Warfarin making me crazy...

[halleyg]

I am 3 weeks today post-op with my mechanical MV. I am having some time getting my levels right. Have been seeing my internist twice weekly for the finger stick. First my levels were too low, but now they're too high. They want between 2.5 and 3.5 but last Friday I was 3.9 and yesterday I was 3.8. I have been taking 6 mg warfarin since last Friday... after yesterday she wants me to keep taking 6 mg, except on the weekends take 5 mg. After thinking about it and talking to my husband about it, I don't see how that is going to lower my level that much. I put in a call to my cardiologists office to get a second opinion and am waiting for a call back. Just wondering if anyone with experience has any words of wisdom for me. I keep reading posts saying that warafin is not that bad as it's made out to be, but I am having a hard time adopting that attitude. Before my two surgeries this year I was always very healthy and didn't take meds unless I absolutely had to. Now I am going to be on something for the rest of my life and it makes me nervous. I guess you could say I don't trust daily meds b/c I have always had neg. experiences with side effects and things like that. I always thought I could rely on vitamins and green tea and I miss that... Just rambling but hoping for any insight - thank you.

 

[Bina]

Halley.....you are doing just GREAT!
An INR of 3.8 and 3.9 are nothing to be concerned about.
Keep your diet steady and don't lower your dose much at all, it is much safer to be a bit high than to be too low.

My INR balanced 4 weeks after OHS, and even so I was very freaked out, mostly because the hospitals were scaring me.
2 years later I don't even think about it.

 

[briansmom]

First, I want to say to give yourself a little more time to get this under control. Managing your INR is not an exact science, so plan for the ups and downs. Second, don't worry about a 3.9 or 3.8, they are barely out of range and in no way more dangerous. I think that I actually agree about lowering your dose for only 2 days. I'm not sure that I would do it on 2 consecutive days, I would probably do it every 3-4 days. Third, please read up on this site and on Al Lodwicks site about managing your Coumadin. As your activity levels change, your dosing will change. Fourth, see if you can home test. It is certainly more convenient and therefore will allow you to stay in range more often. I manage my son's dosing, we don't even call the doctor.
BTW, I am not a medical professional, I have just educated myself on this process.
Good luck, feel free to ask any questions.

 

[Ross]

Halley don't fret it, it's better to be where your at then far too low. Actually, your INR WILL come down as you recover, so your exactly where I'd want to be at this point. Also Halley, there is no reason that you can't have your vitamins and your Green Tea. You'll simply adjust the dose of Coumadin to include those in your diet, that's all. You may want to talk with Al Lodwick, our resident anticoag expert and pharmacist. He has his own site at www.warfarinfo.com and his email address is on the front page. Read all you can on his site. It's a wealth of up to date information and will dispell many myths and horror stories that your most likely being told to this day by the medical profession.

 

[Freddie]

Halley, You sound like me...........
Been there and felt the exactly the same way. If you are similar to me it may be too early to try to be stable. I'm 5 months pre-op with MVR and taking 6mg a day of warfarin to stay in the range 2.5 and 3.5. Only now I'm I becoming stable. Don't worry what your eating so much like I did. More excerise will help bring the levels down. If its still high have a dill pickle and enjoy.
I used to really worry about my levels, I don't any more. I eat what I what when I want and adjust the meds by 1mg or so.
Don't fret, just get it some time

 

[Guest]

You can still take vitamins (just not vitamin K unless you want to increase your warfarin dose) and drink green tea (just don't eat the leaves). There is no replacement for warfarin now or in the forseeable future (for mechanical valve people). Just live your life and have warfarin be a part of it. Before long it will not be a major factor in your life. There are people on here who have been taking it for 30 to 40 years. (Before then there will be a replacement.)

 

[Karlynn]

I echo Ross and the others - at 3 weeks post op I think it's super that your last few tests were 3.9 and 3.8. As you recover, your metabolism will start to increase and your need for a higher dose of warfarin will go up. For some, it's a pretty significant increase, for others it's very little. So at 3.9, you have some room for your metabolism to increase and not put you at a lower than range INR.

INR testing is not an exact science. You can test on the same machine with the same sample of blood, just a few minutes apart and get different results. The variance can be up to .5, which is why most of us prefer to stay at the high end of our range and don't do any dosage adjustment for an INR like yours. Anything up to 5.0 is nothing to get worried about. Certainly don't let your manager have you skip any doses for a 5.0 - or you'll end up too low. The best way is to do a small % decrease of your weekly dose total.

So far, from what you said - it sounds like your internist has a good idea of what needs to be done (although, personally, I wouldn't have made any changes.)

You are doing just fine. Don't get concerned INR's that are slightly higher than your range.

I tested at 3.8 on last week and didn't do a thing to my dose - I really consider that in-range.

 

[Ross]

I do no adjusting for INR's between 2.0 and 4.0. I usually fall right about 3.2 or so.

 

[geebee]

Since there is a + or - factor of about .4 for most machines, I would consider a 3.8 or a 3.9 to be dead on for your range.

I rarely adjust for anything under 4.5 unless I am noticing bruising or gum bleeding. Also, my range is 3.0 - 4.0 so, obviously, you being under 4.0 is no danger whatsoever.

Please relax and know that things will become routine very soon.

 

[halleyg]

Thank You

Thank You

Thanks so much for all of these helpful posts! I feel like giving you all each a hug b/c I feel much better now knowing that it's OK for my levels to be a tad higher than the range. I was really stressed about it. Guess I will be doing some reading tonight so I can learn a little bit more about all this and hopefully ease my fear of the unknown. All of you were so helpful.

 

[Karlynn]

You are already on the right road. You'll learn it as it comes. Look at it this way, if diabetics can learn how to test and manage their own daily insulin dosage, we can certainly do this.

Best wishes!

 

[imhayley]

way to go!

way to go!

Hi Halley Sounds like your doing a great job with things.......awesome! Things will go smoothly I promise. Just keep on doing what your doing and you will soon have more confindence with your Inr testings and such. The wonderful people in here have taught me how to manage my coumadin and have reassured me so many times I feel like I should pay them They will help you too!!!!

 

[catwoman]

Hallyg:

Those INRs are terrific! Like others have said, you'll become more comfortable in time with INRS & warfarin.

FYI: Forgetting a dose is no reason to panic. You may eventually forget to take your warfarin one day.
From time to time, many of us do that -- usually when our daily routine is changed (vacation, weekends, travel, etc.) If I forget one day's dosage (Day 1) until the next day (Day 2), I take 50% of the forgotten dose on that day + my normal dose. Then on the next day (Day 3), I take the remaining 50% of the forgotten dose (Day 1 dose) + the normal dose. Sounds like a lot of warfarin for 2 days, but it will even out over the entire week's dosage.