Proactive Management

[Protimenow]

This may sound a bit odd - but I haven't seen it discussed here before.

Next week, I'm going to attend two different trade shows. These will probably involve a LOT more walking than I usually do. This will most likely raise my metabolism so my body will probably metabolize the Warfarin I usually take faster than it does when I'm sitting much of the day at my computer.

My INR is usually stable in the high twos. I'm concerned that the activity at these events may push my INR in the low 2s - or even lower.

The problem with increasing my dosage on a day when the INR is low won't help me that day -- it'll take days for a positive effect.

Normally, I take 51 mg/week (8 mg on Sunday and Thursday, and 7 on the other days). Here's what I'm thinking of doing: I'll take 8 mg tonight (Saturday), 8 mg Sunday, and test my INR on Monday night. (I'm taking a few test strips and my ProTime 3 -- if it gets stolen, I've still got my InRatio at home, and, God Bless the thief--I hope he needs it or has a friend or family member who does - and he can afford more strips and a charger). Unless the INR is still low - or unusually high - I'll probably take 7 mg on Monday night, and possibly 8 mg on Tuesday night, if the INR is low on Tuesday (if I even test on Tuesday). I don't expect to be doing a whole lot of moving around on Thursday and Friday, so I'll probably return to my regular 7 mg/day regimen.

Does it sound as if this small spike on Saturday and Sunday (and maybe Tuesday) makes sense?

Al? Others?

 

[Bina]

If it were me, and even with my rock-steady INR, I would NOT try to "predict" my INR reading; there are
just too many variables and especially while travelling or changing a regular routine.

The only thing I would do is try to have my INR right smack in the middle of my range, let's say at
around 3.0 so that if it bumps up a bit or drops a bit there is enough wiggle room to make an adjustment.
Keeping hydrated is probably a good idea regardless of what you decide, and of course bringing along a monitor
is a bonus.

 

[catwoman]

Protimenow:

I agree with Bina -- don't try to predict what's going to happen.
I haven't been able to predict the effects of travel (auto or by air), changes in diet/schedule, etc., and extra activity when I'm gone on weekends.
Normally my INR is stable. I was gone 2 weekends back-to-back judging shows and expected a drop in my INR. Duh, silly me!!!!!!!!!!!! It was 4.4 on Thursday, April 7, up from 3.3 on March 31.
I'm not changing my dosage because it had been relatively stable for quite some time. The only thing I can consider is that I was quite active last weekend. I left work @ noon, didn't eat lunch, drove to Dallas, helped a group set up a recording studio for a cat show, judged the show Saturday (moving back and forth in a judging ring, taking cats out of cages, judging them, putting them back in, marking NCR forms -- all in break-neck speed, did 7 final presentations), tore down things after the show, ate with friends and then drove 60 miles home Saturday night. I was drop-dead-tired until Tuesday. My guess is that I was just so tired I wasn't eating right, not moving around enough during the several days before the April 7 test so that not as much warfarin was being metabolized as normal. Thus the 4.4.
I'll just retest at my normal time. If it's 4.1 or under, that'll be OK.
This has happened before, and I didn't change my dosage and everything was OK.

So, my answer is you can't always predict. Just wait to react afterwards. But you'll need to test about 72 hours after your activity ends......

 

[Bina]

Marsha, your's is a very good example....going from an INR of 3.3 up to 4.4 was no big deal because you were
in a good range to start with.

 

[Protimenow]

My concern was that my INR may go DOWN because my metabolism would probably increase. I didn't really take into effect the countering effect that underhydration could cause.

My INR has been fairly stable -- usually between 2.4 and 3.3. I had a surprising 1.6 blip - and I'm not sure why - but a really minor dosage change fixed that.

I'll bring along a meter and a few strips -- but realize that the INR would be more for information than anything else -- anytihing I do in response to a surprising reading wouldn't have any effect for 3 or 4 days, anyway. I guess the best I can do if I wind up with a 4+ reading is to be a bit more careful about bumping into things than I usually am, and if I get a reading of 1.5 or lower to slightly increase my dose.

Thanks for the advice....it's always good to ask such questions and carefully consider your responses.

I'll let you know next week if my INR does anything unexpected.