Oh Goodie

[Freddie]

This just might warrant a phone call - todays INR 4.9
Crap!
From 2.0 last week to 4.9 today
I took 7mg last Thursday then continued with 6mg for the rest of the week.

Oh Good Gravy Marie, looks like I'll have to test again next week
Guess I best see what the calculator says.

CRAP!



(could someone please hang me out to dry? I think I've had enough of this)

 

[Freddie]

Calculator says to hold for 2 days, then start alternating 6mg and 5mg and test again in 4 to 8 days.

Any feed back on this?

 

[Freddie]

Anyone care to join me in this roller-coaster ride?

Or is everyone busy getting ready to hang me out to dry? That would great if you were.

 

[Karlynn]

what was your weekly dose Freddie?

 

[terodac]

I am to new to my self testing! That seems high to me I would skip a dose for sure, then maybe cut it back. They told me in the lab by skipping a dose you can knock it down almost a point. I think Ross could help with this one, and a few others. Good Luck, hang in there.

 

[Freddie]

Karlynn, 7mg last Thursday (INR was 2.0) and 6mg until yesterday = 43mg for the week.

Should I start wearing a helmet?

 

[Freddie]

Well, can you believe it? My Doc called me, but is contradicting what the calculator says.
As explained to me - doctor is in red:
Hold for 2 days and retest on Saturday okay that's cool
If it's higher than 3.0 on Saturday skip again until Sunday and take 5mg.
IF your INR is 3.0 or lower on Saturday start with the lower dose first - 5mg, then alternate the following days with 6mg and 5mg and retest on Wednesday or Thursday. Do you really think I'll have to skip 3 days?
If terodac is correct about dropping a point for every day missed......holy crap!

So what do you think gang? Is she or isn't she on the ball?

 

[Karlynn]

The calculator says hold 0 - 2 days. What was your weekly dose prior to the 2.0.

With a mitral valve - I'm assuming your range is 2.5-3.5. If it were me, I'd just reduce my dose by 10% and test in a week. A 2 day hold will drop you low.

My new cardio reminded me that many years ago the INR range was 2 - 5. In other words - his message was "don't sweat anything up to 5"

I've been quite a bit higher than 4.9 throughout 17 years and I've never had a bleed. So don't worry about the 4.9. Just make your % adjustment and retest in a week.

And let us know what your dose was for the 2.0.

 

[Freddie]

My dose for 2.0 was 5mg per day = 35mg for the week (between tests)

 

[Karlynn]

Sorry - but I think these directions are bad. Your doctor doesn't know how to manage Coumadin.

1. Retesting on Saturday is too soon.
2. Is he on crack - hold again for something higher than 3.0, when the range for a mitral valve is 2.5 - 3.5?

What was your dose on for the 2.0?

If he's afraid of a 3.0 - then why was 2.0 to low? I don't get this doctor.

 

[Karlynn]

So this doctor raised your dose almost 23% for a 2.0 INR. And now he's freaking out over a 4.9. Sorry - but DUH! But believe it or not - him suggesting "alternating 5 & 6" he's getting close on what, if it were me, I'd be doing without the holds.

If you take 5/3 days and 6/4 days, that's almost a 10% decrease.

 

[Karlynn]

If it were ME - I'd decrease my dose 10% and test in a week. I don't hold for anything under 5 for my mitral valve.

PS - He also doesn't understand that a 3 day hold is him basically saying "I don't want you to have any sort of anticoagulation in your system at all."

Sorry - but doctors that don't know what they are supposed to know are really annoying!

 

[Freddie]

Okay, so now what?
Calculator says to hold. If I hold for today and tomorrow and retest on Saturday the readings should show a drop.....even a slight drop.....yes?
Try to understand that my doctor gets VERY concerned if I get higher than 3.5.
My doc's explanation for the 2.0 was that she figured I could handle the proper dosage. Boy did I screw up. (for the 2.0 I was on 5mg per day = 35mg for the week)

 

[Karlynn]

No - the calculator says to hold 0 - 2 days. (Zero to Two) And this is protocol. It is telling you it may be okay to not hold a dose. You have a mitral valve, the standard range is 2.5 - 3.5. Your doctor is like many - much more afraid of you bleeding than stroking and don't forget - blood cells can be replaced - brain cells cannot. Your doctor's concern for anything over 3.5 is not warranted. I've been higher than 7 without any bleeding. And yes - I did hold then!

 

[Freddie]

decrease to what mg? I don't like %.
Okay here's the story:
May 21 INR 3.8 was on 6mg (42mg/week) and continued with 6mg for the week....until
June 4 INR 4.3 - doc suggested to hold for one day, I didn't. Took 3mg on testing day then started with 5mg until the retest the following week
June 11 INR 3.7 continued with 5mg (5mg X 7 days = 35mg)
June 18 INR 3.6 started to alternate 4mg and 5mg X 7 = 31mg
June 25 INR 2.1 went back to 5mg (my doing - didn't hear from the doc)
July 2 INR 2.0 - I got scared took 7mg on testing day and started (on my own) with 6mg
Today July 9 INR 4.9

 

[Freddie]

I know it's hard to understand why my doc is the way she is, and even with a INR of 3.6 I shouldn't have done anything.

So, should I take half a dose for today?, skip today?

 

[JimL]

May 21 INR 3.8 was on 6mg (42mg/week) and continued with 6mg for the week....until
June 4 INR 4.3 - doc suggested to hold for one day, I didn't. Took 3mg on testing day then started with 5mg until the retest the following week
June 11 INR 3.7 continued with 5mg (5mg X 7 days = 35mg)
June 18 INR 3.6 started to alternate 4mg and 5mg X 7 = 31mg
June 25 INR 2.1 went back to 5mg (my doing - didn't hear from the doc)
July 2 INR 2.0 - I got scared took 7mg on testing day and started (on my own) with 6mg
Today July 9 INR 4.9

Your weekly dosage was 42, then 33, then 35, then 31, then 35, then 43? Welcome to the rollercoaster! A ten percent change is 3 or 4 mg per weekly dosage, not 9. For example, on June 4th, if you'd taken half a pill and continued with 6mg, you would have dropped nearly 10%, from 42 per week to 39; that would have fit the pattern. On July 2, you upped your dosage 8mg; if you'd alternated 5mg and 6 mg, you would have gone up the 10%. I'd take half a pill today, a couple days of 5mg, then back to 6 mg, which is a slight increase from where you were two weeks ago when you dropped so low.
I rarely change more than 1 or 2mg per week.

 

[Freddie]

Thanks Jim, so I'll take 3mg for today and tomorrow too? The doc wants me to test on Saturday and I want to show a drop in my readings.

 

[JimL]

Normally it takes three days for a change in dosage to register on the INR, but Thursday to Saturday is only two days.

 

[Freddie]

Yea, I know that and I questioned my doc on that. She figured it should still show a drop, if I was to hold for 2 days.
Maybe the reason she wants me to hold for 48 hours is to start over with my dosage. uhmmm, if I was to get my INR low enough then we (she & I) could slowly bring me back into range..........but would that be safe??? What am I saying, I was at 2.0 and I'm still here, so maybe that's her plan.