It's working!

[Raverlaw]

Well, the saga continues:

You may remember that my INR, which was on a downward trend, had fallen as low as 1.9. I got it up to 2.0 last week by increasing my dosage in contradiction of my doctor's order. Then he actually told me to change from 2.5 mg daily to 5 mg WMF ( a reduction in total weekly dose). So, I again ignored him and increased my dose to 5 mg MWF, 2.5 mg the other days.

Yesterday, I tested and my INR was 2.5. I think I'm on the right track here, so I'm going to hold at the same dosage this week and see what next Monday's poke discovers. If I'm stable, I'm going to increase slightly to try to get up to around 3 or a little higher.

I've switched my Coumadin management to my PCP's office, and will see him next Tuesday to go over the chart I've meticulously maintained and discuss what to do in the future.

I want to thank Ross and Al Lodwick for their valuable experience and input, and the rest of you rat poison users, too. The things I learned here are paying off, and I think I'm on the road to stability in the proper range.

 

[SJJ]

Bill,
I'm glad you're heading into range and have been willing to do your homework and participate in the decision regarding your dosage. I've been fortunate that the last two weeks I've been in range, 3.1 and 3.4 prompting my coumadin nurse to say she didn't need to see me but once every 2 weeks now. I happen to have an appt. with my cardio next week so I told her I'd like to get a reading while I'm in the office. It didn't seem to me that since I wasn't even 5 weeks post op and only had 2 in range readings that we could safely assume I was stabilized. Go figure, first I'm complaining to my husband that I have to go get another dang reading and then I'm making a pitch to the nurse that it's too early to cut me loose for two weeks at a time. Brings an additional level of meaning to the INR sayihng,"it's never right." At any rate I hope you're successful with your plan and agree that Ross and Al are crackerjack sources for coumadin concerns.
Sue

 

[Ross]

If the next test is still stable or just slightly below or above the current level, I'd bump it up an additional 2.5mg over the week and that should put you where you want to be.

Bill isn't it nice to know that you can do this and understand more about what your doing and why your doing it, then those that are getting paid to manage your therapy?

Congratulations and I bet your veins will be thanking you shortly also!

 

[Raverlaw]

Ross,

Yeah, that's what I'm guessing at this point. I think I'll end up on 5 mg 4 days a week and 2.5 mg the other 3 days.

Right now, I'm eating normal levels of greens and keeping to one or two glasses of wine daily (although I've skipped a few days ) so I'm confident that I'm adjusting the Coumadin to my regimen. I'd like to get back on my eye supplements, though, and that will probably mean some more fine tuning.

I'm about to go on a little trip to the East Coast, though, and will wait to mess around until we see what a little vacation does to the 'ol INR.

 

[Ross]

Whatever you do, don't go making changes for slight overs or shorts. If your 3.6 to 3.8 leave it alone. If your 2.2 or so, leave it alone and see next time around. Rob's got the right idea, as long as it's between 2 and 4, don't worry too much about it.

 

[Georgia]

Congrats on getting the inr thing going the right way. It's incredibly frustrating to feel so much better after surgery only to have your life nearly ruled by that bloodwork.

Continue to be really careful of extra greens; and put that wine back in your diet.

And it's great that you'll have someone else monitoring your coumadin - once I got rid of my old doc my inr stabillized nicely - the new doc NEVER changed anything until at least 2 readings (except once when it went really high); he seems to understand the dynamics of the drug that Al talks about.

Hang in there, kid - it'll come around.

 

[bvdr]

I'm real pleased with you being an active participant in your coumadin management! Good for you!

Now, when is it that you fly into Raleigh? Are you going to make it down to Pinehurst during your stay? It is a beautiful time of year in N.C.. We have many things beginning to bloom and I expect the Dogwoods to start any day now. I saw the picture Hennyslee posted of her wisteria and have been watching for the vines by us to start but they haven't as yet. I hope you have a wonderful time here. I'm sending you a PM.

 

[catwoman]

Bill:

Congratulations! It is a struggle right at first to get your INR in range, but once you do ... voila! When you understand the effects everything has on Coumadin, you have a better handle on your health.

Sue:

My PCP's office was willing to do the every-two and every-three week testing schedule. However, I've found that there can be too many variables -- vacations, antibiotics for this and that, not enough rest one week -- that will throw off the INR, not to mention food intake.
I prefer to test weekly so I can be on top of any drastic changes quicker.
My PCP says he's much more comfortable with me having a home test machine. If he needs to prescribe an Rx for an infection/whatever, I can catch a change in INR quicker myself. I travel a lot on weekends, which throws things off. I have to work harder on weekends to stay consistent -- convention centers don't have "healthy" offerings!

 

[SJJ]

Marsha,
My thinking exactly......can't wait until I meet the 3 month prerequisite so I can get my own machine. Bill is chompin' at the bit for one too I think.
Sue

 

[ALCapshaw2]

Raverlaw wrote:

"I think I'll end up on 5 mg 4 days a week and 2.5 mg the other 3 days."

Let's see, that comes to 27.5 mg / week which is almost 28. 28 divided by 7 days = 4.0 mg / day

Personally, if that is where you stabilize, I would go to 4mg a day instead of bouncing between 2.5 and 5. Seems more 'stable' to my engineering mind.

'AL'

 

[Shelba]

Congrats, Bill. I hope to catch up with you soon. I've tested at 1.2 for the past two weeks, and 1.4 and 1.8 before that. Which reminds me....time to take my coumadin!

 

[Gail in Ca]

Shelba, tell the doctor , you need to up your dose. pronto!
I found that when my INR dropped below 2.5 ,I always take extra that day.
It seemed to keep going down if I didn't, especially in the first yr or so after my surgery. Even now, almost 4 yrs later, if it is low I will add, but if it's a bit high, I will leave it alone and it always goes back in range.
Now that I have been trying to keep it closer to the 3-3.5 range , it seems to rarely be too low,now.
I have been regulating my own dose for 2 years, no problems.
Gail

 

[Ross]

Raverlaw wrote:

"I think I'll end up on 5 mg 4 days a week and 2.5 mg the other 3 days."

Let's see, that comes to 27.5 mg / week which is almost 28. 28 divided by 7 days = 4.0 mg / day

Personally, if that is where you stabilize, I would go to 4mg a day instead of bouncing between 2.5 and 5. Seems more 'stable' to my engineering mind.

'AL'

Oh mister engineer, what if all he has is 5mg tablets?
That's sort of like myself. I could use 6mg everyday rather then 7.5 x 3 + 5 x 4= 42.5 7 x 6 = 42 See, I did graduate high school much to everyones surprise!

 

[Shelba]

Hey Gail,

They've steadily upped my dose every week. I was positive that this was going to be my week to be in range, but no luck. I make sure I eat a salad every day, and I don't stray.

I'm now at 5mg five days a week and 6 two days a week.

When I was in the hospital, I shot out of range....I tested at 7, so they kept me in the hospital until they brought me back down. I had to have a plasma transfusion. Now...I'm way down at 1 point freakin' 2. I really hope next week is my week, but I doubt it. I test every Tuesday.

What do you think?

Michele

 

[Raverlaw]

Michele,

You're probably a lot smaller than I am, yet you're taking larger doses and have a lower INR. People really do metabolize this stuff differently.

Ross,
Although I like Al's suggestion for consistency (I test on Mondays; how do I know that I'm not just getting a reading based on Friday's dose?), I'm not going to maintain a whole different inventory of pills. I've got 2.5 mg tabs now; I'd like to get some 5 mg pills too and just use a combination of those, although my co-pay (if I get the warfarin generic) is only $5 bucks a bottle of 60. Once my dose is stablized, I can order mass quantities of pills through mail order and get an even better deal.

Al,

I just love engineers. How about I take 2 mg each morning and 2 mg each evening? That will really spread things out evenly.

 

[Ross]

See that's the beautiful thing about testing. You never know what's going to come up and you'll never get the same number twice, back to back. The number you do get, it the number at the time of that particular test. The question from there is, "Is it on it's way up or down from here?" Who knows.

The technical thought would be as your looking at, "Is it Fridays dose or is it a build up over the week?" This stuff isn't technical, so we shouldn't think like that, but take the number we get and make a sound judgement of what we need to do from there.