Nose Bleed

[Creed3]

Hi Everyone!
Well, here is what has been going on with my INR lately. About a month ago my pt was done and I was at 1.9. The docs like to keep me between 2.0 and 3.0. My usual dose for a week is 51mg. The next week I took 52.5 mg and then went back to my normal schedule of 51mg per week. The past two days I ate quite a bit of spinach and I thought that my INR would drop too low but still continued on my normal dosage. This weather has really been drying out my nose and I have had a couple of nosebleeds but nothing major. This morning I woke up, blew my nose and my nose wouldn't stop bleeding. It wasn't gushing but it was a steady bleeding. My doctor told me to pack it with tissues and give it a couple hours and it should stop. He then sent me over to the hospital to have my pt done stat. It came back 3.7. It hasn't been that high in a very long time if ever. My doc told me to hold my next two doses of coumadin then go back to my normal schedule. Then he wanted me to get tested again in two weeks. I told him I was afraid to go without my coumadin for two days but he told me that would bring me back down to between 2.0 and 3.0. Won't skipping two days drop my pt too low? I know from various discussions we have had before that totally skipping isn't a good thing and just lowering your dose by a certain amount works better. What do you all think?

Take Care!
Gail

 

[Karlynn]

Hi Everyone!
Well, here is what has been going on with my INR lately. About a month ago my pt was done and I was at 1.9. The docs like to keep me between 2.0 and 3.0. My usual dose for a week is 51mg. The next week I took 52.5 mg and then went back to my normal schedule of 51mg per week. The past two days I ate quite a bit of spinach and I thought that my INR would drop too low but still continued on my normal dosage. This weather has really been drying out my nose and I have had a couple of nosebleeds but nothing major. This morning I woke up, blew my nose and my nose wouldn't stop bleeding. It wasn't gushing but it was a steady bleeding. My doctor told me to pack it with tissues and give it a couple hours and it should stop. He then sent me over to the hospital to have my pt done stat. It came back 3.7. It hasn't been that high in a very long time if ever. My doc told me to hold my next two doses of coumadin then go back to my normal schedule. Then he wanted me to get tested again in two weeks. I told him I was afraid to go without my coumadin for two days but he told me that would bring me back down to between 2.0 and 3.0. Won't skipping two days drop my pt too low? I know from various discussions we have had before that totally skipping isn't a good thing and just lowering your dose by a certain amount works better. What do you all think?

Take Care!
Gail

So sorry to hear of your problem. I think you're post tells of the worst problem with Coumadin - Doctors that don't know how to manage it. You are correct in thinking that holding for 2 days is going to drop you too much. If it were me I wouldn't drop any dose. 3.7 is not very high and I really doubt that it was a big reason your nose continued to bleed for a while. My guess is that your membranes got dried out, they continued to stay dried out and your few smaller bleeds kind of signaled that one bigger one may come along. If you weren't on Coumadin, I would image you would have bled almost as long. I have dry nose membrane problems frequently and saline nasal spray is my best friend (can be found in any drug store or Sam's or Walmart etc. Ocean is a brand name, but most companies have their own house brand.) Some people use Vaseline to coat their nose, which works as well if the dryness doesn't go too far up.

Anyway, back to the INR #. There are a few things you could do - keep your same does and drink some V8, have a nice dark green salad and test in a week. Or you could lower your dose a little bit, maybe 5% for a week, if the 3.7 scares you, and test again in a week.

Keep in mind that these are just my suggestions.

Your doctor's orders to hold 2 days when you are only .7 out of range is crazy. And your instincts were right! Congratulations.

 

[Karlynn]

I also wanted to add that my brother-in-law had real nose bleed problems a few years ago. He would get horrible nose bleeds that looked like he slaughter a calf in his bed. They would continue to bleed for a long time. He finally had to have the area cauterized. My point is, he wasn't on Coumadin. They'd test his INR and it would be 1.0. So while sometimes Coumadin can exacerbate a problem, unless the INR is really high, it doesn't cause as much of an issue as people think, particularly in an are (like the head) that's highly vascularized.

 

[Guest]

Holding two days for an INR of 3.7 when you take more than 5 mg per day will almost surely put your INR at 1.0. If effect it will be the same as if you had never taken any warfarin.

 

[Perrster]

Nose Bleeders Club!

Nose Bleeders Club!

Gail,

A couple of years ago in the middle of a Chicago January I think I was the nosebleed champion of the world!! I went to the ER 3 times in a 24 hr. period and got every kind of remedy known to man. My episode cost me a fortune (thanks to pee-poor health insurance and a new yearly deductible not yet met), I missed 3 days of work and learned a valuable lesson: I don't ever want that to happen again!! My INR tested 2.7 while on my second visit. I even manned the suction hose while the ER docs climbed all over me cauterizing and stuffing rockets (tampons) up my schnoz. The docs bet I'd be back a 4th time!

Well, the moral of this experience and lesson learned is that I don't go anywhere without a tube of vaseline (one in every bathroom, car, office, golf bag). I use it all the time, even in summer.

Good luck to you and do invest in some Vaseline. May your nose remain happily moistened at all times.

Hi, Karlynn!

 

[Creed3]

Thanks Everyone!

Thanks Everyone!

I didn't think it was a good idea to stop my coumadin for two days. I think I may just take 5mg tonight, usually I take 7, and then I'll go back to my normal doses starting Saturday. I also changed my appt and am having my INR checked a week from today. I noticed when I looked at my schedule that I have a dentist appt in just over a week, that would mean taking the antibiotics are going to throw off my INR for that week.
I'm wondering what would throw my INR off so much. I have been taking the same doses for about two years now with only slight variations every now and again. The only thing differently I have done is more exercise and I have started eating more whole grains and protein. Oh well, who knows. I will definitely get me some saline spray as well as keep vaseline on hand. Thanks again for your input. You guys are great.

Take Care!
Gail

 

[Guest]

I still have some of the Nosebleed QR trial size if anyone wants to e-mail me about how to get them.

 

[Creed3]

Just To Let You Know....

Just To Let You Know....

I had my INR tested for the first time since having found out my INR was 3.7. My doc had told me to hold for two days and then continue with my normal dosage. I didn't feel comfortable with that so I ended up lowering my dose by about 8%. I wasn't sure whether to do 5 or 10 percent so I went in between. My INR is now 2.9, right where it should be, between 2 and 3. Then I found out my regular doctor wasn't in and another doc was covering for him. He wanted to know about my dosages etc....I then found out it was a doctor who made a HUGE MISTAKE with me before I was diagnosed with the dissection etc.....I told the nurse under no circumstances was I going to discuss or listen to what this covering doc had to say to me. Three years ago he rolled his eyes at me and dismissed the whole thing the day after I went to the ER. No way was I going to let this doc get near me again. My doc will be back in a couple days and I will talk to him about how I believe the Monistat caused my spike. My Gyn also believes Monistat is the culprit. I also want to talk to him about getting a home testing unit.
Thanks again to everyone here for your input regarding the coumadin dosages. Al, you are awesome!! It feels good when you start to really understand how coumadin works and how tweeking your doses is much better than skipping them.

Take Care Everyone!
Gail

 

[Karlynn]

Don't you just love the feeling you get when you run across the doctor that could have killed you? I have one of those also, and 19 years later, I still will see him in a store and I feel like an electric shock goes through my body because my reaction to him is so strong.

I'm glad you got your INR issue straightened out and figured out the culprit. Yes, Monistat is a common culprit for women.

Good luck with getting the home testing going. You will LOVE it!