Off Topic

[Protimenow]

We've had so many threads twisting and turning in all manner of directions that I'm putting one here with no specific topic so we can ALL go Off Topic
Here's one item, and I don't actually expect any response that really applies to it:
I've been home testing since 2009.

My INR has recenty started to climb -- possibly because I've been taking acetaminophen a few times a day to hep me deal with the pain from broken ribs.

It may have something to do with a new medication - FDA approved in May - Intefa (I think) - this is for congestive heart failure, Type 2 Diabetes, and chronic kidney disease There was nothing in the documentation about interactions with warfarin. Or, perhaps, it;s the phase of the moon, how tightly I tie my shoelaces, or who knows what else?

I don't expect any on topic responses -- but we'll see where this goes.

 

[pellicle]

Mornin

My INR has recenty started to climb -- possibly because I've been taking acetaminophen a few times a day to hep me deal with the pain from broken ribs.

well, dunno, but to me the question seems to have a topic, which would probably be Anticoagulation

https://www.valvereplacement.org/forums/anti-coagulation.18/
none the less, my advice would always be to be conscious of medications doing that (some are known for that, like paracetamol) and with a little practice and home testing you can gently guide your daily dose in the direction needed to keep INR down (which would probably be a reduction of dose).

Since this is now (for a little while at least) your new diet then as we say here "dose the diet".

Best Wishes

 

[carolinemc]

We've had so many threads twisting and turning in all manner of directions that I'm putting one here with no specific topic so we can ALL go Off Topic
Here's one item, and I don't actually expect any response that really applies to it:
I've been home testing since 2009.

My INR has recenty started to climb -- possibly because I've been taking acetaminophen a few times a day to hep me deal with the pain from broken ribs.

It may have something to do with a new medication - FDA approved in May - Intefa (I think) - this is for congestive heart failure, Type 2 Diabetes, and chronic kidney disease There was nothing in the documentation about interactions with warfarin. Or, perhaps, it;s the phase of the moon, how tightly I tie my shoelaces, or who knows what else?

I don't expect any on topic responses -- but we'll see where this goes.

There are all kinds of meds that counteract with each other, including warfarin. Acetaminophen is one of them, depending on how many and how often it is taken. This is a discussion with your doctor on, so you can figure it out and work on the dosage on the warfarin. This happens lot no matter what the reason for the medication. Good luck in finding out what is affecting the INR.

 

[ScribeWithALancet]

We've had so many threads twisting and turning in all manner of directions that I'm putting one here with no specific topic so we can ALL go Off Topic
Here's one item, and I don't actually expect any response that really applies to it:
I've been home testing since 2009.

My INR has recenty started to climb -- possibly because I've been taking acetaminophen a few times a day to hep me deal with the pain from broken ribs.

It may have something to do with a new medication - FDA approved in May - Intefa (I think) - this is for congestive heart failure, Type 2 Diabetes, and chronic kidney disease There was nothing in the documentation about interactions with warfarin. Or, perhaps, it;s the phase of the moon, how tightly I tie my shoelaces, or who knows what else?

I don't expect any on topic responses -- but we'll see where this goes.

A couple years ago, I went to the Urgent Care clinic of my health plan with two large hematomas. They checked my INR because of the Hematomas since they knew I was on Warfarin. I got a call from the health plan's anticoagulation clinic with an urgent message that I should stop taking the acetaminophen for the hematoma pain because they had just read a new paper showing that Tylenol had a new and unique way of interacting with Warfarin. For me, using the CoatSense meter, I figured out that reducing my Warfarin dosage by 1 mg for each Time Release Tylenol (650 mg) was a good way to keep my INR in range. I know only take it when I really need it. You may have to figure out your own substitution rate to reduce the Warfarin dosage. When possible, I expedite rechecking my INR per your previous suggestion on this topic.
=
I agree that new medications can be a problem. A friend of mine, who was a Type 2 diabetic, was prescribed a new medication and ended up dying in the emergency room from it. You mentioned "Type 2 Diabetes, and chronic kidney disease". You might read Dr. Jason Fung's book on the "Diabetes code". He was a kidney dialysis doctor and found that kidney disease and diabetes are linked by insulin resistance. Diet and periodic fasting were the only things that he found helped. He was a chemistry major as an undergraduate and went into Kidney medicine because it was the most biochemistry related field.
-
Thanks again for your and Pellicle's tips on using a meter. I only have two. The second gives identical answers to the first (within 0.1 unit of INR). They both match my Health Plans lab instrument (within 0.1 unit of INR) when I have checked them.

Walk in Peace,
Scribe with a Lancet

 

[Protimenow]

Okay -- a bit more on this topic, then maybe we can go off topic.

My pain is manageable now, and I've stopped acetaminophen, skipped a dose of warfarin last night and dropped my dose from 5.0 down to 4.5. I'll retest in a few days and see if these changes dropped my INR back into range (although 3.8 or 4.1 don't concern me much). I gave up on the Coag-Sense a while ago - I couldn't get affordable strips, and I'm not happy with the results that are always significantly below the Coaguchek XS and usually the labs.

Once any effects of acetaminophen are out of my system (and these should last only a short time), I should be able to tell if my Inpefa has anything to do with rising INR. The literature that came with it didn't show this to be an issue.

I usually check for effects of new medications. The results were inconclusive because I also took acetaminophen.

Enough of this -- let's go off topic.

Here are a few possibilities:

How much reliance (if any) should we give to our devices? I have an Apple Watch 7 - it can report blood oxygen. And it seems to be always wrong, when compared to a more reliable (I think) oximeter. I usually ignore the values reported by the watch and trust the oximeter. Others may put more trust in their watches, Oura rings, and possibly other devices. Should they? And if not, how can they be educated that these devices aren't foolproof?

My ejection fraction is around 30%. Who else has an ejection fraction that low? What are they doing about it? What (if any) are their limitations? Etc., Etc.

Making this not all about myself -- 'How about them Dodgers (or whatever team, etc. you want to comment on)'? "Can you climb Mount Everest in Jockey Shorts? (I suppose that you might be able to, but you'll freeze your butt and other parts off)"? Other miscellaneous off topic stuff you want to propose.

 

[pellicle]

Making this not all about myself -- 'How about them Dodgers (or whatever team, etc. you want to comment on)'? "Can you climb Mount Everest in Jockey Shorts?

a good question, my answer is yes if you are wearing the jockey shorts under your gear ... no if you can't and may only wear jockey shorts

 

[slipkid]

GO PHILS!!!!!!!!

(sorry about your Dodgers Protimenow)

 

[Protimenow]

Just a rhetorical question. But thanks for your off topic response.

I could have also said 'How about them Phils' or 'them Celtics' or 'them (fill in the blanks)'

 

[Gail in Ca]

The Dodger manager messed with the team chemistry, taking out a great player and substituting another who had just been with the team a minute!!! Stupid thing to do.
On another note about construction in the home. I even had my husband, who was in commercial construction, do my kitchen gut job. I found that one must always double the time it will take estimate! We used a camp stove, bbq and microwave for a lot longer than anticipated!

 

[Protimenow]

Good switch off topic, Gail.

Repairs to my flooded rooms are taking FAR longer than expected - it's been three months and they haven't even cleared the rooms and pulled up the carpet. I'm still waiting for an inventory of the art that they took 4 weeks ago.

With everything almost to the bare walls, it's a great time to replace my 60 year old electrical panel - but I haven't got a clue how I'd pay for it. (The roof has to go, too, we need air conditioning (maybe a heat pump?), probably add some solar panels, and, eventually get a new coat of paint.) Of course, I can't do any of these tasks.

 

[Gail in Ca]

I found out how much my ex husband used to do for free when I got my first place on my own. I have had to replace a toilet, not cheap, and to do the 1972 electrical panel I was quoted $1200 and $700 to replace all the plugs and switches. After I pay off the car I had to buy when I moved, I’d like to get new windows, paint, update baseboards, electrical and look into solar since my electric bill goes over$500 in the hot months. This is a wish list. No more honey to do this stuff!!

 

[Protimenow]

Toilets aren't that much - at least not the ones I've installed. If I didn't get a rebate, the ones I installed (and it's actually pretty easy) cost less than $200 each.

I'm estimating that my electrical panel and switches will be many times what you paid. In 2024, supposedly, the Infrastructure act will help subsidize some of the costs. I'll have to look into this further.

We only have one wall air conditioner in a room that we're never in - and OUR bill goes up when it's hot.

 

[Gail in Ca]

Infrastructure act? I’ll wait for that. I actually haven’t upgraded my electrical, yet. Got the estimate from the electrician I hired to ground the air conditioner/heater I had to get last year. The installer didn’t ground it and the inspector caught it, thankfully. I’d seen my ex replace toilets and it doesn’t seem too hard, but getting a Toto up to 3rd floor I couldn’t do with a leaky mitral and hemolytic anemia. So I paid $1400 total which I think was too much, but they were honest and oh well!
All I’ve done is replace a leaky shower head whoo hoo!
My realtor said I could replace my own water heater when it dies. Haha it’s also on top floor!

 

[Protimenow]

The Infrastructure Act will apparently pay for a number of infrastructure improvements -- electrification is one of the goals. It would be good if some of my most important ToDos are partially or completely subsidized by funds in the act. Tax credits are pretty meaningless - with the only income coming from Social Security, I really don't need tax credits.

IIRC, the Toto toilets are fairly expensive. Some will do everything but shake your hand when you approach them, and when you leave. If you needed electrical wiring (so the seat can pop up and salute you when you walk into the bathroom, then return to its usual position) or adding a hot water supply line (to heat the water in the bidet), this would have been beyond the abilities of most husbands. If you needed this level of expertise, $1400 may have been a good deal. (At least toilets aren't yet smart enough to tell you what you ate last night). And, for many of us with negative heart histories, having someone else lug it up to the third floor is not really an option.

 

[Gail in Ca]

Well, I got the regular Toto toilet no frills. It is a very good flusher for the amount of water used. My friend got a Toto topper that does a lot. She had her guests use it and I must say it’s a nice toilet. Heated seat, bidet w a remote!
I just don’t have the strength to do these things. I couldn’t even push a drill into a stud for a curtain rod. Thank god for handymen!

 

[Protimenow]

A 1.1 gallon toilet in L.A. is required, and I'm sure works pretty well.

When I replaced our toilets, I got toilets that were higher than most - I'm not sure what they call them - but they're easier for people with reduced flexibility to get on and off of. The only problem is that if you go somewhere with standard toilets it can be a bit of a shock when you go to sit on them because they're lower, and you probably don't expect to drop that far.

 

[Gail in Ca]

I didn’t realize they are higher and it was going in my daughters bathroom.
She’s 5’4” and found the new toilet too high. She ordered a squatty potty! I’d never heard of it.

 

[Protimenow]

Yes - there are at least two heights for toilets. Maybe a small step in front of your daughter's toilet - maybe even STUCK to the floor would help your daughter.