Coumadin Emergency? Please read and help asap!

[JeannieF]

I am posting on the off chance that someone might see this in the next few minutes and have some advice...I have just discovered that I totally screwed up my coumadin dosing (yes, I feel like an idiot). I am a frazzled mom of twins and somewhat new to the coumadin thing, not that this excuses my stupidity in any way. In any event, I went to get my INR checked last Thurs and it was 3.0...this was after it was low the week before and I had to add a couple extra 5 mgs to the normal 7.5 that I take. Doc then said that we would go to 9.5 each day and gave me some 4 mgs to CUT and take with my 7.5. Somehow I forgot about the cutting and have been taking the whole 4mg with my 7.5 for an entire week. Mind you I have been feeling awful this week, which I thought was from a virus, but now I am freaking out thinking that the dizziness, inability to concentrate and wierd chest discomfort that I have been feeling is because of something (like bleeding) going on internally. I am one step away from going to the ER but I don't know if I am over reacting. I guess my question is this: is essentially taking 14 mgs too much in one week enough to put me into a super high INR danger zone when I was already a little high to begin with (3.0). I have already eaten a whole bunch of broccoli tonight but I am not sure if this will help if I have put myself in danger. I have 2 young kids, so I don't want to spend the whole night in the ER if it is unwarranted but I am really scared. Please help if you can.

 

[Lionheart]

Jeannie

I don't know the answer but I think you should call your cardiologist or primary care physician right now and have the answering service connect you to your doctor or the doctor on call. That is call whoever manages your coumadin dosage and tell them what happened. You need some reassurance from someone with technical expertise, don't be apologetic, mistakes happen.
I think it may require that you have your INR tested at the ER to really understand the effect of the extra dosage.

John

 

[JeannieF]

Thank you very much for your solid and rational advice. I just called him and he told me not to panic and to just take less of a dose tomorrow and Sunday. Then I will go in on Monday and get my INR checked. Feel better now but still feel stupid and a little worried...I keep reading all about people who have bled out on coumadin and I am really paranoid about it.

 

[Lionheart]

Jeannie,
No problem, I'm glad you called them. It is good to have some reassurance from your doctor based on his knowledge and experience.

I encourage you not to feel stupid, rather figure out a way to track your conversations with you MD better. It has always amazed me that doctors don't provide us with a printed reminder note with all the instructions they give us during a visit. It's a lot to remember. I usually take a little notepad and furiously write down what my cardio or coumadin clinic nurse says during a visit.

It's late here so I'm going to sign off and get some sleep. I see that you are still on line too and it is really late back there in NY. Get a good night's sleep and don't worry.

Take care,
John

 

[zipper2]

Well i'm certainly happy we are human and
theres someone else normal as i am to take
too much coumadin...I feel so much better now
if i don't miss i double on occasion and been 16
years for me on this stuff. Im glad you called
your dr. to clarify and you can get some rest
and not be so hard on yourself,about it.
and just wanted to say hello,welcome

zipper2 (DEB)

 

[ALCapshaw2]

Your concern is understandable Jeannie.

On the other hand, IF you were "bleeding out" I think you would know it. IF you find yourself bleeding profusely, call 911 and get to an ER ASAP.

I'm wondering where you read about patients "bleeding out"?
Certainly NOT on VR.com (at least I don't recall any such reports).

And don't forget the famous VR saying:
"It's easier to replace Blood Cells than Brain Cells".

SO, How can you avoid making a similar mistake in the future?

First, do you have a 7 day pill box? If not, that is a great help in getting your daily doses set out in advance (hopefully during a low stress time) with your written weekly doses as a guide.

Second, your anxiety would be GREATLY relieved if you had a Home Test Unit. You may want to consider this option and discuss it with your PCP or Cardiologist. You will need an Rx and a statement of medical necessity to file for insurance coverage which may or may not be another battle to wage. QAS has a lot of experience dealing with insurance companies.

In the meantime, try to relax while keeping an eye out for 'symptoms'.

Best wishes.

'AL Capshaw'

 

[SHEEPDOG]

Thanks for the sanity!

Thanks for the sanity!

I am glad Al beat me to the topic of his post. I was wondering the same thing. Yes, there CAN be risks. Life is risky. But if I have 3 doctors and an ACT nurse telling me there is NO reason I couldn't continue with being a POLICE OFFICER while on the stuff, I think the risks are no more than driving in ATLANTA traffic or flying, or heck, going to an amusement park.

I understand being new, frazzled and nervous, but read a bunch, ask questions and learn all you can. That will add some calm when you have a very understandable OOPS moment.

 

[sue943]

If it helps at all, my INR hit 8.9 once and I am alive to tell the tale. What I did get are pinpoint red spots on my arms and chest, that was as near as I got to bleeding.

I am not saying that is it always completely safe to get this high, obviously, just saying that it can be survivable with no after effects.

 

[Ross]

I am glad Al beat me to the topic of his post. I was wondering the same thing. Yes, there CAN be risks. Life is risky. But if I have 3 doctors and an ACT nurse telling me there is NO reason I couldn't continue with being a POLICE OFFICER while on the stuff, I think the risks are no more than driving in ATLANTA traffic or flying, or heck, going to an amusement park.

You just wait mister copper, my boys will take care of you in a darkened alley and then you'll see.

 

[Bina]

Jeannie, I hope you were able to relax and get some sleep.
I know you are very busy with the girls, but if you like,
take a minute next week to update us.

 

[catwoman]

SO, How can you avoid making a similar mistake in the future?

Get a "Coumadin diary" booklet from your doctor's office -- or download one from the internet. Or just buy a small purse-sized calendar and record your dosage each day and your INR test results. Note when your doctor changes your dosage, when you start/stop any Rxes or are ill (diarrhea, fever, things that can affect your INR) or start a low-fat diet or increase/decrease your current activity level.

Even though your doctor's office is recording your INR results, you too need to be keeping a record of these and your dosages.

This will help you to understand what affects your INR (Rxes, illness, diet/exercise changes) so that anticoagulation therapy isn't a mystery anymore.

 

[EVELYN]

Hi Jeannie
Don't get crazy....I would enjoy the weekend eating all the veges you like and go first thing Monday and get your INR checked. What is your target range anyway? If you can, it's well worth it to invest in your own home monitor.....that way you can check whenever it's necessary or you think you're out of range. Remember, we're all human and things happen....don't get crazy over it....it will work out.

Evelyn

 

[JeannieF]

I am totally with you on the at home testing...my doctor has flat out told me no to writing a prescription for the at home tester. I suspect that this has quite a bit to do with the fact that he is affiliated with a giant cardiology group (basically the only gig in town) that has a coumadin clinic that charges a $20 co-pay every time that I go, which is at least 3 times/month these days. If you have any suggestions as to how to "force his hand" on this, so to speak, let me know.

 

[JeannieF]

Very good to know...funny that nobody at the MD's office has ever told me how high "high" is....so last night I was thinking that I was probably in the 5 range and not knowing if that would be the kind of INR that would get you into big trouble or not. Thanks for your post!

 

[JeannieF]

Thanks, Evelyn...I did just that...had a GIANT bowl of broccoli (yum!) this afternoon, some guacamole as a snack and a great dinner of chicken topped with spinach. All some of my favorites, which obviously can't be enjoyed all that much as of late. Will go on Monday to get checked out and hopefully won't be too high by then.

 

[Freddie]

Hey there Jeannie, you know you can always enjoy your broccoli, guacamole and spinach everyday of the week? You just have to be consistent with these foods.

 

[Roger Frank]

I am totally with you on the at home testing...my doctor has flat out told me no to writing a prescription for the at home tester. I suspect that this has quite a bit to do with the fact that he is affiliated with a giant cardiology group (basically the only gig in town) that has a coumadin clinic that charges a $20 co-pay every time that I go, which is at least 3 times/month these days. If you have any suggestions as to how to "force his hand" on this, so to speak, let me know.

My doctor was the same way and I suspect for the very same reasons. (que Dave Ramsey voice) While I don't advocate the use of plastic, I did pull out the old credit card and bought one for my self. The test is not rocket science and I feel like a tether's been removed from my neck!

 

[Ross]

Thanks, Evelyn...I did just that...had a GIANT bowl of broccoli (yum!) this afternoon, some guacamole as a snack and a great dinner of chicken topped with spinach. All some of my favorites, which obviously can't be enjoyed all that much as of late. Will go on Monday to get checked out and hopefully won't be too high by then.

Why can't they be enjoyed? Are you falling for more disinformation from the so called Coumadin Prophets? Eat whatever you like and as much of it as you like, just try to be consistent daily and adjust the dose of Coumadin to that diet. Don't be depriving yourself of foods because some moron said to avoid vit k containing foods.

 

[ALCapshaw2]

I am totally with you on the at home testing...my doctor has flat out told me no to writing a prescription for the at home tester. I suspect that this has quite a bit to do with the fact that he is affiliated with a giant cardiology group (basically the only gig in town) that has a coumadin clinic that charges a $20 co-pay every time that I go, which is at least 3 times/month these days. If you have any suggestions as to how to "force his hand" on this, so to speak, let me know.

If your Cardiologist won't write you a prescription for a Home Testing Instrument, you can always ask your Primary Care Physician. You may want to contact QAS first and get their "information package" to give to your PCP to evaluate.

Good Luck !

'AL Capshaw'

 

[netmiff]

My doctor was the same way and I suspect for the very same reasons. (que Dave Ramsey voice) While I don't advocate the use of plastic, I did pull out the old credit card and bought one for my self. The test is not rocket science and I feel like a tether's been removed from my neck!

This is the kind of situation they made plastic for