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lilteach3234

Well-known member
Joined
Mar 4, 2009
Messages
236
Location
Houston, Texas (USA)
I can not get my INR in check....it is either too low or too high. This past week it was 5.2 so I am off Friday, Sat and Sunday. I then begin a 2,4,2 series and re-check in one week from Monday.

Does this ever become normal?

I do nothing differently each week. I had a couple of margaritas and a beer the weekend before on a weekend away. Would it affect the INR 1 week later?


Trina
 
Trina,
It will become pretty normal.
A few drinks a week ago have an impact on your INR? NO!
Has there been any changes in your lifestyle such as stopping or starting any medications, including over the counter things?
Any changes in your diet?
How about changes in your activity level?
I hope you can get this under control,it can be very frustrating at times.
I am a little concerned about your doctor's orders to hold for three days. You could drop to the low side and then end up on the proverbial 'roller coaster'.
Rich
 
Off?

Off?

I'll readily defer to those with medical degrees and licenses who know more than I do, but I think skipping doses will drop you into a "roller coaster" cycle.

On Thursday when I did my usual weekly check and was surprised to see 4.8 appear on my monitor. My response to being high was to simply reduce my dosage for a couple of days. I usually take 7.5 mg daily so I dropped back to 5 mg. I'll do another check in a day or two to see if I'm back in range.

As far as causes go, there are probably lots of culprits. It could be your body's response to activity changes, some food you ate, or something else. My 4.8 this week was probably related more my diet over the last couple of weeks than anything else.

It would be really nice to be consistent, but every now and again I seem to slide out of range on the high side. Adjusting isn't a big deal and it's more manageable for me than trying to manage by skipping doses.

-Philip
 
For heaven's sake - DO NOT HOLD FOR 3 DAYS!!!!!!!!!!!!!!!!!!!!! This will mean that by Sunday - you will have absolutely NO Coumadin in your system and your INR will be 1. Is this doctor trying to cause you to have a stroke!

Please give us the weekly dose you had prior to the 5.2. If your INR has been high and low, it's my educated guess that they are messing with your dosing way too much. 5.2 is not all that high. I was 7.6 one time and only held 1 day, then took a half dose and was back in range.

Who ever gave you these instructions to hold 3 days just proved in a huge and extremely dangerous way that they know NOTHING about Coumadin. Time to find a new manager immediately.

But in the meantime - please provide us with your INR and dose history.
 
The good news is I didn't forget my dosage.

The good news is I didn't forget my dosage.

I tested at 7.3 on Thursday, so she did a second test, 6.8. Well, that answered my question, because I thought I had forgotten to take the pill last Friday. So the good news is I didn't forget to take the pill, I just forgot I had taken it.
Anyway, since I thought I had forgotten, I upped my dosage to compensate. I have been hovering around 37 mg a week; so I upped my dosage so that if I had forgotten the pill, I would have been at 35 mg a week, but if I remembered, at 40 mg. I have become very sensitive to small changes in dosage.
So, at 6.8 I decided not to hold any dosages, but to take 33 mg this week. My thinking is 40 + 33 = 73 / 2 = 36.5 per week. My goal is to avoid the roller coaster and maintain my dosage. I did also drink a can of V-8. I love that stuff!
We'll see what happens. By all means, don't hold for three days!
 
I know we're not supposed to diet the dose, but when I landed a nasty bruise a week and a half before a test, I had a couple of nice salads for dinner and relaxed. When I went in for testing I was actually down to 2.3, but the tech said not to worry. She upped my dose a little for that night, but said to continue my 5 mg every day but Tues and Thurs (2.5).

I upped the greens because I'd had one 3.9 level with a big bruise on my wrist, so thought the extra vitamin K would bring things back to normal this time, which it seems to have done. We're trying to keep me therapeutic (2.5-3.5) for three months so I can get approval for home testing--which is what I love about my clinic. So it does seem to be possible to fool with the diet a little to make minor adjustments--just not a primary means of control.
 
Vindication

Vindication

I followed the regimen I prescribed for myself a couple posts above, and turned up in range this week.
I was 7.3, and a week later down to 2.9, well within range. I simply figured what I should have taken for the two weeks, the week before the 7.3 and the week after it. Skipping a day, or holding a dose, was not an option. My actual doses following the 7.3 were 3mg that day, and 5mg the remaining days until the next test.
 
This is a repeat of previous sentiments. If your manager makes you hold for 3 days, they don't know what they're doing and that is why your are bouncing. My advice is don't even hold for 1 day. Find someone who knows what they're doing.
 
Holding for three days is bonkers !! If this horrible stuff stays in your system for 3 days it stands to reason that you'll have no cover after 3 days and then a further 3 days for your inr to come up again, Crazy ?
Take a good look at your diet, exercise levels and even skin cream or shampoo that you might have changed to or started using ?
I think the answer to dosing is to tweak over a week ...
 
Woodbutcher said:
I think the answer to dosing is to tweak over a week ...
Click to expand...

Amen....to what Woodbutcher says. The only way I have been successful in maintaining my INR level is to make small changes (tweaking) over time. For me, large dosage changes are dangerous and guarantee a "roller-coaster":(.....and this is NOT the fault of the drug, but rather, the fault of the warfarin manager:p.
 
Well I went in this past Tuesday and I was at 1.1 but prior two weeks I was at 7.2. Now that I am at 1.1 I had taken 2 mg that day. They added two more that day, and then told me 4 the following day and then back on the 2,4,2,4 schedule until next Monday.

I am eating basically the same thing and doing everything normally except working out 5 times a week.

This is driving me batty!
 
It's important to keep your dosage relatively constant from week to week, and even day to day. To skip a day (or two or three) pretty much guarantees a plummeting INR. Also note that the INR test, to be really helpful, should be not only a number (where you are now), but should also be a direction (where you are going), that is, is the INR going up or down?
Do keep a record of your weekly dosage, and keep to it. If your care provider tells you to skip a day, don't.
lilteach3234 said:
Well I went in this past Tuesday and I was at 1.1 but prior two weeks I was at 7.2. Now that I am at 1.1 I had taken 2 mg that day. They added two more that day, and then told me 4 the following day and then back on the 2,4,2,4 schedule until next Monday.

I am eating basically the same thing and doing everything normally except working out 5 times a week.

This is driving me batty!
Click to expand...
 
lilteach3234 said:
Well I went in this past Tuesday and I was at 1.1 but prior two weeks I was at 7.2. Now that I am at 1.1 I had taken 2 mg that day. They added two more that day, and then told me 4 the following day and then back on the 2,4,2,4 schedule until next Monday.

I am eating basically the same thing and doing everything normally except working out 5 times a week.

This is driving me batty!
Click to expand...

Right there they just said they don't know what their doing. How are they ever going to determine the correct dose if they have you taking different amounts all the time? It can't be done. They need to put you on 5mg and leave you alone for at least 4 days and preferably one week, then see where you are and go from there.
1.1 is the same as not being anticoagulated at all and at risk for stroking. I'm afraid your going to have to be proactive and learn to do this yourself or get another Coumadin manager somewhere else. These people are going to get you killed at this rate.
 
lilteach3234 said:
I can not get my INR in check....it is either too low or too high. This past week it was 5.2 so I am off Friday, Sat and Sunday. I then begin a 2,4,2 series and re-check in one week from Monday.

Does this ever become normal?

I do nothing differently each week. I had a couple of margaritas and a beer the weekend before on a weekend away. Would it affect the INR 1 week later?


Trina
Click to expand...

lilteach3234 said:
Well I went in this past Tuesday and I was at 1.1 but prior two weeks I was at 7.2. Now that I am at 1.1 I had taken 2 mg that day. They added two more that day, and then told me 4 the following day and then back on the 2,4,2,4 schedule until next Monday.

I am eating basically the same thing and doing everything normally except working out 5 times a week.

This is driving me batty!
Click to expand...

I'm just really confused. In your first post you said you were 5.2. Then in the 2nd post you said you were 7.2 (was that just a typo?) I'm guessing you went ahead and held the 3 days like they instructed and then they had you go back on too low of a dose. If so, what this means is they flushed all the anticoagulation out of our system, then put you on a dose that was too low, so you've been walking around basically unprotected from clots for a week or more.

Ross is right - you need to be on 5 and retest in 4 - 7 days. 5 mg is what most people are started on and then the dose adjusted from there.

Most importantly you need to find a new Coumadin manager - the ones you are seeing don't know jack and they are going to either kill you, or stroke you out so bad your life will never be the same. I'm sorry to be so blunt - but what they are doing is malpractice. Keep their instructions documented for your family should they ever need to sue one day.
 
Know how you feel. My INR has been up and down since January. Was back in Hospital a couple of weeks ago to have Sternum wires removed. They went to a lot of time and effort to prepare me for the Op and to get me right afterwards in regtard to INR.
But it seems that my problem was related to my diet. I was using Soya milk seems their is a link to it causing problems with us on Warfarin.

Best of luck with it and try to be patient it will come right.

J
 
jorsarge said:
Know how you feel. My INR has been up and down since January. Was back in Hospital a couple of weeks ago to have Sternum wires removed. They went to a lot of time and effort to prepare me for the Op and to get me right afterwards in regtard to INR.
But it seems that my problem was related to my diet. I was using Soya milk seems their is a link to it causing problems with us on Warfarin.

Best of luck with it and try to be patient it will come right.

J
Click to expand...

Josarge:

Just adjust your dosage to reflect your enjoying Soya milk.
 
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