Veinous blood at 6.0!

[Aggie85]

Had my weekly veinous blood draw today come back at 6.0!!! :eek2: It jumped up from 3.8 last week despite them lowering my dose last Monday and my being pretty liberal on eating Vit K rich foods this last week. I had suspicions today's draw would be high, But NOT THAT HIGH, because the scratches from my cat on Friday (more like puncture wounds) started spontaneously bleeding this morning when they had been scabbed over all weekend and had hardly bled at all when I got them.

I've noticed my levels staying pretty regular in 3.0-3.5 range until last week's 3.8. In fact, last week was large rise too (from 3.2 the prior week to 3.8). Because of rising level, pharmacist changed last week's dose plan, it was reduce dose from 7 to 5 for Monday only and continue regular 7 dose the rest of the week.

Now, this week, my level was insane! Told today to eat a salad tonight and skip all together my coumadin for tonight and tomorrow and come back to retest on Wed.. I've noted Protimenow and Pellicle strongly recommending NOT doing drastic dose changes but is that still true when the INR is THIS high? I asked about a Vit K shot, but she said no need yet. At what point would they add extra prescription K, assuming NO signs of internal bleeding?

Regarding internal bleeding, there is some concern as my mom and I noticed I've been having some difficulty talking today. NOT severe, but noted. I'm having trouble pronouncing certain words or words that slide together in order (for example can't for the life of me say "sweet red wine". It keeps coming out sReet Wed Rine), getting words in a sentence in wrong order, stumbling over words or repeating them. That sort of thing. Interestingly, NO trouble typing. NO other neuro signs either. I'm still on pain meds, but much less so, and last few weeks had quit having drowsy, neuro type issues from the pain meds at all. So, it's odd that it started today and persisting 13 plus hours since taking the dose. But, because of having taken the Tramadol last night, the pharmacist is just having us watch for further neuro signs or rapid, pronounced change, or any other signs of bleeding. Strongly urged that if I have any further neuro signs or ANY internal bleed signs to GET TO ER and not hesitate.

Anyway, resting in bed today, watching for any internal bleeding signs, drowsiness, headache, slurring speech, ect... and making SURE I don't get any cuts!!!! NO CATS near me!

Linda

 

[pellicle]

Hi

wow, thats high.

Salad may not be enough (and often isn as Vit K rich as you'd assume), spinnache or broccoli are better sources.

i would want to bring that down, but don't drop it off a cliff. There can be harm in that.

Have you been taking Paracetamol? Any drug changes?

I can certainly understand your concern at 6! Personally (meaning if this was me) I would go to a healthfood shop and get some vitamin K tablets / capsules and take one. I would also be testing daily or 2nd day till you see a trend.

I know that gymguy takes vit K daily to stabilise his INR, might work for you too?

Keep us posted please

best wishes

 

[ski girl]

Have you drunk any grapefruit juice? I washed down my warfarin with a BIG glass of grapefruit juice for about a week and when I had my INR tested at the end of the week it was 9.0!! I got vit K at the hospital for that.

There is a strong interaction between warfarin and grapefruit juice - now I know!

 

[Freddie]

from Drugs.com/ interaction
Using warfarin together with traMADol may cause you to bleed more easily. You may need a dose adjustment based on your prothrombin time or International Normalized Ratio (INR). Call your doctor promptly if you have any unusual bleeding or bruising, vomiting, blood in your urine or stools, headache, dizziness, or weakness. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Personally, I like to keep some warfarin in my system even when I've been told to "skip". I've been as high as 5.0 (no vit "k" shot) and take 6mg a day. At 5.0, I cut my dosage in half for two days and drank Carnation Instant Breakfast and a couple Boost's along with eating spinach and broccoli salad for supper. Retested in three days (counting the day the result was 5.0) and I was within .4 of my upper range. I realized what caused the jump and went back to my regular dosage.

FWIW:
Face and hand cream/lotion can cause a jump in ones INR, so may want to check the ingredients if you use these products.
Also, I am assuming that you know that it takes 3 maybe 4 days after any adjustment to your dosage to have a change in test results.
"Skipping" for two days may cause you to drop drastically and cause you get on even a bigger 'roller-coaster' that you've already been on.

 

[pellicle]

Hi

ahh ... I recall the grapefruit post ... I'd forgotten it was you

Have you drunk any grapefruit juice? I washed down my warfarin with a BIG glass of grapefruit juice for about a week and when I had my INR tested at the end of the week it was 9.0!! I got vit K at the hospital for that.

 

[Aggie85]

Thanks All,
No grapefruit juice.

((lBTW the last time I drank G juice was when I discovered I was pregnant with my 20 year old son. Drank a whole bottle and ate half a jar of large kosher dill pickles. When I realized they'd tasted good together, I immediately went and got a pregnancy test! Talk about a weird craving!))

No other changes in diet or meds this week either. I've been on Tramadol since my surgery and have been pretty stable INR wise while on it. I'm down to taking it once every couple days at night when can't sleep because of surgical pain. My pharmacist also knows I'm taking the Tramadol. And even if taking every couple days only, I've been consistent in that.

Yeah, I wondered about the NO Coumadin for TWO days. Seemed pretty drastic change and I don't want to start YoYo-ing. I also know that testing in two days isn't going to show change from this dose reduction, but also feel more comfortable getting retested just to know where it is. And that's coming from someone who has to do veinous draw sticks which don't go well and usually take more than one, but I'd rather know than avoid a stick or three. I'm trying to decide if to call her and talk about it or just take a smaller dose and then tell her when I go for retest tomorrow.

I assume I should expect to be retested again in another couple days as well, like on Friday, to see what sudden drop did.

It was a spinach salad at lunch and had snow peas w dinner which are also listed as high K. So should have it covered diet wise. I'll go to store and get some Vit. K as well, but am Leary of doing too many things at once so will just have it on hand.

I'll keep all posted.

Linda

 

[T in YVR]

BTW the last time I drank G juice was when I discovered I was pregnant with my 20 year old son.

That is one long pregnancy! God help you in the delivery room

Hope you get it back in range soon - that is a big spike...a nice big kale salad would help out, but you are right - don't change too many things at once. At least you caught it and they're watching it.

Good luck,
Tony

 

[pellicle]

Hi

Yeah, I wondered about the NO Coumadin for TWO days. Seemed pretty drastic change and I don't want to start YoYo-ing.

it is and you will ... the enzymatic regulation of your warfarin levels (your body's disposal metabolism for warfarin) will alter in responce to there being none present and when you get your next dose you'll go higher.

I also know that testing in two days isn't going to show change from this dose

how do you know this? I know that from my own testing, and the observation of testing with others that this is a false argument. I only assume it persists in the world due to either blatant ignorance (unsurprising) or the desire to stop people from micro-managing (because it will even out with a steady hand on the tiller anyway).

But its wrong to assume that to be the case . I refer you again to this post by Ola, where he shows a very tight correlation between actual INR and variations he predicted (using similar modeling methods to what I use) his INR would vary by. Just look at the pictures if you don't want to read it. Bottom line is that its false and wrong to say you will not see variations within 2 days.

but also feel more comfortable getting retested just to know where it is

exactly ... and its from seeing the trend moving that you can remove the anxiety or know to do something about it. Don't over manage / micro manage it, but this is why self testing is soooooo damn good.

.but I'd rather know than avoid a stick or three.

and that reason also for self testing with POC machines like Coaguchek

I'm trying to decide if to call her and talk about it or just take a smaller dose and then tell her when I go for retest tomorrow.

tough call ... I know what I'd do (and what I did) but you can be in for a battle (I was).

It was a spinach salad at lunch and had snow peas w dinner which are also listed as high K. So should have it covered diet wise.

unless you ate 500g of the stuff ... put 500g (raw and uncooked) in a plastic bag (thats 17 Oz for people using the antique scales) and see if you'd actually eat that much. (willing to bet that no way will you eat that much ...

I agree, don't do too much, but seriously you'll need to scoff more spinach than I'm expecting you are actually eating to make a dent in it ... but measurement will tell you for sure.

seriously, self testing and knowledge are your friends.

 

[Protimenow]

A few thoughts:

In my experience, my system responded to Vitamin K quite rapidly -- the results are much more rapid than my body's response to Warfarin. If you increase your Vitamin K intake, your INR SHOULD drop within 12 - 24 hours.

If you've been taking acetaminophen regularly, there's a possibility that you may have damaged your liver -- it may be worthwhile getting a test of your liver enzymes. Liver damage can contribute to a sharp rise in INR.

If you had a meter, testing every day or so could ease your mind - or at least give you a fairly timely status report.

 

[pellicle]

Thanks All,
No . I've been on Tramadol since my surgery and have been pretty stable INR wise while on it. I'm down to taking it once every couple days at night when can't sleep because of surgical pain. My pharmacist also knows I'm taking the Tramadol. And even if taking every couple days only, I've been consistent in that

It could be your culprit



http://www.ncbi.nlm.nih.gov/pubmed/17064212

.... We report a tramadol-warfarin drug interaction that caused a supratherapeutic INR in a 65-year-old man in previously stable condition who was being treated at our anticoagulation clinic. Within 6 days of starting tramadol 50 mg twice/day, the patient's INR rose from 2.5 to 6.14. He elected to continue therapy with the tramadol. A 30% dosage reduction from warfarin 60 to 42 mg/week was eventually needed.

Paracetamol can also cause issues...


http://www.ncbi.nlm.nih.gov/pubmed/17145598

RESULTS:
Mean INR rose rapidly after the start of paracetamol and was significantly increased within one week of paracetamol intake

 

[Aggie85]

Hi guys, YES self testing would be best. But please remember, I'm the one who the POC CoaguCheck is NOT working on!!!! (See the other thread by me) I'd LOVE to self test, but the machine keeps giving false high levels over the vein lab draws. The 6.0 Monday was a vein draw. We've stopped doing POCs for now.

I tried to reach the pharmacist yesterday to ask about the dose. She didn't get back to me, so I took half my normal dose. I will tell her when I go this morning for the recheck. I'll also mention the Tramadol. I'm not arguing that the Tramadol could changes INR levels, but that I've been on it consistently, if lower dosages now, since my surgery. It's not a new drug for me. She also knew I'd taken some that previous night because I was having some trouble talking that day and we were trying to determine if it was from a problem with the high INR or residual from the midnight Tramadol dose. ((BTW I took the same dosage of Tramadol last night too, so will be consistent again. It'd be nice if I could not take a dose and see what that does, but can't sleep some nights without it.)) I go to the lab roughly the same time of day, mid morning, each time and am taking the Tramadol probably every other night. I'm not positive, but am sure I've taken it before other INR checks. What may have changed is how I'm metabolizing it and all my meds differently after taking the Tylenol so long. It was a good suggestion to get liver checked. I'd actually been thinking a few days ago about asking my cardiologist to check at my appointment next week because I've needed the Tylenol for so long.

Side note:
Just called pharmacist to ask about liver panel. Since I'm getting INR, I didn't want to get stuck again if she wanted one when I see her after my blood draw. She's gonna put in for stat results of INR and full CBC. She was also ok w me taking half my dose yesterday. She said not normally, but that she knows I'm informed and active in my care and is comfortable w that. It really is too bad that the dang POC machines aren't working for me. Hopefully when my body is further along in recovery, that will reverse and I can start using them.

Probably not eating enough spinach :rolleyes2: but being liberal w my K otherwise too. I'll see what today's INR is and stop and get K supplements on my way home, either for today or just to have on hand. When you're controlling w K, how much do you take at a time? Since I can't home test, should I just take for one day? Just re-read your reply about K acting quickly. So, I assume take one dose if needed today and wait till next test.

My comment about knowing it takes a couple days was more relating what I thought I'd read before on the forum here and on your blog, Pellicle. I remembered things wrong. But it was because of your blog that I remembered about not waiting for testing and about the not letting them do drastic dose changes like she was. It's all so much to take in and I'm still pretty new to this. That's why I posted my thoughts about the high INR; to get feedback and affirm if what I was thinking was right. THANKS again for correcting my errors.

Tony, yeah that would be. Of course I meant when I was pregnant w him 20 years ago! LOL what's funny is I like grapefruit juice, but haven't touched the stuff since then. Still eat pickles occasionally but not those big ones (just too salty). :biggrin2:

I think that hits everyone's comments. Thanks and I'll be back later w today's results. Off to the clinic. Hope traffic has cleared out; around here the drive can be either a 20min or 1.5 hr one.

Linda

 

[pellicle]

Hi Linda

Hi guys, YES self testing would be best. But please remember, I'm the one who the POC CoaguCheck is NOT working on!!!!

sorry Linda, I had forgotten that. As it happens I read the threads and think about the problems of others here and to me that thread had slipped into an unreferenced memory. Also there were questions I had on that (before I was willing to relegate the CoaguChek to junk status, and it seems those questions are re-emerging here.

I tried to reach the pharmacist yesterday to ask about the dose. She didn't get back to me, so I took half my normal dose.

I think that's sensible (although will probably cause you some discussions). I feel that its consistent with the practice settled upon by that fellow in that article I cited above. So should work. I am sure that taking some Vitamin K will bring that INR down fast.

I'm not arguing that the Tramadol could changes INR levels,

I am

but that I've been on it consistently, if lower dosages now, since my surgery.

that fits your INR problems and fits the issues you've reported.

It's not a new drug for me.

what does this mean? That you were taking it before OHS? Its only important what you are taking now with your warfarin.

She also knew I'd taken some that previous night because I was having some trouble talking that day and we were trying to determine if it was from a problem with the high INR or residual from the midnight Tramadol

you are approaching this the wrong way. I am saying "go off the Tramadol and substitute another pain killer all together. See if your INR stabilises. This is the only way to work it out (and frankly I'm shocked that your pharmacist isn't taking that approach, for that is what pharmacists would do here).

I suspect that when you aren't taking that drug that the POC machine may now give data that matches the vein draws (now that the vein draws are high too).

I hope you printed that article and took it

 

[Protimenow]

I think, too, that the inability of the CoaguChek XS to give results that approximate those of the lab doesn't preclude you from testing with a POC machine.

Personally, the one that I trust, the Coag-Sense, does testing a different way from the CoaguChek XS and the InRatio - it actually moves the blood, mixed with reagent, until a clot forms. I was told by the company that some labs will use the Coag-Sense as a secondary test if the other monitors give a 4.0 or above. A Coag-Sense just may work better for you.

The ProTime machines - which are a bit more of a pain to use and require somewhat more blood - also use a mechanical method for detecting a clot. These may also work for you. (FWIW - I have both machines -- ProTime and ProTime 3 and an extra Coag-Sense. I may be able to help you out if you send me a PM). There's also the Hemochron, made by the same company that manufactures the ProTime and ProTime 3, but it's designed for professional use in clinics and, I'm told, even in Operating Rooms (but it's probably not easy to get your hands on one).

The point here is that you shouldn't give up on POC testing - there are other meters that may just work for you, even if you have issues with the CoaguChek XS.

And Pellicle's advice to consider switching to another pain reliever makes sense. (However, as has been well documented, aspirin and other NSAIDS might effect clotting if taken in high doses because of their effect on the platelets).

 

[Aggie85]

Thanks for inputs guys. Ok, first yesterday's results then discussion.
Vein blood INR was 2.9 which is great. But was a 3 point drop between Monday and Wed. BTW Liver tests were normal, so that's probably not cause of spike.

1. Good thing I self dosed to half my amount or INR would've dropped even more. My pharmacist said she was actually comfortable w me making that call. She stated that she is confident with my knowledge level (mainly because of all the help I'm getting here) of how Coumadin works in body, that I know what to watch out for and what changes mean. She would rather have been consulted but agreed that since I couldn't reach her, my decision was ok given that I'd see her the next day.

2. I had taken Tramadol the night before, same as before Monday draw. Same time at night, same dose, same amount of time between taking it and my blood test and the INR level went down. Granted, had also significantly reduced the Warfarin intake, but Trmadol use was same those two nights AND previous three weeks when levels DID NOT SPIKE. So pharmacist and I doubt it was the Tramadol causing the spike. Again, I've been taking the same Tramadol doses for a few weeks and had NO other spikes. Also as below, Tramadol usage and doses have decreased.

...Pellicle, actually your comment below about my pattern is incorrect (I can't get Ipad to let me insert quotes, but am referring to the your comment quoting my consistent use of the Tramadol). According to the articles you inserted, adding Tramadol increased INR. The guy in study ADDED Tramadol and they needed to REDUCE his Warfarin. My Trmadol intake is going DOWN. A spike would be expected if I had ADDED Tramadol or had INCREASED my dose. With Tramadol intake going down my INR would be dropping, not spiking or rising. My Warfarin dose should need to be be raised to keep INR steady. As I take LESS Tramadol (I'm taking significantly less than I was), my INR would go down, so to stay at a desired level, I would need more Warfarin. If Tramadol had been added since starting Warfarin, I could see your point, but it was started at the same time Warfarin was started (ie postop) and dose has been reducing. Your point is really good though to be aware of when I STOP Tramadol as my INRs could be expected to decrease and I may need to add more a Warfarin then.

...Until this spike, I've been pretty stable in my INRs (hanging consistently in the 3s and always in range!) There's been a slow trend up in INRs (NOTE up trend is despite LOWERING my Tramadol use), but no high and low fluctuations. My Warfarin dosage has also been pretty stable until the spike. The issue was mismatched readings between POCs and Vein draws. Not fluctuations from week to week (until this one spike). The vein draw levels have always been stable. For that matter, the POC levels were also stable, just way too high compared to vein ones.

... It is an interesting theory as to the Tramadol maybe affecting the POC machine usage. Why/how would the Tramadol affect how the machine reads the blood? Disregarding the question, for now, about its effect on the actual INR levels, just looking at its effect on the machine readings. I'll be interested to see if stopping Tramadol would change readings issue and will talk to pharmacist about it, but please see note below about me and pain meds. I may just have to wait for more healing and pain levels to get to where Tramadol isn't needed to see if stopping Tramadol changes POC issue.

Medication issue: as to why Tramadol is not being changed. Mainly, I have problems with too many other pain meds. Tramadol so far has the least side effects problems for me. Tylenol by itself isn't giving enough relief (I'm taking max dose already). NSAIDS also cause problems with INRs and cause heart issues, so those are out. I'm allergic or hypersensitive to almost all Codiene drugs. I can take Codeine (which also hasn't help my pain and has unwanted side effects) in small amounts but NO codeine derivatives (Percocet, Vicodin, Decadron, etc). They have the opposite of normal effects on me; making me hyperactive (almost manic), tachycardic (biggest issue), hallucinate, EXTREMELY dizzy and nauseous. Drs had a hard time finding what to give me for pain relief while in the hospital that didn't cause more problems than helped.

Finally, Protimenow, on the other thread (or I may have started a separate thread for this) I'd asked if anyone anywhere near me had a CoaguSense machine I could test on just for a trial run. So far no one has offered. There is someone who has an INRatio machine, but I suspect I'd have the same problem on that one. Unfortunately, you're across the country and mailing your machine back and forth for me to try it out to SEE if it makes a difference, is a bit excessive. I don't want to buy one, only to find out it still doesn't work on me. I'll update that thread and bring it back up to top to see if anyone else steps up, but will keep it a separate thread since is a different issue than this one.

Finally, finally Pellicle, I'll also update and reopen the POC problem thread and answer your questions there regarding that issue. THANKS.

Thanks again All,
Linda

 

[Aggie85]

Keeping issues on this topic separate: I'm doing a separate reply to another aspect of this high INR.
in the opening of this thread, I'd commented about having speech difficulties and pharmacist and I not being sure if it was the Tramadol or the high INR. Well....

I was not slurring words yesterday, after taking the Tramadol the night before again, and now that I've thought about it, haven't been any other times I take Tramadol at night. I suspect the slurring may have been from the high INR level; hence high anticoagulation going on. Scary! No other neuro signs but a very obvious one. It might be a good indicator (at least for me) that my INR is getting too high and that I should get it checked.

That got me thinking about the Pumphead phenomenon I've seen discussed on the PostOp Forum. I wonder if part of Pumphead is from the anticoags given while on the ByPass? I had the same symptoms for the first few days PostOp and just assumed it was the pain drugs and anesthesia. Now I wonder if it was the blood thinners???

Linda

 

[pellicle]

Hi

..Pellicle, actually your comment below about my pattern is incorrect (I can't get Ipad to let me insert quotes, but am referring to the your comment quoting my consistent use of the

ok, sorry about my misunderstanding, what it seemed to me you were saying was that your INR was good ... then it spiked to 6 and you were taking Tramadol. The point of when you were taking it (specific time and place) was to me not as important because I do not know

• the pharmacokinetics of Tramadol (how fast its absorbed, how quickly or slowly it acts on other drugs, what its half life is)
• I understood that your INR spiked to 6 (even though at first it was not) and that correlated with the Tramadol.

I would still regard it as an agent.

According to the articles you inserted, adding Tramadol increased INR. The guy in study ADDED Tramadol and they needed to REDUCE his Warfarin.

correct, and that seems to be what you have found too. Exactly when you started Tramadol and the cocktail of other drugs you were on Post Op makes this all unclear. Now if you had said your INR had been stable for 2 years and you were on Tramadol that whole time I would be thinking differently. How far post op are you again?

My Trmadol intake is going DOWN. A spike would be expected if I had ADDED Tramadol

perhaps, but perhaps something else changed which made it recently more effective in its interaction. I do not yet feel that enough evidence exists to write it off.

But I am not saying with 100% certainty it is the cause. Do you have any other theories or explanations of the INR rise?

With Tramadol intake going down my INR would be dropping, not spiking or rising. My Warfarin dose should need to be be raised to keep INR steady. As I take LESS Tramadol (I'm taking significantly less than I was), my INR would go down, so to stay at a desired level, I would need more Warfarin.

sadly its not as simple as weights on either side of a balance. There are other issues. Such as which enzyme group clears Tramadol and which enzyme group clears warfarin. Altenating the doses can give a signal to the endocrine system to shut down the enzymes (the bodys disposal mechanism OR how drugs get out of your system) involved. Then another dose (even though smaller) can send the levels higher.

but Trmadol use was same those two nights AND previous three weeks when levels DID NOT SPIKE. So pharmacist and I doubt it was the Tramadol causing the spike.

fair enough, but I know where I'd be looking if you experience another spike. Also keep in mind that its not a single input system. Other things can combine give it a "boost over the fence". What interaction may not have caused a raise to more than 4 can be cumulative / synergistic and give you 6.

I only raised the Tramadol issue because you mentioned you were on that drug and a search showed a very high relationship to your case.

There are after all natural cycles in ones INR metabolism, for myself (and every graph I've ever seen) there are ups and downs. Sometimes my dose goes up and sometimes it goes down. I'm not on Tramadol or any other medication except antibiotics.

...Until this spike, I've been pretty stable in my INRs (hanging consistently in the 3s and always in range!)

strangely I have recollection of other posts of yours complaining that your INR was not stable. I must have mistaken that.

Finally, finally Pellicle, I'll also update and reopen the POC problem thread and answer your questions there regarding that issue. THANKS.

if rolleyes is is used to indicate you're unhappy, I'm sorry. if its a tedium don't update anything. I personally only wish to help. I don't actually mind what happens nor do I need to know unless you are wanting intelligent answers from me.

 

[Aggie85]

Pellicle,
First, my rolls eyes was at me for a very long post, where I was then adding a second "finally". Not you! I very much appreciate ALL your insight. :thumbup: just goes to show how different folks can interpret the written (or emoticon) word.

Hmmm.... I don't think my other posts were about unstable INRs other than the crazy POC issue of POCs and Vein draws not matching. No, I've been rather surprised at how well I was progressing to stable doses and stable levels. Given my initial slow response to the Warfarin, I'd expected many more problems.

You're right about my thinking it single in / out system. We tend to simplify things to make sense of them. No real idea of what caused the spike. I was trying to say that like many other things in my life, Tramadol use and other factors hadn't really changed much between the Monday test and the previous 4 weeks of testing where the level had stayed stable. I didn't have a cold or illness, hadn't changed diet (in fact had taken in a little more K since I knew I had a buffer from previous week's test), hadn't changed meds, ect... Nothing we could think of that would account for the spike. As you said, I've been on quite a cocktail of drugs and those have been changing as I get further postop (8 weeks BTW) as well as my metabolism shifting as I continue to heal. I suspect it's a reason many people are made to wait at least 3 months before being given option of home monitoring. So many changes going on and things can change rapidly with no apparent reason why.

Unfortunately, I will probably have to start up on oral Voltaren again at some point. It was something I'd discussed with a pharmacist friend who used to run another Coumadin clinic BEFORE my surgery. It was part of the consideration about going mechanical valve. I've have been dealing with what is being called Plantar Facitis (I have my doubts about the diagnosis because a little atypical symptoms but is closest to what I feel) for several years. My foot always hurts and then has debilitating flair ups. When it flairs up, Voltaren is all that's ever worked to get it to bearable pain levels again. We'll just have to adjust Coumadin to work with the Voltaren. I was on it for about 6 months prior to OHS and only got off for surgery. I tolerated it well gastric and cardiac wise. Of the options out there, it is one my cardiologist feels most comfortable about using when we have to.

I read your PM and the articles that you sent. Thanks. I seem hosed either way Tramadol is a problem, don't take; Voltaren is a problem, don't take.... Interesting that it was the cardiologists at Cleveland Clinic that started both the Tramadol and Wafrarin. You'd think THEY would know about the interaction between the two drugs!

I think given that Tramadol has gotten less effective, I'm already taking max Tylenol, I need to see what Voltaren does to my INR since I WILL be on it at some point in near future; this is still a good time to try it and just be well aware of what it could do my INR and bleeding risk.

Lesson for all out there reading this post; it's hard to tell what affects our INR levels or when a change might occur. We really need to be as aware and as informed as we can as to what can effect it and what to watch for. It also really speaks to weekly or frequent testing of INRs. Sure hope I can eventually use a home tester.

Linda

 

[Aggie85]

Bold is quote from earlier post, I can't get this to do the quotes right this time.

you are approaching this the wrong way. I am saying "go off the Tramadol and substitute another pain killer all together. See if your INR stabilises. This is the only way to work it out (and frankly I'm shocked that your pharmacist isn't taking that approach, for that is what pharmacists would do here).

I suspect that when you aren't taking that drug that the POC machine may now give data that matches the vein draws (now that the vein draws are high too).


Sorry to move this out of PM and back to thread but can't get the quote to copy into PM. I still read the above, as you saying you think the POC issues will resolve when I'm not taking the Tramadol.

Can you please explain what you meant about the Tramadol and the POCs misreading my levels? I think I'm missing something.

One further note, so far it's just been that one draw that was high. Yesterday's was back down significantly (down to 2.9).

It may be a moot point as I'm going to try to get off Tramadol this weekend although I don't know how long it takes to get it out of system. Let's just agree who knows what caused the spike, may have or not have been Tramadol, and cross fingers I can get off it soon and that when off, we see a change in the POC issue. That's my main goal.... Deal with INR issues as they come along and someday be able to home monitor.

I'm sorry if I'm belaboring this. Please bear with me.

THANKS, Linda

 

[Freddie]

Maybe you don't need any more pain killers?
I don't suggest even trying Voltaren.

Individuals taking oral blood thinners or anticoagulants (for example, warfarin [Coumadin]) should avoid diclofenac (Voltaren) because diclofenac also thins the blood, and excessive blood thinning may lead to bleeding.

 

[Aggie85]

That would be nice, but not possible. I'm not a whimp but am still in LOTS of pain particularly in the late afternoon and at bed time. I've gotten down from Tylenol round the clock with bridging 2-3 times a day with Tramadol to now still Tylenol 3x a day and using Tramadol just at night (about every other night depending on what I've done during the day.) The pain is constant but varies and I tolerate it as best I can but still ranging from there but just nagging ache to take my breath away. I've tried cutting further back on the Tylenol and not using the Tramadol. Then I can't function at all or can't sleep at all because it hurts too much. I'm someone who hates taking meds and hate idea of getting hooked on stuff. I make myself cut back as much and as soon as I can. I'm also trying mild massage techniques and warm compresses to ease the pain, it helps but only for short while and only to limited degree. I only take the Tramadol if I'm woken up during the night with pain, not to help with sleeping.

Difference may be that this is the FOURTH time my chest has been cut opened. What's trying to heal is not fresh bone, but lots of scar tissue. My Dr. and I have talked about this issue. I was dismayed to still be in this much pain at my 6 week visit. We discussed possibly needing to send me to a pain management clinic but he wanted to wait another 4 weeks and see how I was. He is fully aware of what I'm taking and how much I'm still needing. Our difference in pain levels (assuming by what you wrote in reply and your signature) may be in the difference of our procedures. Mine dealt with 3 different issues in my heart and was a 5 hour open heart procedure. Pretty extensive operation.

I do appreciate your concern that maybe I'm becoming dependent on the pain meds, that's how I read your comment. I'm fully cognizant of that possibility and am doing all I can to get off them. I am seeing progress, even if painfully slow. (pun just too good to pass up)

As to foot pain, I've been dealing with this for many years. It may be a result of injury I had as a kid, when I'd cut my foot open on coral once. As I've gotten older, the scar tissue from that injury causes what's similar to Plantar Facitis pain. I have tried podiatry, orthopedic inserts, corrective shoes, massage, cortisone injections, PT, different meds. I'm avoiding surgery because of my heart problems, especially now that I'm on Coumadin, and because I'm not convinced that surgery would work any better. The only thing that got me off a cane and to tolerable pain levels was oral Voltaren. This pain issue and med issue is not something I'm taking lightly.

As discussed below, I'm aware of issue of Voltaren and Warfarin. In fact, I had discussed this with a pharmacist friend who used to run a AC Clinic before the surgery because it was my main concern about getting a mechanical valve and having to take Warfarin (W and V interaction). As he said, what they do is manage the two together.

It'd sure be nice to not be in pain and to not be needing pain meds, but as your signature says... Ignoring the facts doesn't change the facts. :redface2:
Linda