Post-vacation testing

[Ross]

Georgia I have to say that it depends on the Doctor and your abilities to manage yourself. I got downright tired of bouncing all around and getting needle sticks every week because I was "Just following instructions". After 4 months of this crap, I drew a line and said to myself, "Why am I doing what they are telling me to do, I know that by doing it this way, I'll be too low or too high" because I had charted every dosage and INR test number for a long time. They had me making dosage changes for slight out of range numbers like 2.4 and 3.6.

It's pretty hard for them to fight with you when you can present evidence to support your theory of what your dosage should be from all the information gathered from charting. Just remember though, it is only theory. None of this is exact science.

Some Doctors will fly off the handle with the mere mention of it, even if they can't or don't know how to manage you. Others are somewhat supportive and are willing to give you some rope. For myself, I've listened to what they said, compared it to my charting, then adjusted from there. If I don't actually change anything, I tell them that at the next appointment. The nurse I have now is a stickler for following protocol even though I've proved time and time again that protocol isn't always the right thing to do. We've locked horns a few times, but I got her with my charting. Even she couldn't argue with the results!

 

[Guest]

It seems that you removed the source of the temporary problem (vacation) and now it is time to go back to the routine.

This is why I rarely get excited about an elevated INR if the person is not bleeding. They are very simple to correct.

 

[ShezaGirlie]

Georgia...

Georgia...

I have always communicated directly with my cardiologist. He has taken it as a compliment that I am more interested in my medical care than most of his patients. I have his cell phone, pager number and I even think his home number.

So I haven't had the uphill struggle some folks experience with those pompous docs who seem to patronize their patients.

I will soon join the ranks of those searching for a new cardiologist as my dear doc is moving from Texas back to Yankeeville... He is originally from Maryland and I can't blame him and his wife for wanting to raise their precious daughters near the grandparents.

Boy will I miss that guy! I was his first valve patient and I've got all the faith in the world in him. We had such a good rapport. There are going to be some lucky heart folks in Maryland...

 

[EVELYN]

Thanks, Guys!!! We are back on our "normal" routine, and you're right, Rossman, we won't deviate, or if it happens we know what WE have to do to get back to "normal!" Yes, I definitely journal everything. The 1.9 was from our Protime as was the 7.1. As it stands, he took his normal 7.5 tonight and we're back in the groove.....and to think I thought they knew what they were doing!!!! VERRRY SCARY!!!

Peace.

Evelyn

Now Al, couldn't you have come up with one of your limericks for this one??????

 

[Guest]

Yankeeville!!

The Mason-Dixon Line is the northern border of Maryland. I think them boys from Maryland gave their lives on the side of the rebels.

 

[Guest]

Don't get me started!!!

INR 7.1 in New York
Tyce afraid to eat with a fork
valvereplacement.com
Advised - remain calm
Tomorrow - right back to work

 

[Marty]

Maryland was a "border" state

Maryland was a "border" state

Al, Maryland was one of those unhappy border states that had people fighting on both sides, sometimes brothers fighting each other. However I agree that the majority favored the rebels. During most of the war the yankees controlled Baltimore and the rest of the state.

 

[Guest]

I should have just said that I was too young to remember.

Or better yet said nothing, but that is too hard for me to do.

 

[EVELYN]

Hi Guys

Well, it looks like Tyce is getting back on track, after a bit of a scare. Checked his INR last night and the machine said: "INR TOO LOW, RECHECK CALL MD!!!" Well you know I absolutely freaked out!!! Tyce said we would wait and recheck again, so I decided to check mine, too as a base line. Our protime is right on target, mine was .9, which is where it should be. Tyce's recheck was 2.1 and on the way up, which is good. We figure he hadn't washed all the "greased lighning" solvent cleaner off his hands prior to his first checkand it definitely reacted with the blood draw. What a scare, though!!! I was all set to bring him directly to the hospital, but then I do over react!!

So, he's back on his normal schedule of 5mg 4 days a week and 7.5 three, will recheck Friday and call in the results.

Thanks to all of you......AL, THIS ONE'S FOR YOU:

There once was a man named Al
Who became very much an ol' pal
He was very smart
and had a big heart
He'd better never part!!!!

(That's the best this Irishman can do for a Limerick!!)

 

[ShezaGirlie]

Very clever Evelyn...

Very clever Evelyn...

Loved the limerick...

Al and Marty -- as Gomer Pyle used to say, "Gaw-lee," and here I was thinkin' anybody livin' north of Austin was a Yankee!

 

[EVELYN]

Thanks, Sheza----a poet I'm not, but I just like an respect Al so much......and if he can write a limerick, well, so can this DAMNED YANKEE!!!

Stay well!

Ev

 

[Guest]

Thanks, Evelyn.

I don't know how I do it, they just jump into my head.

I once did an hour-long talk all in Limericks.

Did you know that there was even a civil war battle in New Mexico? The Battle of Glorieta Pass. Colorado got word that the South was sending men to rob the gold mines to finance the war, so they sent the militia down to head them off just north of Santa Fe.

 

[Georgia]

Here we go again, and no vacation

Here we go again, and no vacation

Here's the deal - on Wed. I had INR of 4.4 (no bleeding); have been on 5 mgs (but was just increased to the 2 weeks previously b/c I was low -1.9 - at alternating days of 4 & 5 mgs); my instructions (I'm beginning to think of them as "sentences") - HOLD TWO DAYS and decrease dosage to 4 mgs per day. Right Like I was going to do that.

I ate broccoli and two salads that day, have skipped my daily wine for two days, and reduced daily dose to 4 mgs right away. I did not hold. I figure I'll go back to regular diet including wine this weekend unless I get the "taste" back.

Sound about right? The reduction in dose is higher than 10%, which worries me. Should I add some back in on alternating days? I seem to have a problem 5 mgs per day sends me high, 4 and 5 alternating days I go low.

 

[Nancy]

Hi Georgia-

Are you a self-monitoring person? If not, then trying to stabilize your Coumadin with dietary changes if just too iffy, in my own opinion. How could you guess how many helpings of green stuff to eat? You could miss and get way too low.

You might have better results by questioning your doctor about the holding for 2 days and then reducing your dosage. It seems radical. Hopefully they are going to test you again soon, so things don't get too far out of line.

 

[Ross]

Are you taking 32MG a week or 27MG? I think I'd just reduce by 10% over the week. Watch the greenies. If I ate that much in one day, I'd be in serious trouble. Your mileage may vary.

 

[Georgia]

Ross - I've been taking 35 mg (5 per day). He wants me to reduce to 4 per day (28) which in past has been too low. In fact, I'd just been increased to 35 per week b/c alternating 4 & 5 was too low.

He also wants me to hold for two days. As I said, I think not; the last time he told me to do that I held for one day and was worried so went to new dosage and STILL dropped to 1.7 (from 4.2) in a week.

I retest this coming week so I'll know if it's overshot or not. Also see him this Monday; need an attitude adjustment. I truly don't think he knows what he's doing. We'll discuss home testing - since both surgeon and cardio support it, I'll be interested to hear what he has to say.

I know you have trouble keeping your inr in line. But I think he really overreacts and cuts dosage too drastically.

Nancy - no, I don't self-monitor, but he has me set up for retest in a week from last test, so I figured this would be a good time to try the dietary thing - we'll see. I just can't believe it'd do as much damage as what MD wanted me to do by holding for two days. Have to get some idea what it'll do so I have something to gauge myself by.

Understand, I eat some greens everyday for consistency's sake, so I would guess that I probably doubled my greenies yesterday - not really as bad as it sounded.

Thanks for replies.

Now I'm going to sit back and observe our "dangerous weather." If Jim Cantore from Weather Channel comes up here from St. Louis, I'm going to Chicago & get a motel room. That guy should be banned from anywhere.

ARGH

 

[Ross]

If I figured correctly, I'd drop it to 4.5 every day and wait for a test result. As you know I'm no Doctor, so take what I say with a grain of salt.

They had me alternating days too and I've found that my consistent level is with the same dose everyday. Whoever is telling you to hold for 2 days is just following the protocol that is set for them. I argue with them about it all the time. If I hold one day I'm very close to bottoming out.

I don't know if you've seen this page or not, but it has dosing algorithms on it if you want to take a looky. Al Lodwick also has a neat reference card that is similar. You might want to get one off of him.

http://www.aafp.org/afp/990201ap/635.html

 

[Granbonny]

Georgia

Georgia

I take 32 1/2 mg of coumadin a week....5 mg... Monday- Sat..and 2 1/2 on Sundays.. I have NEVER changed my dosage in almost a year..since I got my Protime..I have NEVER been below 2.2 or higher than 3.6.......I have been in lower range like 2.5...2.6.. so last week ON MY OWN..decided to tweak.. a tad for 3 nights...like taking a tiny bite off a tablet.. Tested 3 days later...3. 1....GET A PROTIME... .Then you can be worry free and drink that wine. Bonnie

 

[Georgia]

I plan to get a protime, but thought probably I need to be leveled off before I do. Perhaps I'll just go ahead. Speak with pcp about it on Monday (THAT ought to go over well - ).

I'll try upping it to 4.5. I lost the "taste" today that seems to indicate higher inr (seems to show up about a day after it goes hi).

Thanks, folks.

And HAPPY MOTHER'S DAY to all (including mother hens)