Help, new to this!

[Luana]

Ross,
The meter is brought by the home health nurse. I don't know the brand of the meter. The nurse at the cardiologist's office on Wed insisted those readings could not possibly be right. My only defense was that I saw the reading on the meter, not that it's right, but that's what it was.

My question now is I've had no Coumadin since Tuesday morning. Cardiologist's office was supposed to call me on Fri about when to resume, but I got no call. Should I take a 4 mg pill today? I'm getting nervous. I dearly thank everyone here.
Luana

 

[Mileena46]

Luana,

Believe me I know what you are going through. It can be very scary when you first start out....it still scares me!

I had surgery July 16th and came home on 400 mg of Amiodarone! It interacts with the Coumadin to make your INR higher. My Cardio dropped me down to 100mg once the surgeon released me to him, but I had to be watched carefully then because without the Amiodarone it can get low really quickly.

I am still having trouble (see my post) but I am starting to relax more.

Here is what I wanted to tell you....it hasn't been that long ago that I felt the way you do, tired and running a low grade fever and basically just feeling bad! Trust me when I say that passes and you will soon feel much much better!!

I wish you all the best! Hope you feel better soon!

Mileena

 

[Ross]

Ross,

My question now is I've had no Coumadin since Tuesday morning. Cardiologist's office was supposed to call me on Fri about when to resume, but I got no call. Should I take a 4 mg pill today? I'm getting nervous. I dearly thank everyone here.
Luana

By all means, please do! Your likely not protected at all right now. Do you have any other size pills to work with? Can you make 25mg for the week? I don't mean take all of it now either, but spread out over the full week.

I'm basing my actions on your ER draw and that draw only. That machine is way wrong and if the INR is wrong, the PT is likely wrong also.

You need to call that Doctor of yours first thing Monday morning and REAM someone a new one! They could and are leaving themselves wide open to litigation by not calling you back.
If you had a stroke right now, they would be responsible and should be held accountable. You need those test results on the SAME DAY, not the next. INR changes from minute to minute. Yesterdays INR doesn't tell you crap about right now. Were you falling or rising etc.

I should not be telling you what to do or take, but your at risk and even if your too high when you test again, at least your protected. Right now, your not. You can replace blood cells. You cannot replace brain cells.

 

[ALCapshaw2]

Ross,
The meter is brought by the home health nurse. I don't know the brand of the meter. The nurse at the cardiologist's office on Wed insisted those readings could not possibly be right. My only defense was that I saw the reading on the meter, not that it's right, but that's what it was.

My question now is I've had no Coumadin since Tuesday morning. Cardiologist's office was supposed to call me on Fri about when to resume, but I got no call. Should I take a 4 mg pill today? I'm getting nervous. I dearly thank everyone here.
Luana

Sometimes you need to take things into your own hands / control. It would have been better if you had called your Cardio's office early Friday afternoon and INSISTED they get an answer for you by the end of the day. Going 3 days with NO Coumadin is NOT a Good Idea. Most people would be at or close to an INR of 1.0, certainly below 2.0 after 3 days of NO Coumadin, even with an INR of 8.0 to start with. Be sure your Cardiologist is made aware of this "oversight"!

In the mean time, it would 'probably' be wise to take 'something' but I'm not comfortable making a recommendation in this situation so I will refrain. Sorry. Is there an "On Call Cardio" you can call for directions?

'AL Capshaw'

 

[Mileena46]

Just read your last post. Do you have an emergency number to call your surgeon? Has he released you? They should have called to tell you something...you need to get in touch with someone (your cardio or your surgeon) and find out what to do about your coumadin! I left the hospital with a notebook telling me what number to call if certain things happen. Do you have that? I was told to call my surgeon until he released me.

Not calling you when they were suppose too is unacceptable. You need to call them

Mileena

 

[Lily]

Just read your last post. Do you have an emergency number to call your surgeon? Has he released you? They should have called to tell you something...you need to get in touch with someone (your cardio or your surgeon) and find out what to do about your coumadin! I left the hospital with a notebook telling me what number to call if certain things happen. Do you have that? I was told to call my surgeon until he released me.

Not calling you when they were suppose too is unacceptable. You need to call them

Mileena

I've had very little experience with ACT and hesitated to reply, Luana, but this

is about what I've been thinking. Maybe they can send a different nurse out (if you can't get to the hospital for emergent lab work or something) one more experienced, maybe with a different machine? It's worrisome.

 

[ShezaGirlie]

Just another thought here after reading this thread. My CoaguChek machine only reads up to 8.0 and no higher. I don't know if other brands read higher or not.

Might I suggest that you call your sister RIGHT NOW and ask her to take you to the ER to get your situation sorted. Please let us know..

 

[Lynlw]

Just another thought here after reading this thread. My CoaguChek machine only reads up to 8.0 and no higher. I don't know if other brands read higher or not.

Might I suggest that you call your sister RIGHT NOW and ask her to take you to the ER to get your situation sorted. Please let us know..

I agree totally.

You are only 3 weeks out from surgery aren't you? Don't you have a bunch of numbers to call on evenings and weekends? I don't remeber what kind of hospital you went to but IF it is a teaching hospital your should have the number to call the cardiology residents or fellows or surgery ones IF you can't get ahold of your cardiologist or surgeon.
Also I haven't read your other thread from the other day, but has your SOB, tiredness more pain we were talking about cleared up at all? IF not did you call the surgeon since a few days ago you had a "small amount of pericardial fluid"? The reason I am asking that here, is we really have NO idea what your INR is, I don't know when you stopped your coumadin, BUT whatever is causing your SOB could be related to the coumadin, IF it really is a HIGH INR, the fluid around your heart could have increased greatly in just a day or so and can cause all kinds of problems.
I THINK if you were My son, (since he is the patient not me) and all these things are going on so close to surgery, I would drag him down to the hospital UNTIL I got answers, CALL the on call doctors and ask them if they can meet you in the ER.
Be SURE to explain to them that you live ALONE so really should get answers before you go to sleep.

 

[Ross]

I PM'd her to call that dingbat doctor and see about Lovenox until she can start the Coumadin again, then gave her a link to dosing guidelines to print out and take to this guy before he kills someone.

 

[Ross]

Luana is going to be a fun subject. Just about everything she takes causes INR to rise.

WARFARIN SODIUM (in Coumadin Tablets) may interact with LEVOTHYROXINE (in Levothyroxine and Liothyronine Tablets)

Blood clotting normally occurs in response to a cut or other types of injuries to protect the body from excessive bleeding. Many substances are involved in the clotting process including various chemicals that are produced in the body like vitamin K.. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. Although levothyroxine does not appear to directly interact with warfarin, it may increase the breakdown of vitamin K-dependent clotting factors and make your blood much less likely to clot. When levothyroxine and warfarin are used at the same time, the anticoagulant effect of warfarin may be increased and this may increase the risk of excessive bleeding. If these drugs are taken together, your doctor may want to monitor you closely for signs of bleeding (bruising, nose bleeds, ect). Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is well-documented and is considered major in severity.

Last Updated: December 2003

WARFARIN SODIUM (in Coumadin Tablets) may interact with PROPRANOLOL HYDROCHLORIDE (in Propranolol Hydrochloride Tablets)

The exact causes of this potential interaction are not understood completely, but propranolol may increase the anticoagulant effect of warfarin. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When propranolol and warfarin are used at the same time, the risk of excessive bleeding may increase. If these drugs are taken together, your doctor may want to monitor you more closely for 2 to 4 weeks after therapy with propranolol is either started or stopped. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is poorly documented and is considered moderate in severity.

Last Updated:May 2007

WARFARIN SODIUM (in Coumadin Tablets) may interact with AMIODARONE HYDROCHLORIDE (in Amiodarone Oral)

Amiodarone may block the breakdown of warfarin by the liver. If this happens, blood levels of warfarin could be increased and this could increase its anticoagulant effect. Warfarin is generally used to prevent your blood from "coagulating" or forming blood clots. When amiodarone and warfarin are used at the same time, your blood may be much less likely to clot and this may increase the risk of excessive bleeding. This potential interaction may continue for months after therapy with amiodarone has been stopped. If these drugs are taken together, your doctor may want to monitor you more closely for 6 to 8 weeks after therapy with amiodarone is either started or stopped. Blood tests can be used to make sure that you are getting the right amount of warfarin. If you are experiencing problems, it may be necessary to adjust the dose of warfarin.Ask your healthcare provider about these drugs and this potential interaction as soon as possible.

This interaction is well-documented and is considered major in severity.

Last Updated:February 2009

 

[Lynlw]

Ross have you heard from her since your PM? I'm a little concerned especially since she lives alone.

 

[Ross]

Yes. She said she took 4mg, then the Doctor called and told her to continue holding until she tests again. I told her to call him back and ask about Lovenox until then and then to find a new doctor.

 

[Lynlw]

Yes. She said she took 4mg, then the Doctor called and told her to continue holding until she tests again. I told her to call him back and ask about Lovenox until then and then to find a new doctor.

Did she mention how she was doing with her SOB and feeling badly?

 

[Luana]

I am ok! Still lots of SOB, extreme fatigue, not feeling good, and unanswered questions, but have faith all will be resolved. I dearly thank all of you for your thoughts, ideas and suggestions.
Hugs,
Luana

 

[Luana]

Another update: just got a call from a case manager with my health insurance co. I mentioned that I would like to get a unit for testing at home for INR/PT as what I've been getting so far from home health nurse seems quite unreliable. She said she will start the ball rolling to get coverage for a home unit.

Also, nurse called earlier to come over for another INR/PT and I asked if there was another machine she could use. That's the only unit her office has. She said she can do a venous draw instead, and I said fine, I need to get some reliable results. I think I mentioned many posts ago, the first time she came out she had no idea what the therapeutic range was for AVR surgery, and I had to Google it. I still find that unacceptable. I have a list of complaints about this home health agency.

Anyway, am very much looking forward to getting this under control and getting better. I'm due!
Luana

 

[Ross]

Just remember, you really need the results the same day.

 

[art]

I am ok! Still lots of SOB, extreme fatigue, not feeling good, and unanswered questions, but have faith all will be resolved. I dearly thank all of you for your thoughts, ideas and suggestions.
Hugs,
Luana

Hi Luana you need faith in the medical people around you unfortunately God will not fix your INR
Welcome to the other side

 

[Ross]

Hi Luana you need faith in the medical people around you unfortunately God will not fix your INR
Welcome to the other side

Unfortunately, many of those medical people won't either.

 

[art]

Unfortunately, many of those medical people won't either.

I agree
So she needs to have faith in the medical people

 

[Luana]

Good News

Good News

Home health nurse did blood draw yesterday to send to lab for INR/PT. Here are the results:

INR 3.26
PT 34.7

Just want to be sure this is the range I should be looking for? Found this online:

According to the American College of Cardiology/American Heart Association Guidelines for the Management of Patients With Prosthetic Heart Valves1, the following International Normalized Ratios (INR) are recommended for bileaflet valves. For the first 3 months after valve replacement:

* INR = 2.5-3.5

Three or more months after valve replacement:

* INR = 2.0-3.0 (aortic valve replacement [AVR])
* INR = 2.5-3.5 (AVR with risk factors*)
* INR = 2.5-3.5 (mitral valve replacement)

*Risk factors: atrial fibrillation, left ventricular dysfunction, previous thromboembolism, and hypercoagulable condition.
http://www.sjm.com/procedures/procedure.aspx?name=Heart+Valve+Replacement&section=FAQ