just a rant. inr at 2.26

[jax]

well i had my inr tested yesterday. it is at 2.26 so not too terribly bad but it took 24 hours for me to hear anything and the only reason i did find out what my inr was is because i called the doctors office. since my doctor quit on july 24th i have had two different doctors telling me adjustments. this week with it being below range when i called they said to keep it the same and go back in a month. my range is 2.5 to 3.5 so of course i questioned it because i don't want to be dropping down too low again and have to bridge again. i am so glad that i did question it because they ended up putting me to 10 mg twice a week and test in a week. but if i had followed their instructions without question it i would probably be too low in a month and i don't want to take that risk. the nurse said that the doctor that gave the instructions apologized and that it was an oversight. grrr. i realize that doctor's are busy but i think they should be paying a little closer attention to people's charts that are on coumadin so they don't make mistakes like this. anyway sorry for the rant. it's just frustrating when you know that you should be on a higher dose and have to question the doctor when the instructions you are given just don't make any sense.

 

[Bina]

Good for you that you are paying attention and are an informed patient.
The doc having you go back after only another month could have been disastrous.

 

[jax]

i thought so too bina. i don't want to take that risk. especially of a stroke. and i am truly hoping that i won't have to bridge again but if need be it isn't that bad but i should be alright with them increasing the dose on a couple of days by 2 mg. i figured that there would be a small adjustment as i just went back to work two weeks ago and am a lot more active. it just amazes me though that the people that we trust our health too would not take the time to look into a persons chart a little better when that person is on coumadin.

 

[Bina]

I've found that some doctors (and nurses) become too accustomed with the "average" Coumadin/ A-Fib patient having a range of 2.0--3.0
A while back I had an ER nurse come back with my blood work results and tell me that my INR was a bit high.
I asked her what the reading was and she said, " 3.2"
When I replied that 3.2 was perfect, she looked totally appalled. LOL

 

[Cris N]

Jackie,
I went through a similar situation with incompetent dosing. My INR was definitely trending down and the dr's office told me to maintain the same dosage. I told the nurse that it didn't make sense to do that. She called me back later with adjustment upwards. What on earth is so hard about this that so many medical people can't see to figure it out but us 'mere patien'ts' can? That's why I self-test and self-dose.

Trust your gut instinct when you get weird instructions.AND, IMHO, you should not be waiting a month for INR test at this point in your recovery. That's way too long.

 

[Ross]

Incompetency abounds out there. You can't even get two doctors in the same practice to agree on dose. Yes, it's that bad out here.

I thank God that I have a Cardiologists that understands that I understand how to manage my own.

 

[ALCapshaw2]

MY Coumadin Clinic retests in 2 weeks when there is a change in dose. They have 4 CRNP's (Certified Registered Nurse Practicioneers) who 'Know their Stuff' and they have around 1500 patients, seeing over 100 per day.

Can you find a Real Coumadin Clinic in your area?

 

[jax]

no the closest coumadin clinic to is in cleveland which is 2 hours away. so the only thing i can do is go to the local hospital or self-test. and since i have only been in range one time that won't be an option yet. hopefully this increase was enough to get me back in range and hopefully i will stay there for a while so that i can get a self-tester.

 

[Ross]

Not to be a smart aleck, but that 2.2 could easily be a 2.5 on the next test. What I'm saying is, the dose change may put you over range.

 

[Marty]

My PCP is happy to have me manage my own dosage. Every year or so when I am in his office he does an arm draw just to see what my my PT is running.The last few years I have always been in range. Alice, on the other hand, must call in her INR and PT to her cardiologists office. They encourage home testing but say they must regulate dosage. The nurses there are very good. They understand Coumadin, use the 10% rule, and avoid the yo-yo.
Rarely we do not follow their advice but we don't let them know. They say they must keep records for medico-legal reasons.

 

[jax]

well ross i would say that i was more concerned with the waiting a month to be retested than an increase in dosage. especially since i have already crashed down to 1.3 and 1.26 before and had to give myself lovenox shots. at that time my doc (who is no longer there) said that she would rather see high than low like that. thankfully they only increased by 4 mg per week so we will see what it says on monday and if i have to cut back on it fine. but my activity is through the roof at work and it seems every time i get more active it starts to drop. i believe that you mentioned in one of my posts to expect a 10 to 15 % increase this week with me being back to work. my last test when i was finally in range for the first time since surgery was taken the first day i returned to work. so we'll see hopefully it won't jump too high.

 

[Karlynn]

Jackie - it would seem that you have the perfect reason to get a home testing unit. Insurance companies and doctors need to get their stories straight. Some only approve home testing if your test show you are "hard to manage" and some will only approve them if you can show you most always in range.

The point is - home testing is the group with the least amount of bleed or clot incidences. The precious lab draws run a sloppy second, or even third.

 

[Ross]

well ross i would say that i was more concerned with the waiting a month to be retested than an increase in dosage. especially since i have already crashed down to 1.3 and 1.26 before and had to give myself lovenox shots. at that time my doc (who is no longer there) said that she would rather see high than low like that. thankfully they only increased by 4 mg per week so we will see what it says on monday and if i have to cut back on it fine. but my activity is through the roof at work and it seems every time i get more active it starts to drop. i believe that you mentioned in one of my posts to expect a 10 to 15 % increase this week with me being back to work. my last test when i was finally in range for the first time since surgery was taken the first day i returned to work. so we'll see hopefully it won't jump too high.

Please don't misunderstand me. I'd rather you be higher too, but that 2.2 could easily work out to 2.5 or above on another test. Depends on if the stars are lined up right at the time. 4mg more for the week should still keep you in range. It's not that much of an increase.

 

[catwoman]

Depends on if the stars are lined up right at the time.

And sometimes ... Which way the wind is blowing.......

 

[jax]

at this point i am hoping i'll be on the high side. i am getting sick of it sliding downwards. atleast if it is on the high side of my range i can eat more salad and it will bring it down if need be. but with it being below range i am holding back on eating salad and broccoli and all the veggies i love of to eat atleast for this week. i don't know whether the heat affects inr or not but it has been just unbearably hot and humid in work lately. i am drained of all my energy by the time my 8 hours are up.

 

[Bina]

Drink enough water and enjoy a normal portion of veggies or salad, it's good for you.