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Wow! Go to sleep and wake up to a hoard of messages!!!

Marsha - thanks for an interesting article, but correct me if I'm wrong, but this indicated that Asian (and black) people will generally need a lower dose of warfarin together the same target INR?

Mydoc mentioned that as a white person, I needed a higher INR!

In terms of origin, i don't know where my warfarin comes from. In South Africa, i could buy a tube containing 100 x 5mg tablets, now I buy a box with 2 blister-pack strips, each strip containing 14 tablets. This is the one made by Norton Pharmaceuticals Ltd, not sure who manufactured the others. I also get little blue and brown ones, which I had never seen before.

Ultimately, the pils look the same to me (although I never really studied them in the past!

So, there may be a different manufacturer too, i had never thought of that!

And in terms of where you prick the finger, anyone here a guitar player? I must be careful where I poke my finger, as I have callouses on one hand, and sore fingers donotmake a happy guitarist! I generally get the blood drop okay now, time will tell, thanks for all the input!

David

Thanks
 
David:

It's been a long time since I did ANYTHING with a guitar. From what I recall, you probably get good callouses on your strumming and picking thumb and fingers, and I'm not so sure about callouses on the fingertips of your other hand. The point (no lancet puns intended) is that you DO find a finger that a lancet will penetrate deeply enough to get an adequate drop of blood. I'm guessing that your callouses are on ONE side of the finger, and not so much on the other - so you may consider doing the incision on the less calloused side. Also - if all sides of your fingertips are calloused, you may be able to get blood out of the skin below the knuckle (I've never tried this, but I'm guessing that capillary blood from anywhere on the finger will work with the meter and strips.) As far as pain, I very seldom get much discomfort - other than the immediate occasional discomfort of a lancet prick. (The fingertips and sides of the finger are most sensitive - I avoid these when I make the incision) Of course, if you're using the same finger for strumming or pressing strings on the guitar, you may get some discomfort later.

Regarding how to tell the origin of the warfarin, there are a few things to consider. If your warfarin comes in a box, it should say on the box who manufactures it, and probably the country of origin. If it's dispensed in a bottle, you can probably ask your pharmacist if it isn't already on the label. If, like my prescriptions, I get mine 90 at a time, the pharmacist takes 10 pills out of a 100 pill bottle and gives me the bottle. The manufacturer's name is on the bottle.

Different dosages are dyed different colors, so you (and the pharmacists) don't accidentally give you the wrong dosage. This is probably a universal standard. I personally can't imagine ANY manufacturer of warfarin intentionally giving any dosage the wrong color - I can't imagine them putting their company at risk by releasing an unsafe medication. So, in theory at least, a white 10 mg dose from Taro (Israel) or Barr (United States) or other manufacturers SHOULD all have the same biological effect.

But, in case they don't, you've got your meter. When I changed from one manufacturer's warfarin to that from another manufacturer, I just tested a bit more frequently, until I was sure the effects were the same. With your meter, you should be able to adjust your dosage (if necessary) to match the effects of any new source for the pills. The meter gives you power. The meter lets you put your life into your own hands, instead of making you wait until your doctors decide it's time to run another test.

Good luck -- I'm sure you'll figure out how to get a good drop of blood - at least 9 times out of ten - and that you'll be able to keep your INR within range regardless of which country's warfarin you take. (You may need to refer to dosing charts to adjust dosage if you wind up way out of range, and may have to contact your doctor if your INR ends up in the low range, but I'll bet you do just fine).
 
Hehe, i tend to play relatively frequently (although not what i would call often)

I am a worship leader in the church,, but also one of the ministers, so i tend to have more Sundays off than on duty with my guitar!

Yes, the calluses occur more on the Left hand (strings) than on the right hand, since i generally use a plectrum/pick to play... But they typically live on the tips, not on the sides.

I thinkg that the thought of lancing yourself on the knuckle is awful :):):):) sounds so sore! I'll stick to my occasional bad draw on the sides of my finger, and avoid that finger when I play for the next few days...

And yep, i will start to rely on my home kit rather than on the doctor's convenience.

Thanks for the encouragement.

David
 
NO - I was afraid you would think I meant knuckle -- I didn't. I was referring to the sides of the finger between the second and third joint. For my own testing, I usually use the right side of the ring finger on my left hand. (I'm a rightie, so it's easier to position the lancing device and easier to squeeze the blood out). Fingertips work - especially with the relatively small amount of blood that your meter needs.
 
David,
Sorry to take so long to answer, but I generally only check in during the morning my time, before I start work.

I know you think 77 mg/week is high, but everyone is different. There are people who require 100 mg/week to stay in range. It depends upon how effectively your body metabolizes the drug, your diet (vegans eat more vitamin K), your activity level, other drugs you may be on, your body weight, etc.

It may also be the source of your medication, as others have said. Perhapse there's an inert ingredient in the drug you are now taking that changes your body's metabolism of the coumadin.

Anyway, if it takes x dosage to get you into range, it is unlikely that your dosage will be reduced by much for maintenance, unless some of the other factors change over time. It takes however much it takes to get you into range, and keep you in range. Using a higher "loading dose" to get someone into range quickly then dropping back to a lower dose causes a "roller coaster" effect on the INR. too high, then too low, then too high, etc. It's best to increase in increments to the dose that puts you in range, then stay with that dose unless/until things change that require a tweak.
 
Hi Laurie,

Thanks for this, i am just trying to figure out why my body would suddenly jump from 55 to 77, seemingly overnight...I guess it was not overnight, but the dramatic nature of hospitalization, etc, made it feel that way!

I also understand that my final dose might be this high, but i cannot think of a good reason, while my INR is still climbing rather quickly, to plan a the next test two weeks ahead (and then, I assume 3 months), surely weekly until it is shown as stable.

Ah well, i am on the way to the hospital now for the arm stick, then starbucks to get morning coffee, do the parallel self-test, then wait for the results! Only after this do I get my meeds for the next week (dishing them out like candy to kindergarten kids - slowly, slowly)

David
 
I don't ever recall Baker/Norton warfarin being talked about in the US. It is actually Kunming Baker Norton Pharmaceutical Co., Ltd: http://www.kbn.com.cn/en/default.asp?id=1&mnu=1

The member I was thinking about is ChouDoufu - here was his thread about the warfarin he purchased in China. I don't believe he mentions the manufacturer but it is something to consider.

Hey Mark, you're in some of those posts :biggrin2:
 
Cris N said:
I don't ever recall Baker/Norton warfarin being talked about in the US. It is actually Kunming Baker Norton Pharmaceutical Co., Ltd: http://www.kbn.com.cn/en/default.asp?id=1&mnu=1

The member I was thinking about is ChouDoufu - here was his thread about the warfarin he purchased in China. I don't believe he mentions the manufacturer but it is something to consider.

Hey Mark, you're in some of those posts :biggrin2:
Click to expand...
Oh ya, Chou was our expert of all things happening in rural China. Wondering how he is doing. Cool Dude. :)
 
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