Stuck at 1.9

[Gisele]

Starting to feel really annoyed now. I tested on Friday with my Protime unit and got a reading of 1.9--increased my dose from 6/7/6/7 to 10mg daily and add Lovenox 30mg twice a day. Retested on Sunday and got a reading of 1.9 so I thought maybe tomorrow it will go up seeing as it takes 3 days for a dose change to take effect.
Testing this morning--still at 1.9!

Can someone (Al?) tell me how the heck I can increase my dose and not bump up at all????? This makes no sense to me what so ever. My pills aren't expired, and they are brand name. So it isn't as though I changed anything (such as brand).

I have been on Lovenox so much this past year it is ridiculous. I know that I am hard to regulate and my doc doesn't want to give me too much of an increase as I have had two bleeds in the past. So I am stuck between a rock and a hard place.

By the way, my dose increase and the Lovenox was on the direction of my doc. I didn't do this on my own.

Oh, and I didn't eat or drink anything out of the ordinary-so we can't blame it on that.

I guess I just need to vent.

Gisele

 

[LUVMyBirman]

Hi Gisele,

Sorry to hear about your low readings. If you haven't been to the lab for a draw, I would do so.

Keep us posted.

 

[Ross]

Yeah, what the Gina Lady said!

 

[terry40]

I know how you feel...

I know how you feel...

I just got off the phone with my doc and my INR was 1.3, of course this means yet another increase in my coumadin!

My family doc recomends I take the coumadin without any other meds, that sometimes other meds can interfere with the absorbtion, but of course my cardiologist said just the opposite, so now here I am with another increase in my coumadin, this week I'm following my family docs advice!!!

Sorry I just had to vent!

Terry

 

[Ross]

Terry, have you read this link:
http://www.aafp.org/afp/990201ap/635.html

You might want to, if you haven't. It's making a big difference in the decisions being made on my Coumadin therapy.

 

[Blanche]

Ross:
That's a mighty powerful article and a keeper for me. It speaks to alot of issues that have been discussed on these forums of late, including the switching from Coumadin to Warfarin. I need to have a second or third reading to comprehend the many important points. Many, many thanks.

The article did not mention this, but I think it's important to note that INR isn't always stable and that changes can happen easily without apparent reason--or at least the a reason that's not readily apparent. My thought is that it has something to do with the fact that the human body manufactures its own vitamin K. I think that something happens to make that process more or less efficient, and that causes changes which are unexpected. There has to be more to this than just what one puts in one's mouth. But, that's just my thought and I can't back it up with anything other than experience.

Again, Ross, thanks. Everyone with anticoagulation concerns could benefit from this article.

 

[Ross]

Thanks Blanche.

I tested at 2.6 today. I sort of blew off most of the Doctors suggestions (Orders) and went with that link, Al Lodwick, and a few other members. Presto-I'm now in a functioning range.
I printed the whole article out and took it with me. I got some strange looks, but they don't want to see me for a month this time, so I think I made my point. Now, if I could just get the Doctor to approve home testing..........

I think your right about the body and Vit K. My diet is really next to nothing and INR has bounced all over the place.

 

[Guest]

That article comes pretty close to saying it all.

I wonder if the author is former Marine Sergeant Jon Horton who used to wake us up at 6AM every morning in 1968 by signing on American Forces Vietnam Radio with,"GOOOOOOOOOOOOOOOOD Morning Vietnam." No, it wasn't Robin Williams who invented that.

 

[Gisele]

Ross, updated photo?

Ross, updated photo?

Is that what you look like first thing in the morning? LOL

I will print that article also, as I have got to do something to stop bouncing all over the place. It is totally out of hand. As far as my diet goes, I eat healthy, but I don't eat too much. You know, that eternal quest to keep the weight down thing that most women endure.

I have to re-test this afternoon, so I guess I have to wait unitl then to see where my 12 mgs got me. I am so grateful that I get my Lovenox through mail order (20 syringes cost me $10.00) as I have gone through a small fortune of Lovenox this past year.

Well, I will post this afternoon and let you all know how I made out.

PS Al: is Coumadin affected by patients with a liver condition?

Gisele

 

[Ross]

" No, it wasn't Robin Williams who invented that."

I suppose your going to tell me that Rudolph isn't a reindeer either.

 

[terry40]

thanks ross y...

thanks ross y...

I'll have my daughter print out the 19 pages

 

[Ross]

Actually, I think the link came from Rob thats me when I first came to VR. Please direct the thanks in his direction.

Gisele: I look much worse then this AV in the morning!

 

[Gisele]

Results from this afternoon

Results from this afternoon

INR @ 3.6--guess I really jumped up from yesterday's 1.9, huh? Now I have to re-test tomorrow again. I am officially out of fingers to stab. Very discouraged today, and this migraine I have had since yesterday hasn't helped.

Maybe tomorrow will be a better day.

 

[Guest]

The liver is a huge factor in INR stability because warfarin is metabolized by enzymes in the liver. In fact it is only metabolized when it is in the liver. None of the blood that is anywhere else is having the warfarin that it is carrying metabolized.

 

[Gisele]

Al, so what you are saying......

Al, so what you are saying......

is that the liver and coumadin are "working together" so to speak?

I have been monitored monthly for abnormal LFT's for the past six or seven months. Liver scan and ultrasound are normal. Negative for the hepititis panel and normal iron binding. Now I might be one of those people who just get abnormal LFT's, but when I asked the liver specialist a few weeks ago if my bouncing INR's could be related to my liver she said NO.

I remember recently you mentioned that a lot of doc's don't really understand the whole Coumadin picture. Could this be the case here, because I am getting really discouraged with all of this. I haven't really been able to find any info on the web related to articles on Coumadin and liver disorders.

What do you think Al?

Thanks, Gisele

 

[Guest]

I would be concerned about a liver doctor who does not think that the liver could be responsible for fluctuating INRs. Warfarin is metabolized in the liver mainly by an enzyme called Cytochrome P450-2C9 and to a lesser extent by Cytochrome P450-3A4. For practical purposes 2C9 is the only important one. Anything that stimulates these enzymes to work faster will cause the INR to drop because the warfarin will be metabolized faster. These are mainly barbiturates and phenytoin (Dilantin) which is metabolized to a barbiturate and carbamazepine (Tegretol). Anything which slows down the action of these enzymes will cause the INR to increase because the warfarin will be metabolized more slowly. The strongest example of this is amiodarone, but antibiotics and dozens of other drugs work this way. If this did not happen, there would be no business for people like me. Besides this forum plus probably the whole valvereplacement.com would fold, because there would be nothing to having a mechanical valve put in. You would have no medication concern.

Second, before there were all of the fancy LFTs that they have now, they used to just check the patient's blood clotting time to determine if there was a liver dysfunction. (assuming that they were not on warfarin) A long clotting time meant liver disease.

Third, there is a disease called Budd-Chiari Syndrome in which the blood flow out of the liver is intermittently blocked. The resulting intermittent congestion in the liver makes it impossible to regulate the warfarin dose.

Fourth, a fluid build-up to the point where a person has shortness of breath, almost always results in a high INR because there is also fluid congesting the liver. When a diuretic is given and the breathing is easier, the INR will drop over the next few days.

So, I would be very skeptical of a doctor who does not think that the liver can be responsible for fluctuating INRs.

 

[Nancy]

Al-

I know you don't need anybody to confirm what you have just said, but Joe went to the ER today and was admitted to the hospital. He has congestive heart failure with fluid backup in his liver and ascites, plus he also has some kidney failure. His INR was sky-high because of this.

 

[Gisele]

Thanks Al

Thanks Al

I have seen two liver specialists in the past six months. I didn't care for the first guy my PCP referred me to, so I went to someone who is highly regarded in her field. I was a bit surprised that both of them disregarded my irratic INR's and felt it is unrelated to my liver.

Tues INR @12mg =3.6
Wed INR @12 mg=2.8

Very difficult to control. I have to test this morning and see what number pops up on my machine. This is all very discouraging.

By the way, this doc wants to book me for a colonoscopy due to a family history (she treated my mother this year for polyps), and her office called me to review the booking date etc and I mentioned to the girl I was on Coumadin and I was unsure how this was going to be handled. Very casually, she indicated that I should stop my coumadin 5 days prior. I told her I didn't think so. Thank goodness I know enough not to blindly follow orders in this case or I would have listened to her. I delayed my procedure until the end of April as I am not in any rush to have this done.

Al, thank you so much for this information. I will print this out and mention this to my doctor.

Gisele

 

[RobThatsMe]

Hi,

I just wanted to let you know that you can have a vertual colonoscopy. You do not have to get off of Coumadin for this procedure.

Doctors don't like it because if they do find anything, they will have to then reschedule to remove the polyps. During a traditional colonoscopy, they cut and remove as they perform the original procedure.

My doctor recommended the vertual colonoscopy becuase I AM on Coumadin. He would rather look around first without taking me off Coumadin, then if necessary setup a time in a controlled hospital environment to perform the procedure. IT would be handled as any other surgerical procedure for someone on Coumadin.

I think you may want to look into this yourself,

Happy Holidays,

Rob

 

[2hartsas1]

nancy

nancy

just wanted to let you know you and joe are in my prayers.
~shirley