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Johnny Stephens

Johnny Stephens

Well-known member
Joined
Jan 20, 2002
Messages
1,140
Location
Seattle, WA
OK, so I'm usually a benchmark of INR stability - usually right around 3.5. My group of Drs wants me at 3 to 4, but 2 weeks ago I was 4.7 and today I threw a 5.0. I'm not too concerned about that, but I am concerned about the orders to hold 2 doses..today and tomorrow. I'm kicking myself because I didn't question it at the time (not awake yet, I guess). They also made a small adjustment to my total weekly dosage.

I'm eating less these days, so I think that's why my INR is up.

Does holding 2 days seem extreme?
 
Yes it does seem extreme. I'd hold one, if any and decrease by 10%. Or hold one, eat some brocoli or brussel sprouts, drink a v8 and check it again in 3 days. Eating does make a difference. I've not been eating and mine took off to 4.8 on the last test. No hold for me, just reduce by 15% and retest in 2 weeks.
 
Hmmmm?

Hmmmm?

Hey my double clicker pal,

What the heck is with the 5.0?! A 2-day "hold" does seem extreme to me.

Are ya getting any nose bleeds up there? If I was that high, I'd have to wear a bucket around my neck, but luckily (knock on wood) I've never been there.

I don't think eating less would affect your INR, unless you've drastically cut your food intake (you on a diet or something or been sick?). You know the routine about consistency.

Good luck with this.

Regards,
 
Let me be the first of many to say that holding 2 days for an INR of 5.0 (without bleeding evidence) IS extreme. Don't worry about not asking the doctor. You would have gotten the same advice. Everytime Albert goes beyond 4.5, and it has been several times because his range is 3.0 to 4.0, we get the same message..."Hold for, in Al's case, 3 days" He has held for two days twice and both times he dropped below 2.0. Now we just ignore the hold part and reduce the dosage by 10% of the weekly dose.

You have a good reason to suspect that eating less is the cause. You might also want to consider a problem with the lab report. Many others here have had the same concerns that you have. I know you'll get many more responses to this.

Blanche
 
Thanks All for the quick responses - they're pretty much what I thought everyone would say :) Perry, yes, I'm on a diet - I have a "few" pounds to lose or my doc will have a few choice words for me. So the lower food intake is intentional.

No bleeding or unusual bruising. I do have a bruise on my thigh where I whacked my desk at work a few days ago, but I hit it so hard I'm sure I'd have a nasty bruise even if I wasn't on Coumadin.

Gina: Before today I was taking:

5mg Tues Sat
7.5 mg Mon Wed Thurs Fri Sun

Today they changed Thursday to 5mg too.
 
As a rule, 5.0 is just the lowest number where I start to get concerned. Rarely does anyone have a problem that would necessitate a trip to the ER (much less the hospital) at an INR <5.0. Especially someone like you who has been on it a long time without any problems.

If any of my patients take over 5 mg/day (35/wk) I will only on the rarest of occasions (like an INR > 8.0) hold warfarin for more than one day.

If I were managing you, I'd have you hold one day, and reduce your dose to 5 mg for 6 days per week and 7.5 mg on the other day.

My clinic's serious bleeding rate for 11,000 + visits covering over 900 patient years is about one serious bleed for about 33 patient years. Statistically, I have proof that my works very well.
 
Johnny

Johnny

Which doctor. Card or PCP said you needed to lose a few pounds? I saw my pcp and the ONLY thing wrong was I told him..I had gained 20 pounds. He just laughed. Did they give you a reason why? you need to lose a FEW pounds?.....Maybe you can do it by walking a little more and leaving off Carbs. Me to talk:p :p Drink a few V-8's and have a little cabbage.:p :p Bonnie
 
Al's advice as usual, is the best!


Though, myself at a 5.0 taking 6.5mg a day.....would half it for one day and eat some nice greens. Back on track. Doing it this way for almost 4 years now. Almost every single time I reduce 10% on top of the decrease I fall hard.

We have to remember.....everyone is different when it comes to warfarin.

Let us know what you decide....and how it works for you.

Guaranteed to be messed up come next week. Going on vacation. Usually equals disaster for my INR. Will try to behave this time
;) :rolleyes:
 
Vacations are really problems for people on warfarin.

The people who are usually the easiest to manage are the ones who have a set routine and do almost the same thing every week.

By definition vacations are a break in routine.

Therefore, almost by definition, you will get out of range.

Another thought -- a motto for the members of this group.

Descartes, the philosopher said, "Cogito ergo sum." In English, "I think therefore I am."

valvers motto

"Click ergo sum"
 
I click therefore I am

I click therefore I am

I love the motto!

Thanks Al, Gina & everyone! Well, I had pretty much decided I was only going to hold one dose - just felt like the right thing to do. We went out for dinner tonight and I had some broccoli - and a little salad, so that will probably help.

Gotta go see my internist in October, and he's the one who actually signs my warfarin prescriptions. I think it may be time to see about getting a Protime.

Bonnie - I was being a little bit facetious when I said a "Few" pounds. It's actually more than a few, and it's a problem I have struggled with for my entire life. As far as which doctor told me this, I would say "all of them."
 
Johnny.....question here.

Since you have two mechanical valves, do you hear them tick in unison or not? I would suppose the mitral clicks first and then the aortic, but then -- I'm certainly no expert. Just curious here...;)

And Gina....behave on vacation.:D Where ya going? It's noooooooosey Janie here...hehehe! By the way, I think we need a 'vacation' thread. I love hearing about people's trips -- the good, the bad and the ugly...!

And I see 'Clever Al' is at it again! "Click ergo sum"
 
5.0

5.0

HI everyoen ,my inr also has been runnin g on the high side all summer From 4.2 toa whopping 5.0 . I never seem to bleed
or get any symptoms that other people describe .
My doctor still teases me cause inever wanted to take the drug in the first place :( He has this sexy accent ( from Spain and
gorgeous blue eyes hmm thats why my heart pounds
everytime he walks into the room lol :p
Perhaps, it could be to many full moon's,
or Rains dogs in the flowerbed again
:D
Seriously,this has been occuring the last 2 summer's .
It is true vacations are a disaster for the INr but hey
no more sitting around fo rme i refuse to change my life for
any drug . I still eat my veggies go hiking etc .
Al u crack me up with your intelligent sense of humor
u are a very important part of our VR Family please
keep posting .
Has anyone heard from Christina from Arizona have not
seen her post in while ?

I am off the hospital next week to have na balation to stop
very bad arrythmias heart rate of 240 :confused:
My doctor is so awesome and very attentive so i will
recieve excellent in patient care .
Stay well, Dara
new york city
tricuspid valve replacement ( feb 9th 2001
Dr Fuster ( my angel)
Dr poon ( karate man )
Dr Griepp ( surgeon )
MAG ( outstanding Nurse practioner )
 
Hi Janie,

Universal Studios, Orlando. Sea World. Doing the Dolphin swim for Kara at Discovery Cove.

Working vacation with lots and lots of walking! Kids enjoy so much..... it's worth the efforts to enjoy the priceless look on their little faces:) Will do my best to post photos when we return.
 
Hi Johnnie,

5.0 isn't too worrysome if you are not bleeding. I've been at 7.8 and never bled. What should concern you is your doctor telling you to hold for a few days. I've listened to that in the beginning, and went right to the bottom of the scale. So I just don't listen to that advice. I cut my dose in half and eat a lot of greens, and it has worked for me going on 4 years. I always test again in 3 days to see where I am.

Dara, thanks for asking about me. I am still kicking here in Arizona and doing very well. Thank you very much!

Love and hugs to you all..
 
Consider the 10% solution

Consider the 10% solution

Johnny, At 5.0 I personally would not "hold" but would lower weekly dose 10% and then retest. If you wished to use 20% in this situation I think it would be OK. I personally do not favor "holding" because it can lead to the old yo-yo.
 
Johnny Stephens

Johnny Stephens

Hi Johnny. Just a quick note to add the little levity here. :) Gotta love that caption under your name! Good luck. You seem to have it all together, judging from your smile. I will be having my surgery soon, however not going with the metal valve, even though I have always took a licking, but kept on ticking! :p
 
One guy who had two valves told me that he saw himself as the alligator in Peter Pan who had chomped off the pirate's arm and as a result swallowed his watch - tick-tock-tick-tock.
 
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