INR....all-time high at 7.7!!!

[Bob Gleason]

Great huh? Really pissed off about this and the way I have been feeling lately. Having TIA symptoms, now my INR at 7.7. Been through the gamit of tests including MRI, MRA, EEG, carotid doppler, blood, etc. and the brain scan revealed a narrowing of myright carotid artery.

Of course, my cardio, the non-sensitive ******* that he is, disagrees with the brain scan or the possibility of my having TIAs.

Time to pack up my records at tests and get my ass over to Columbia where they treat you like a human being and not an accounts receivable.

 

[DickV]

Hey Bob, don't hold back. Please tell us how you really feel.

Man, we sure are hearing a bunch of Dr. horror tales here lately. I think we need to start a new thread.

 

[Hank]

Medical School

Medical School

How about we all invest in sending someone through medical school and then they can be the ValveReplacement.com physician. then maybe we could trust them. Unless being a dork is a required course, then we're out of luck.

No offense to any docs reading this!

 

[Tammy]

Bob-
What was your last pro-time?
I hope you get some answers real soon. Doctors!!??!

Mine is not available to answer my echo questions until Monday.

At least you have some connections at Columbia.

I hate how most Doctors trivialize (sp) everything. They told me my Aortic Stenosis was nothing to be concerned with. Well hey - guess what - I am concerned.

Hanks idea is good. We can just send someone to Med school. Hey we can even form our own society. All heart patients and their families with our own Doctor. Reality Sucks.

The sun will come out tomorrow, tomorrow, tomorrow.

Tammy

 

[Marty]

Bob, As you know I am a self tester ( Coaguchek) and also self manage my Coumadin which by the way is OK with my cardiologist and my general internist. I have been collecting stories of anticoagulation mis management and non managemnt and I am curious as to how your INR got so high. Could you let me know some details? e.g. who tests your prothrombin time a commercial lab, a hospital lab, your doctors office, etc. Who prescribes your dose schedule, M.D., nurse, pharmacist,etc. Do you take coumadin or generic warfarin? How often do you test?
Please reply personally if you like to mthomas52 @aol.com
Hope you get squared away soon. Marty

 

[Bob Gleason]

INR to Marty

INR to Marty

I usually test about once a month......I have my own machine but also go to my cardio since its only minutes away. My range has been good for the past year and this is the first time it has been off the charts.

Since I had been having TIA symptoms and a recent MRA/MRI showed a narrowing of my carotid artery (right side) my cardio was consulted by his assistant (he was away at the time) and about three weeks ago he suggested I take one aspirin a day, and keep my regular dosage of coumadin going.

So, although on Friday, no one at the cardio's office mentioned that maybe the aspirin was the culprit, my wife reminded me of that and when I go back on Monday for another reading, I will make sure to mention it.

I bet that they failed to include in my records that I am currently taking aspirin so that when my INR was read on Friday they had no clue about it. (and I forgot as well)

For all reading this thread, please excuse my horrowing language above, but now and then I get so darn frustrated with post-op maintenance and the symptoms I am now having.

Thanks, Marty for your post......and Tammy, too. Dick....a good idea about posting horror stories separately. We should not be treated as if we are a commodity or just something that represents an invoice to benefit someone's medical practice. I know that sounds harsh and that I am sure most medical practicioners put their patients first, but I am sensing something in my own case that says I can find better.

 

[strayze]

It's disappointing that after the recommendation of adding aspirin, a known powerful blood thinner, you were not advised to check your INR in one week or less. That is mispractice. I'm surprized that your INR when measured, though high, was as "low" as it was.

I've been through sloppiness in such medical business firms. When reviewing my chart, the most accurate information is the billing record. The chasing down of adequate medical care is time-consuming and exasperating, and detracts from my quality of life.

 

[Marty]

Bob and Strayze, You are both right on! Adding aspirin to coumadin is dangerous! I checked on this when I first started with my cardiologist after surgery and I guess didn't believe him so I checked with the hematologist guru of anticoagulation in Boston Dr. Jack Ansell who gave me a resounding NO! I thought if a little anticoagulation was good a lot would be better. Coumadin and aspirin work on different factors in the clotting cascade and are most difficult to manage together. By the way Dr. Ansell answers questions promptly, concisely, and decisively. You may reach him at [email protected]. Marty

 

[strayze]

Thank you for the reference to Dr. Ansell. I believe i'ts imperative that all on anticoagulation check and double check any drug prescribed for its interaction with warfarin. I check the package insert and on www.rxlist.com.

Just because one's INR doc prescribes it does not make it without problems. Sometimes those offices are so busy that one's other medications/conditions are overlooked in the zeal to fix whatever is at hand. I think very carefully before taking any medication, OTC or prescribed.

After the bleeding disaster of a friend who was prescribed ciprofloxacin by his trusted local INR doc (he's a valve patient) with no warning or immediate INR check) I decided to get a prothrombin time monitor. My friend went out of town, became ill his first day out, and somehow got back despite being even sicker. He was placed in the hospital for one week and after being home for a week is a very weak changed man. I hope the damage is not permanent. His lungs, amoung other organs, were affected. He's being treated by the same doctor- - I don't get it!

 

[Marty]

Another horror story!

Another horror story!

Thanks Strayze! I expect more in my "new thread"

 

[strayze]

Yes. According to www.rxlist.com Cipro enhances the effects of warfarin. A number of antibiotics do, just by virtue of knocking out gut bugs that make vitamin K. I haven't checked as to whether Cipro has in addition another effect on warfarin independent of its antibiotic nature.

One effect on warfarin that is not in the package insert, but is very real indeed is with the common drug is prednisone. As part of a chemotherapy protocol I was placed on large amounts to be tapered down over a period of 6 months (along with increasing amounts of a chemical mustard ). Prednisone suppresses thyroid stimulating hormone independent of circulating thyroid hormone level. This led to hypothyroidism. In addition prednisone inhibits the conversion of the T4 hormone (thyroxin, the export product of the thyroid) to the active T3 hormone (triiodothyronine). So it was a double hypothyroidism whammy. The resultant reduction of metabolism (my temperature reached 95 - 96 degrees) results in less metabolism of warfarin. Hence the warfarin dosage had to be decreased. And this fairly common effect of prednisone was not on the package insert. It took some doing to get this one straightened out and to get an increase in thyroid medicine.

My biochemistry background comes in handy in this warfarin business.

Sooooo as a result I am very wary of any medication, and take only those which are necessary to sustain life, or in extreme circumstances, to alleviate pain.

 

[SandyK]

Coumadin & Aspirin

Coumadin & Aspirin

Hello, I had my 2nd Aortic valve replacement & mitral valve repair on 12-13-00 and now I am on Coumadin Plus Aspirin. I have had my PT drawn every week for the past 6 months and my INR is either high or low. I am supposed to be between 2.5 and 3.5. I take 7.5 mg of coumadin 4 times a week and 5 mg 3 times a week, Plus 325mg of Aspirin every day. My doctors wont let me home check or have a finger stick due to me having bloodclots in "95" , they say they need a "real" reading. They can only take blood in my left arm (wrist), I had the bloodclots in my right arm and they wont put a needle or even a bloodpressure cuff on that arm. I know all about the scar tissue and calloused veins, I have them. I have been on coumadin 11 yrs. this is my first post to the new forum. Thanks for listening.

SandyK

 

[LUVMyBirman]

Cipro and Coumadin

Cipro and Coumadin

Janie...

I have taken Cipro and Coumadin together twice with no problems.
It all depends upon how each person metabolizes the combination.

This is truly on an "individual" basis. Just as Coumdain reacts differently within each individual. All we can do is test. test test

 

[Bob Gleason]

Dr Ansel........to Marty

Dr Ansel........to Marty

Marty, does Dr Ansel have a website? Please advise.

Thanks

 

[strayze]

Gina,
Last year, due to unrelenting pneumonitis, I was on and off of antibiotics, a number of different types. Each time, my INR went up when measured, that is WHEN is happened to be measured within 2 weeks of starting the 10 day treatment. (I was on a 4-6 week draw schedule unrelated to any other event, surgery, medicine, etc.) I started self treating by lowering my Coumadin dose ~ 10% while on antibiotic so as to not chance a too high INR that I knew of. This worked out fine.

This year I'm on prophylactic antibiotic for the same condition. This works out fine for the levels of antibiotic are constant and I'm no longer up and down in INR, with self-lowering needed to maintain INR.

The gps nurse who handled INR measurements was not terribly knowledgable, so I took whatever I could in my own hands and stayed on the unrealistically rigid INR schedule. There was inability to communicate with that office the need for an INR draw, short of a letter hand delivered or included with my payment, and that didn't work either.

 

[Sharon]

inr all-time high at 7.7

inr all-time high at 7.7

Hi Bob,
What a pain for you to be struggling so - when you've been doing so well until now. When did the dr put you on the aspirin? It's not uncommon - I've seen posts on other sites that tell about drs prescribing aspirin along with coumadin to other valve replacement patients. Also, what were your tia symptoms? Hope you are feeling better by the time you read this note.
Sharon

 

[Sierra Bob]

On March 20, 2000, I went in to my primary physician at 2:00 P.M. for my normal blood draw. The blood was then sent to a hospital lab 40 miles away to determine the protime and INR. My doctor called me at 9:00 P.M. that night. My INR was 11.4!!! Neither my doctor nor I believed this could be correct since I had no apparent bleeding or bruising. I had another blood draw the next day. Before I got the results back, I started hemorrhaging from the mouth. (The original INR was correct.) Off to the hospital (different hospital, same results) we went. After a complete blood count, cultures, chest x-ray, and urine specimen (filled with blood), it was also determined I also had a raging case of pneumonia in my right upper lobe. The congestion was so great, neither two doctors nor ?????nurses knew I had pneumonia by listening to my chest, until they saw the x-ray. The pneumonia was also confirmed by the cultures. They all said the lungs sounded clear. It sounded clear because the lobe was so full of fluid it didn't "rattle". I saw the x-ray. It was pure white, where it should have been dark. I spent eight days in the hospital treating the pneumonia and getting my INR adjusted. I now monitor and adjust my INR myself with my doctors blessing.