INR shot up !!!

[Sagebrush]

I am soooooo upset, I just don't know what to do?? Sunday morning I got a bloody nose. So bad that I couldn't get it stopped and had to go to the ER to get it stopped, it was bleeding above the bone in my nose. I live in a high mountain desert where there is very little humidity, so I know that doesn't help. I do have a humidifier running 24-7. Anyhow come to find out my INR had shot up to 4.0 and my cardio wants it at 3.0. The ER doctor told me not to take my coumidan Monday(I had already taken it before I got the bloody nose), get my blood drawn first thing and call the doctor who is monitoring my INR and see what he wants me to do. I called the doctor 3 times Monday and actually stoped by to see what I should do. I guess he was so busy Monday that his nurse actually talked to me and told me to call Tuesday morning and found out that my INR was up to 4.3 Monday. Well I work full time and forgot and when I remembered to call it was noon, so I called and some rude person who answered the phone in the office said he was gone for the day and I would have to call back Wednesday moring. Ok so I about burst into tears not knowing what to do and I told her that I was supposed to call in the morning but had forgotten and she says rudely back"Well I guess that is why the nurse told you to call in the mornig" So I am thinking calling 3 times and leaving messages, and stoping by doesn't merit a call back in the moring, plus going to the ER the day before for a nose bleed when on comidin is a giant RED flag to call the patient back. So I am thinking of maybe switch doctors. I am so pissed, I could just burst out crying will I am typing away here, but then I couldn't see. More reason to get one of those home testing machines. I am calling my cardio firt thing in the moring to see how I can get one, I am sick of my INR since September never being the same, plus I am eating no Vitiam K. I just am so fustrated, I want to cry again. By the way my Cardio is in Minnesota and I live 1300 miles west, so that is the reason I have a different doctor ???? trying to monitor my coumidan or is that me just monitoring it don't know !!! Any helpfull advise would be much appreiciate, FAYE

 

[Ross]

Good Morning Faye

Don't go berserk yet. 4.3 is high but not even close to life threatening. I've gone as high as 4.6 myself. I don't know if your a fast metabolizer of the drug or not, but they usually tell me to hold for 2 days then have my INR checked again. If I hold for 2 days as they tell me, I drop into the 1+ range, which is dangerous. Don't take any of my advice without consulting your own Doctor, but I'll give you a link to a sight that may help you get yourself back in range or at least be helpful in the future.

http://www.aafp.org/afp/990201ap/635.html

How much coumadin do you take a week?
What is your desired range?

I've found that by eating something high in Vitamin K like spinach, I can kick the INR down in no time. If your range is 2.5 to 3.5 I'd say maybe withhold one dose and decrease your overall weekly dose by 10%. Again, I'm not a doctor and certainly wouldn't want you doing this without consulting your physician!!!

I would bring the offending phone person to the Doctors attention. If you like the Doctor, maybe you should keep him, but someone else should be fired. If it's going to be this way all the time when you call, I'd find someone else. You don't need that aggravation. There really is no reason for people to act like that. I don't care if they're having a bad day or not.

 

[GregB]

Stay cool

Stay cool

Faye
I can understand some of your frustration.
I think Ross has it pretty right.
I too have pulled a 4.6 and some other 4 point readings at other times. Each time the INR has gotten itself down into range again without adjusting the dose at all. It is a strange drug we live with.

I get the idea that many of us here feel more uneasy about low readings but keep our fingers and toes crossed in the high ranges as well. With luck and good management you should be able to get to range again

I self test with a coaguchek machine but do not adjust dose without consulting my doctor. Fortunately for me I have not encounted the hostile responses that you have endured.
The other thing I have noted here is to be suspicious if anybody suggests a dose change that varies your weekly total dose by more than 10% and to miss a dose only in extreme circumstances if ever at all.

I am still learning the ropes on this too. I am sure other more experienced people will have more to say.
I really hope things can level out for you soon. Take care.
GB

 

[JimL]

I've been to over 5.0 without any increase in bleeding. The nurse told me to hold two days; I didn't. I took a half dose for two days -- the equivalent of holding one day -- and my INR dropped dangerously low from Friday to Monday.
When the INR is checked, it is a snapshot look. You don't know from the reading you get if your INR is steady at 4.6, or on its way down, passing through 4.6, or on its way up, passing through 4.6. That's why any adjustment in the dosage should be minor, the 10% change per week idea.

 

[Nancy]

Hi Faye-

Calm down. Joe has had INR over 5 on occasion and he's still here. He's been on Coumadin for 25 years and it is mostly in good control, but the nature of the drug is that it fluctuates, and there are many, many reasons. That's why you will have to be checked often. BUT___ it's imperative that you have a doctor who is responsive to your needs. INR can jump in a couple of days, if there are no adequate changes. I would start checking out the Coumadin management alternatives in your area. Even if you self monitor, you will need a doctor, clinic, or other medical professional to give you the proper dosages and to get your scripts for you.

BTW-Your doctor must have someone covering for him when he's out of town. I would press his office for a name of the covering doctor. Don't cry, just be your own best friend. Walk softly and carry a BIG stick. Get on the phone and be insistent

 

[Marty]

Bloody nose

Bloody nose

Faye, As the others have noted above your INR is not bad and does not require a drastic dose change. For patients like you I advocate the 10% solution. A 10% reduction in weekly dose divided over the seven days and then retest. The nose is another problem. I doubt the INR 4 started the problem but it could keep it going. Nose bleeds can be serious and you should go to the ER for a doctor to look and see where the bleeding is coming from. Packing and sometimes surgery is needed. Frankly if I had a bad nose bleed I would not bother the FP or cardio, I'd go straight to an ENT specialist.

 

[terry40]

Faye Lewis

Faye Lewis

I second what was said, especially reducing only 10%, and have a salad or some green veggies, just one serving though.

I had a few bloody noses since the start of coumadin, but nothing that I couldn't control, the humidifier does nothing to relieve the gas heated dry air, so I opt for the ocean spray (nasal)

You might need to get a more attentive doctor, and they (the doctor) should give you the bottom line of what to do, all we can do is give suggestions.

I'm at the other end of the coumadin level, taking a high dose, but the level keeps dipping low, it scarey at either end!

Keep us updated with your progress,

Terry40

 

[Nancy]

I forgot to mention in my other post that nose bleeds do not always mean a high INR. Joe has had them with his INR well within range. So I wouldn't load up on greens just because you have a nosebleed and you think it might be caused by a high INR. That's bad science. Go to the ER and they will check your INR right away. Then you will know for sure what is happening, instead of guessing.

 

[ccrawford]

why not do it yourself ?

why not do it yourself ?

Nancy - I live about 20 miles from my family doctor and much of that is county roads that can be bad. A test strip for the coagulant checker sells for about $5.00 vs the $25 the doctor charges. Figuring out the dosage changes seems pretty simple, and my cardio is very responsive in answering his email. I'm thinking a home test unit makes sense. Whats the flip side ?Chris

 

[Nancy]

I guess Joe's lucky. We live about 20 minutes from the hospital and he's been going there for 25 years. He knows all the gals in the lab. Plus the doctor who monitors his protime is in the building connected to the hospital. He's very comfortable with the lab draws.

Also, our insurance is good and covers everything.

In your case it makes a lot more sense. 20 miles away with bad roads is not a good scenario. And if you're paying out of pocket, another good reason to do it yourself. But you will still need a doctor to write your scripts.

 

[Guest]

I live in high desert, too and monitor warfarin for a living. If you have a one room humidifier, it probably is not enough. When you have 10 to 15% relative humidity outside and 10 to 20 degrees and heat the air to 70 degrees, you are going to need about 5 gallons of water in the average house every day. The way to tell you have enough is when the windows start having water run down them - then you can cut back a little.

I see INRs between 4 and 5 every day and they rarely cause a nosebleed. I don't consider anything below about 6 as "shooting up". Probably 90% of the people with INRs of 8 (for a few days) do not bleed.

The 10% rule is a good one. There was a study published this week that concluded that decreasing a warfarin dose by more than 20% will almost always result in an INR that is below the therapeutic range.

I have developed a set of warfarin dosing algorithms which I sell through my website. They are $4.95. If you would like information about how to purchase them send me an e-mail [email protected]

 

[ccrawford]

dosing plan for antibiotics

dosing plan for antibiotics

Al - many of us will undoubtedly need antibiotics for dental work, or a prolonged antibiotic treatment for an infection. Is there a preferred dosing strategy to deal with that given that it takes a while for the medication to kick in and kick out ?

 

[Sagebrush]

Thank You !!

Thank You !!

I just want to thank everyone for their reply to my post. OK, I guess I was freaking out, but the doctors really scared me when I got on coumadin about nose bleeds being life threatning. I think I would be consided a problem nose bleeder, I have them all the time. I think I had convinced myself that I would bleed to death if my INR is too high. My nose is much better and I did get a new filter for my humidifier, I use about 3 gallons of water a day and have an atomic clock that says what the humitity is 24/7. My nose tends not to bleed if the humitity is 22% and above. Thanks for all the advise, it is sooo helpful and comforting to know there is someone out there that knows what I am feeling. THANKS, FAYE

 

[Guest]

I wish I had a strategy for antibiotics but they are so different that there is no one rule.

Short bursts, for dental work, can usually be ignored because they are only taken for one day. If the INR goes up, it is for such a short time that it rarely causes a problem.

The others are almost impossible to predict.

 

[Rain]

Coumadin for some people is a real pain in the .........

Coumadin for some people is a real pain in the .........

Faye,

Like Nancy said.. when my cardio is unavailable, there is always someone else on call. If there wasn't THAT would be reason enough for me to change cardios.

I understand your frustration with your INR. To fight with it constantly and have it swing for no apparent reason is enough to make anyone cry. How can you fight and win when what you're fighting is not "CONSISTENT" sorry... I just hate that word.

My INR was 5.1 according to the lab on Friday. Grrrrr!!! THAT, after eating salad for dinner all week?! Maybe I didn't drink enough Margaritas in Vegas... hmmmmm.... hadn't thought of that!

Hey, I have a 45 gallon fish tank. I have two huge pumps with filters in them, circulating the water... not only do I never have to clean the tank, but it puts over a gallon of water in in the air every day..... great humidifier.

 

[LUVMyBirman]

Protime......Rain

Protime......Rain

Rain, Did you check your unit vs. lab results out? You mentioned a 1.0 gap. Hope all is well.

 

[Granbonny]

Rain

Rain

I would have a panic attack if mine went over 4.0...Not bragging but made 2 trips to ER last summer and fall....The first..just bleeding gums and the 2nd..urine blood. Both times my INR was in range. Just coumadin making it worse. The urine blood was a UTI..Never had one before and NO pain with this one.. But if gets over 3.5..I drink a V8 juice.....eat some cabbage and test again in 4-5 days...Comes back down...PLEASE this is just me dealing with me..I'm NO doctor Bonnie

 

[Rain]

My friend... coumadin.

My friend... coumadin.

Hey Girlfriends!

I?m gonna check my unit against the lab on Thursday. I?ll let you know how it turns out.

I just skipped my Saturday dose and went back to life as if this never happened... because I don't really know what cause it to go so bizzerk. It must have something to do with being in Vegas... the sun, the veggies, the drinks, the walking, bright lights.... maybe all that nasty cigarette smoke... who knows... maybe I was just having too darn much fun, and my friend Coumadin was getting jealouse?!

You see Bonnie, its like this..... coumadin and I have been around the block together several times. We're beginning to understand each other pretty well, however, on occasion.... he just has to throw up his ugly little head and let me know I?m not in complete control.... and that I do have this lovely friend, my INR, to keep happy. And if I don?t there are consequences.

He always wins.... just makes me wish I could reach out there and smack him sometimes.

 

[Guest]

Rain, you getting any snow over there? It's so dry on this side of the divide that they are talking about cutting off the water to the power plant. That really makes sense, then we wouldn't have any electricity either.

Did you mean to send me the picture of your daughter getting her hair cut? You said that you were sending it to "family".

 

[Rain]

Hey, Uncle Al!!

Hey, Uncle Al!!

Yes, I sent the pictures to you on purpose! I started off sending them to her big brothers who are away at college, but then I decided to share them with the whole family. The immediate family then started running over to the vr.com family.

Before we cut her hair it was it was all the way to her knees! And it was her very first hair cut.

It?s also VERY dry here. It did snow a little the last couple of days, but it?s blue skies and sunshine this morning.... only a tiny bit of snow in the shady areas. I hear there's supposed to be snow in Denver on Saturday.... that figures... the weekend I wanna drive over the continental divide. THat's OKAY!! I?m not complaining!!