My new cardio wanted to hold 2 doses

[COLLEEN S]

:mad Had a 4.5 today on my coaguchek xs. Reported it to the cardio who GULP, wanted me to HOLD 2 days worth of doses!!!
When the dr. came to the phone, she said "So Colleen, a little THIN today huh?" THIN>??? UGH!!!
Anyway, I told her that I thought this was excessive and I dont want to be on a roller coaster again with the INRs. She told me hold a dose for that day, switch to 5mg 3 days a week and 10 the rest, and retest in a week.
I promptly hung up the phone and took half a dose! I WILL retest in a week though. When I questioned holding 2 doses as being excessive, I The nurse was all "you are questioning a DOCTOR!!!" I responded that yes I realize she is a dr. however I am vigilent, diligent, and informed about my care and how to dose myself and how I thought, again, that this was excessive and she put me on hold and got the dr. to the phone lickety split!
I just started with this dang cardio in April and already this happens.
FYI I was on 65mg/wk. By her calculations, she reduced my dose by 15% a week. By my calculations, I reduced my dose by 5%, held NO doses, and only halved that day's dose. Besides I forgot to tell her that I took acidophilis that week for a raging diarrhea problem, and that I am now exercising every day! Go me!
But, I can't believe this is happening again with the dr. not knowing how to dose and the brain cell vs bleeding and the fact that my own cardio doesnt understand it. I am sick of explaining and educating every doctor I meet!!!

 

[ALCapshaw2]

In my (engineering) opinion, it is Foolish to Hold a Dose for an INR under 5.0 and the CRNP's at my Coumadin Clinic agree. They usually do just what you did, cut HALF a Dose for ONE Day and retest in a week (or two) for an INR in the 4's.

I'd say to start looking for yet another Cardio but I think I recall you had a hard time finding this one so perhaps a 'discussion' about Coumadin dosing is in order. You might want to arm yourself with Al Lodwick's dosing guide and a copy of the AAFP Guidelines that Ross mentions from time to time. THE Standard Guidelines are in the C.H.E.S.T. Guidelines which many Doctors have in their offices. Your Doc will probably HATE it that a Patient has the audacity to try to 'educate' them (but some are actually open to information and will at least look over your 'stuff'.)

Good Luck !

 

[tobagotwo]

Congrats on standing up for yourself and doing the right thing in the face of professional opposition. It can be really hard to stick by your guns when the We-Know-What's-Best-For-You-s start chiseling at your self-confidence with their empty credentials. The best revenge is getting it right. Start training 'em for the next patients!

You go, girl!

Very best wishes,

 

[Ross]

I'm forever hopeful that I will, In my lifetime, see every doctor on the same page and actually be knowledgeable about dosing, but they better hurry it up. I don't think I have a whole lot of lifetime left.

 

[Karlynn]

You are quite the prick!

 

[skeptic49]

Keep them on thier toes, Colleen! Good for you.

Best wishes,

Jim

 

[lance]

This is going to happen

This is going to happen

Hi Colleen,
Unfortunately you will receive "bad advice" I bet your glad you knew better and know enough to stand your ground.

So good for you. One day your doctor will tell you that you know too much and you can heave a sigh of relief and know you've arrived at your warfarin knowledge destination.

I look forward to learning of it.

Cheers

 

[catwoman]

Colleen:

That diarrhea could have caused the jump in your INR. That's a significant bit of information that could have changed the doctor's order.

Al Lodwick's 2.0-3.0 INR range chart suggests for an INR of 4.1-5.0 to hold 1 dose, adjust dosage by 15% and recheck in 2-4 weeks.

If your INRs have been relatively stable and pretty much in or near range previously, I probably would have halved my dose (as you did) for 1 day and just retest in a week. Because the intestinal tract produces about 50% of your vitamin K needs, diarrhea can reduce that production and thus your INR would increase. The increase in exercise should increase your warfarin metabolism, reducing your INR some.

Will be interested in your INR on your next test.

 

[Bina]

In my (common sense) opinion.....many of these docs don't take into consideration the whole picture.
Colleen, your diarrhea problem, and increased exercise would need to be factored into your INR changes.
If you had a huge spike in INR from one day to the next, then a "Hold" could be acceptable; otherwise, a small adjustment down or "wait until next week" plan would be just fine.
Personally, I don't do much for an INR of 4.5 (half dose or enjoy spinach soup).

 

[Ginger]

I agree with Catwoman and Bina. Do you have a home test machine? My insurance wouldn't cover it but we bought it anyway - stopped me from freaking out and having the primary sending me on a roller-coaster ride. I go to the gym and my weekly is 60mg. (10 Sunday & Weds, 8 the rest of the week). I would have enjoyed some broccoli or spinach. And, Ross, your a trip! Thanks for the L0L!

 

[CThrock]

Way to go Colleen!! You keep those drs and nurse straight ( too thin blood) they have their nerve!!!

 

[COLLEEN S]

Thanks for the replies. I knew the diarrhea and exercise would have an impact but thought they would cancel each other out...but there I go trying to be too smart (alecky) again.
<evil grin>

 

[lance]

W e l l ..............

W e l l ..............

last Monday a.m. my INR was 4.5 (my range 3.5-4.0) so the dose was reduced by 2 mgs for 1 day only.
Today I tested at 3.2--go figure. That's just warfarin being warfarin.
For several months my dose has been 72-74 mgs per week.

 

[Ross]

last Monday a.m. my INR was 4.5 (my range 3.5-4.0) so the dose was reduced by 2 mgs for 1 day only.
Today I tested at 3.2--go figure. That's just warfarin being warfarin.
For several months my dose has been 72-74 mgs per week.

Exactly. Sometimes it's off just because and for no other reason. Leave the dose alone and next time, it's spot on in range. We usually blame it on Rain's dog, but I don't know how that dog is doing these days.

 

[lb151]

I just came from my PT check,,it has been spot on 3.4 for months. Today it was 5.0,,the nurse came back in and said hold it for 2 days. In my head I'm thinkin,,no friggin way! But,I smiled and said ok,,she smiled and said I know you will do what you want so come back in a week. Gotta love those peeps!