PT Too high

[SHerrin Hutt]

Well Al,
I guess I've got another winner for PCP. She has no clue how to control my PT. It has been 1.8 two weeks in a row. She increased it from 5 every day to 5mg for 5 days and 7.5 for two . It should have work but it didn't. No new meds. or change in diet. Still out of supplies for my protime machine so I went to her office today and it was 4.9 . Her Rn told me to not take any warfin for 3 days. I question her about it going the other end but she said that is what the Dr. said to do that. I am supposed to have myliogram of my back on 2/3 and the surgeon wanted to know what she wanted to do about the warfin. So I call her nurse wanting to know where she wanted my pt to be for the test. Then she gave the question back to me to ask the surgeon where he wanted the pt it to be. Are theses people crazy are is it me!!!!!!!!!!! How can I pick two Dr's that are so bad!
Medicare doesn't want to pay for the supplies for the protime machine and the secondary won't pay if the primary doesn't. So now I'm stuck with a machine with no supplies and a Dr. that has no clue what to do.
Thanks for letting me vent!!!!!!!

 

[William]

Hi Sherrin, I'm sorry to heal about all the troubles with the Docs. I know how that can go from past situations. My PT/INR has been up to 4.9 too and down to 1.8 in less than a month. I see where this can get nerve racking. Can you tell me a bit about your home testing unit and Medicare? I was thinking of that and have Medicare also. Will

 

[geebee]

Sherrin,
I don't want to usurp your PCP but if your INR is 4.9 and you stop your coumadin for 3 days, you will end up too low. I agree with you that this PCP has no clue about regulating INR.
INR drops a lot faster than it climbs. Obviously 4.9 is too high and you should adjust some but even if you skip any it should only be for 1 day and then perhaps lower your daily dosage. I am not enough of an expert to tell you how much to take (perhaps Al will chime in here) but I still think stopping for 3 days will put you in a dangerously low INR range.
Is there any opportunity to research a PCP in your area that acutually HAS coumadin experience. Perhaps an internist to use as a PCP?
Good luck.

 

[SHerrin Hutt]

William,
Medicare will pay for you a machine and supplies if you only test once a week. QAS will take care of everything for you if you all them. My problem is I have to test more than once a week. My PT has been up and down for the last three yrs.

 

[Karlynn]

Sherrin, do you have Al Lodwick's chart for INR ranges and what you should do if you are high and low? I just tried to locate it on his site but couldn't find it. Maybe someone else will know where it is.

How often do you test and which machine do you have for home testing?

 

[Ross]

William,
Medicare will pay for you a machine and supplies if you only test once a week. QAS will take care of everything for you if you all them. My problem is I have to test more than once a week. My PT has been up and down for the last three yrs.

Sherrin if your testing more then once a week, you maybe causing the swings. It takes almost 3 days for a dose to show in the test result, so even if you tested on the 3rd and 6th day, you'd be chasing yourself all over the place. Once a week is plenty. Take that result, make whatever adjustment and leave it alone for one week and see where it's at.

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

 

[SHerrin Hutt]

Thanks Ross,
I've tried that and sometimes it ok and others it just doesn't work. When I've to have oral surgery or out patient surgery they want me to test more often. The last three yrs I have been out of norm for everything. Every drug has a different effect on me . Like last summer I was on crestor and my PT went real low .8 then when they stopped it and I even told the Dr. office that I knew that it was going to go up if we didn't back off the amount. No one listen to me the results were it went up to 14.9 and I ended up in the ER twice and they did nothing till I told them to give me Vit. K. I fell and ended up with a nasty blood blister on my foot that took 6 mo, to heal. I could have died if I had fell on any thing other than my foot. My daughter(the RN )and I have been doing a pretty good job of keeping in range. Then there every once in a while it goes crazy for no reason. I have the information card from Al too!

 

[Ross]

Sherrin I truly think your going to have to grab the bull by the horns, learn how to manage it yourself and do it all yourself. There just isn't anyway your INR is going to change that fast unless like you cited, drugs of other sorts etc. What I truly think is happening is the test results they are getting are not at all accurate, then they change your dose, test you again too soon, change the dose again and on and on it goes.

My first clinic I went to did that. I was getting veinous sticks and I don't have any good veins left for poking, they kept the same stuff up until I finally blew and called a different Doctor and got to a fingerstick clinic instead. I knew I was in good hands then as most all of her reference material was that of our own Al Lodwick! At this point, it brought my seesaw nightmare to a halt.

 

[catwoman]

Sherrin:

Sorry you're going through all this.

I took my ProTime 3 with me to San Antonio last weekend to demonstrate a test to a friend w/ a bovine mitral valve who takes Coumadin for a-fib/flutter. She's not able to get in range, I suspect due to a thyroid problem and lack of education about what all affect INRs. She has a lab draw once a week, which costs her about $50 out of pocket.
I mentioned that many vr.com folks will drink some V-8 juice when their INR is too high, and from her response, my guess is she rather enjoys V-8.
My INR was 3.1; I prefer to be 3.5-4.0, so I told my friend I would bump my meds from 6.5/4X and 7/3X to 6.5/3X and 7/4X. She asked how I knew to do that, and I told her about Al Lodwick's nice dosing chart.
My friend's INR? 1.5.

 

[Ross]

Dosing chart for 5 mg tabs to get the idea.

 

[Christina]

Sharon,

You need to learn to do the dosaging yourself. The doctors will drive you bonkers yet. Believe me, I know what I am talking about. I took 6 months of their BS and had had enough.
I bought my Protime out of pocket in 1/2001 and still buy all my supplies out of pocket, but IT IS WORTH IT NOT TO HAVE THE HASSLES. Over the more than 4 years I have done the hometesting, I have tried numerous times to get my insurance to pay for the supplies but they refused every time. We had to switch health Insurance last summer and I tried again (UHC) but they also refused. My husband said, forget it. Just order and we'll pay ourselves. This is far better than to have to deal with all the crap from the insurance and doctor's office.
I call my doctor once a month and if the results that day are within range I give him that number. If not I give him the number from the week before if that was within range, but I NEVER call in a number over 5 because he'll tell me to skip 3 days and I won't do that. When you do that your numbers will drop real fast, and you'll run the risk of a stroke or blood clot. The only reason I keep him as my friend and call him is that when my refills are up I need him to write me another prescription, otherwise I wouldn't deal with doctors at all.
See, when you learn to do the dosaging yourself, you'll learn real fast how your body reacts, and you can deal with that. It really is not that difficult. No doctor is able to do that, you only can. Plus you have Al's site to guide you.
So just bite the bullet, do it yourself, and stay away from labs and doctors offices as much as possible.
Wishing you well.

 

[terryj]

My husbands doctor finally figured out I know more about coumadin adjusting then he does. The lab draws the blood, I get the results the next day and I let the doctor know if I need to adjust his dose and he writes on his chart what we're doing. Our insurance pays 100% for the blood draw and we hardly ever have to adjust in over three years.

 

[Lisa in Katy]

Holding for 3 days because of a 4.9? That's ridiculous. I NEVER hold a dose anymore because mine drops like a stone. I have taken half, which works if it's really high. For 4.9, I would just eat some extra broccoli or have a V-8. I do agree with Ross that swings can be caused by too frequent testing. It takes a while for your blood to adjust to the new dose, so if you adjust too soon, it's like chasing your own tail. You should really try to back off the testing and see if that works. It certainly couldn't hurt at this point, and will probably save you a lot of money in the long run.

 

[SHerrin Hutt]

Well Thanks all for your input. I had an app. with my cardiologist today and told him all the crap that had been going on and he agrees with most of you. He thought not tking it for three days was scazy too! But I also got alot of great news today! I had a echeo and mini -stress test and the results were all great. He said I have bounce back again, I guess that angel is working overtime. My injection is up from 10% to 40% since this fall. I 'm not as depressed as yesteday.

 

[Guest]

It is OK to test more than once per week but you have to use the amoun that you took over the past week as your basis for any dosage changes. I probably wouldn;'t even hold one dose for an INR below 5.0. I think the person who told you that must use the dart board method of warfarin management. She certainly has not has much experience or if she has, she hasn't learned from it.

 

[catwoman]

Al:

Wish medical professionals would consider the possible consequences of holding/changing a dose vs. doing nothing and then ask themselves if they would want to experience those side effects.
Of course, they may not know what holding a dose for 3 days would possibly do...

 

[SHerrin Hutt]

Well Al,
I didn't listen to the Dr. and I ajusted it from your chart I order an it sill was 1.9. Went back and had it checked this moring and the Rn,. said it sure did drop. I didn't tell her I didn't followed her advice though. I don't want to burn that bridge all together. I have this test coming up.So now I am back on the lovenox roller coaster. Was told to come back in a week. Still waiting for them to send in the orders so medicare will pay for the supplies to test once a week. It better than having to deal with the Dr. office with no clue! Thanks for your help.

 

[Lisa in Katy]

Lovenox for a 1.9? Something is wrong here.

 

[Birky]

charts for regulating coumadin

charts for regulating coumadin

I have printed this out so I can keep it for my records. I went today for a protime and was at 3.6. Said to cut down to 5mg 3 days a week and 2 1/2 rest of the time. I was 1.9 3 weeks ago. I was taking Levoquin, an anitbiotic which tend to really thin the blood. Doc wants me between 2 & 3 which is lower than most of you with mechanicals. I am still hoping to get a home testing unit. Blue/Cross wouldn't commit themselves on payment when Lance contacted them.