Dumb question..........

[gijanet]

I guess I jinxed us with our great 2 month post-op checkup post. Katie is sick - been running a low grade fever (100) since 4 AM this morning. I don't believe it is heart-related at all, although her heart rate has gone up a tad, but I think that is due to the fever. I think that she has that miserable bug that I had a couple of weeks ago - headache, low grade fever, diarrhea and upset stomach. That part lasts about 48 hours then it moves into upper respiratory. It almost feels like the flu, just not quite as bad.

Anyway, this is our first real illness on warfarin. I know that illness is supposed to affect our INR, but how? Is it supposed to go up or down? What should I do different - if anything - and is there anything else I should be on the lookout for valve-wise or otherwise? Our INr levels have dropped in recent weeks, down to 2, then 2.4 about ten days ago. We have upped her coumadin slightly and are now doing 2.5, 2.5, 2.0, and repeating that cycle. She was at a straight 2.0 mg when her INr dropped to 2.0. Then we switched to 2 & 2.5 every other day, but that only got her to the 2.4, so we are hoping that the new regimen will keep her in range...........but now this. We are due to have an INr check Monday, but now this illness may throw her out of whack.............sigh! I'm so befuddled..........

Any help or insight would be appreciated. Gina, I just PMed you a few minutes ago in hopes that you might see a new PM......... Katie says she can't have a bug in her tummy because she hasn't eaten any bugs. Well, that's good to know, anyway...............sigh! Thanks much. Janet

 

[Ross]

INR will go down with diarrhea and upset stomach. Depending on how long and how much of the stomach bacteria is expelled is what will determine when the INR will begin to stabilize again. I'd just keep doing what your doing for now. I'd rather risk seeing slightly elevated then way under.

 

[geebee]

Janet,

Sorry I wasn't up - just forgot to log out.

If Katie is losing a lot of fluid, you might even consider upping her coumadin one time just a little to compensate - maybe an extra 1mg or so.

Is she better this morning?

 

[Mary]

Janet,
You know I'm not on coumadin, but I'd err on the high side of an INR, if you can figure out how to do it!
I'm sorry Katie is sick. It's bad enough being sick yourself, but being the momma of a sick one is doubly hard. We have a similar "bug" running rampant in SE Missouri, but so far we've managed to escape it.
Katie is always in my prayers, but I will add a little more emphasis to my requests until she recovers.
Give her a kiss and a hug!
Mary

 

[Ross]

I'd try 2.5 everyday until she gets the necessary bacteria built up in her system again.

 

[gijanet]

Thanks, guys!

Thanks, guys!

I was thinking that it would probably drop the INR as opposed to elevating it. Common sense says it would, but I have been running a tad bit low on that these days. And, yeah, I'm like y'all - I would much rather be a bit high than a bit low.

Katie doesn't seem too much worse for wear. I guess after all she's been through, a little ol' bug "ain't nuthin' but a thing." She slept better last night with a good dose of tylenol and another one around 3:30. I'll spare y'all her description of her diarrhea events.............. Well, she just got out of the bathtub and running around naked (butt nekkid) again. Got to try and wrastle her to the ground and get some clothes on her.

Much love and many thanks. J.

 

[catwoman]

???

???

I thought diarrhea & fever are apt to elevate the INR, not decrease it. The intestinal tract produces some vitamin K, and "bugs" -- which Katie says she has most certainly NOT eaten -- will wipe out that vitamin K production. Which means you're taking in more warfarin than needed for the time being.

 

[Ross]

GiJanet, Catwomen is right and we are wrong!

Can diarrhea cause the INR to go up? Yes. The bacteria in the intestinal
tract produce vitamin K. In diarrhea, these bacteria are often washed out
of the intestine. Therefore, the vitamin K they would have produced is not
available. Less vitamin K causes the INR to increase. One way to overcome this is to take lactobacillus. You can do this with tablets or with yogurt.

 

[geebee]

That is very interesting because I have always found it to decrease my INR. Always knew I was backwards. I just thought it had to do with not keeping things down (or things going through too fast) and the warfarin not staying in my system.

 

[gijanet]

Okay, now I am in a quandary...........

Okay, now I am in a quandary...........

I read this earlier and debated whether to up Katie's coumadin or not. We tested at 3.3 today - what I consider to be ideal. This was on the 2.5, 2.5, 2. Tonight was thenight I needed to decide whether to do the 2 or 2.5. I went ahead with the 2.0mg, since I think we have a little wiggle room either way................sigh! Here's hoping and praying anyway. I feel better with the 3.3 anyway, as opposed to the 2.4. Then I would have really not known what to do. And the diarrhea, thankfully, is beginning to slow down. BTW, we got our paperwork today from QAS wanting copies of our insurance cards, so I guess they are still working this for us.

Much thanks and many hugs. I am sure this will all seem old hat to me after a while.............I know you guys are hoping so.......... Much love. J.

 

[Guest]

Usually over the short term there is little risk that the INR will get extremely far out of line and cause a problem.