Oh my!! That looks painful!!
Hubby back in a-fib. *sigh*
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Lisa from LJ
Well-known member
That's her! I self test a couple of times a month, so just report my result monthly, or if it's out of range, I let them know in between. My PCP is at the Pearland facility and I did PT there after ankle surgery. Convenient to Sonic for my Route 44 Diet Dr. Pepper!
Lisa from LJ
Well-known member
It was! The bruise hung around for at least a month. Super fair skin and Warfarin. When they removed my sternal wires, my entire chest was dark black! It was ugly, especially as it started to fade, but didn't hurt!
pellicle
Professional Dingbat, Guru and Merkintologist
if he buggers up the sternum (and he's already in a situation with a less than ideal sternum) and the joint fails he really won't like the outcome.
It involves
- reopening him
- spread the sternum enough to allow access
- abrade both sides again
- close with fresh wires
My friends father had this and then got a second go at it because he got a golden staph infection requiring a third opening.
But hey, he's free to do what he wants. Fafo Illuminatio Mea.
You are preaching to the choir.
Which facility did you do Cardiac Rehab at? I don't see one in Pearland...
carolinemc
Well-known member
I bruise more easily on the warfarin. Gotten bruises on the stomach due to deal in with the Utility cart at the store, I use to get my groceries home. And have to figure out how, from the cart. LOL! On my stomach.
carolinemc
Well-known member
But they should wait a week for the new dosage to take affect. The lab I use at my hospital does all the time.
At least we have this site to learn how to manage.
Lisa from LJ
Well-known member
I had my one cardiac rehab session at Houston Northwest because that's where I was working in 1998. Because of pericarditis, I had to stop, and by the time it resolved, I was past the cardiac rehab window. I could have appealed, but I was pretty active with two young kids, so really didn't need it. In my opinion, it most benefits those who are older, out of shape, and/or not willing to be reasonably active on their own.
Would you want to perhaps go get coffee one day?
Lisa from LJ
Well-known member
Sure! I don't drink coffee, but will have a soda!Would you want to perhaps go get coffee one day?
Just let me know when you have some time. You work Monday through Friday, right? I am off work through next week, but then I go back to rotating shift work, so I have a couple weekends off a month.
Lisa from LJ
Well-known member
Yes, Monday - Friday, in Lake Jackson Monday, Wednesday, Friday and in Houston Tuesday and Thursday. I could meet you somewhere on my way home from Houston or I'm available most weekends, so just let me know what works for you.
carolinemc
Well-known member
And you will find we all agree, they need to give him more time, like a week. They have to give the new dose time to metabolize in his system. Good luck.At least we have this site to learn how to manage.
So, with the one reading from Monday that was high end of the range, they halved his dose for that night only. Then he went in for what is to be his regular day to do inr checks, Thursday (yesterday). His reading was 4.5. So they requested he skip that night's dose and then halve it the next night (tonight). His next reading is next Thursday. Until then I am going to make sure he is careful and not let him do anything where he could bump or cut himself.
Yesterday he dropped a pickle jar from the fridge and grabbed a broom and started to sweep. Um... NO. His post-op instructions say sweeping is a no-no. This is before I knew his INR had jumped so much. I told him to go sit down and I would clean it. He doesn't need to be not following doctor's orders, and he doesn't need to be dealing with broken glass (although I didn't know that at that time.)
My INT has been steady at 2.2 since leaving the hospital, but that’s below my range of 2.5 - 3.5. They are very cautiously and slowly increasing doses. Thru Monday I will alternate 5 mg and 6 mg instead of all 5s.
Lisa from LJ
Well-known member
Just a note that the reason for no sweeping is because of the back and forth motion to the healing sternum. Same reason that driving is a no no. However, unless he is sweeping vigorously for an extended period of time, I doubt it will matter. As to the broken glass, he should avoid it as much as possible, but he isn't going to bleed to death from a cut.
Unlike what some people think, Warfarin is an art more than a science. There are too many variables, many "unknown", to rely totally on science. It will take some time to figure out his sweet spot and to determine how to adjust based on his metabolism. Then it may change as he heals, his heart rate normalizes and he becomes more active. I don't hold for any reason because I know that I will bottom out quickly. For a 4.5, I would take a half dose two days in a row, which may sound the same as skipping a dose, but the difference is that there is always Warfarin in my system.
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Yeah, we don't yet know enough about how hubby's body handles it. For now we know he was initially slow to rise, but then shot up like a rocket. We are trying to keep his diet consistent, but it is all a learning curve. This is probably the reason for the 90 day wait to be able to get on the home monitoring problem. Get your levels steady, figure out how your body takes to specific dosages, timing for coming down, going up.... We will get there.
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As noted, there is some variability in the warfarin dose to achieve the target INR for a given person. Each dose of warfarin tends to have a duration of action of 2 to 5 days and a half-life elimination of 20 to 60 hours. The INR measurement is the net combined effect of doses from the previous few days. This is why it can take a while for the INR to move up to the target level upon initiation of warfarin.
One other important consideration is the effect of other medications. I had some a-fib episodes during my post-op stay following my AVR and was prescribed amiodarone. The onset or duration of action of amiodarone varies considerably from a few days to several weeks. As the effects of the amiodarone builds up, it can have a substantial effect on how the warfarin is metabolized and typically results in a reduction of how much warfarin is needed to achieve the target INR.
As an example, I was initiated with a daily dose of 5 mg warfarin and a target INR of 3.0. My INR one week after my AVR was 1.5 and two days later it was 2.3. However, one week later, my INR had jumped up to 7.0. I was told to skip two days of warfarin followed by a 2.5 mg dose, and I indulged in eating turnip greens and was back down to 2.2 INR three days later. My amiodarone dose was reduced later that week and eliminated altogether a month later. My warfarin dose was gradually increased over the next few months as its interaction with amiodarone mitigated over time.
One other important consideration is the effect of other medications. I had some a-fib episodes during my post-op stay following my AVR and was prescribed amiodarone. The onset or duration of action of amiodarone varies considerably from a few days to several weeks. As the effects of the amiodarone builds up, it can have a substantial effect on how the warfarin is metabolized and typically results in a reduction of how much warfarin is needed to achieve the target INR.
As an example, I was initiated with a daily dose of 5 mg warfarin and a target INR of 3.0. My INR one week after my AVR was 1.5 and two days later it was 2.3. However, one week later, my INR had jumped up to 7.0. I was told to skip two days of warfarin followed by a 2.5 mg dose, and I indulged in eating turnip greens and was back down to 2.2 INR three days later. My amiodarone dose was reduced later that week and eliminated altogether a month later. My warfarin dose was gradually increased over the next few months as its interaction with amiodarone mitigated over time.
