cardiologist!

[psalmist]

Well, I had my first cardio visit since leaving the hospital. It has been two weeks from surgery. I went in expecting to have a pretty thorough exam but left with a quick look over. I was seen first by the cardio's assistant. He asked if i had been back to work and then stopped and I told him it was only two weeks ago since my surgery. He listened to my lungs and heart and asked how I felt. He then said, that the cardiologist would be in to see me even though there wasn't any reason for him to see me. A few moments later the cardio came in and asked how I felt. Listened to my lungs and heart. Looked at my incision and said wow it looks good. he then asked if I had an echo before i left the Mayo. I said yes and they said every thing looked good. He said, good, i only do one echo a year so that would be one for this year. . . . well, I will go ahead and see you in six months. I am glad you are doing o.k. thank you. This cardiologist will also be managing my coumadin. He has nurses who do coumadin only. I am part of a study with the Mayo clinic that consist of Home testing. They gave me an INRatio machine and I am supposed to test every Tuesday and call in my results. It supposed to prove the benefits of home testing. When I test the study group sends my results to my coumadin managers office. They sent these result to my cardiologist office and they had a fit! They complained because they weren't managing my coumadin. Of course not, I didn't meet them until today. I had to explain that it was just a study group and it doesn't affect their management of my coumadin. Well we use coagucheck and that is a INRatio machine and we don't recognize it. To say the least they did not like the idea of me home testing. It took alot of explaining. Sorry that this is so long but I wanted to get some of your opinions on this. My INR was also high, 4.5, and she told me to hold tonight and come back in friday. Any ideas?

 

[Bina]

Hi Seth, it sounds like you are doing GREAT.
At 2 weeks post op I was still in the hospital.....
Don't give in on the home testing, it will become so incredibly helpful to you to be independant and testing whenever you please.
So your INR is 4.5, that is not really very high.
I never hold a dose for anything like that, half a dose may be more reasonable.
You don't want big swings in your dosing. What is your dose?

 

[Ross]

Now that your on Coumadin, we need to know exactly what dose your taking daily and how often they are testing you. For 4.5, I would not hold a dose. I'd take half and continue with the normal schedule. As your activity level increases, your INR will go down. I guess we'll see if your Coumadin managers know what their doing very soon. Most of them don't, so don't be surprised and don't feel torn if we say one thing and they say another. They don't take the drug. We do!

Study this link if you have not done so already:

http://www.aafp.org/afp/990201ap/635.html

 

[Karlynn]

I would have asked them if they have more experts than the Mayo clinic to justify the fact that they don't "recognize" the INRatio.

Ross is right - many so-called Coumadin managers don't know how to manage their way out of a paper bag. I hate to say this, but the fact that they told you to hold a dose for a 4.5 doesn't give me a lot of hope that they know what they're doing. I agree that a half a dose tonight and resuming regular dosing tomorrow is probably the way to go. They want you to come in on Friday, but a held dose tonight will not give them the full picture of what it did until Saturday.

Ross is also correct in that it will be very helpful if you tell us what your dosing schedule is and what your target range is.

Your best bet is to study the link Ross provided, keep your own charts of INR and dose and start learning how your body reacts to dosing. You'll pick up on it quickly enough.

Keep in mind that most of the people they manage are probably older and don't want to learn the ins and outs of their own Coumadin use - they just want to be told what to do. Some of these clinics don't react well to people who actually want to have a say in what is done.

Home testing and self-dosing with Coumadin is no different than a diabetic that does their own testing and dosing - and most diabetics do. At your age there's no reason you can't be trusted with your own testing and dosing with the right education.

And welcome home!! I must have missed that post. I hope you are doing well. And were your fears worse than the actual experience??

 

[psalmist]

Target Range

Target Range

Yes. My mind feels like it's been through something really traumatic,but my body doesn't agree.

My target range is 2.5-3.5; I started out at 7.5 mg but then tested last Thursday at 2.3. They had me to alternate 7.5 and 10 mg until Monday when I tested at 3.4. I was instructed to go back to 7.5 until my doctor's appointment today but mistakenly took 10 mg last night.

What do I say to my manager if I decide to do a half-dose tonight? I'm not sure if I"m ready for that fight.

 

[briansmom]

I wouldn't even tell the manager that you did not listen to her. I also would wait until Saturday to test, especially since you just took 10 mg last night. I would just not show up on Friday. Of course I am more ornery than most. I pretty much nod my head and then go do what I want.

 

[BDMc]

Nice To See Your Post!

Nice To See Your Post!

Seth, Glad the recovery is going well. Cardiologists are notorious for quicky exams. so don't be too shocked by your experience. As for the person in his office, that is the typical ignorance that is so sadly dominant in the medical world! You may try to diplomatically educate her, and try to enlist one of your doctors to help, or change doctors. You'll get much more knowledgeable info here than you will from a nurse in most coumadin clinics. The other option, would be to not tell her you took half tonight, and let her think you are following her dosing, just go on following the advice of those that know from experience, and report your results to her. In some cases the ignorant are less trouble if we don't try to educate them. Keep us posted, Brian

 

[ALCapshaw2]

Greetings Seth -

I'm glad to see you came through your surgery in good shape. FWIW, I cast my vote for HALF a Dose also, and second all that Karlynn said about self education.

One of the Best Sources of Information on Managing Coumadin / Warfarin is AL Lodwick's Website www.warfarinfo.com

If you read that over a couple of times, you will probably know more than most Coumadin Managers, at least the ones who only handle a few patients.

The CRNP's (Certified Registered Nurse Practicioneers) at my Coumadin Clinic see over 150 patients a DAY, 5 days a week. They seem to know their stuff. A nurse in a Doctor's Office doesn't hold a candle to that kind of experience.

Someone once posted a curve that showed Bleeding Events rising ABOVE 5.0 and Stroke Risks rising BELOW 2.0.

Bottom Line: For patients under age 70, the SAFE Region seems to be from 2.0 to 5.0 so I see NO reason to Hold a Dose for anything under 5.0

'AL Capshaw'

 

[Ross]

Yes. My mind feels like it's been through something really traumatic,but my body doesn't agree.

My target range is 2.5-3.5; I started out at 7.5 mg but then tested last Thursday at 2.3. They had me to alternate 7.5 and 10 mg until Monday when I tested at 3.4. I was instructed to go back to 7.5 until my doctor's appointment today but mistakenly took 10 mg last night.

What do I say to my manager if I decide to do a half-dose tonight? I'm not sure if I"m ready for that fight.

If you mistakenly took 10 last night, then maybe go ahead and skip one dose. Your going to be high anyhow. How long have they had you on the 7.5 dose? I'm thinking that's going to be your sweet spot.

 

[donnamarie]

Seth, Glad the recovery is going well. Cardiologists are notorious for quicky exams. so don't be too shocked by your experience. As for the person in his office, that is the typical ignorance that is so sadly dominant in the medical world! You may try to diplomatically educate her, and try to enlist one of your doctors to help, or change doctors. You'll get much more knowledgeable info here than you will from a nurse in most coumadin clinics. The other option, would be to not tell her you took half tonight, and let her think you are following her dosing, just go on following the advice of those that know from experience, and report your results to her. In some cases the ignorant are less trouble if we don't try to educate them. Keep us posted, Brian

I think I would find a cardio that I could get along better with, not one I had to hide information from or do my own thing. there are lots of doctors out there - I would want to find one that I had confidence in.