Still out of whack

[Rich]

I think my doctor got carried away with my adjustment.
Went from 1.9 in Dec to 2.5 in Jan and that was OK.
But staying on the same dosage I'm now at 4.3 as of Friday.
He said to hold for three days(Fri, Sat & Sun) and go for a check Monday morning, so that's what I will do first thing tommorow.
I could just see this coming but he wouldn't listen.
After almost eight years on this stuff I'm no expert but I would not have made such a large adjustment. He and I are going to talk soon.
Al if you read this tell me this, I have a bad head cold and I hope it doesn't turn to something worse.
But if it did and I had to take an antibiotic at this time with my INR this high what would I do?

Rich

 

[Nancy]

How good are you at "teeter-totter", cause you're on one right now, especially going off for 3 days. Wish you luck. Not a fun situation.

 

[Guest]

First of all, I would only have held one dose at 4.3 and probably would not have even adjusted downward until I got two readings at that range. If the INR goes down by half every 2 days then you would be under the desired range in 2 days, then be at 1.? after the third day. Then it will take 3 to 5 days to build the INR back up. At 4.3 you were unlikely to bleed or clot. This will put you at risk of clotting for about a week. Probably the only reason for a 3 day hold was because of the weekend.

I would avoid Zithromax, Z-Pak, Biaxin and Cipro. If you have to use them then you should be checked in about 3 or 4 days to make sure it did not go too high.

 

[tommy]

Rich,

Sorry to hear that you are bouncing around. From what I've read, I would prefer to be 4.3 than 1.9.

I went through a period where the coumadin nurse was over-reacting in both directions. I pushed back a little, but had only 6 months history, so had little leverage. Finally the cardio put a stop to it. He picked a "middle" dose and told me to stay away for a couple weeks.

For 2.5 years since then, I have only had one long term dose adjustment - only 2.5 mg per week change ~10%.

I've had temporary changes when on antibiotics and lovenox bridges, but have always come back to the previous long term dose.

It seems like the coumadin nurse works from a script that does not take in all factors.

You have 8 years experience. That ought to count for something when talking to the doctor. Good luck Monday. Hope you stabilize quickly.

 

[Rich]

Thanks to all,
Hopefully tommorow we will get this straightened out.
His initial increase in dosage was 20% and I thought it was too much, I guess I was right.
I think a 10% increase would have been enough.
Oh well it's my fault for doing too much physical activity.
But it won't slow me down, that time will probably be here soon enough.

Rich

 

[Ross]

I got a nice big bag of brussel sprouts I'm willing to share. Want some?

 

[Rich]

Thanks Ross,
That sounds good to me.
Funny thing is brussel sprouts wee one of my favorites but since my surgery Iv'e avoided them totally.
But let's see I think I could be there in about four hours
Well maybe a little longer since the big bridge collapse in Toledo.
Well maybe not today but I might surprise you one day when we come to visit family in N. Canton.

Rich

 

[Rich]

Well Nancy I'm on that teeter totter.
Friday I was 4.3 and today I'm at 1.3 after holding for three days.
Kind of scary. Now he has me back on the same dosage that pushed me too high, but just for another week and then we will see what next Monday brings.
After I left the lab this morning I walked over to his office.
I gave him my recommendation for MY dosage, also shared Al's note with him.
Kind of a slap in the head to get his attention.

 

[RCB]

Go to Ross's for the brussel sprouts

Go to Ross's for the brussel sprouts

Rich,
Have no fear- the South bound lane is open. Spend a week
with Ross and the North bound lane will be open.

 

[Nancy]

Oh my goodness, Rich-

I'm happy that your doctor is at least being kind to you and not leaving you in the up position or the down position too long. Just hope he doesn't decide to hop off and let you hit the ground hard. He doesn't have a Coumadin "gift", unfortunately for you.