Stable INR

[RWS]

My INR is pretty much rock solid stable. I read about many of you having problems and I wonder if that?s what I have to look forward to. Are there others out there where coumadin seems to basically be a non issue? I take 5mg warfarin daily and am always between 2.5 and 3.5. (St. Jude AV, Oct. 02) I test weekly using my CoaguChek S. I would trust this little wonder before any lab. It seems, so do many clinics. My cardiology office has 45 cardio docs and several clinics all using CoaguChek. I do all the calibration checks but you got to believe when I volunteer a family member and they test at 1.0 and check out at 2.5. Oh well, just wondering if I?m more the norm or the exception. I have had some nose bleed problems but all pretty minor I guess. Hey, after three bouts of Bacterial Endocarditis and emergency surgery ( 3 hours notice) I?m thrilled just to get up every day and have my feet hit the floor. After that, the rest of the day is just life?.
Randy

 

[Rich]

Hi Randy,
Sounds like you have it under control and that's great.
I still go to the lab every month and have done so for seven years.
My INR is always where it belongs and I have not had to make any adjustments to my dosage in all these years.
I still beleive consistency is the key to the whole thing.
So I guess Coumadin has been a non-issue for me.

Rich

 

[LUVMyBirman]

Hi Randy,

Welcome to the VR.com family. Sounds like you have it down! Great going.

Have had my share of INR concerns. Mostly it boiled down to knee jerk decisions on the part of my former anticoagulation nurse. Change the dose, test, change, test. This would go on 2-3 times a week. Wonder why my INR was jumping!
They never gave me the opportunity to level off. It's not rocket science. Though, there are some out there that make it more difficult on patients that it has to be.

All the best to you.

 

[Ross]

Ah now I'm jealous. I thought mine was rock solid steady then summer hit. Once the heat and all started, my INR has jumped around. Of course having to take antibiotics didn't help matters either. It sounds as though you've got it under control and that's good. Just don't get to complacent about it because it can fluctuate. Be sure to continue testing as you always do.

 

[Granbonny]

Randy

Randy

I figured your age to be about 54? from an earlier post...I am age 63 and Rich about the same.. I have noticed the older the coumadin Taker the more stable the range. I'm about 16 months post-op..On 5 mg. a day. Always in range..Home check with Protime..weaned myself away from it now to about every 2 weeks. Nothing seems to affect me..beer, Grandson, Hubby, sun, travel, and Rain's dog digging in her flower bed. Home-testing is the best. Bonnie

 

[Nancy]

I don't know about the age thing. Joe is 72 and has been on Coumadin for 25 years. He fluctuates quite a bit. He has many medical problems, and they are not always stable. So I think a lot has to do with your overall medical condition and the various medications you are on.

If you have one or two medical conditions and they are stable, and you aren't on too much medication, then your chances of INR being relatively even are probably good.

Joe just got over a period of testing every week because he had a minor incident of CHF which congested his liver a bit. So the increased diuretics, and then the reduction of them, and the congestion of the liver and then the clearing of it, caused his INR to be higher than he should have been. He's on a two week schedule now, but that could change if his conditions do.

Just part of life for him. Each person is different.

 

[DickV]

I have a Coaguchek S and so does my cardiologist. My INR has remained very stable and has averaged 2.89 for the past 18 months with a dosage in the 8.5 mg. range. Here are a few rules I have set and I believe these have helped reduce my INR fluctuations. Again, this works for me and may not work for you.

1) Test the same time of the day. I do it about 5:00pm because I will not have had any food or drink since lunch. I believe this time span is very important as you need this consistency for true comparison of INR measurement.

2) I only adjust my dosage if I am above 3.6 or below 2.4 and then only .5 mg. (This is only my opinion but it works for me).
I firmly believe that over adjusting, either by dosage or frequency) can contribute to fluctuations. My cardio use to adjust my dosage by 1 mg. and when I started self-adjusting, I reduced it to .5 mg. and the fluctuations were reduced.


3) I don't over test. If I do adjust my dose, I let it set in and only retest in 10 days to 2 weeks. If it is back in the 2.5 to 3.5 range, I return to monthly testing.

3) I pretty much avoid all foods high in Vitamin K completely. They say in moderation but my intake of it is almost non-existent and I believe this is a main factor for my stable INR. (Just my opinion again)

4) I try to avoid all over-the-counter medications if at all possible. Tylenol is about the only one I take and maybe once or twice a month.

Given the above I still have an occasional glass of wine or martini and an even less occasional cigar. While I don't recommend these, they don't appear to effect my INR (thank GOD).

This is not medical advice but my opinion only. I find consistency in the timing of the test, dosage changes and diet all contribute to my INR ramaining fairly stable.

 

[RWS]

DickV, same rules I follow, exactly...I believe that the home machines have a better baseline and are consistent. It is easier to adjust yourself because you are not using lab results that could be off from test to test. If you were to test at the same time and send it to five labs you would have five different results. Make sense?

 

[DickV]

Yes and most self testers on the board, regardless of their brand of machine, would agree.

There are less than a handfull of "S" owners on this board because they are a bit hard to come by. Where did you get yours?

 

[Marty]

Love my Coaguchek

Love my Coaguchek

I helped a friend break in his Coaguchek S last year and really liked it. I have the old (5 years old) Coaguchek and it keeps working so well I'm not going with the S till the old one goes belly up. I wonder if it ever will? I havn't been to a central lab in 4 years
and the last time I did go, they were having control problems and gave me a goofy reading. I test once a month and do not change my dose( 3 mgm/day) unless I am over 4.0 or under 2.5 and then I use the 10% solution.

 

[RWS]

DickV, got the S model here http://physicianequipment.com/coaguchek.html

 

[Lisa in Katy]

I agree with Dick - of course he is my homey so we have to agree! I still don't have a home machine, and since changing my career to teaching, I only test about once every two months. I haven't had a dosage change since about October-November, and alternate between 6-7 mg each day. I think that pre-menopausal women have a difficult time with INR because of fluctuating hormones. Since my hysterectomy, I still have hormones but I don't know exactly where I am in my cycle so I just try to have it done around the same day every other month, usually later in the afternoon.

The only rule of Dick's that I don't follow is avoidance of Vit K foods. I love most vegetables and eat them on a regular basis, so my dosage has been adjusted to accommodate my diet. I rarely drink, although tonight I had 3 margaritas, which should balance out the creamed spinach I had for dinner and buttered popcorn I had at the movie!

When I do make adjustments, I NEVER hold for a day. This only bottoms out my INR. I will cut my dose in half for one day, and then resume normal dosing. After 5 years, I can honestly say that I feel that I have a pretty good handle on this, but if you look in the archives, you will find that this hasn't always been the case. I've just become more relaxed, and I don't always take the direction of the Coumadin nurse. I listen, and then I tell her what I am going to do so that they can have it in their records.

 

[DickV]

Lisa, you can drop by and I'll test you anyday. I have a ton of test strips. I don't eat much V-K foods (greens) because my mom use to make me eat them upon the threat of torture or death and I have always hated them so now I have an official excuse to do what I have been doing all my life, avoiding them.

Randy, I got my S in the UK and the only difference in the two models is that it came with about 10 adapters so you could plug it in in damn near any country including the US but I use it with batteries so they just clutter a drawer. Plus it was about half the cost.

Again, regardless of your machine brand, self testing is the way to go if you can swing it.

 

[Les]

It is a non-issue with me. I have been on Coumadin for ten years, and I live my life like I want. I don't obsess about it,and am consistently in range. Maybe I'm just lucky...I don't know. The only times I have been "messed up" is when, on those rare occasions I have been a little "thinned out", they started the dosage adjustment routine and my INR would bounce all over the place. I refuse to do that now, which is the reason I do not ever want a machine. I just continue on with fairly consistent diet and exercise and the numbers speak for themselves.
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Les AVR '93 / '95