How long does it take to get you regulated?

[Guest]

Four weeks post op today. I went for my INR today, 1.5 so I get to do the lovely lovenex shots tonight, tomorrow morning and evening and Friday morning and go for another INR Friday a.m. I really don't mind the shots, my husband gives them to me as I'm not ready to deal with that yet, I just hate the bruises. I still have 2 from the week of Thanksgiving.

My INR on the 3rd was 1.5, dosing 2.5 mg on the 3rd, and 3.75 mg coumadin on the 4th, plus lovenex shot the evening of the 3rd, a.m. and p.m. on the 4th, and 1 on the morning of the 5th and then retest on the 5th. My INR on Dec 5 was 1.9, I would have thought with the 4 lovenex shots plus coumadin, my INR would have atleast been in range on the 5th.

From Dec 5, I stopped the shots that evening, dosed 3.75 on the 5th, 6th, 7th, 8th, 9th, and 5 mg on the 10th, 3.75 on the 11th, and 5 mg tonight and tommorrow.

My appetite is good, I'm off pain killers, I sleep well, walk, and overall have a positive outlook in spite of the crap that keeps rolling down my hill. Am I misunderstanding what the lovenex shots are supposed to do? Are they to help you get in range or are they just to thin your blood immediately? Can they not increase my coumadin any faster than where I am so I can avoid the shots?

I hope I'm not confusing you, I'm confused enough for all of us.

The nurse I have is very good and I like her, she said new surgical patients are a little harder to get regulated. I told her I really wasn't worried about taking coumadin, I just want to get in range, stay there, and manage myself. I know it takes time, I just have to be patient I guess.

Oh, to top it all off, the pharmacy gave me 30 pills instead of 60 and since I ran out as of today, the nurse said to count my pills every time now. You can't even trust the pharmacy to fill your prescription correctly. I called the pharmacy and talked to the pharmacist, she verified they made the mistake, I'll pick up the other 30 tomorrow. Thank goodness the nurse had samples and sent me home with enough to get me through tomorrow. I tried to refill my prescription and my benefits won't let me have the prescription until tomorrow, the 13th!

 

[Ross]

Louise what is the total mg that you've taken in the last 7 days? Give as much information as possible. Any other meds, diet, excercise etc. So far, I think your manager knows not how to dose Coumadin and has you on far too low an amount.

 

[Guest]

Louise what is the total mg that you've taken in the last 7 days? Give as much information as possible. Any other meds, diet, excercise etc. So far, I think your manager knows not how to dose Coumadin and has you on far too low an amount.

I've taken 27.5 mg coumadin in the last 7 days, quit taking my prilosec OTC as of Sunday this week, as I've been on that a month for reflux and not supposed to take it continuously. I take 50 mg flacainide twice a day for a fib, 12.5 medopropol(lopressor) twice a day, 81 mg baby aspirin in the a.m., occasional tylenol 500 mg. for sternum pain. I had 2 on Monday, 3 yesterday, I take claritin for allergies as needed, I took 1 tab on Monday. Other than that no medications.

I eat at least a bowl of raisin bran or shredded wheat for breakfast, cup of coffee, orange juice sometimes. If I don't eat cereal with 1% milk, I'll have 2 eggs over easy with a piece of toast. Lunch, I usually have a sandwich like a grilled cheese, or a can of progresso soup, 15 oz. I drink hot tea during the day, try to force 16 ozs of water. I'm not a big eater to begin with and usually don't eat breakfast, since my surgery I'm trying to be more consistent. For dinner, I try to atleast have a meat, potato, and vegetable. Last night I went out with a friend and had a turkey melt sandwich on wheat toast with lettuce, tomato, pickles, and fries. I did not eat all of the fries, maybe 1/3. I'll snack on a couple cookies or have an apple or an orange. An occasional handful of fat free potato chips (ruffles) I'm watching my salt. I've lost 8 pounds of fluid since my surgery! Yay!

I walked around stores yesterday with my neighbor, walked 45 min on Monday, nothing today because of cold and rain. I go to cardiac rehab next week so exercise will be picking up. I hope to start running again soon.

When I go again on Friday, depending on my INR, should I suggest to the nurse to keep me at 5 mg and retest in a week?

 

[Karlynn]

Please do not start worrying about what you eat. Eat what you normally eat.

So your dose over the last 7 days was 27.5 What are they having you take now? Plus Lovenox will not register in your INR. So your INR # is just due to your Coumadin dose.

As you heal and exercise more your metabolism will increase and your dose for Coumadin will most likely continue to need to be increased.

Think in terms of weekly dose total. This is how an informed Coumadin manager should be adjusting your dose. With an INR of 1.5, my opinion, is that the Coumadin manager should have increased your weekly dose by 20%. That would be 33 mg a week or 4.7/ day. Round that out to 5 a day. But test again in 4 days or so in order to make sure the increase isn't pushing you too high.

If you aren't near that increase, they're already worried about you going too high, when they haven't been able to get you out of the low range yet.

 

[Bina]

I agree on taking 5 mg per day and re test in a few days; don't worry, the INR won't sky rocket.
I bet you are much more stable in a couple of weeks.
You may want to check with your pharmacist if the Claritin conflicts with the metoprolol; I've been told not to take any cold or allergy meds.
It sounds like you are doing well, remember to rest enough.

 

[Guest]

Please do not start worrying about what you eat. Eat what you normally eat.

So your dose over the last 7 days was 27.5 What are they having you take now? Plus Lovenox will not register in your INR. So your INR # is just due to your Coumadin dose.

As you heal and exercise more your metabolism will increase and your dose for Coumadin will most likely continue to need to be increased.

Think in terms of weekly dose total. This is how an informed Coumadin manager should be adjusting your dose. With an INR of 1.5, my opinion, is that the Coumadin manager should have increased your weekly dose by 20%. That would be 33 mg a week or 4.7/ day. Round that out to 5 a day. But test again in 4 days or so in order to make sure the increase isn't pushing you too high.

If you aren't near that increase, they're already worried about you going too high, when they haven't been able to get you out of the low range yet.

Thanks for responding Karlynn.

I'm supposed to take 5 mg tonight, 5 mg tomorrow and then retest on Friday morning. Depending on where I am, she'll adjust my coumadin. She has my weekly totals in their computer and pulls it up to evaluate my dosing, she works off of weekly totals too. Hopefully I'll even out soon.

 

[ALCapshaw2]

Louise,

FYI, Heparin and Lovenox are FAST acting and SHORT acting, i.e. they come on fast and die out fast (roughly 12 hours) vs. Coumadin which takes 3 or 4 days to fully metabolize.

One reason recent Surgery patients are hard to regulate is that their metabolism continues to rise as they heal and become more active so it's like chasing a moving target until your exercise level stabilizes.

If you haven't read AL Lodwick's website, www.warfarinfo.com, I highly recommend doing so. Also order his "Dosing Guide" for $5. GREAT TOOL for Self Dosing.

'AL Capshaw'

 

[Guest]

I agree on taking 5 mg per day and re test in a few days; don't worry, the INR won't sky rocket.
I bet you are much more stable in a couple of weeks.
You may want to check with your pharmacist if the Claritin conflicts with the metoprolol; I've been told not to take any cold or allergy meds.
It sounds like you are doing well, remember to rest enough.

Thank you Bina, I didn't think about the claritin/metoprolol combination, I will ask about that. My trigger is mold and we're getting wet again here, lots of leaves on the ground.

I still nap during the day too, even if it's just an hour.

 

[aussigal]

Ask the Chemist for an alternative to the Claritin...I know there are some out there that dont conflict.

Looks like you have gotten good advice regarding the coumadin already...mine took about 2 months or so to level out but I had a big problem with nausea that wasnt helping. Hang in there it will more than level out soon.

 

[Karlynn]

I've taken Claritin and metoprolol for years without issue.

I can take allergy meds as long as they don't contain a decongestant. Decongestants speed up the heart rate and since I'm on the metoprolol for my heart rate - that would be counter productive.

Remember that testing on Friday will not show you the full effect of today's 5 mg dose, nor tomorrows because of the 3 day acting time.

 

[Ross]

Your diet is fine, you just have a manager that is too conserative and not aggressive enough in dosing you. I vote the same as the others. 5mg a day and retest 4 days after doing so. By now, things should be stablizing somewhat and they don't even have you in range. I think you'll find that 5 a day puts you just in range. You may need to do 5mg four or five days a week and 7.5 two or three days a week so that you have some room for eating some extra veggies and such. Don't let them tell you what to eat. Eat like you always do and the dose can be adjusted for that diet.

 

[Karlynn]

Ross brings up a good point. If they are asking you "What have you been eating." they don't understand that what we eat doesn't have a huge effect on our INR. Nor should we try to control our INR by what we eat. Our INR is controlled by our dosing. Occasionally we have to take medications (like some antibiotics) that will control the INR, but you test - and then take back control by adjusting the dose to accomodate.

They should have had you in-range by now, not on your second course of Lovenox. Don't let them make you thing it's you and your body and not their management.

 

[Freddie]

Hope this helps,

Hope this helps,

Louise, don't get discourage or confused..............
It took me months to get my INR leveled out.And yes, I too got concerned and totally confused when my INR would not level out. Until I read on this site that the more active one becomes the more one has to up the dosage. Don't adjust your diet. Just live your live as you would.
I'm 9 months post-op and I'm on 39mg of warfrin a week. That's by alternating each day with 5 and 6 mg, and finally get tested every two weeks. This is what has been working for me, and in time you'll will find your proper dosage too.

Keep your head up, enjoy life and try to relax.

Greetings
Freddie

 

[Guest]

Thanks for all your replies. I plan on eating what I want and dosing the diet.

Karlynn, this is actually my 3rd round of lovenox, the first round was so that I could come home from the hospital on Monday before Thanksgiving with a 1.6, I tested on the Wed before Thanksgiving, my INR was 4.1, we stopped the shots, left out a day of dosing, retested on Monday after Thanksgiving, INR was 2.7, went down hill from there to 1.5 on Dec 3rd, 1.9 on Dec 5th, then yesterday's 1.5.

We'll get there, just going to take time and tweaking. I'm going to suggest the 5mg four or five days a week and 7.5 two or three days a week to have room for eating some extra veggies and such as Ross suggested. Let's see how they handle 'information empowered and independent' patients.

I see my cardio in January and I'm asking for home testing! I can stick my finger, my abdomen is another story, I can see myself fallling off the chair now.

 

[Ross]

Plan on 5mg daily and see where you are.

 

[Guest]

INR Retest this a.m.

INR Retest this a.m.

My INR this a.m. is 1.8, full effects of Wed's dose not there yet, last nights should start tomorrow, she wants me to finish the last 3 lovenox shots I have left. Total coumadin in the last 7 days, Fri, Dec 7 through last night is 30 mg.

Tonight I'm to take 5 mg, then 3.75 on Saturday and Sunday, retest next Monday. Counting the 7 days starting on Monday, Dec 10 through this Sunday, my total coumadin will be 31.25.

Here's hoping I'm finally in range next Monday!

 

[Ross]

My INR this a.m. is 1.8, full effects of Wed's dose not there yet, last nights should start tomorrow, she wants me to finish the last 3 lovenox shots I have left. Total coumadin in the last 7 days, Fri, Dec 7 through last night is 30 mg.

Tonight I'm to take 5 mg, then 3.75 on Saturday and Sunday, retest next Monday. Counting the 7 days starting on Monday, Dec 10 through this Sunday, my total coumadin will be 31.25.

Here's hoping I'm finally in range next Monday!

Hon the 3.75 days are whats going to be what I'm figuring too small and will likely just barely, if at all, be just in range. Lets see how it goes though.

 

[Guest]

Hon the 3.75 days are whats going to be what I'm figuring too small and will likely just barely, if at all, be just in range. Lets see how it goes though.

I know, I asked if I could stay at 5 mg but she was hesitant, I didn't want to argue and actually thought of just taking 5 on Sat, then the 3.75, then again I don't want to mess their dosing up. If I'm barely in range on Monday, I'm going to insist on the 5mg dose.

 

[Ross]

I know, I asked if I could stay at 5 mg but she was hesitant, I didn't want to argue and actually thought of just taking 5 on Sat, then the 3.75, then again I don't want to mess their dosing up. If I'm barely in range on Monday, I'm going to insist on the 5mg dose.

Play it her way this time and lets see. I'm figuring your going to come out at about 2.3 or less. Myself, I'm not comfortable with something low, I stay mid range at around 3.0. This way, I can eat more veggies and worry much less about going too low. Look at your total doses taken from Monday back 6 days after you get tested.

I have the distinct feeling your manager is one of those that sets the goal of "Just in range" when she should be setting her sights higher.

What range did they give you anyhow? 2.0 to 3.0?

 

[Guest]

What range did they give you anyhow? 2.0 to 3.0?

My range is 2.0 to 3.0, I prefer to get to and stay mid-range myself.