INR 6.6 symptoms and questions??

[denobobeno]

Hi everyone,
I have a couple of different issues going on right now...
Last week I started Nexium, 40 mg a day. My INR was 3.3 on Monday, yesterday (Thursday) it was 6.6. I have been having leg weakness, diziness, and bad headache and I feel confused (or slow)
Plus, I need to begin an antibiotic (Cipro) because I now also have a UTI with blood in my urine.
The Coumadin Clinic told me to hold FOUR days. I'm not so sure about this! (past stroke in July).
I am not sure what to do because I know my INR is going to be more out of wack due to the Cipro but, I'm not sure how much to hold.
Last week I had an incident and I don't remember what transpired. I was at a friends house looking at one of those clothes lines people sell at their house when I noticed my eye site was getting blurry. I felt like I was in a dream state and got a headache. I don't remember this but, I told my good friend nearby that I felt weird and had a headache and told her that I was leaving. She insisted that she drive me home but she said that I became adimant that I was fine and left. I don't remember driving home, I do remember 'waking up' in front of Chili's resturant wondering what I was doing there. Apparentally I must have gone in and ordered some food to go (I don't remember this either)
The next morning I woke up and wondered why I was so hungry. I saw Chili's in the fridge and asked my husband what happened..he told me that I walked in, set the food down and went straight to bed. I told him I had a headache before going to bed. He knew I was tired before I ever went to the party and just thought I wasn't feeling well once I got home. I don't know what couldv'e happened to me if I was still able to operate a car? (my INR had been 1.5 a few days before this and the day before this happened I was at 2.1)
My Nuerologist' wife had a horse riding accident and is now a parapalegic and I need to switch Docs. I was supposed to see him in Jan. for follow-up and I really need to see someone.
Is there anyone you recommend in the Fort Worth- Dallas area?

sorry there are so many questions!! I don't feel like there is anyone in my hometown that I trust to ask so many crazy questions.

thanks,
Deana

 

[geebee]

Deana,

Confusion, headache, weakness can all be signs of a stroke. A stroke can be caused by clotting or bleeding.

You should contact your doctor immediately to discuss your symptoms.

I agree that holding 4 days is way too long but you do want to get your INR back down. I would probably hold one or two days, resume normal dose less 10% and retest in 4 days. I do not know how fast you drop but I drop pretty quickly so I am more conservative when it comes to altering my dose.

You are correct that the Cipro will probably alter your INR also but it could lower it as well as make it higher. Have you had experience with it in the past?

Also, is it possible the Nexium could be causing your new symptoms?

 

[catwoman]

Deana:

Nexium could possibly lead to an increase in INR. If you have any diarrhea at all after starting the drug, it would cause an increase in your INR because your GI tract produces about 50% of your vitamin K. Disrupt that vitamin K production, and you're taking too much warfarin to counteract the reduced amount of vitamin K in your body.

You'll probably want a neurologist much closer to your home (Abilene? San Angelo?) than Dallas-Fort Worth.
I know of one through my church here in Fort Worth. If you need her name, please PM me and I'll send it to you.


<From www.costco.com>

What side effects may I notice from taking esomeprazole?
Side effects that you should report to your prescriber or health care professional as soon as possible:
? chest pain or tightness
? dark yellow or brown urine
? shortness of breath
? skin rash
? unusual tiredness or fatigue

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
? headache
? diarrhea or constipation
? flatulence (gas)
? nausea/vomiting
? dry mouth

 

[Karlynn]

I'm also wondering if the Nexium might be causing some strange things to go on with you. Given your history however, the first thing you need to do is rule out a clot or bleed. For anyone else, I would say that a 6.6 is high but probably wouldn't cause the type of bleed for them to experience what you have been experiencing. I'm suspicious of the Nexium. And it does deal with the digestive tract which is also where your Coumadin is absorbed. Although, didn't see it on Al's list.

 

[ALCapshaw2]

I'd be tempted to repeat the INR test. I know the instruments at my Coumadin Clinic are NOT deemed to be accurate above 5.0 (and possibly less based on 2 of my own experiences at 5.0 & 5.5 which came back 3.2 from Lab draws).

Who manages your Coumadin Clinic? Can you talk with them about your history of strokes, treatment options, and risks? IMHO, you need someone who REALLY knows their stuff at this point

Frankly, had you told me what you told your friend, I would have insisted you go to the ER for an evaluation. I agree, you should discuss this with your PCP and Neurologist. "Sucking it up" when you may be having (another) stroke is NOT wise...

'AL Capshaw'

 

[Rich]

Deana,
I have been on Coumadin for almost eleven years with few problems.
About a year and a half ago I was put on Nexium, and my INR went crazy.
The end result after several months, was reducing my Coumadin weekly dosage by around fifteen percent. My INR has been right in range ever since.
So I agree with the others regarding what effect Nexium might have on you.
I also question holding your Coumadin for four days.
Rich

 

[Arlyss]

With stroke/TIA, while some part(s) of the brain are affected, others continue to work. So, yes, it is possible to drive home but still have problems in other areas of the brain. It is a very dangerous situation. I am very thankful that my husband had not left for work yet when he had his stroke - it was a major one, and he would have lost control of the car, endangering other lives.

Everything is in the brain - memory, yes, but also judgment. When someone has a TIA or stroke, their judgment may be one of the areas affected. They are not in a position to make decisions about their own safety or what is happening to them.

One of the most treacherous things about stroke/TIA is that the nerve center that we depend on to tell us something is wrong very often does not work. My husband had no real understanding of the severity of what had happened to him.

Some people with bicuspid aortic valve disease are extremely complex. Deanna, you certainly appear to be one of them. If you were my loved one, I would get you to help immediately to prvent another stroke/TIA.

And after this immediate crisis, if this were myself or my loved one, I would insist on being evaluated head to toe at a major medical center, with coordination across the different medical specialties.

There is too much at stake when the brain is involved.

Best wishes in getting the help you need,
Arlyss

 

[Susan BAV]

...Everything is in the brain - memory, yes, but also judgment. When someone has a TIA or stroke, their judgment may be one of the areas affected. They are not in a position to make decisions about their own safety or what is happening to them.

One of the most treacherous things about stroke/TIA is that the nerve center that we depend on to tell us something is wrong very often does not work. My husband had no real understanding of the severity of what had happened to him...

This can be very true of any kind of brain injury and can be very dangerous, Deana.

 

[catwoman]

You are the first person I have heard the same thing I have been trying to descride to people for 6 years....This dream state...I decsribe mine as "Deja Vou"...but very weird feeling. Very confusing feeling, goes away in about 10-20-15 minutes followed sometimes by headache.

I have never had this in the 4 years I've been on warfarin.

However, this sounds exactly like what my mom's sister did when she had a stroke WHILE driving. She found herself somewhere, didn't remember how she got there. This was about 20 years ago; I don't believe she's had a stroke since then. She's about 83 now.

 

[kbheart]

You are the first person I have heard the same thing I have been trying to descride to people for 6 years....This dream state...I decsribe mine as "Deja Vou"...but very weird feeling. Very confusing feeling, goes away in about 10-20-15 minutes followed sometimes by headache.

I've had this dream state, as well. It was in the morning so I just thought that I hadn't fully woke up, yet. I wasn't sure I could figure out what was real and what wasn't. I drove to work, but probably should have waited longer. I felt fine later in the morning but thinking back I should have called someone.

I'd get in to see any doctor you can, whoever can see you the soonest. If you don't like the doctor, you can always switch later. Make sure your friends and family know to insist on the ER if it happens again. I hope everything goes well and you find a doctor that is helpful!!

 

[Karlynn]

Been on warfarin for over 15 years and have not experienced what Deana and a few others are describing. Seems the commonality is an aortic valve - (correct me if I'm wrong.) - Have we stumbled upon something here?

 

[denobobeno]

Let me say first that I really appreciate all the responses. It is really helpful to talk to some people out there who understand!
I'm glad to know that other people have experienced this dream- like state...when I had my first stroke I felt weak and then I remember looking around at the surrounding cars and thinking where am I? My husband was driving and took me straight to the hospital.
When I had this incident last week I did try to minimalize it...to myself and my husband. I get tired of being the 'high maintenance' one..but, when I talked to my friend later that weekend she filled me in on the missing details..(I didn't even remember that I talked to her before I left the party). This did kind of scare me.. I did try to get into my Neurologist but, he only has a voice mail and I didn't hear back so, I blew it all off.
There is not a Nuerologist where I live that anyone recommends. I would rather travel than get someone that I don't trust. I do like my Family Practice doc so I'll call him Monday for an appointment and just tell him what happened.
My stomach feels better today for the first time in a week.. I DIDN'T take the Nexium today. Just for an experiment I thought I'd see how I felt without it.. I feel so much better. I don't understand that, but, since I started taking it about a week ago I have had more stomach aches than I ever did! I started taking it because I have a little acid reflux.. but, I do feel better without it! weird.
Anyway, I have again learned much from all of you and feel encouraged to pursue this further.
Love to all,
Deana

 

[Karlynn]

Let us know what the doc has to say on Monday. And you know the drill, if you feel worse before then- it's off to the ER with you! Best wishes.

 

[Guest]

Deana,
You need a neurologist who can determine whether this was a TIA or some sort of headache. Migraine people can sometimes have this too. Don't delay.