Just try to keep INR around 2, I dare you!

[Gail in Ca]

Well, I finally talked my dermatologist into leaving the unna boot off my leg. However, she took another culture from the still open 1/2" wound right in the middle of the incision.
Because it's still open, I will just have to place a duoderm patch on it and then use a compression stocking on my leg to help it not swell, and so it should finally close, right?
I took a real shower today, and got another use for the PICC line cover I had used in '08. It fits my skinny shin. I washed my leg and foot myself for the 1st time since Aug 18th!!
However, I took my INR reading today and it's back up to 2.8! I am finding it's really difficult to keep one's INR closer to 2 than 3. When I took 42.5mg/week my INR dropped to 1.8.
So, I took 45mg last week and it's up to 2.8. She said to go back to 42.5mg this week. But, I'm thinking I should get 1 or 2mg tabs and add just a bit more to that.
Well, just news on my saga of melanoma removal on Coumadin. It has been an eye opener. And it's still not over 9 weeks later. I sure hope the staph is gone. Will find out tomorrow.
I am happy to be wearing a different shoe today as well!

I also wanted to say that if you wonder about something on your skin, have it checked sooner than later. My doctor said usually when it's at the stage mine was, it is like those ugly pictures we see online and in magazines. But, mine was really different, she almost didn't biopsy it, and it could've been lethal. I waited a year before having it looked at. Don't do what I did!

 

[pellicle]

bloody hell, still going!

I am wondering why a vac dressing is not being used?

WRT tabs, I keep stock of 1,3 and 5 so that I can adjust my dose more easily (when I do alter it).

As an Australian we seem to take Melanoma more seriously than anyone else in the world. My friend (aussie) here in finland is a redhed and goes back to Australia for checks cos here they just don't have a clue about it.

Best wishes mate

 

[Agian]

Does it even exist over there?

 

[pellicle]

Does it even exist over there?

what?

does the US exist or is it a fiction?
do vac dressings exist over there
do 1mg tablets exist over there?
do melanomas exist over there?

reply with quote really clears up this. The up down left right arrow keys make selection and deletion of text really convenient (unlike typewriters)

(if you haven't guessed it "net users" who can't use the net drive me spakko {like smakkos}]

 

[Agian]

I meant melanoma in Finland, given that it's cold. I wouldn't have thought they'd have the sun exposure that people here do. It's sort of what you implied when you said they don't have a clue about it.

 

[pellicle]

Hi

I meant melanoma in Finland, given that it's cold.

ahh ... *that* meaning ... I hadn't even thought you meant that meaning (seriously).

yes its cold, but we still have sunshine, in the winter you get MORE sunburnt because the snow reflects more UV than the sand even.

so yes, they have it. Less commonly than sunburnt australians, but yes they do deal with it. Usually way too late though.

I wouldn't have thought they'd have the sun exposure that people here do. It's sort of what you implied when you said they don't have a clue about it.

but as it was unclear *which* thing I said it was only clear to you. My mind was on the USA and my reply to her. Which brings me back to the simple etiquette of reply with quote. You know what you meant but the other may not.

its actually just beside the other button ...

 

[Agian]

Are you sure you de-alcoholised the wine you're drinking?

 

[pellicle]

Are you sure you de-alcoholised the wine you're drinking?

pehaps not enough ...?

<shrug> ... everyone has something which irritates them. I've just seen way to many misunderstandings start that way. You may be ok with that, I'm not.

<looks at clock> way too early to start drinking

 

[Agian]

Meh. Misunderstanding something isn't the end of the world, as long as people have good intentions.

 

[pellicle]

Gail

Well, I finally talked my dermatologist into leaving the unna boot off my leg. However, she took another culture from the still open 1/2" wound right in the middle of the incision.

Are you seeing stomal specialists? I would suggest that your wound has entered a chronic definition.

VAC dressings (see wikipedia) work well. They promote tissue growth and remove surface bacterial colonies increasing wound healing.

I had the VAC company stuff on my wounds and you can see from the histories of that they closed well even though I was on warfarin.

how deep is your wound?

However, I took my INR reading today and it's back up to 2.8! I am finding it's really difficult to keep one's INR closer to 2 than 3.

yes, I had similar see sawing when I was going through my debridement recoveries.

When I took 42.5mg/week my INR dropped to 1.8.
So, I took 45mg last week and it's up to 2.8.

I have found here that (using your language and converting my data) a change from 49 to 50.75mg a week was enough to deflect my INR a few points.

I'm not on 49mg a week (says 7mg a day and feels relieved to see a meaningful figure) and that has me a around 2.4 pretty consistently. My opinion is that keeping dose very stable and not alternating days helps to stabilise my INR, thus I work on daily or at most bi-daily doses. 7mg alternating with 7.25mg was seeing me trending higher in the ranges (2.6 and above) and now that I'm on 7mg a day INR is 2.4 ~ 2.2

So if you want to hover close to 2.1 I suggest that will be a plan to try.

over 9 weeks later. I sure hope the staph is gone. Will find out tomorrow.
I am happy to be wearing a different shoe today as well!

hope so too ... keep us posted (or at least me ;-)

and do consider that VAC dressing.

 

[clay_from_nj]

but as it was unclear *which* thing I said it was only clear to you. My mind was on the USA and my reply to her. Which brings me back to the simple etiquette of reply with quote. You know what you meant but the other may not.

its actually just beside the other button ...

But here in the USA, we know that we're the center of the world and that, unless specified, everything said refers to America or something American, so we understand your mind being on us. <gdr> :biggrin2:

 

[Protimenow]

What's wrong with a 2.8? I'd rather have a 2.8 than a 1.8 -- which is what some meters that say 2.0 actually mean. I would personally be very satisfied with a 2.8.

 

[Agian]

But here in the USA, we know that we're the center of the world and that, unless specified, everything said refers to America or something American, so we understand your mind being on us. <gdr> :biggrin2:

If America didn't exist, we wouldn't have the Simpsons... and if we didn't have the Simpsons, I wouldn't be able to say... D'OH.

 

[pellicle]

If America didn't exist then we wouldn't have the internet and we'd all be isolated like when I grew up.

Heaps better information and access to groups who may be small percentages but number in the thousands globally

 

[pellicle]

What's wrong with a 2.8? I'd rather have a 2.8 than a 1.8 -- which is what some meters that say 2.0 actually mean. I would personally be very satisfied with a 2.8.

In an earlier thread Gail mentioned that she was trying to keep her INR close to 2 because it may help in the wound on her leg healing. She didn't want it to become a permanant feature.

 

[Bina]

Gail, sorry to hear of the ongoing saga, but at least you are happily washing that smelly old foot
Keeping a lowered INR will be a challenge, but it is possible. Lots of good diet choices and testing often should do the trick.

 

[Gail in Ca]

Nice replies folks! Well, it was infected, so I started on Keflex 500mg tid instead of bid, for 14 days. I have been on it for 6 days, now. I peeled off the duo patch today (after a week with it on) and it looks better, almost closed, just a couple of tiny openings that weren't oozing, so that's really good. I think it's on it's way to finally healing. I had to replace the duo patch and keep it on for another week, and so on until it is healed up. I believe my incision was probably 2cm deep at least, and maybe wider than that where she had to stretch the skin closed over it. It was borderline for a graft, but she chose not to go that route due to the warfarin I think, and having 2 wounds to heal instead of the one I got.
I'm so lazy that I never have looked up the VAC info. I'll do it now.
Yeah, my friggin shin is finally healing!

 

[Guest]

almost closed, just a couple of tiny openings that weren't oozing, so that's really good. I think it's on it's way to finally healing. I had to replace the duo patch and keep it on for another week, and so on until it is healed up. It was borderline for a graft, but she chose not to go that route due to the warfarin I think, and having 2 wounds to heal instead of the one I got.

Sorry to read this Gail, did she prescribe wet to dry dressings? Use saline to clean the wound, soak the bandage in saline, cover the wet bandage with another bandage and let dry. Twice a day changing, it removes dead cells and the saline helps to close the wound. I had to do this for my foot after some tendon surgery. My wound opened post op, thanks to a hematoma and the doctor having to place a pressure bandage to get the bleeding to stop, all the while cutting off oxygen to the skin, resulted in dead skin and ugly scab. I was going to his office weekly for debridement. Coumadin complicated my recovery too. As the wound got better, I was allowed to soak my foot in Epsom salts to speed healing. I do not want to ever go through an ordeal like that again. A minor surgery turned into a three month ordeal.

I wish you the best of luck in your recovery.

 

[pellicle]

Hi

I'm so lazy that I never have looked up the VAC info. I'll do it now.
Yeah, my friggin shin is finally healing!

once you see on in action you realise that many other techniques are simply medieval for wound treatment. I would have argued for one from the start as quite probably it would have prevented this. They are more labor intensive however but given where it is I'm sure you could do the re-dressing yourself.

 

[Gail in Ca]

Thanks, Pellicle, Lucy, and all. The vac was interesting, but my dermatologist never mentioned it. So, when I was in for my Unna boot changes I forgot to ask about it.
My dressings were wet with that Unna boot, under a wrap like the vet uses. It was always closed up, except when I went in for boot changes, and a leg wash, which I think is where the staph started. The duo patch is supposed to create a healing environment, so we'll see.
I also was unaware of how big this surgery was, and the length of time it would take to heal. I would imagine that getting s. aureus didn't help, either.
My doc did the procedure only a couple of days after getting the pathology, so I didn't meet her to discuss the process, or how difficult/serious a case this would be, before the surgery. She did it on a Sunday, so I knew it was urgent, but that was all until it was over, and I had 26 stitches and the boot on my leg. Well, INR was back down to 1.9 yesterday, so I will flip flop the dosage again.