Today's INR

[Homeskillet]

Well, I suppose we can officially identify Pellicle as a "prophet" :coolhank:!

INR, May 10 (today): 3.4

Dosage:

May 11 = 8.5mg
May 12 = 8.5mg
May 13 = 8.5mg
May 14 = 8.5mg
May 15 = 8.5mg
May 16 = 8.5mg

Return to clinic for another test after that. Though I hate to admit it - you da' man Pell :test:!

**Incidentally, I filled out the paperwork for Coaguchek XS & dropped off Roche's specific prescription form to the surgeon's office.

The "discounted" price for self-pay for the unit alone: $2,400 :confused2:!

 

[pellicle]

Hi

...I suppose we can officially identify Pellicle as a "prophet"

determined scientist will do me thanks ;-)

The goal of science is after all to be able to predict outcomes

INR, May 10 (today): 3.4

good, that's in my upper range. Was that on the 7.5mg daily (which is what I had recorded) ... because if so then why does this seem to be an incresae:

Dosage:

May 11 = 8.5mg
May 12 = 8.5mg
May 13 = 8.5mg
May 14 = 8.5mg
May 15 = 8.5mg
May 16 = 8.5mg

unless you want your INR to raise? My quick "what if" suggests a potential range between INR = 3.8 ~ 2.5 with over 2.5 more likely

The "discounted" price for self-pay for the unit alone: $2,400 :confused2:!

ya have to love the way that the US medical system distorts the free market.

 

[Protimenow]

$2400!!! It's priced this way because Roche (or the distributor) knows that some insurances will actually pay that much.

Meters on eBay are much less expensive. (And, btw, I still have an extra Coag-Sense that I'd prefer not to put on eBay).

 

[Homeskillet]

Was that on the 7.5mg daily (which is what I had recorded) ... because if so then why does this seem to be an incresae:



unless you want your INR to raise? My quick "what if" suggests a potential range between INR = 3.8 ~ 2.5 with over 2.5 more likely

May 5th (last Fri.) was a dose of 10mg. for a quick boost since I was low @ 2.0 INR that day.

From there, yes, my dose was 7.5mg daily up until today's test.

I suspect that she is thinking that 7.5 daily might bring me in too low for the next test since I'm not going back for a whole week. I suspect that she's correct, although I do think I'll likely be a bit high (I surmise that she's thinking better a little high than low for a whole week).

I imagine she's attempting to cinch down my dose & does indeed seem to be getting me closer.

At least she's now being more consistent w. the dosing....which I do appreciate.

 

[Homeskillet]

$2400!!! It's priced this way because Roche (or the distributor) knows that some insurances will actually pay that much.

Meters on eBay are much less expensive. (And, btw, I still have an extra Coag-Sense that I'd prefer not to put on eBay).

Not sure how to reach you via PM. Have tried several times already (just tried again).

 

[pellicle]

Not sure how to reach you via PM.

Tap my name, goes to my profile, tap send message ...
Or just go to your messages, put my name in the to field

Have tried several times already (just tried again).

Just email me then

 

[pellicle]

From there, yes, my dose was 7.5mg daily up until today's test.

I suspect that she is thinking that 7.5 daily might bring me in too low for the next test since I'm not going back for a whole week.

I imagine she's attempting to cinch down my dose & does indeed seem to be getting me closer.

At least she's now being more consistent w. the dosing....which I do appreciate.

Agreed, lets go with it and see the outcome

 

[Agian]

Well, I suppose we can officially identify Pellicle as a "prophet" :coolhank:!

Nostrapellicle

 

[Protimenow]

Homeskillet - I'm having issues with the mail system on this forum. It tells me that I have 33 topics and it will only support 20, but I'm not sure how it's defining a topic, or how to delete them. FWIW - my profile name is also my domain name for receiving mail. And many people on this forum know that my name is Mark.
Perhaps this information will help.

I plan to eventually build my Protimenow website, and if I had it up, there would be a button to contact me there.

 

[LondonAndy]

The "discounted" price for self-pay for the unit alone: $2,400 :confused2:!

$2,400??!! Here in the UK, the official Roche website price is £300 - this is $386.67 at today's exchange rate!

 

[Homeskillet]

$2,400??!! Here in the UK, the official Roche website price is £300 - this is $386.67 at today's exchange rate!

I know. Good ol' American healthcare system (roll eyes).

I chuckled at their "discounted price rate" & thought, "Oh please, don't be silly."

 

[Homeskillet]

Today's INR reading was 5.8 at the clinic using the CoaguChek XS. The did a blood draw & the INR came back at 6.3!

The lady had me skip tonight's dose & drink 2 cups of "strong" green tea in an attempt to bring down my INR (which I think will do very little).

She then instructed me to take a mere 2mg tomorrow night - which I cannot understand for the life of me.

Going back Friday, but suspect it will be too early for any major alteration to my INR. Gotta' love this.

Incidentally, upon taking the blood draw my blood flowed freely - while they stumbled around looking for the coban (this was after they knew my INR was so high). Would seem far more competent to have the coban ready prior to drawing blood from someone w. such a high INR (?). Yes, I notice things like this .

I also noticed that the blood appears much darker than before I began warfarin (also noted this when the same thing happened in the hospital). Don't know - might just be me.

 

[jwinter]

Homeskillet, I believe your numbers will come where you want them. Mine took over 2 months. I had a run in with Pericardial effusion(fluid around heart) that took two extra surgeries, two rounds of bridging with Lovenox by injection to belly, and several trips to coumadin clinic (60 miles during +10 and -10 degree winter weather). It will happen and I know it is hard to go through as I am not a very patient person.

I think my blood looks lighter and darker at times also. Weird huh?

Will be waiting to read your success post. Take care.

 

[Homeskillet]

Homeskillet, I believe your numbers will come where you want them. Mine took over 2 months. I had a run in with Pericardial effusion(fluid around heart) that took two extra surgeries, two rounds of bridging with Lovenox by injection to belly, and several trips to coumadin clinic (60 miles during +10 and -10 degree winter weather). It will happen and I know it is hard to go through as I am not a very patient person.

I think my blood looks lighter and darker at times also. Weird huh?

Will be waiting to read your success post. Take care.

Wow...and I thought I was having a rough go of it?

Yea', admittedly, patience is not my best attribute either.

Can tell this is going to be a lot slower recovery than I anticipated.

Thank you for the input - take care.

 

[Zoltania]

It's tempting to treat recovery as a competition to see who can recover the fastest, but that's not a very productive approach. Just make sure you're doing the right things like walking a lot and resting a lot, and consider these few months as an investment in your long-term health.

My surgeon wouldn't let me go back to playing clarinet or tuba for four months after my surgery, which felt like a long and frustrating time for me, but once I got back to playing and worked my way back to being in shape, it was as though I had never taken the time off, and I had the comfort of knowing that my valve had had the chance to heal well.

 

[LondonAndy]

As somebody who has had a mechanical valve for about 2.5 years now, and whose INR is usually very stable without the need for much of a change of dose, I don't know if my recent aberration in readings will help to see that dramatic dose changes CAN sometimes be necessary (and also how quickly INR can shift out of range quite significantly, validating again the need for weekly testing.

My therapeutic range is 2.5 to 3.5, and over the preceding 12 months my weekly readings have been 100% in range thanks to minor "course corrections" in dose when a reading was getting close to one end or the other of range. Taking an alternating dose of 8mp one day, 9mg the next, recent results were:

3.3 7 May
3.4 26 April
3.3 13 April
3.4 6 April
3.2 30 Mar

Then on 10 May I had to send a reading to my anti coagulation clinic, and my reading was 4.7! So in three days my INR had increased by 1.4 instead of the usual 0.1 variation seen in a week!!

I think the reason for the surprise difference was a stomach upset that left me with "loose bowel movements" (always love that comparatively innocuous description for something that makes me very glad for efficient sanitation and a well ventilated toilet ...) for several days, during which I also had marginally more alcohol than normal.

To compensate, the clinic advised that I skip one day's dose completely, and because 3 days later the reading was still a little high, I decided to take a reduced dose of 6mg for two days. This brought me back to 3.0 and otherwise dose has continued as before, alternating 8mg and 9mg daily.

Just thought I would share the experience.

 

[Homeskillet]

As somebody who has had a mechanical valve for about 2.5 years now, and whose INR is usually very stable without the need for much of a change of dose, I don't know if my recent aberration in readings will help to see that dramatic dose changes CAN sometimes be necessary (and also how quickly INR can shift out of range quite significantly, validating again the need for weekly testing.

My therapeutic range is 2.5 to 3.5, and over the preceding 12 months my weekly readings have been 100% in range thanks to minor "course corrections" in dose when a reading was getting close to one end or the other of range. Taking an alternating dose of 8mp one day, 9mg the next, recent results were:

3.3 7 May
3.4 26 April
3.3 13 April
3.4 6 April
3.2 30 Mar

Then on 10 May I had to send a reading to my anti coagulation clinic, and my reading was 4.7! So in three days my INR had increased by 1.4 instead of the usual 0.1 variation seen in a week!!

I think the reason for the surprise difference was a stomach upset that left me with "loose bowel movements" (always love that comparatively innocuous description for something that makes me very glad for efficient sanitation and a well ventilated toilet ...) for several days, during which I also had marginally more alcohol than normal.

To compensate, the clinic advised that I skip one day's dose completely, and because 3 days later the reading was still a little high, I decided to take a reduced dose of 6mg for two days. This brought me back to 3.0 and otherwise dose has continued as before, alternating 8mg and 9mg daily.

Just thought I would share the experience.

Interesting. Didn't consider that loose bowel movement could alter INR. Posts like this is the very reason I really like this forum.

My INR was 2.4 today - down from 6.3 Wednesday.

The clinic lady put me on a lower dose of 7.5mg tonight (Friday), 6mg Saturday, 7.5mg Sunday, 7.5mg Monday, 6mg Tuesday.

The clinic lady said that if she put me on 8.5mg daily she thought I would still come in too high since I was so high Wednesday. However, since I am now in a much lower INR, in my opinion, this dosage seems too low & potentially puts me at risk for a low INR for several days.

Guess I have no other option than to wait & see Wednesday.

 

[Homeskillet]

So, new turn of events just unfolded. I went to my general practitioner (GP) yesterday to get set up w. monthly lab blood draws just as an additional cross reference. He sent me to labs today just to check my INR. The on-call Dr. called a few hours later & said I tested at 7.6 INR! He told me to hold last night's dose, as well as probably tonight's.

But, the lab lady had trouble locating the vein today & had to try 3 times. She seemed unsure that she had actually gotten what she needed (there were 3 vials when it was all over). So, I immediately tested on my home-meter twice & it read 3.2 INR the first time (PT = 38.8); 3.1 INR the second time (PT = 38.2).

My INR Friday at the clinic was 4.3 & I've had lower doses since then - w. 2 glasses of steeped green tea as per the clinic's instructions. Also, 2 days ago my home meter read 3.5mg. The home meter has consistently been about .1 point below the Coumadin Clinic's CoaguChek XS.

I was really hesitant to skip last night's dose since my suspicion was that the lab botched the draw. And, I had 4 needle pokes yesterday & they hardly bled at all. It would seem that if my INR was that high I would've been bleeding more (?).

Sooo, today I went to the Coumadin Clinic & got retested using the CoaguChek XS. INR showed 3.8, but the lady correctly pointed out that if a lab draw read 7.6 yesterday she would feel better doing another lab draw since she has seen the meter's be wrong.

Today's lab results came back 4.1 INR. Yesterday's lab draw had to be bunk. I will be calling the Drs. office tomorrow to report this since this could have potentially been dangerous.

The clinic dropped my dose to 5mg for tonight since I am still out of range - then 6mg for the next 2 night's (I return Friday).

On a positive note, this does indicate in my my mind that my home meter is pretty accurate since today's clinic reading was only .5 difference than last night's home-meter-reading.

Although, to be completely transparent, it does concern me a wee-bit that today's lab reading was a whole point different than my home meter last night. Makes me wonder if I should consider this my "real" INR (?).

A learning experience to be sure!

 

[LondonAndy]

I agree - given what you say about the problems with the blood draw, I would be very wary of the lab result. My self-testing results have always been within 0.2 of the lab results over the last 2.5 years,and if a lab result gave a big discrepancy now, I would have more confidence in my machine's result than the lab's.

 

[Protimenow]

It looks like your lab has a real problem. If they can't get a good blood draw -- that's a problem. If they mishandle the blood - that's another problem. If they use a wrong value for the reagent that the use for testing your blood - thats one more problem. I would be concerned if the same errors happen to others who visit the lab for an INR -- potentiually dangerous dosing advice could put these others at risk.

You can compare the results of your meter (Coag-Sense) and the clinic that uses a CoaguChek XS. THEN see what the lab comes back with.