Pain/INR

[Richard]

Hi

I had my surgery 1st December. Generally I am doing great but just have 2 questions if anyone can help:

I still have a fair bit of pain in the top right side of my chest, I am still taking low grade pain killers but the pain gets bad at times, espcially at night, the pain is especially bad when I breath in, it feels just like a pulled muscle but has been going on now for 2 weeks so not sure it can be, any ideas?

My surgeon said I should have an INR of 2.0. This has been failry steady to date hovering around 1.9/1.8 etc and they have amended warfarin dose , now I take 5mg. I had test yesterday and the INR had gone to 2.8 but doctor( local GP not surgeon) said to leave dose at 5mg. I questioned as this seemed a little strange, after a further conversation they now say take 4mg one day, 5mg the next day and so on and go back Tuesday. Concerns me they also say the INR should really be around 3.0 but that conflicts with surgeon. I get impression this is as new to them as me and I dont have a great deal of confidence in them. Any thoughts/questions to ask would be much appreciated

Thanks

 

[Bina]

I also had right side pain in the first few weeks post op....it is wise to mention this to your doc. Mine was muscles and a bit of lung fluid.

I'm guessing that your docs have given you an INR range? Probably 2.0--3.0
Your INR of 2.8 is just fine.....you could continue the 5mg daily and test next week, otherwise if you keep switching the dose for nothing your INR will bounce around.
When an INR is OUT of range, then moderate adjustments will work best.

 

[Ross]

Richard what valve did you have replaced and if you know, what manufacterer?

How often are they testing your INR?

Personally, I think you may have some effusion and the Doctors should take an xray to confirm it. I think that is the cause of your pain. Are you on any diueretics? Also, can you list what all meds you are on?

 

[Richard]

Hi

I had aortic valve replaced with mechanical but sorry dont know the model/make.

I take warfarin, cardicor 2.5mg (bisoprolol fumarate) beta blockers, I only take these for 6 weeks from surgery and then just paracetamol for pain relief.

They test INR once a week now, at first it was daily.

What is effusion?

many thanks

 

[Bina]

With a mechanical valve you should have an INR reading above 2.0
Most of us prefer to stay closer to 3.0 and have some room for variance that way.
My INR is usually 3.1 and my doc and I are happy with that.

 

[Freddie]

I was lead to believe that with a mechanical valve one should be in the INR range of 2.5 - 3.5. I too like to be around 3.0, but last week I tested 3.5 - and no one panicked (meaning; myself or my doctor)

 

[Ross]

For an aortic valve, your INR should be between 2.0 and 3.0. Some Doctors, like mine, want it 2.5 to 3.5. Mitral Valve people are 2.5 to 3.5 by default. If they test you more then once a week, they're mismanaging you. It takes Warfarin 3 days to show up in a test or hit it's full effect, so the most you could test is 2 times a week. I'd of left your dose alone for another week, then checked to see if it's still trending upwards. As you recover and become more active, your going to need more Warfarin to keep you in range.
Now, what kind of rubbish are they telling you about eating? What's you diet like? Include everything you can think of.

Pleural Effusion is what I suspect you may have and it's water between the lining of your lungs. The pain gets worse as you breath in. It makes sense because your body is full of water at the end of the day and that's when it's bugging you the most.

 

[Marty]

Ross is probably right about the pleural effusion. I had one. It was picked up on the routine chest x-ray they do two weeks post op by my surgeons. They aspirated three pints of nice bright red blood and I felt better immediately. My INR was running in the 5's at that time. My warfarin dose was lowered from 5 mgm to 3mgm and is still there with minor variations 10 years later. I was 72 at the time and later read an article out of Hopkins that you shouldn't "load" old people at any dose higher than 3. I personally think you should start every body at three and work up if you need to. Also, get a chest x-ray stat

 

[geckley]

My docs want me at 2.5 to 3.0. My body has ll kinds of aches and pains. Alot is from te positioning and the way they stretch your body while in the O.R. I also had severe pain in my shoulders back and neck. It would be worth having checked out.