counter intuitive solutions which follow evidence....

[pellicle]

I normally measure my INR on a Saturday morning. This Sat my reading was 2.4 and I looked at my data and thought "well that's odd, I thought I'd more than likely go up a little more" (based on my other metrics).

Then on Saturday night I went to take my pills and I observed that Friday night had not been taken (expletive omitted) ... so I thought well here's another "opportunity to turn a pain in the arse into an experiment".

So I took my INR on Sunday and it was already down to 1.7

Knowing that I don't want a swing set up from over dosing my warfarin I decided on the following course of action:

* take half of fridays dose on saturday with saturdays dose (done anyway, before reading the INR on Sunday)
* in response to the 1.7 - pick Sunday to sit around sorting out stuff and drinking red wine (which raises INR a little in a short term manner)
* eat a home made Lamb Rogan Josh curry with extra cumin , ginger and tomato paste to further increase INR
* why the hell is that bottle of 2014 McLaren Vale Shiraz not yet empty ... fix that...
* then in preparation for bed time, at 11pm, take 1000mg of paracetamol (which also raises INR by inhibiting losses of warfarin by P450) in preparation for a dull head on monday morning (and the inevitable production meeting, which is anything other than productive)

I'll report my Tuesday AM INR reading (unless I'm in consultation with the Police for strangling particular team members for their inability to stick to production schedules in the production meeting tomorrow)

god I love science

yours Truly

Wild Colonial Boy (well old bugger nowadays)

 

[pellicle]

if this works out well, it may become a template for next weekend ...

 

[Agian]

You could write a book on your experiments with Warfarin.

 

[Agian]

PS Hope you've had a good weekend matey.

 

[LondonAndy]

Looking forward to seeing your Tuesday result! I am all for a little experimenting when needed.

 

[epstns]

I think I'll make some popcorn. . .

I don't normally read the anticoagulation forum, but this one has my interest.

 

[pellicle]

Ok ... being curious (and like why not) I checked INR this morning

1.8 ... so on the climb

and I don't feel bad at all (thus I clearly underestimated the wine requirement)

 

[djacq]

Hey Colonial Boy, You are scaring me. I hope its not too much of the 2014 McLaren Vale Shiraz causing memory loss. Wonder if this is what captured epstns's interest? No, its the science, Im sure. Why are you so low with one dose missing? What are your parameters? Mine are tight at 3.0-3.5. Of course you didn't use testing equipment that was not meant for use with anemias and got a clot on your valve! Not sure of the science behind Lamb Curry Josh Rogan but post the recipe in case my INR drops. Jeez, below 2.0, even before the valve thrombus, I had to use Lovenox. Be careful my friend.

 

[Protimenow]

The problem with experiments where you throw all kinds of things into the mix is that you don't REALLY know which thing (red wine, dose and a half of warfarin, other things) contributed to a change in your INR.

A Duke clinics study that I noted years ago (in defense of criticism for allowing my INR to drop below 2.0) had a protocol to take an extra half dose after missing your regular dose, then retesting.

It's good that you caught your lower than expected INR, and moved to adjust the dosing - not precipitously - but enough to bring it back up in a day or two (or three).

I'm assuming that you only took that extra half dose ONCE. Right?

 

[pellicle]

The problem with experiments where you throw all kinds of things into the mix is that you don't REALLY know which thing (red wine, dose and a half of warfarin, other things) contributed to a change in your INR.

for sure ... but its not that kind of experiment ...

I'm assuming that you only took that extra half dose ONCE. Right?

correct

 

[pellicle]

Hi

...I hope its not too much of the 2014 McLaren Vale Shiraz causing memory loss.

nahh ... normally I don't drink more than 1 or 2 glasses per night ...

Why are you so low with one dose missing?

dunno ... all would be speculation, but it is a notable drop in a short time ... the best answer is that it was on the way down before Saturday and the missed dose simply gave it a shove.

What are your parameters?

my surgeon initially gave me 2.2 ~ 3 ... however I'm usually not worried by a dip over the short term ... and my average is about 2.6. So I'm well within statistically safe zones for my valve type / condition such as identified in GELIA

and of course while I make few dose changes to my regime it underscores why weekly testing is of benefit. Even though 95% of the time I take no action its picked up things in the past as well as being handy to read and 'know' now. Thus no gut wrenching, no times off work to wait at the clinic ...

Not sure of the science behind Lamb Curry Josh Rogan but post the recipe in case my INR drops. Jeez, below 2.0, even before the valve thrombus

will do ...

Either I'll develop problems and die or I'll keep on posting my experiences. Either way will be informative to others.

 

[Protimenow]

Hi


Either I'll develop problems and die or I'll keep on posting my experiences. Either way will be informative to others.

You probably won't be posting your experiences if you die. Of course, you're too careful to let your INR drop out of range for very long.

 

[Agian]

Hm, INR 2.3 this morning. Lab check around 12 showed 2.1. Pretty close. Checked it at home, twice: 2.5 and 2.6.

I don't know what do make of it. Are coaguchek results known to be less than lab draws. This is a learning exercise.

 

[pellicle]

You probably won't be posting your experiences if you .

True
Hopefully someone will post to say I'm dead

 

[epstns]

True
Hopefully someone will post to say I'm dead

I will - if you promise to call me and tell me I need to post.

 

[pellicle]

I will - if you promise to call me and tell me I need to post.

They have phones there?

However good it us to plan these plans are premature

Something like this will probably get me before my heart issues

http://mobile.abc.net.au/news/2016-...ning-car-crash-into-two-motorcyclists/7638084

 

[Protimenow]

My Coaguchek XS was consistently either matching or above the lab results. Some of this relates to the reagents that your lab uses. You can probably have blood draws at the same time - put into two vials - and tested by two different labs, and get two different results. Not all tests are easily reproducible - INR is not like counting blood cells. Different labs use different solutions, so the results may not match from lab to lab.

My personal preference is to have a meter that reports slightly lower than the lab. This way, if my meter tells me that my INR is 2.0, I can be pretty comfortable in the assumption that the lab results would be 2.0 or higher (usually slightly higher).

Yes, repeat tests, same meter, different fingers, within a minute or two of each other, CAN give slightly different results.

Don't read too much into the differences -- INR is a tricky bug to measure. Just staying within your range, and trying to avoid the low end, should be enough to keep safe from clotting.

 

[pellicle]

Wednesday AM Australian time - INR = 2.1

I have just held a steady dose of 7.5mg daily aside from taking the extra dose on Saturday PM when I discovered that I'd missed Fridays

I will now taper my dose to 7.25mg daily and I expect it to flatten out to INR = 2.5 by saturday

 

[Protimenow]

I'm a bit curious about how you get a 7.25 dose. Two 3.5 plus 1/4 of a 1? One 5 mg plus one 2 mg plus 1/4 of a 1? I don't think they make a .5 mg dose that you can split in half. (Of course, I could be wrong about the really low doses)

 

[Protimenow]

I figured out one way - there may be others: 1/2 of a 7.5 mg (3.75 mg) plus a 2.5 (or half of a 5), plus a 1. There are enough different doses available that, if you're clever enough and don't mind taking a handful of pills to get your exact dose, that you can probably get your dose to any quarter number (except, perhaps .25, .75, 1.25 or 1.75). You COULD do those other numbers by quartering a pill or two, but it wouldn't be too exact (not that there isn't a bit of wiggle room allowed, anyway).