Anyone hear of a new "protocol" (as our PCP's clinic calls it) on warfarin dosing??? Maybe with Ohio or Iowa in the name???
I hope Al Lodwick will drop in and see this. BTW, haven't seen any posts from him lately (is he on vacation in the South of France, maybe?). Hope he's OK.
See below:
John (catman) is on warfarin because of post-op a-fib. I've been following how our family doctor has been adjusting his dosage, and I've agreed with the changes.
However, this week our doctor is on vacation and another doctor adjusted the dosage.
John's INR was 1.5
. His range is a narrow 2.0-2.5 (set by Dr. Ryan, the surgeon). He had been taking 7.5mgX4 + 5mgX3 (45mg/week). One of the other doctor's in our PCP's office said to bump it up to 7.5X5 + 5X2.
EXCUSE ME??? Only a 2.5mg increase? That's only a 5.5% increase.
I told John to fergeddit and to up his dosage at least 10%. It would be at least 7.0mgX7 (and he could take 7.5 one day -- for "insurance" -- if he wanted).
John said the woman who did the test asked if he was eating a lot of "greens." He told her he **was** eating greens. But did he tell her he's walking 3-4 miles, sometimes 5, a day? Nope! He also said something about they didn't like splitting things. I love John to pieces, but he's not always great with details, so I couldn't determine if the doctor's office doesn't like us splitting 10mg tabs to come up with 7.5mg, or split dosage schedules, instead of the same every day. (Who knows?)
He did say they're using a new "protocol."
Today I left a message on the nurse's voice mail that I was concerned that the dose increase was TOO small. I explained that I had consulted my algorithm chart for dosages and said I got it from a certified anticoagulation care provider who runs a hospital Coumadin clinic.
The nurse soon called back and said that since our doctor is on vacation, she would defer to my judgment on the increase -- because I was certainly well-versed on warfarin. Asked what I suggested increasing the dosage to and I said 7X6 + 7.5X1. She bought it. I said that I would check him the end of next week, and she said fine.
I told her that I didn't think eating green stuff was the problem with his INR, that it was more likely his exercise program.
She mentioned that they're using a new dosing protocol, something with Ohio or Iowa in the name. Because I had a customer on hold on my desk phone, I couldn't spend more time quizzing her.
I was pleased that our doctor's co-workers and employees do believe that I know a little about warfarin.
I hope Al Lodwick will drop in and see this. BTW, haven't seen any posts from him lately (is he on vacation in the South of France, maybe?). Hope he's OK.
See below:
John (catman) is on warfarin because of post-op a-fib. I've been following how our family doctor has been adjusting his dosage, and I've agreed with the changes.
However, this week our doctor is on vacation and another doctor adjusted the dosage.
John's INR was 1.5
. His range is a narrow 2.0-2.5 (set by Dr. Ryan, the surgeon). He had been taking 7.5mgX4 + 5mgX3 (45mg/week). One of the other doctor's in our PCP's office said to bump it up to 7.5X5 + 5X2.EXCUSE ME??? Only a 2.5mg increase? That's only a 5.5% increase.
I told John to fergeddit and to up his dosage at least 10%. It would be at least 7.0mgX7 (and he could take 7.5 one day -- for "insurance" -- if he wanted).
John said the woman who did the test asked if he was eating a lot of "greens." He told her he **was** eating greens. But did he tell her he's walking 3-4 miles, sometimes 5, a day? Nope! He also said something about they didn't like splitting things. I love John to pieces, but he's not always great with details, so I couldn't determine if the doctor's office doesn't like us splitting 10mg tabs to come up with 7.5mg, or split dosage schedules, instead of the same every day. (Who knows?)
He did say they're using a new "protocol."
Today I left a message on the nurse's voice mail that I was concerned that the dose increase was TOO small. I explained that I had consulted my algorithm chart for dosages and said I got it from a certified anticoagulation care provider who runs a hospital Coumadin clinic.
The nurse soon called back and said that since our doctor is on vacation, she would defer to my judgment on the increase -- because I was certainly well-versed on warfarin. Asked what I suggested increasing the dosage to and I said 7X6 + 7.5X1. She bought it. I said that I would check him the end of next week, and she said fine.
I told her that I didn't think eating green stuff was the problem with his INR, that it was more likely his exercise program.
She mentioned that they're using a new dosing protocol, something with Ohio or Iowa in the name. Because I had a customer on hold on my desk phone, I couldn't spend more time quizzing her.
I was pleased that our doctor's co-workers and employees do believe that I know a little about warfarin.
