does this sound right?

[Lynlw]

I don't know alot about coumaden, but this was on another board i am on and (that earlier today i mentione good place to learn about home testing is here) she is really new at this, but I'm not sure if this sounds like the best plan, if it isn't I'll email her and ask her to please come here


--------------------------------------------------------------------------------

Well, test #2 proved to be too much... I am now off coumadin for 4 days, then will have one 2mg tablet starting again on Monday; then test Tuesday. This isn't going to be an easy thing - is it...

 

[Ross]

NO That is completely wrong! Holding for 4 days will have her completely bottomed out. We need to speak to her and get more information as to her dosing and such. Can't tell you how to fix it until I know how it's broken.

 

[Lynlw]

thanks Ross

thanks Ross

that's what I thought , I just sent her a PM asking her to come here.

She has had a rough time w/ her heart lately, she lives in Alaska and went to both cal and i think chicago for her repair. and had post op problems
a week or so ago she was admitted for blood clots in her lungs and had Afib
and was started on coum and lovenox
here was the post from Monday

Well, after only 3 days of coumadin, I am at the perfect level (2.5). So, I can stop the shots of lovinox (yay), and the dr dropped my dose from 5 mg to 4. I get tested again on Thursday to see how it is going.

I Really hope she comes here. I think she needs you guys, lyn

 

[Ross]

I would assume she is high risk, which would put her range at 2.5 to 3.5. Why on earth would someone tell her to drop the dose just beginning to get in range? They are going to kill her. She needs to find someone that knows what they are doing. If she clots and has afib, I'd rather see her at the high end around 3.5.

Lyn don't get me wrong, I don't know it all, but I know enough to manage my own dosing and what this person is doing to her is wrong.

 

[Lynlw]

I know you guys know probably more than alot of docs, (which is sad and scarey too) Anything i learned I learned here, 'just in case' but the little i do know was sending up all kinds of red flags, thanks, I hope she does join, Lyn

 

[Alaska]

Here is the scoop...

Here is the scoop...

1. Went to ER Thursday night - turned out to be blood clots in lungs; was given a shot of lovenox
2. Started 5 mg coumadin on Friday; continued lovenox.
3. First INR test on Monday - results were 2.5. Stopped lovenox. Dose reduced to 4mg.
4. My range is 2-3
5. Went today for INR test #2; INR results 8.0!
6. Doctor directed stop for 4 days; on Monday take a 2mg tablet & Tuesday test

As you can see - this is all new to me. We have no cardiologist in this town. Pretty frustrating. I am going to order a INRatio Self Test machine so that I can test regularly.

I apologize for the spelling - like I said, I'm a newbie!

 

[geebee]

Welcome Alaska.

Is the only reason you are on coumadin is because of blood clots or do you have a mechanical valve?
In any case, stopping for 4 days is an outrageous direction. Even from an 8.0, you will be down to way below range by the end of 4 days (probably around 1.0 which is a non-coumadin user).
The most I would hold is 2 doses then pick up with 3 or 4mg and retest on Tuesday.
With blood clots in your system, you cannot afford to have your INR too low. I would much rather be at 8.0 than below 2.0 even without clots.

 

[Ross]

I cannot see how it could climb to 8.0 in 4 days. I think the test result is wrong. Holding for 4 days is going to bring you back to coagulated and with your troubles, you don't need that. At most, I would hold maybe two doses and I hesitate at that because I think the test was wrong, and then start the 2mg. It takes 3 days for a dose to show in the test.

For the most part, what he/she is tellling you is correct except to hold for so long. They are afraid of bleeding, we are afraid of clotting and stroking out. Our Manta, You can replace blood cells, you cannot replace brain cells.

If you decide to home test, you'll need a prescription for the machine. All the necessary paperwork can be downloaded from the link below:

http://www.ptinratio.com/patient_how_to_get.asp

I'm under a tornado watch and the storm is on top of me now. I have to get off until it passes. I'll be back to address whatever as soon as possible or someone else can on my behalf.

 

[Alaska]

No mechanical valve. A-fib/flutter & blood clots is my reason...

 

[Ross]

Here is a link to an article that will help you understand more with dosing charts, how to manage low and high INR etc.

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

 

[Georgia]

Hey, Alaska! Glad you dropped by.

You need to go to www.warfarinfo.com - a site written by our resident coumadin expert, Al Lodwick (a pharmacist & runs a coumadin clinic). There's an incredible wealth of information there.

Now - about this holding for 4 days. You inr will fall 50% by holding one day. Guess what happens in 4 days - you'll be back on lovenox (or on a heparin drip if you have more clots). 8 is really high; but 0 is really low. I'll let other experts recommend just what you should do.

You MUST understand that doctors for the most part don't have a clue about managing coumadin. They don't understand how it works, how long it takes to get in the system, or how to dose it. Further, coumadin patients are nothing but trouble for them. YOU have to learn about this quirky treatment and how to manage it.

Many of us spend our lives arguing with our docs or simply not doing what they tell us to. We use the dosing charts on Al's website, and get guidance here.

We all feel that recommending holding 4 days constitutes malpractice - it'll leave you completely un-anticoagulated. Coumadin takes about 3 days to get metabolized; so what on earth is a doctor thinking by taking you off it for 4 days?????

Enough of the soap box. But I'll tell you this - if I hadn't tripped over this website, I'd have been seriously at risk many times due to mismanagement of my coumadin.

 

[Alaska]

Thanks Ross & Gina. I found online a dosing chart and it pretty much said to stop for 2 days too. I think I'll call the doc tomorrow and ask for a new reading just to be sure. I'm thinking she is probably doing the four days because of the weekend and not being able to test.

Ross - good luck with the tornado warning! Yikes...

 

[geebee]

We just finished a horrendous thunderstorm and tornado warning here but all is past now. Hope Ross is OK.

Alaska,
I think redoing the test makes a lot of sense but, even if a second test shows in the 8 range, I would still not hold more than 2 doses. Then take 3 or 4 mg/day until you can test again which I assume would be Tuesday because of the holiday.
Best of luck to you.

 

[Ross]

First round went through pretty uneventful.

How is your diet? What do you eat? Please tell me they haven't told you to stay away from greens and everything containing Vit K.

Friday to Monday 5mg=20mg then dropped to 4mg for Tuesday through Friday=16mg for a total of 36mg for the week. Minus 20% would put you at 29mg for the week with 4mg per day.

2mg X 7 days= 14mg which is more then a 50% drop from where you were.

How soon do you get the test results? Same day?

 

[Alaska]

They gave me a pamphlet of all the vit k foods, and said to either be consistent eating them or stay away. I'm not sure how to be consistent though - how many times can you have broccoli or asparagus? I must say I'm confused. Seemed like the easiest way was to stay away...

 

[Alaska]

Oh, and diet... fairly healthy; not much fast food at all (1 am mo maybe - then it is Subway). Ie: last night - chinese food - chicken, veggies, noodles, rice (ok, not so good); night before - a mexican casserole with gr beef, olives, tom sce, cheese & tortillas; breakfast: cereal; lunch: sandwich; 3 times a week - salad; don't get as much fruit as I should.

I drink a couple glasses of milk a day. I take a multi without vit K.

 

[Alaska]

Yes, I get the results immediately @ the dr office.

 

[Ross]

They gave me a pamphlet of all the vit k foods, and said to either be consistent eating them or stay away. I'm not sure how to be consistent though - how many times can you have broccoli or asparagus? I must say I'm confused. Seemed like the easiest way was to stay away...

Mantra #2 Dose the diet you eat, do not diet the dose of the drug. Eat all you want too and adjust for that diet. I'm anything but consistent. Al refers to me as "Street People" because of poor diets, but I have no troubles keeping in range. I eat lots of broccoli, brussel sprouts, asparagus, salads, spinich you name it.
Diet plays a very small role in INR management, but if your not getting any Vit K, then it can be a problem.

 

[Alaska]

OK - so how do I learn all I need to learn? I noticed the article that you referred to was 1999, anything more current, or is it pretty much status quo?

What do you do when their is no cardiologist in your town (or even close by)?

All this is on a bit of a rush basis - I'm supposed to be getting married in the Caribbean on 6/24. We are planning on being gone for almost a month. I'd like to get this all worked out/figured out before we leave on 6/16. I can take my test kit with me, and hopefully by then will know what I'm doing????

 

[Ross]

That page I posted is pretty much it. Again, visit Al Lodwicks site at www.warfarinfo.com and read as much as you can. He also has a chart to use that he sends out for a $5 donation to his site. It's not rocket science and I don't know why Doctors have such hard time understanding it, but they do. Maybe it's to simple for some of them and they aren't use to something so uncomplicated?

The big thing for you right now, is getting you in range, getting you stable and then making minor adjustments of 10% -/+ over a week to keep you there. Once you have a handle on that, things will smooth out for you. Notice I said over ONE WEEK, not every 3 or 4 days. They need to look at the total you've taken over a weeks time and adjust from there. As is, they'll keep you seesawing.