The trials and tribulations of managing my INR

[Laura]

Hello Group! I haven't posted in years, but I had a second aortic valve replacement in Feb of this year and now I'm on Warfarin for the first time. Overall, it's been a rocky road with my INR numbers too low (1.2) at first. Now they are too high (5 last Wed and 4.1 yesterday)! My optimal range is 2.5 - 3.5. I did acquire a home testing kit and I've used it twice. Getting enough blood on to the stick has been my biggest issue. Their support line gave me some tips which have helped.

The reason I am here today is an issue with my urine turning darker and brownish on Thursday. I really noticed it yesterday. I believe that I was dehydrated. I tried to remedy that last night with about four bottles of water. It was still brownish this morning. My cardiologist's office said go for a urinalysis on Monday. Based on what I've read here and elsewhere I have to think my symptom is related to the high INR. I test again tomorrow. I'd love to know what you think. At this point, I have no other known health issues. I plan to go back to work on 4/18. Thanks!!

 

[dick0236]

For me, a 4.1 INR would not cause discoloring in my urine.....but I have noticed that urine can darken after I've been sweating a lot....especially if I don't drink a lot of water. I have knowingly had blood in my uring only twice in all my years on warfarin and it was a very long time ago.....and I remember the color to be bright red. See what the INR test shows on Sunday and a urinalysis should be able to pinpoint the probllem. It is understandable for your INR frustration with INR testing after only two tests. Stay with it...it takes a little while to get the hang of it. What is your dosage and what brand meter do you have?

 

[Laura]

Hello and thanks for the feedback. I signed up with Alere and I have a CoaguChek XS meter. I'm taking 6 mg a day, but my Coumadin nurse has occasionally dropped my dose down to 4 to get my number down. She also encouraged eating some greens so I had two spinach salads.

 

[pellicle]

Hey Laura

Overall, it's been a rocky road with my INR numbers too low (1.2) at first. Now they are too high (5 last Wed and 4.1 yesterday)! My optimal range is 2.5 - 3.5. I did acquire a home testing kit and I've used it twice. Getting enough blood on to the stick has been my biggest issue. Their support line gave me some tips which have helped.

sorry to hear that ... have you tried my rubber band wrap method?

[ link ]


Before you even prick yourself (and possibly waste a strip) just check that your fingers aren't cold and pale (indicating little blood flow) This seems to afflict a lot of ladies.

Then remember to work that rubber band wrap from about the middle of the finger then down towards the tip. You can test it by just doing a finger stick without a strip (on any old time) and make sure you get a good "hanging drop" of blood. If not then you're in risk of wasting a strip.

I hope your house isn't too cold as that'll do it too.

The reason I am here today is an issue with my urine turning darker and brownish on Thursday. I really noticed it yesterday. I believe that I was dehydrated. I tried to remedy that last night with about four bottles of water. It was still brownish this morning. My cardiologist's office said go for a urinalysis on Monday. Based on what I've read here and elsewhere I have to think my symptom is related to the high INR. I test again tomorrow. I'd love to know what you think. At this point, I have no other known health issues. I plan to go back to work on 4/18. Thanks!!

well unlike Dick I don't have any experience to ever see blood in the urine but I agree with everything he wrote. I'd say it may be related to your kidneys just extracting something else ... if its not bright red.

without knowing you INR its pure guess work

Are you testing weekly?

What are your doses (daily) and what are the INR's for those doses? Without actually gathering information you are basically in the dark which is not only bad but probably the reason why you've been having problems managing your INR.

Write down your INR from every test, if you afraid of computers and don't have a spreadsheet to do this with then get some graph paper and write it along the side: with the date of the test. Then with the rest of the graph paper draw a graph like you did when you were at school. [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/4\/3697\/33782876401_d661e400e2_b.jpg"}[/IMG2]




Be methodical, keep the readings to be weekly and then the graph will be nice and logical "Time Series Data" That's a link to a year 10 school tutorial (sorry if you already knew how to make a graph and the importance of regularity in the time period axis).

Myself I use a spreadsheet, which enables me to graph it in a simple manner
http://cjeastwd.blogspot.com/2017/01/2016-inr-data.html

If you aren't writing things down and being methodical then quite frankly you're never going to learn it NOR be able to spot any trends.

Let us know some data like your INR and dose and if you've had some medications or something which is likely to cause colouration of your urine (as some foods and drugs can make you piss brightly coloured (often tan) urine.

 

[jwinter]

INR does take time and a few adjustments until it gets in line. Mine took two months but has been good since. The only thing I know about dark urine is that they ask me at coumadin clinic at each draw if I see any blood in urine. I also have PBC of liver and liver issues can make urine brownish colored. Dehydration is a big indicator also.

I, like the others posted, don't get too excited anymore at some (SOME) variation in those numbers you posted. Stick with what your cardio tells you.

Good luck and one day at a time.........

 

[Laura]

Hello! I have not tried the rubber band trick yet, but it looks like a great idea. I warmed my hand under warm water, massaged it a bit and changed hands and finger. I was using the blue pen like device, but on their advice switched to the small red preloaded device. It seems to make a bigger puncture mark. It definitely hurts a little more.
I have been keeping track of my INR levels and everything else frankly in a Comp book. I am comfortable with computers so the plan is to keep track with the Alere app on my iPad.
I'm testing at least weekly. My INR was 4.1 yesterday, 5.0 Wed and 3.4 the prior Wed.
The only changes I can think of over the past couple of days were that I took a multivitamin and some Crest whitestripes
Thanks a lot for your response!

 

[Laura]

INR does take time and a few adjustments until it gets in line. Mine took two months but has been good since. The only thing I know about dark urine is that they ask me at coumadin clinic at each draw if I see any blood in urine. I also have PBC of liver and liver issues can make urine brownish colored. Dehydration is a big indicator also.

I, like the others posted, don't get too excited anymore at some (SOME) variation in those numbers you posted. Stick with what your cardio tells you.

Good luck and one day at a time.........

Thanks for the encouragement!

 

[pellicle]

Hi

let me approach this out of order:

The only changes I can think of over the past couple of days were that I took a multivitamin and some Crest whitestripes

well I'm willing to put the multivitamin as the culprit. They often have that effect and if you don't take them regularly you may not have noticed it before this (being more attentive now)

.. I warmed my hand under warm water, massaged it a bit and changed hands and finger. I was using the blue pen like device, but on their advice switched to the small red preloaded device. It seems to make a bigger puncture mark. It definitely hurts a little more.

don't forget, lance the side, not the pad, because you will end up killing nerves in that spot over time (and this is a long term thing right), This is common advice to diabetics who lance more frequently than us.

also, guage (thickness) of needle is important at least as much as depth. If its smarting quite a bit perhaps its not a required depth. There is a guage more suited to the size we use. I think its 21...

I have been keeping track of my INR levels and everything else frankly in a Comp book. I am comfortable with computers so the plan is to keep track with the Alere app on my iPad.

excellent!

I'm testing at least weekly. My INR was 4.1 yesterday, 5.0 Wed and 3.4 the prior Wed.

sounds like its within the "safe zone" mentioned in my above blog post (which is actually the result of a large study, not just something I pulled out from between my cheeks...

Best Wishes

 

[pellicle]

oh ... and

Hello and thanks for the feedback. I signed up with Alere and I have a CoaguChek XS meter. I'm taking 6 mg a day, but my Coumadin nurse has occasionally dropped my dose down to 4 to get my number down. She also encouraged eating some greens so I had two spinach salads.

as a one off that makes sense ... I concur (for what that is worth

 

[neil]

hope you get it sorted laura

 

[Laura]

Thanks to all for the terrific advice! (I'm not sure how to post individual responses). I will be putting them to good use on Monday. The good news on the brownish urine front is that things are back to normal. I've been drinking A LOT of water!

 

[LondonAndy]

The reason I am here today is an issue with my urine turning darker and brownish on Thursday. I really noticed it yesterday. I believe that I was dehydrated. I tried to remedy that last night with about four bottles of water. It was still brownish this morning. My cardiologist's office said go for a urinalysis on Monday. Based on what I've read here and elsewhere I have to think my symptom is related to the high INR. I test again tomorrow. I'd love to know what you think.

Hi Laura, and welcome too. These things do tend to worry us, and of course typically happen when your local doctors are closed, so I have bought some of the urine testing strips like the doctors use from Amazon (just a packet of 6, as shelf life is only a few months to a year at most). Now I can do a dip at home if needed and decide whether to bother a doctor or not. They work out at less than £1 (or a bit over $1) each, and so quite cheap.

About six months after my heart surgery I had darker urine too, and that time it turned out to be dehydration. (I am on a water tablet, Furosemide, and a very hectic day meant that I had not drunk enough water). So I'm glad to hear it has now cleared up.

 

[Laura]

I have to admit that I was pretty freaked out about the possibility of a blood clot when my INR dropped to 1.2 for a couple of weeks. In the beginning, my Coumadin was being managed by a clinic at the hospital where I had my surgery. I had a visiting nurse come to the house to draw the blood. The nurse was great, but some of the people at the clinic were rather unpleasant. I asked by cardiologist if her office could take care of me instead. Somehow in the handoff the Coumadin nurse wasn't told that I had a mechanical valve. She said that was why she initially underdosed me. I guess I have to take her word for it!

I'm going to try a lot harder to avoid getting dehydrated. I know it's bad news and potentially dangerous. Thanks for the help!

 

[pellicle]

Hi

(I'm not sure how to post individual responses).

If using a phone (which is tedious) you will find three little dots at the bottom of the post. Tap that and pick quote

Typically I edit out what I don't want

 

[Laura]

Today's Blood Test - The amount of blood generated from the lancet was enough. More than enough! The lancet is 21G x 1.88mm. I though I would try dropping the blood onto the strip instead of coming at it from the side. I guess I didn't do that right because I turned my hand over and the blood just rolled down my finger to the other side. I just kept squeezing until I had more for the side of the strip. It feels like a miracle that it worked! My INR was 4.4 so I'd say it's pretty obvious that 6 everyday is too much now.

Next time I will try to lance my finger from the side with my hand palm down. Such fun! lol

 

[pellicle]

Hi

Today's Blood Test - The amount of blood generated from the lancet was enough

Love the success stories

I guess I didn't do that right because I turned my hand over and the blood just rolled down my finger to the other side.

I lance and have things set up so that I can turn the finger to have drop form underneath.

My INR was 4.4 so I'd say it's pretty obvious that 6 everyday is too much now.​

Seems like it .. I'd steer it down by a mg daily at first, given what you've said