Doctor wants to adjust my dose.

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jax

jax

VR.org Supporter
Supporting Member
Joined
May 7, 2009
Messages
486
Location
Green Springs, ohio
So I did my weekly home test yesterday and my results was a 3.5. I had to go to the doctor this morning for some woman stuff and she told me that she didn't know what to do with that reading whether she should make an adjustment or not. I am on 6mg monday, wednesday and friday and 8 mg the rest of the time. She proposed that we I take 8 mg on sunday and then 6 mg the rest of the time. That would have been a 6 mg drop per week from what i am taking now. I told her that I wasn't comfortable dropping that much in doseage and settled for a 2mg drop but i am sitting here now wondering if I am her only patient that she has to worry about dosing their coumadin. The last time she made a drastic change in my doseage and she wanted me to skip a day and drop down to 6 the rest of the week I dropped down to like 2.2 and I refused to take her advice in skipping that dose and ended up taking half the dose. I wasn't going to change a thing in my doseage and I still might not. It just seems to me like I am teaching her how to dose coumadin and not the other way around. Sorry for the rant, it just made me scratch my head why she would want to make an adjustment so drastic when technically i am still in range. All be it that I am at the very top of my range I am not worried about it.:confused:
 
Now, what is your gut telling you to do?

I have someone else at the older folks forum that just started Coumadin and they are already jerking this guy around. Being an older gentleman, he won't deviate from the Doctors professional judgement, even if it is totally wrong.
 
jax said:
Ross my gut is telling me not to adjust at all and just retest in a week. I don't think that a 3.5 even warrants an adjustment at all but that iis just my thought.
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Makes perfect sense to me. Heck, last week I tested at 4.3 and didn't do a thing about it, yesterday, 3.2.
 
jax said:
Sorry for the rant, it just made me scratch my head why she would want to make an adjustment so drastic when technically i am still in range. All be it that I am at the very top of my range I am not worried about it.:confused:
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I wonder why she would even want to make ANY adjustment.

IMHO, you're much better off at 3.5 than at 2.5.

Both my PCP and my cardiologist want me at the higher end of the range for mitral valvers (2.5-3.5).
 
you have a mitral valve mechanical, right? Isn't your range supposed to be 2.5-3.5 ?? Sounds like you are right within your range to me.
 
3.5

3.5

Yup, 3.5 is right at the top of my prescribed range.

There are times I'll reduce my dosage if I'm at 3.5, but I only do that if my testing results indicate that I'm on a rising trend. Usually, I just leave it alone.

-Philip
 
yeah really i am in the perfect spot and really don't understand why she would want to adjust my dose. The only thing that I can come up with is that she is pretty inexperienced. I am not sure how long she has been out of medical school but she is pretty young and seems as she really isn't all that comfortable with having to dose coumadin. As she told me this morning that she really didn't know what to do since I was right at the top of my range. I really do believe that it is because she is inexperienced and that I could probably dose myself better than what she could because when we were talking about it and i told her i was uncomfortable with such a drastic change she ended up going with me with just the 2mg drop and the only reason i said 2mg adjustment was because she kept mentioning going down by 6 mg per week. But, I don't think that I am going to do an adjustment at all and just see what it is next week.
 
jax said:
yeah really i am in the perfect spot and really don't understand why she would want to adjust my dose. The only thing that I can come up with is that she is pretty inexperienced. I am not sure how long she has been out of medical school but she is pretty young and seems as she really isn't all that comfortable with having to dose coumadin. As she told me this morning that she really didn't know what to do since I was right at the top of my range. I really do believe that it is because she is inexperienced and that I could probably dose myself better than what she could because when we were talking about it and i told her i was uncomfortable with such a drastic change she ended up going with me with just the 2mg drop and the only reason i said 2mg adjustment was because she kept mentioning going down by 6 mg per week. But, I don't think that I am going to do an adjustment at all and just see what it is next week.
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Sounds like you are ready for self-dosing! Go for it!
 
I agree with you. Do nothing, and check next week. If the machine doesn't beep at me (which it won't at 3.5) then I'm not even going to THINK about changing dosage.
 
I think you should see if she's receptive to some Coumadin dosing education from an experienced patient. :wink2:
 
Your PERFECT! :thumbup: I wouldn't change a thing, your fine just the way you are.

I was told by my neighbor who is a lab tech, that they allow a .2 variance in INR testing. They do 3 tests with your blood draw/sample and average them out. So, using this format, you could be 3.7 or 3.3. Stands to reason why INR = It's Never Right. :smile2:
 
Well, "it's never right" sure doesn't apply to me. My INR is pretty much always right. No problems at all, testing at home every 2 weeks.
Jackie, your INR of 3.5 is great, unless that is a huge change from whatever you had a week ago, then u would need to watch out for a trend happening but I think you have got the hang of it. Over-reacting is the best way to become unstable and screw things up.
 
Did your 3.5 reading come from a Finger Stick Instrument?
If so, what kind?

The Coaguchek XS Instruments used by my Coumadin Clinic typically read on the High Side when the reading is at/above the normal upper range. FWIW, I've seen finger stick readings between 5.0 and 5.2 where the Lab Draws ALL came back in the range of 4.0 to 4.2

Doing NOTHING and checking in 1 week makes Good Sense to me.
Your idea of dropping only 2 mg is also reasonable.

'AL C'
 
My monitor is a coaguchek XS. And I definitely am not going to adjust my dose. I may just ask her next time I have to go to see her whether she would allow me to start self-dosing. Since I am not comfortable with her dosiing and not really having the knowledge of what to do when i am at the high end of my range.
 
Cris N said:
Jackie, I think you're right on track with your wanting to self-dose. Don't forget the dosing calculator - one of the stickies: http://www.valvereplacement.org/forums/showthread.php?31691-Online-Coumadin-Dosing-Calculator

You might want to share it with your dr as well.
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If you are going to home test and self-dose, it is a very good idea to use a "dosing protocol" such as the one above. That will make your adjustments consistent and you will not need to "guess" each time you need an adjustment. I use the one from Al Ludwig but both are very similar in adjusting doses. I do not use the protocol exactly since I round off the dosage adjustment in order to use only 5mg tablets (0, 2.5, 5, 7.5, 10mg). Some feel more comfortable keeping several Warfarin strengths on hand to "fine tune" dosage adjustments. I seldom make any changes and having only one strength on hand makes sense for me. I recently acquired a new PCP and once I explained that I used a "dosing protocol", he had no objection to my self dosing. I think it also helped that I have been taking this stuff for a long time and he was comfortable with my ability to self-dose. Since I am on Medicare, I have to use an INR Service in order to have insurance coverage for this testing. Alere does forward the results to my PCP and his office always calls me, even tho I self-dose. The few times in the past that my doc and I did not agree on the adjustment we were able to compromise. Frankly, I like the idea of my doc "looking over my shoulder".

Warfarin is used for many reasons besides mechanical valve ACT. Many patients are non-compliant and docs have to be wary about self-dosing since they have a "fiduciary" responsibility for your care. Once your doc is comfortable with your ability, odds are that he/she will be happy to let you participate in your care. That is a "win-win" situation for all.
 
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well I didn't make an adjustment at all last week when i was sitting at 3.5. the doctor wanted to drop me by 6 mgs per week. I finally said i would be willing to do 2 mgs but never did because I really didn't feel that an adjustment should be made when i was still in range. Just got done doing my finger stick and my inr today was 3.2. So gald I didn't listen to the doctor. Especially with the 6 mg drop. I would have been way too low if I had listened to her.
 
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