Lost and confused per usual

[heartfelt]

Hi Everyone,
Once again I am mired down trying to figure out what to do when my INR is all skewed. You probably won't even believe what I did to try and help myself (Ross, don't look)...My INR was 7.5 sun. so I'm feeling okay and didn't want to go to ER since they'd probably keep me and I had a 1/2 of a Vit. K laying around so logic prevailed and I figured I would zap my INR down in a hurry. Gulp. Faster than I thought! When I tested just a minute ago it was 1.8. Geez'. I am too right brained to figure out the the %'s on the Lodwick Warfarin chart, so don't know what quite to do now. The good thing is I haven't been bleeding. WAHOO! I've probably mentioned my creepy cardio-guy who I don't want to call AT ALL! It will mean a lecture about home monitoring and a $40 co-pay so I can run out to their clinic and get re-tested and it will be w/in one point of my machine, so of course, mine isn't the one that's accurate. What should I do now? Can anyone give me a clue? I'm thinking about taking my ususal dosage of 5mg + 1mg tonight ( I didn't take any last night since I took 1/2 of 5mg of vit K), but then how much do I do? I think it was a couple of reg. dosages of aspirin I took for a pinched nerve that has hurt so bad I seriously didn't care what it did to my coumadin; clearly it has done something and obviously I do need to care. Maybe it would have been better to take the vicodin I have that always makes me sick to my stomach. Oh well. Now I am where I am and don't know how to fix things. I feel so stupid b/c I honestly don't get math-story problems and figuring out my INR has turned into one giant one.
Any ideas?
Thanks in advance,
heartfelt

 

[Lisa in Katy]

The skip a dose and the Vitamin K was probably the problem, and you obviously metabolize both Warfarin and Vitamin K quickly. When I skip a dose, I bottom out within a couple of days. I'm not sure how long Vitamin K stays in your system, but if I were you, I would go back on my regular dose and check in 3-4 days. Remember that when you get a high test on the monitor, you aren't necessarily that high. They aren't accurate above a certain level. You also should throw away your aspirin and take Aleve, which isn't as likely to cause issues.

 

[ShezaGirlie]

misery loves company...

misery loves company...

Hi there Heartfelt..
I can commiserate with you on this since my INR was also 1.8 this past Sunday morning. I have absolutely no explanation for that..!!

What I'm doing is upping my dose some. Hey, I'm right-brained too..! I take 10mg, so on Sunday I took 14 mg and this morning I took 12mg. Go figure?!?!!

I'll probably test tomorrow since it takes a few days to get it up there. Meanwhile when are they gonna develop a tissue valve to insert in a beating heart by way of the femoral artery to replace this crappy mechanical and dealing with rat poison. I'll be first in line..!!

My CoaguChek S will only read a test up to 8.0. Don't know what kind of machine you have..

 

[heartfelt]

Yes, I'm with you ShezaGirlie!! I was so NOT designed for rat poison!! Just saw an article about how the only truly accurate way to dose yourself with this stuff is through having DNA test done and w/o it, it's all pretty much sheer luck. Love your kitty!! I have a Tuxedo one and love the black and whites.
I was told the only thing I should take is Tylenol which is pretty much like doing nothing for me. I didn't know Aleve is safe.
I greatly appreciate the help with all this!!
heartfelt
P.S. I use an InRatio monitor by Phillips/Raytel and so far, knock on wood, it's been w/in 1 point of my tests at the clinic...I'm usually 1 pt. higher than they are.

 

[Blanche]

Maybe you could check with your doctor?

Maybe you could check with your doctor?

heartfelt:

I would hold up on the Aleve, if I were you. You might want to check it out with your doctor...the one who told you to take aspirin.

From what I understand, Aspirin affects the platelets by making them more "slippery." I'm not sure Aleve would do the same thing.

Also, Aspirin does not affect your INR levels...

I could be wrong on this, but I think you should get an opinion from your medical professional. Perhaps s/he would recommend something else for you, or at least give you more direction.

Hope you solve this concern soon.

Blanche

 

[njean]

heartfelt:

I would hold up on the Aleve, if I were you. You might want to check it out with your doctor...the one who told you to take aspirin.

From what I understand, Aspirin affects the platelets by making them more "slippery." I'm not sure Aleve would do the same thing.

Also, Aspirin does not affect your INR levels...

I could be wrong on this, but I think you should get an opinion from your medical professional. Perhaps s/he would recommend something else for you, or at least give you more direction.

Hope you solve this concern soon.

Blanche

I have been told by my cardio & PCP, NEVER to take Aleve because I am on coumadin. I never have.

 

[Bina]

Yes, I'm with you ShezaGirlie!! I was so NOT designed for rat poison!! Just saw an article about how the only truly accurate way to dose yourself with this stuff is through having DNA test done and w/o it, it's all pretty much sheer luck. Love your kitty!! I have a Tuxedo one and love the black and whites.
I was told the only thing I should take is Tylenol which is pretty much like doing nothing for me. I didn't know Aleve is safe.
I greatly appreciate the help with all this!!
heartfelt
P.S. I use an InRatio monitor by Phillips/Raytel and so far, knock on wood, it's been w/in 1 point of my tests at the clinic...I'm usually 1 pt. higher than they are.

I don't know where you read that article about how to accurately dose Coumadin....
Those of us who are in range consistently and have no problems are not relying on sheer luck. Believe me.
My 2 docs taught me well, VR.com taught me alot, and I test every 2 weeks,
that way it's simple enough to make small adjustments before things go out of control.
I'm in my 4th year of this and am doing fabulous.

Blanche is correct regarding Aspirin....it only affects blood platelets.
Tylenol is safe (in moderation).

Since you have the Lodwick chart, can you figure out your next couple of doses with a calculator.?
If not, that's fine, just post your regular doses and what you've done, and we'll figure it out for you.

 

[Lynlw]

I don't know where you read that article about how to accurately dose Coumadin....
Those of us who are in range consistently and have no problems are not relying on sheer luck. Believe me.
My 2 docs taught me well, VR.com taught me alot, and I test every 2 weeks,
that way it's simple enough to make small adjustments before things go out of control.
I'm in my 4th year of this and am doing fabulous.

Blanche is correct regarding Aspirin....it only affects blood platelets.
Tylenol is safe (in moderation).

Since you have the Lodwick chart, can you figure out your next couple of doses with a calculator.?
If not, that's fine, just post your regular doses and what you've done, and we'll figure it out for you.

I think it was the articles about genes being helpful when Starting coumadin, instead of starting at 5 and going from there it can show who will need higher or lower to you get in range quicker. BUt I don't think it helps after that.

 

[heartfelt]

Bina, thanks for helping. I have the Lodwick chart and if INR is 2.0 it says to increase wkly dose by 15-20%. Since I have gone from 7.5 yesterday to 1.8 today, thanks mainly due to 2.5mg of vit. K, I thought to take in order to not have to deal with any drs. or hospitals; according to Ross the vit K might not have been such a hot idea. I totally agree b/c I'd rather be too high (maybe not INR 7.5 too high), but I didn't expect the vit. K to have that dramatic of an effect overnight. So 20% of 35 mg. is 7 right?...is that mg. so do I only increase it to 42 mg. for the week and add in 1 mg. every day? I feel incredibly stupid out here that I cannot figure this out. I've never been good at story problems so no surprise, but I do think once I know how to work the %'s I can read the Lodwick thing and figure this out. I just need some math tutoring. In order to go to bed tonight I've decided to take 7.5mg now and see what you all recommend for tomorrow. I think I may retest tomorrow too.
Oh, I normally (lol) take 5 mg. a day, but I have never had a stable INR for longer than a mo. at a time. I attribute that to my own inconsistencies b/c no matter how hard I try to eat the same, drink the same, excercise the same there is no way I can adhere to all that sameness. It makes me crazy. It was the primary reason I told my drs. I didn't think a mechanical valve was really my best choice, but who am I to tell heart surgeons what is best for me? B/c here I am trying to make this work now and feeling as if I'm failing miserably.
heartfelt
P.S. Lynlw, I think you are correct that that is what I read. Something about DNA testing being more accurate, but that it's several yrs. out before it can be used on reg. basis.

 

[heartfelt]

Actually, what I saw was what NJean posts on the thread on Genetic test for Warfarin sensitivity here on the anti-coagulation site. It was in our newspaper too.

 

[Lisa in Katy]

Here's the link to Al's website regarding Aleve. From what I've read elsewhere and what my cardiologist said, they put out the warning just to cover themselves should a potential legal situation arise, not because anything has been proven.

http://www.warfarinfo.com/naproxen.htm

Even Tylenol in large enough quantities will interact with Warfarin. I would never suggest large quantities of any OTC drug as they aren't intended for that purpose.

 

[Cris N]

If I were in your shoes I would resume my normal dose. AND throw away the Vit K pills. All that's going to do is cause a yo-yo problem, which I'm sure you can see. Sounds like you might be one of those few people who are very sensitive to dietary changes - I know I am. What helps me a lot is my daily multivitamin - it has a full RDA of Vit K. I've adjusted my dosage to allow for that and it really has helped me stabilize my INR. For those times when my INR does spike for some reason I attack it with a can (12 oz, not 48 oz) of V8 juice or have a good-sized spinach salad and continue with my regular dose of warfarin. If it's really high I might cut my dosage in half for one day only.

Are you keeping a dosage diary of some kind? - I find it to be very helpful to see an upward or downward trend from week to week so I can make minor changes if need be.

 

[Karlynn]

Heartfelt, I would not dose yourself with Vit K for a high INR. And I think you found out why. Depending on your dose - I would have held for 1 - 2 days and resumed dosing, with possibly a decrease in the weekly dose total by 10-20% depending on if you knew why your INR was so high.

If you are having some bleeding with a 7.5, you need to call your dr. for instructions, or go to the ER (depending on how much you are bleeding). If you aren't bleeding - a dose hold would have been the way to go.

Like Cris said - throw away that Vit K. Our beloved Granbonny used to keep some V-8 juice in her fridge in the event of a high INR.

 

[Ross]

Whatever you do, don't take all sorts of doses and test all the time. Make it one dose and follow through for a full week, then test. From there, we can tell which way to go, increase or decrease and by about what %. If you take all sorts of zany doses, we'll never know what is/was the correct dose. This first week may be messed up because of taking the Vit K. It'll take about a week to get it all out of your system.