pills to treat an upper GI ulcer. It contains two different types of antibiotics and also prevacid. I am seeing my gastroenterologist on the 12th (or sooner if this occurs again). I'm not sure where the real problem is occuring. I was NOT taken off my coumadin but was told to take what amounts to less than a 10% reduction in my weekly dose. I also was taken off aspirin. I expected my INR to actually go higher with the introduction of so many antibiotics but I tested it a little while ago and it was 1.9. I have never had an INR that low.
I am so glad that I home test but have found that coumadin therapy is more complicated when you have digestive track problems. I also found out an interesting tidbit: A hemoglobin of 10 requires twice the cardiac output to nourish the body than a hemoglobin of 16.
I think I'm doing alright but life sure is complex! Sorry that this ended up so long.
