Perkicar's INR

[Guest]

It is not so much metabolism of warfarin as it is suppression of various clotting factors. The INR does not truly reflect your anticoagulation status until at least 4 days after warfarin is started and maybe up to 7 days. The only reason to do INRs 1, 2 or 3 days after starting to warfarin is to make sure that you are not one of those people who is super sensitive and your INR hasn't blown off the chart. This is scary when it happens. I've seen people bleeding right through their intact skin.

Saying that somebody is in range after three doses of warfarin just is not true. The INR is meaningless, except for what I said above, at this stage.

If a person is continuing on heparin and going to an apartment near the hospital, this is not truly being discharged to home after three days of warfarin. It means that the person does not need to occupy an expensive hospital bed and can come back easily and be rechecked. We have arrangements like this at our hospital. Many of our patients come from 100 miles or so away and there is very little medical care available in that distance. So they go to an apartment across the street from the hospital but not all the way home. Some are even discharged from Denver hospitals but told that they need to stay in an apartment in Pueblo until they are more recovered. (One person who did this was staying alone and thought that she could feel her blood clotting so she go up several times during the night and took an extra 5 mg warfarin "just to be safe". She thought that she took about 25 mg during the night. Obviously she was safe from clotting until they had to give her vitamin K to stop the bleeding. She was eventually give the OK to go home which was about 130 miles away in a mountain town with little medical care available.)

 

[ALCapshaw2]

Hang on tight Carolyn,
you're going to be OK.

I'll bet you a grape popcycle
that the irregular heartbeats
are PAC's (or PVC's which feel
the same) and yes, they DO
feel 'strange' and make you
a little weak.

After you see the Doc's YAWN
when you describe the beats
to them, you too will become
more non-chalant and know
that is just part of the process
(and NOT cause for concern).

IF the irregular heart beats were
something SERIOUS you would
hear the bells ringing in the
monitor room and see people
RUNNING into your room.

(Can you tell that I've spent
way too many nights on the
cardiology floor? )

'AL Capshaw'

(angioplasties, bypass, AVR,
and WAY too many cath's)

 

[SHerrin Hutt]

It was great hearing from you. My husband said he could always tell when I waa felling better because I got a little Bitc**** . It goes with the ohs believe me. And the depression will come later. My prayers are with you.

 

[perkicar]

Good Morning!

Good Morning!

yes, it's 4 am. I've been up for the last hour because I woke up to visit the potty and when I turned on the light in the bathroom, I thought "Oh My Gosh!". I had been slowly bleeding from where they'd taken out my central line on Sunday, it had soaked through the bandaid, gone on to my surgical bra (has anyone else had to wear one of these contraptions?) and started on m pajama shirt. Not a drop on the bed however LOL. Anyway, by the time I got myself and my clothing cleaned up (and even though I am a nurse, I let the nurse help me get cleaned up), I was not sleepy. Gotta love that anticoagulation!!!!!

 

[geebee]

You are having the pleasure of experiencing a lot of the fun things that can happen. I have a long list of them after having 3 OHS. Leaking drainage holes, IV lines, etc. etc. etc.

Keep your smile active - you are almost through the worst part. The rest is just trying to keep yourself from doing too much (or are you up to that already)?

Take care.

 

[SHerrin Hutt]

Sorry Carolyn, I've been in LA! La! for the last cople of days on a new b/p med. called SULAR. All I've done is sleep. Did I hear you menton sugical bra, I never had one but could sure have used one. I would have help from pulling down on the staples. I stopped and picked some sleep bra's on the way home at the vanity fair outlet they helped a lot.

 

[perkicar]

Hi Sherrin,
If I do indeed get out of here this morning (all fingers and toes are crossed in anticipation) I'll have to ask Susan if she'll stop and let me get a couple of sleep bras. The surgical one was very sturdy LOL (I was calling it an Iron Maiden bra) and I think I'd prefer something a little softer. It's not like I have that much to be pulling on the incision needing to be held up/together (aren't you men lucky to not have to deal with this problem!!)

 

[Mary]

Hi Sherrin,
If I do indeed get out of here this morning (all fingers and toes are crossed in anticipation)

Carolyn,
I've got my fingers and toes crossed too, so maybe you'll get "sprung" this morning.

 

[jeffp]

I'll have to ask Susan if she'll stop and let me get a couple of sleep bras. The surgical one was very sturdy LOL (I was calling it an Iron Maiden bra) and I think I'd prefer something a little softer. It's not like I have that much to be pulling on the incision needing to be held up/together (aren't you men lucky to not have to deal with this problem!!)

My wife and I had a discussion about that a few evenings ago. My incision line is sensitive even to the pressure of a T-shirt and I'm always pulling and lifting the shirt up. The tension of the weight on your chest (not just you but women in general) must be a real &^*%!

Hope your next post will be from home. Do well!

 

[Ross]

Hi Sherrin,
If I do indeed get out of here this morning (all fingers and toes are crossed in anticipation) I'll have to ask Susan if she'll stop and let me get a couple of sleep bras. The surgical one was very sturdy LOL (I was calling it an Iron Maiden bra) and I think I'd prefer something a little softer. It's not like I have that much to be pulling on the incision needing to be held up/together (aren't you men lucky to not have to deal with this problem!!)

All women should be braless, that's my take on the situation anyhow.

Hey Miss Hyper gotta go, gotta go, gotta go right now, SLOW down will yeah? I mean, I know your all full of spunk and are bouncy and trouncey and all, but I do not want to see you aggravate yourself into a backslide. Slow and easy gets it.

 

[catwoman]

Hi Sherrin,
If I do indeed get out of here this morning (all fingers and toes are crossed in anticipation) I'll have to ask Susan if she'll stop and let me get a couple of sleep bras. The surgical one was very sturdy LOL (I was calling it an Iron Maiden bra) and I think I'd prefer something a little softer. It's not like I have that much to be pulling on the incision needing to be held up/together (aren't you men lucky to not have to deal with this problem!!)

Carolyn:
I found some cotton knit camisole bralets at Costco (I think 2 for about $10 or so). They were very comfortable and much warmer than a regular bra.

 

[ALCapshaw2]

GM Carolyn,

Since you are still incarcerated, does that mean that your INR is still below 2.0?

What's the plan for your testing and dosing following 'release from the institution'?

OH, and who wins the grape popcycle?
(i.e. were your irregular heartbeats from PAC's/PVC's?)

I've got a new 'nickname' for you - "The AVR Bunny"
(since Duracell probably has claim to the "Energizer Bunny" title)

I can just picture you 'hopping around the hallways'.
Are your bags packed yet?

'AL Capshaw'

 

[perkicar]

GM Carolyn,

Since you are still incarcerated, does that mean that your INR is still below 2.0?

What's the plan for your testing and dosing following 'release from the institution'?

OH, and who wins the grape popcycle?
(i.e. were your irregular heartbeats from PAC's/PVC's?)

I've got a new 'nickname' for you - "The AVR Bunny"
(since Duracell probably has claim to the "Energizer Bunny" title)

I can just picture you 'hopping around the hallways'.
Are your bags packed yet?

'AL Capshaw'

Well, despite the fact that the docs told me an hour ago I was leaving, I haven't seen anyone for d/c instructions. My SIL is bringing over my clothes so I don't have to travel in my jammies.
Ross, you don't have to worry about me overdoing--my body tells me LOUD AND CLEAR when to slow down. My mind is already WAY more active than my body will let me be. Just walked to the end of the hall and back at a "normal" pace and found myself really out of breath when I got to the room. So I know my going will be much slower than pre-surgery. I was scared a little yesterday--my left shoulder was spasming and I could feel the cramp all the way into my arm. And when I took a deep breath it felt like I was being stabbed between my shoulder blades. I decided at that point that percocets every 4 hours were a good thing. I"m still sore this morning but am continuing to use my IS and breathing exercises.
My INR this morning was 2.3 Don't know about when I need it checked next, I'll have to wait for them to come see me and let me know.
Waiting,,,,,,,,,,,but going home!!!

 

[Phyllis]

Happy travels, Carolyn. Look forward to hearing from you soon from home!
The travel will knock you out, so take it easy and keep up the good recovery work.

 

[jeffp]

I was scared a little yesterday--my left shoulder was spasming and I could feel the cramp all the way into my arm. And when I took a deep breath it felt like I was being stabbed between my shoulder blades.

Those were LOTS of fun the first few weeks home. Had abdominal, shoulder and thoracic (not at the same time thank goodness) muscle spasms at totally random times. Man, did they hurt - much more than the post surgical discomfort. I personally found after a few episodes that a hot pack (used one of the microwaveable types) did well to break the spasm and soothe the area. They gradually just stopped happening

 

[ALCapshaw2]

Yep, the Body is very good about telling you when it's time to rest and/or take a nap.

It would appear that you managed to avoid the 'pumphead' experience. That's a GOOD thing. Maybe you need a 'slow down' pill to let your body catch up.

I found that massage (either hand or vibrating disk) provided the BEST and FASTEST Relief from muscle pain. Gentle stretching also helps. If your insurance will cover Cardiac Rehab, I highly recommend it. The 'arm cycles' REALLY loosened up my shoulder / arm / upper back muscles.

Don't forget to get out and WALK for a few minutes every hour on the way to your brother's house, just to keep those nasty clots from getting started.

I'd also keep a close eye on your INR, at least once a week, maybe every 4 or 5 days, for the first few weeks until you see how it acts and to 'zero in' on your long term dose.

How's the food at CC?

'AL Capshaw'