Oh Great

[Freddie]

So not only did I miss my dose last night, I went to the lab today to get my INR checked...........1.9, two weeks ago it was 2.2, 4 weeks ago the reading was 3.6.
The only thing I can think of is stress.......major family stress and or my prescription changed,(I've had it refilled before my 2.2 reading) although everything on the bottle looks the same - as it should.
My usual dosage is 6mg, but thinking of adding 1mg tonight. Question is how long should I add this extra 1mg? Or should I alternate days of this 1mg and recheck next Friday.

Thanks

 

[ALCapshaw2]

I *assume* that your target range is 2.0 to 3.0

AL Lodwick's Dosing Guide shows that for an INR <2.0,
"Increase weekly dose by 10-15% and Recheck in 1 week".

'AL Capshaw'

 

[Freddie]

Al, my range is 2.5 - 3.5
Hope this doesn't mean for me to go ER for the famous "shot"

 

[Freddie]

I guess I should also mention that I have a dentist appointment on the 5th - I would really like to be range before I pre-med for the appointment.
Man things are mess.

 

[Freddie]

Also, I know its been said that you don't feel any different when ones INR is low, BUT.....for the past 8 to 10 days I have felt more tried and experiencing pain in the chest - just left of the sterum, but I can pin point the pain so I figured it was just mussel pain. This pain, hurts and it lingers and it comes on for no reason. I really only notice it when I'm sitting down. Calling it a mussel spasm maybe, but after almost 2 years after OHS can this still happen?

As I sit here and type the pain is in the back of my left should bone area, at times going down my left arm then it come up into the chest, kinda right behind the beast and slightly underneath the breast area.

 

[Karlynn]

You don't need to go get a shot for 1.9. But I would do the 10 - 15% increase, most definitely.

I wouldn't worry too much about the dentist - that's just a one time dose of antibiotic and it shouldn't mess with it too much.

 

[Freddie]

Karlynn, I did up my dose by 1mg tonight. Should I continue taking the extra 1mg everyday until I get rechecked next Thursday/Friday?

 

[Bina]

Fred, if u have been taking 6mg daily, that would be 42mg per week,
so you can easily take 1mg extra for 4 days, that would be 10% increase.

 

[Freddie]

Bina, but I'm thinking on taking the extra 1mg everyday until I retest next Thursday. This should be okay too, right?

I wonder if my pharmacy changed companies - this can be the only explanation for the drop.

 

[Bina]

Sure, the extra 7mg over the week will be fine too since your INR has been dropping for the last 2 weeks.
Your metabolism must be running faster with all the stress that you have had.
Make sure that you have some down time for yourself....don't take on too much. Okay?

 

[Freddie]

I've had down time all week.........well at least I thought I had.

 

[Bina]

Unless you are letting your mind go nuts with stress, then you may need to go "shopping" and spend some $$$
Or meet me in Ottawa and we'll have lunch with the Prez.

 

[Eva]

Did you check with the pharmacist if he changed manufacturer? I also wonder sometimes if the pills are as potent as they should be...about ten years ago, I complained to my doctor that since I got the new prescription of same dosage of Synthroid, my TSH was going up and down. Later, there was an article about the potency of the pill was not right and my doctor commended me for my observation while he mocked me earlier and said it was in my head!

 

[ALCapshaw2]

Freddie,

For a desired range of 2.5 to 3.5, AL Lodwick's chart recommends to "increase weekly dose by 15-20% and recheck in 1 week".

With your original dose of 42 mg/wk, 15% would be a 6 mg increase and 20% would be 8 mg so your idea of increasing 1 mg / day (i.e. 7 mg/wk increase) falls right in the middle of this range. PERFECT!

If you don't have a copy of AL Lodwick's dosing guide, I highly recommend it. At $5 (U.S.) it's a Great Bargain for your Health Care.

For all of your other symptoms / issues,
"When in doubt, Check it Out" comes to mind.

'AL Capshaw'

 

[Freddie]

Did you check with the pharmacist if he changed manufacturer? I also wonder sometimes if the pills are as potent as they should be...about ten years ago, I complained to my doctor that since I got the new prescription of same dosage of Synthroid, my TSH was going up and down. Later, there was an article about the potency of the pill was not right and my doctor commended me for my observation while he mocked me earlier and said it was in my head!

Yes, Eva I have checked with the pharmacist. He told me that they haven't changed supplier's, hasn't been told about any recalls and that I was the first to bring this to their attention. He did suggest to bring my meds down so they could take a look at them "to make sure they are uniformed and the color was right". I'm thinking of going there today since I know I was talking to the bonehead pharmacist that works there. This pharmacist also didn't indicate that they would give me a new prescription

Freddie,

For a desired range of 2.5 to 3.5, AL Lodwick's chart recommends to "increase weekly dose by 15-20% and recheck in 1 week".

With your original dose of 42 mg/wk, 15% would be a 6 mg increase and 20% would be 8 mg so your idea of increasing 1 mg / day (i.e. 7 mg/wk increase) falls right in the middle of this range. PERFECT!

If you don't have a copy of AL Lodwick's dosing guide, I highly recommend it. At $5 (U.S.) it's a Great Bargain for your Health Care.

For all of your other symptoms / issues,
"When in doubt, Check it Out" comes to mind.

'AL Capshaw'

Yes Al I do have the dosing guide, but I'm not mathematically incline to work with percentages - I hate math!

I'm wondering though, if both my 1mg and 5mg are not as potent as they should be, I'll drop even more; putting me in a real danger zone. I can't home test and I'm not sure if I can wait till Thursday for another lab draw.

Oh yea, my doc did call in regards of my drop and agreed with the 1mg increase - so she's not all bad
So until Thursday I'll sit here and fret.

Thanks Everyone

 

[Bina]

Hi Fred,
I'm using the brand name 3 mg Coumadin pills, and even with them there has been the occasional pill that looks like it has a darker spot or blemish on it. That pill goes immediately in the garbage just to be sure.

 

[njean]

I've had down time all week.........well at least I thought I had.

Freddie,

I hope that you are feeling much better, yes?? I worry about you & just want you to be happy & stress free! Stress can be a killer; been there, done that!

Stay well!