Creeping Up

[Cooker]

Question......what is a low dose? I know the right dose is what ever is right for you and I have been stable for the past two years at 35mg/week but I have crept up (4.5) and it is slow to come down....now mind you I am not apposed to being on the high side but just curious.....does it creep up with age? Everything else has been very consistent.....Also, where does the bleed threat come in?

 

[Bina]

Hey chimp, at INR 4.5 you are still fine, but if I was there consistently I would tweak the Coumadin up a bit, or start enjoying more spinach salads.
If you are using 5mg pills maybe add a half pill (2.5mg) one day a week.
Yesterday my INR was 2,8 and I still had some spinach pizza, since I skipped salads this week. No big deal.

 

[Karlynn]

For some reason, many of us tend to run a little high in the summer on the same dose that keeps us in range in cooler weather.

 

[Cooker]

Thanks....a few more spinach salads ought to do the trick

 

[njean]

I too find that my INR is usually higher during the summer months as Karlynn mentioned Cooker. Perhaps our level of activity is at a peak then; it seems to work that way with me & has for the past 33 years that I've been on coumadin!

So like Bina said, eat more (leaves), I mean salads!

 

[Cooker]

I too find that my INR is usually higher during the summer months as Karlynn mentioned Cooker. Perhaps our level of activity is at a peak then; it seems to work that way with me & has for the past 33 years that I've been on coumadin!

So like Bina said, eat more (leaves), I mean salads!

HAHAHAHAHA.....Back to your old self

 

[Jkm7]

I too find that my INR is usually higher during the summer months as Karlynn mentioned Cooker. Perhaps our level of activity is at a peak then; it seems to work that way with me & has for the past 33 years that I've been on coumadin!

So like Bina said, eat more (leaves), I mean salads!

I'm confused. Isn't more activity likely to lower INR rather than raise it? Or do I have it backwards?

Thanks.

 

[njean]

I'm confused. Isn't more activity likely to lower INR rather than raise it? Or do I have it backwards?

Thanks.

No, you don't have it backwards. This too is what I was told by one or two of my cardios in the past. This is the "NORM" & what supposedly most patients will notice when their activity increases --- they will most likely see a drop on their INR.

With me, however, it has always worked the opposite but then nothing in my life has ever really been the "NORM". I am the odd ball & whenever my activity increases I tend to require less coumadin which happens to me during the summer months. During the winter months, I require a higher dose because my INR drops! So go figure......

 

[dick0236]

Last summer my INR dropped into the 2.5 range on 35mg per wk. This summer my INR has held at 3+ on 35mg per week. Nothing in my life has changed. I don't try to second guess what affects INR, except for the obvious, anymore. I watch my trend and make minor changes when my INR shows a several test trend, either up or down. In my case, age has been a factor in INR change. As a young man I started on about 70-75 mg/wk. That has declined linearly(sp?) over time to the current 35mg and is now showing a trend down to a lower dose.

ps: I figured out how to include my photo in my avator. I don't know what I did, or how I did it, but it worked...as an old man from the pre-computer generation I am really proud of myself

 

[njean]

Way to go Dick --- like your picture (what's that you're holding??)

And who said, "you can't teach ole dogs new tricks!"

 

[ShezaGirlie]

Hey there Dick.......is that a Kentucky fried chicken you're holding?!?!

So as to not hijack Cooker's thread -- In almost nine years now I haven't found what affects my INR one way or the other besides these hot Texas summers when it will take a nosedive. I started out on 10mg/daily and just this year went to 8mg/daily which seems to work for me since I'm getting old.

We love to be out on the lake, but my INR was low a couple of weekends ago, so we didn't go..

 

[dick0236]

Cooker, I just noticed your second question. I am not sure if or when the "bleed threat" comes into play. My clotting time has not changed so far. I suspect that other conditions of old age also have to come into play for bleeding problems to increase.

Hey, I don't want to hijack the thread but it looks like I am holding a big sandwich. It really is a young green sea turtle taken at a preserve/farm in the Caribbean.

 

[Marty]

Cooker, I think over 5 is a bleed threat. Most authorities would advise lowering weekly dose at 4.5 by 10% and then retest weekly till you stabilize. This is the advantage of home testing. I seem to do this about twice a year now. I have no idea what causes the change.

 

[ALCapshaw2]

Also, where does the bleed threat come in?

The Medicare Memo which outlined their approval for Home Testing of INR had an interesting paragraph about Bleeding Risk.

As I recall, they stated that the Bleeding Risk for an INR of 4.0 is about 2X the Bleeding Risk at an INR of 3.0

The Bleeding Risk at an INR of 6.0 was considerably greater but I forgot the exact number (it was a single digit). If I find my copy of that memo, I'll update this post.

FWIW, I have a hard time accepting the notion that at certain ranges, nothing happens, then at other ranges, BANG there is a Large Risk or Change or 'Event'. For INR prefer to think that the changes are some sort of a "Continuous" Function (which may or may not be linear). For Bleeding, I guess that is more of an ON or OFF situation.

Years ago (OK, decades) my Department Head had a sign in his office that read:

"The World is ANALOG". The Digital Folks are certainly trying their best to prove that theory wrong! OK, enough of this digression.

'AL Capshaw'

 

[witzkeyman]

spinach pizza sounds good. next time my INR is high and over therapeutic range, I'll look for some.