Help... INR changes making us nuts

[Karlynn]

I guess I can understand why they are testing every day in order to discharge her from rehab, but (just to reinforce the other comments) her 2.5 INR today is not from the 7.5 dose yesterday.

I would highly encourage you to take a look at the total dose she received in the last week, divide that by 7 and figure that that dose may be a more accurate indication of what, most likely, is going to keep her in range. 2.5, as I'm sure you know, is the bottom of the range for her valves. 2.5 - 3.5 is the range for a mechanical mitral valve and most of us are more comfortable with it being on the high end. So it's probable that a slightly higher dose than this last week's average is going to be the "magic number" As you've already learned, it is much easier to lower an INR than to raise it.

Something else to remember - if it gets too high but is still 5 or below, don't let them freak out again and hold doses. They will have her see-sawing all over the place. Our collective wisdom has come to understand that some doctors tend to fear bleeding much than they do clotting - even in cases of people who have had clotting issues. We like to quote the mantra "It's easier to replace blood cells than brain cells."

Many of us have excellent, top-of-their-field cardiologist. But many of us have also found that we end up doing a lot of the educating of our doctors on Coumadin protocol (with help from Al). Just as diabetics learn how to finesse their insulin dosing to account for blood sugar readings, your wife will also learn what type of changes and dosing is correct for her body.

 

[catwoman]

traig:

With your wife's health history, an INR that's a little higher than the range will probably be desired. The INR for a mechanical mitral valve is 2.5-3.5 in the U.S.; folks in the United Kingdom shoot for 3.0-4.0, I believe.
My INR was 4.2 last Thursday. Since my range is 2.5 to 3.5, I didn't adjust my dosage any. I just enjoyed a huge Greek salad for dinner that night, again Friday & Saturday. Also indulged in a huge order of steamed asparagus at the Twin City Grill at Mall of America on Friday night. Yum, yum.
(In time, you & your wife will get to understand our little jokes about indulging in a spinach salad, V-8 juice, asparagus, etc. My family & friends now joke about serving me up some vitamin K, rather than a salad, cole slaw, etc. )

The two of you will probably become very familiar with subjects and forums here at valvereplacement.com. Nowhere else will you get the information an informed mechanical valver needs. If your wife feels overwhelmed with all that she's gone through, she has company and support here.

We even have actual physical reunions, in October. This year's will be in Las Vegas, Nev. I went to the one last year, in Golden CO. There are mini-reunions in some areas -- Chicago, IL for one.

 

[Guest]

I had a very good cardiologist tell me that he didn't go to medical school, internship, residency and post-doctoral training so that he could dose Coumadin. Many consider it a necessary evil of practicing medicine and try to get by with as little effort as possible.

Many people in critical specialties do not get an adrenalin rush out of giving someone a pill and waiting a week to see what happens.

I have a monitoring chart available at http://www.warfarinfo.com/monitoringgraph.htm

 

[traig]

Another update

Another update

Good news. My wife was discharged today. She had an INR of 2.5 yesterday and 4.2 today, so they're scaling back her dosages to 3 mg tonight and 5 mg Saturday and Sunday. She then will get tested by a nurse who will come to our home for the draw on Monday morning.

I still have to find time this weekend (around a wedding I'm Best Man in) to read everything that's been sent my way on Coumadin/Warfarin, but I'm in the process of that already and will be very aggressive with her INR management.

Thanks again to all of you for your support. I will keep updating and reading, and will make sure my wife starts taking part here as well!

 

[Guest]

The good news is that she is out.

The bad news is that she is getting her warfarin dose changed 2 times in 3 days and being checked on the 4th day. Even if it is in range you won't be able to tell what dose did it.

 

[Ross]

The good news is that she is out.

The bad news is that she is getting her warfarin dose changed 2 times in 3 days and being checked on the 4th day. Even if it is in range you won't be able to tell what dose did it.

I told traig the same thing in a PM Al. I think they'll understand real soon now. She'll get tired of being a pincushion and having the seesaw effect soon enough. That was one of the great motivators for me to try to learn all I could and follow your advice and Marty's from here. Until I did it, I was having the samething happen to me. I'm forever indebted to you and all that helped me see the light.

 

[Gemma]

You know, the more I read about all these problems the more I'm grateful to our good old NHS! When Jim was in hospital, he was tested every day which I think is how it's done everywhere. Then after being discharged he went to the anti-coagulation clinic for a test 9 days post-op, and again 4 days later to make sure his INR wasn't going too high. Ever since then, the shortest gap between tests has been 1 week, and that's been if he's had a dosage change. And so far, I think he's been out of range once (at the first clinic test) in all that time. The usual interval now is 12 weeks (gradually increased, 2 weeks, 4 weeks, then I think 8 and now 12).

They won't accept his home-testing results (he tests in between clinic tests to make sure he's still in range - we know it's accurate! and if he was to get an out of range result he'd go for another test at his doctor's), but they are GOOD at making dosage changes so I think we're very fortunate.