Here I am again....!!

[Mileena46]

If you all remember a couple weeks ago I was having trouble keeping my INR down....it got up to 4.6 at 5mg for 5 days and 7.5 for 2!

Doctor put me on 5 a day every day. It came down slowly and it didn't stop....Monday I tested at 2.4 which totally freaked me out..(my range is 2.5 to 3.5) and doc put me on 6mg a day....now here....4 days later ...and I am testing at 2.3!!!

I am waiting for the doctor to call and tell me what to do....but I am asking you all...because I am terrified of going low enough to have to be bridged! I think I should take a 10mg tonight....but I will wait on what YOU all tell me!!

Mileena

 

[catwoman]

Mileena:

I'm scratching my head. You were taking 40mg/week (5mg X 5 + 7.5mg X 2) and tested at 4.6 about 2-3 weeks ago.
Your doctor adjusted your dosage to 5mg and you were at 2.4 and adjusted it up to 6mg and now you're at 2.3. If you stay at 6mg, you'll be taking more warfarin than you were when you got the 4.6. I would probably wait and retest on Saturday and see what you get.

Something is just not making sense here. Have you started/stopped/changed any other meds?

I've had one INR that was 2.0. I had a TEE in July 2007 and before the test, they ran bloodwork (I'm not sure exactly why, just for a TEE) and they informed me that my INR was at 2.0. I didn't bridge; I just increased my dosage by15% and my next test was fine.
BTW, they did not run bloodwork when I had a TEE in late June 2009. Go figure.

 

[dick0236]

Something is just not making sense here. Have you started/stopped/changed any other meds?
.

I agree. I would make no additional adjustment for a 2.3 or 2.4. I would wait a week and test again. You should not experience a lower INR if you have increased your warfarin dose if there has been no other changes in meds, lifestyle, activity etc. My personal experience with warfarin is to make SMALL changes over time.

 

[Bina]

Taking 10 mg tonight would be a big jump....I wouldn't do that for an INR of 2.3
Something doesn't make sense in these results,
but I would just test again in 3 days to make sure there is no further drop.

 

[Ross]

There is something seriously missing from this equation. Lets hear about your diet and excercise.......Well tell us every possible detail including medications and such.

I don't mean this in a mean way, but when someone has as much trouble as your having, it's usually something they are putting in their mouth.

 

[Mileena46]

I have made NO changes from when I was 4.6....NONE. Same meds, same dosages.....and not taking any news ones. I have not started an exercise program.....or changed my diet in any way.......!! I did eat a small amount of cabbage one day when my INR was within range.....3.1 or so and I didn't think it would hurt.

I mentioned the fact that at my org. dose.....40mg a week and now (per the nurse calling) 7mg a day....thats 49mg a week, How can I expect to be below 4.6 at 49 when I wasn't at 40?

My doctors nurse said he wants me to wait until Tuesday to re-test! I cannot re-test on Saturday.....I could tomorrow, but wouldn't expect it to be that much of a change!

Right now I am worried I am going stroke out!!

Mileena

 

[Ross]

Your over 2 so stop worrying. Either you've missed a dose and don't realize it or your testing too much and making changes to fast. Can either of these be the case? I forget, do you have your own machine?

 

[Bina]

Maybe Mileena has been hangin out with our naughty little Freddie? Hee Hee, don't worry so much.
Do you have a pill box?

 

[Mileena46]

No, I don't have my own machine. I went just this past Monday and it was 2.4 at my doctors office. Then today (Thursday) it was 2.3. That was 3 doses and re-check....then I re-check again next Tuesday! I was assuming (which I know makes an ass out of you and me both) that upping the dose would automatically mean a higher INR.

I am trying not to worry.....my valve is very loud today which bothers me! I need a valium!

Mileena

 

[Mileena46]

Yes Bina...just got one....just in case!

 

[Bina]

Your valve only seems louder because you are a bit stressed. Breathe slowly into your stomach and release slowly.

 

[Freddie]

Now hold on here Mileena.

Take a DEEP Breath and relax, there is nothing wrong with a 2.4.

I too have the range of 2.5 - 3.5 and last week I went as low as 1.5 and had no bridging and I'm still here.

My question in regards of food intake; have you had any Chinese food or soya products or fried rice?

 

[Ross]

No, I don't have my own machine. I went just this past Monday and it was 2.4 at my doctors office. Then today (Thursday) it was 2.3. That was 3 doses and re-check....then I re-check again next Tuesday! I was assuming (which I know makes an ass out of you and me both) that upping the dose would automatically mean a higher INR.

I am trying not to worry.....my valve is very loud today which bothers me! I need a valium!

Mileena

There is virtually no difference between 2.3 and 2.4. You could get that testing back to back +/- a couple more. I would say that's stable. At this point, I wouldn't increase anything. I would wait for the next test. If you go to 49 now, they are going to set the teeter totter in motion. They'll send you way over and then they'll do something equally stupid, like tell you to hold 2 doses because of it, then lower the dose too low, and on and on it'll go.

Just chill. Your gonna be fine. Really, you are.

 

[Bina]

There is virtually no difference between 2.3 and 2.4. You could get that testing back to back +/- a couple more. I would say that's stable. At this point, I wouldn't increase anything. I would wait for the next test. If you go to 49 now, they are going to set the teeter totter in motion.

Just chill. Your gonna be fine. Really, you are.

Exactly.

 

[Ross]

If you were my patient, here is what I would do. Increase your dose by 5% for the week from 35 to 37.5 (just a smidgeon over 5% to work with 5mg tablets). That should put you on the spot.

 

[Mileena46]

Thanks Ross and everybody!

 

[Freddie]

Hope your breathing a whole lot easier now.

Your fine and will continue to do so.

 

[ALCapshaw2]

Sounds like a case of testing Too Soon and changing Too Often.

Your original dose (5X5) + (7.5X2) comes to 40 mg/week.

Then 5 X 7 comes to 35 mg/week

Then 6 X 7 comes to 42 mg/week

You should wait at least 4 days before testing (just to see where things are going).

Personally, I think changing doses more often than ONCE per Week is asking for problems. It is best to let your INR 'settle out' before making another change.

(And YES, 2.3 may be a 'tad low' for your recommended range but is not likely to cause a problem, especially for only a few days with an 'expected increase' in the coming days due to your previous increase in dose. An INR below 2.0 would be of more concern.)

Do you have a copy of AL Lodwick's Dosing Guide? If not, Get One ASAP.
It's the Best $5 you can spend for your Peace of Mind.

'AL Capshaw'

 

[Mileena46]

Thanks Freddie and Al! I thank all of you for once again putting my mind at ease. Just like when my INR was going up, I worried that it wouldn't stop.......so in that same sense....I am worried that it will keep going down until I end up in hospital taking those shots in the belly again, OR of course the worse thing, that I would throw a blood clot. I just keep trying to tell myself that while I am taking Warfarin that isn't likely to happen even at my level. I will no doubt have a rough weekend worrying about this.

Mileena


Just saw the post where Freddie asked about chinese food and fried rice. I had that last Friday before I tested on Monday but it was almost a week ago today......no one told me anything about not eating those things.....??? What do they do???

 

[Ross]

So long as your over 2.0, no worries. If you should fall under, the risk is small that a clot would form, but it's a risk nonetheless. I went without anything for 3 days during my dental extraction crisis. Don't let INR rattle you. It's not that big of a deal. Now if you purposely do this all the time, your going to have a problem sooner or later, but when someone is trying, it's not likely to happen at all. Just remember, be happy with anything between 2.0 and 4.0.