INR vs. Hydration / Dehydration

[ALCapshaw2]

What roll does hydration / dehydration play with INR?

I've been working like a slave in my yard, sweating out enough water to soak my clothes, and this week my normally low to mid INR (2.5 to 2.9) registered a 4.7 !

To top it off, my urine looks like coffee that has set too long. At first, I suspected blood in the urine, but it's more brown than red, NO clots, NO strings, and NO pain. This has been going on for several days, maybe a week or more, since I didn't pay a lot of attention at first.

I was put on Lasix (3 to 5 days/week as needed) several weeks ago to reduce symptoms of Shortness of Breath. It worked VERY WELL at achieving that goal, but now I'm beginning to wonder if I've damaged my Kidneys with the advent of our Sultry Summer Weather.

My Coumadin Nurse and Pharmacist both suggest that something other than a high INR is most likely the Root Cause of my dark urine. I've tried to find 'dip sticks' to test for blood but two different Pharmacists said they did not carry them and they are no longer on their 'order lists'. Back to my PCP I guess.

D**n it's hard to keep ones balance with so much tension on my Medical Tightrope...I sure wish I could follow Doctors Orders to STAY AWAY FROM DOCTORS !

'AL' (YES, I'm getting worried)

 

[Ross]

Sounds like you have some type of urinary tract infection Al. Whatever, see the Doctor asap. I'm still searching on the hydration/dehydration portion of the question. Might have to leave it for Mr. Lodwick.

 

[ALCapshaw2]

Thanks Ross,

The book "Symptoms, Their Causes and Preventions" published by Prevention Magazine says 'Go Directly to a Urologist, Do NOT pass by your GP' or words to that effect.

Last week, my feet were swelling due to standing at a workbench for a couple of days so I 'pushed Lasix' and held water. Now I'm back to pushing water and my ankles do show some fluid retention (but nowhere near as bad as when my feet were swollen).

I held a dose of Coumadin Tuesday night and took my (new) regular dose last night. This morning, I see traces of blood (I assume) in my SPIT.

You better believe I'm going to see SOME Doctor this morning. Maybe a trip to the ER as soon as my Protime test strip warms up enough to take a reading. D**n, I wish my surgeon had respected my request for a Bovine Pericardial TISSUE Valve!

'AL' (It's coming up on 6 A.M. local time)

 

[Ross]

It doesn't sound too good. I would say the right thing is to do exactly as you plan. Something is really amiss here. Hopefully you can let us know what's up later today or someone post on your behalf.

 

[EVELYN]

Absolutely, Al, I agree with the Rossman----get thee to a DR. ASAP. Keep us posted.

Evelyn

 

[Nancy]

Hi Al-

Getting to the ER or to the doctor asap, are the right things to do. I wish you had gone earlier. Dark urine is something to be wary of and have checked out. And in addition, dehydration isn't a good thing for your kidneys or anything else either.

Remember David Bloom, the wonderful journalist, who suddenly passed away in Iraq. I read that he had been dehydrated, developed a blood clot in his leg as a result. It went to his lung and he lost his life. he also had been in cramped conditions while riding around in a vehicle. So it's nothing to fool around with.

If you need to cut back on your fluids for some kidney problem, let the doc tell you how to do that.

Please let us know how things went.

 

[ALCapshaw2]

OK, I've taken a few deep breaths, had my breakfast, and cleared the cobwebs now.

INR this morning reads 4.7 on my Protime. It read 4.0 two days ago vs. 4.7 on my Coumadin Clinic's Coaguchek machine. I know it takes 3 or 4 days for changes to stabilize so I may just need to be a little more patient on the INR front. I did hold one dose Tuesday evening.

I also remembered I had some minor bleeding from my gums after flossing last night. My saliva is mostly clear/white now so perhaps that was just some residue from the gum bleed.

OTOH, as I sit calmly I become aware of some 'soreness' at my sides, strangely reminiscent of the early stages of a Kidney stone experience. YUCK, but that's better than some of the alternatives. Looks like a call to a Urologist is in order. (and another call to my Coumadin Nurse) "Prevention" was right on!

'AL' (trying to stay calm)

 

[ALCapshaw2]

This was NOT as productive a day as I would have liked.

The Good News is that my urine is slowly changing back to a lighter shade of yellow-brown. The Bad News is that my INR read 4.7 on my Protime Machine which is typically slightly lower than the Coaguchek machine at my Coumadin Clinic. Note that their machine tracks very close to the few arm draws we have drawn for comparison.

The OTHER Bad News is that after reporting the bloody saliva and requesting my Urinanalysis results (from a Tuesday visit to my PCP) along with Blood Test results, her Nurse STILL had not returned my call by 4 pm. When I called again, she told me the Urinalysis was not definitive but there was (some) blood in the sample. She will refer me to a Urologist TOMORROW morning. I'm beginning to feel some 'discomfort' around my side/back. My drug book notes that kidney stones are a potential side effect from taking Lasix for too long or too much. Who would have guessed that 20 mg several days / week would be too much!

To say that I am disappointed in the support from my PCP's staff is an understatement. To say any more would be premature at this time.

It is still not clear to me or my Coumadin CRNP why my INR is rising so high, even after skipping one dose. She suggested skipping another dose tonight. Fingers crossed.

'AL'

 

[Johnny Stephens]

Dang, Al - you don't need this, to say the least. I'm crossing my fingers too that you get some clear answers tomorrow. Are you actually going get to SEE the urologist or will this just be an appointment for later?

Let us know...

 

[Ross]

I don't know what to say, so until I hear, I'll be quiet.

 

[Nancy]

Hi Al-

I'm so sorry this seems to be dragging on and on. I'm hoping you get some answers soon.

Take care, and please let us know.

 

[ALCapshaw2]

The weird thing, is that I feel well physically, thankfully.
It will be good to get some answers though!
I will push to see 'somebody' tomorrow, even if I
have to camp out in the Heart Center waiting room.

Thank you all for your concern and care.
It's good to be in the bosom of VR.com !
There's nothing like having the support
of those who *really* understand!

'AL'

 

[ALCapshaw2]

Here is Friday / Saturday Update:

I still was not able to see a Urologist Doctor Friday
since there was only one in the office that day and
he was booked.

I DID talk with 4 nurses, some more than once,
including my PCP's Nurse, my Counadin Clinic CRNP,
a Urology Nurse, and a Cardiology Nurse. I will see
my preferred Urologist next Wednesday.

Fortunately, my symptoms were beginning to abate
and all felt I was not in immediate danger. In fact,
by Saturday, my urine had returned to Yellow (darker
than optimal but at least it's yellow) vs.
the dark brown from earlier in the week.

None of us can see a trigger that might have caused
the INR spike. That leaves me a little uneasy but
what can I do? I WILL pay more attention to the
color of my output, even peeing into a cup to check
directly at least a few times per week so that I can
catch any changes at the start.

What a week !

'AL'

 

[Ross]

Yeah well you still worry me buddy. I'll rest easier when you've seen that Urologist.

 

[ALCapshaw2]

UPDATE

UPDATE

Still no definitive answers, BUT, I did see the Urologist (good guy), who ordered an IVP, some Blood Work, and a cystoscopy(sp?)...you know, a scope where the sun doesn't shine and most males fear to ponder...

As of today, August 6, my INR is back to normal, my urine has returned to a mild yellow (not clear), there is NO Blood (Good News), and NO evidence of Kidney Stones (which may have been passed after flushing with lots of water). The Radiologist did say that he saw a cyst on one kidney which is often seen on males over the age of 50.

The Urologist is on leave until September so I can 'look forward' to the cystoscopy or comtemplate cancelling it since all the original symptoms have disappeared.

After my semi-annual Dental Checkup and cleaning, my Dentist presented me with another 'challenge' which I will post under a new topic.

'AL Capshaw'

 

[Mb]

Dear Al:

My husband had a similar expereince about a year ago. His urine was bright red though, so I think he moved a bit quicker than you did with the Dr.'
s calls, etc.
The color also resolved on its own. He did have the cycstoscopy done, very good results, but had to be IV'd the antibiotics first.
It was scarey at first, but we were told it sometimes happens to folks on the coumaden, and they just have to check to make sure everything is OK, and that it is just the meds. His INR by the way was just a bit over 3.5 when this happened. Go figure.
I think all will be well with you! - Marybeth

 

[ccrawford]

Al - That was quite a series of posts and I'm releived to hear that you are doing much better - at least apparently. Keep up the progress.

 

[ALCapshaw2]

Interesting information MaryBeth !

My Coumadin Clinic Nurse and another Doc told me that Coumadin 'shouldn't' cause blood in the urine, but WILL
make it more prevelent if there is an underlying cause.

The Urologist told me he often sees Coumadin Patients
with Urine in their blood and no other apparent cause.
Go figure.

Sooo, please tell me (us) how, uh, 'uncomfortable' the
Cystoscopy procedure was or

'AL'

 

[LUVMyBirman]

Hi Al,

Everytime I get out in the yard and bust butt in the heat....up goes the INR. (Did so today) so I suspect my next test will be high. When I lived down in Memphis it would go down from the extra activity and heat.

In the meantime, my body is going through some female changes.... so the reverse scenario may play true now.

I do feel heat causes fluctuations in my INR. Good example. Last summer I spent a good part of a month during the day inside unpacking our home. Air conditioning was running at a consistant 73-74. My iNR was a consistant 3.3 three weeks in a row. Then I headed outside to the yard in July to work and it spiked!

Let us know how you make out. I think AL L will tell you that an INR of 4.0 is not really too dangerous. I don't worry too much about it in that range. If I held at a 4....rock bottom time.

 

[Icarus]

Just call it "Prostratitis"

Just call it "Prostratitis"

Hi Al,
Had the exact same situation as you during the last month. Went to the Urologist, had a complete checkup down to the scope and came up withe the diagnosis of "Prostratitis". Sometimes you urinate dark, sometimes pink, sometimes reddish then back to normal then it starts all over again.
Naturally, God bless Coumadin, it seems to go on forever. I did notice however, that when I strain, it seems to darken or bleed just a little more, then clear up quickly.
I even had the same "Normal for an adult" cysts on the kidneys and, Oh lucky me, passed a kidney stone last week. That was the most incredible pain I EVER had.
I'm not saying that's what you got, but boy, it sure sound the same.
Icarus