Effect of stress on INR

[gerrychuck]

Had an interesting turn of events this week; I've been on vacation, spending time at our lake cabin. Overall activity level has been fairly high; walking the hills, kayaking, sailing, golfing, but no higher intensity exercise (pulse rate has never been over about 90, where usually I am on the treadmill or bike several times a week for 45 minutes with a pulse of 100-110). Diet and alcohol intake have probably been a bit different than usual, but similar "divergences" from my normal routine have not had a profound effect on INR in the past. However, when I tested 2 days ago my INR was 4.2 - my range is 2.5-3.5, and it has never gone above range at all, much less by .7. INR last week was 2.9, and has been very stable. What I am wondering is the effect of stress, or lack thereof, on INR; this was the first time since returning to work post-op in January that I have been away from the stresses of work for more than few days. Even last week (the first of my vacation) I still had some stress, although it was "good" stress - I flew my wife and myself out to visit some friends in a neigboring province; between not having done a cross country flight in quite a while and not having ideal weather, it did keep the adrenaline moving a little. This week, however, I've been very relaxed at the lake, with minimal stress of any kind.

Really leaves me wondering if the change in stress level is the key variable here; my work stress is moderately high, usually feel moderately tense throughout my work day, and usually feel pretty wrung out after work every day. Anyone else observe this same pattern, or have any knowledge or thoughts on this issue? This reading really surprised me. By the way, I have a great deal of black and blue evidence all over me to suggest that the reading is accurate and not a testing anomaly.

 

[Bev]

I've asked my thrombosis specialist the same question about the effect of stress on INR. She said when we're stressed we don't eat the same, and that could be the reason for INR's to get out of range. She's seen it a lot in her patients over the years. The way we eat and drink on vacation is also a factor.
Hope you get back in range soon.

 

[pellicle]

Could be. I know that metabolism is effected by stress abdi have observed when I am ill that my body requires less warfarin to attain the same INR, so that makes sense.

 

[Freddie]

To answer your question Gerry, Yes stress can and will effect ones INR.

 

[gerrychuck]

Thanks for the replies. Seems logical to me.

 

[gerrychuck]

For the record, this is what it looks like when you combine an INR of 4.2 with climbing out of the water onto the back of a trimaran hull (over several sharp and/or bumpy hard things) in a major panic as said sailboat tries to sail away without you. Follow with using a ball launcher to throw a tennis ball into the water repeatedly for a fetch-addicted labrador retriever. Sit back and wait for pain to start later that evening, and bruising to show up the day after. I don't recommend it

 

[pellicle]

Hope it looks worse than it feels

 

[gerrychuck]

Well, it does now, but I couldn't really move my elbow much for a couple of days! Unfortunately, I banged my calf while de-rigging the boat on Thursday, and it seems to be following a similar pattern; didn't hurt too much at the time, got a bit more sore loading stuff down the stairs from our cabin to the truck yesterday morning, then got much more sore last night when I did a few blocks of walking. Today I am literally on crutches, and didn't really sleep last night. No visible bruising, though (at least not yet), so I can't put up any wince-inducing pics

 

[Freddie]

Even if there's no visible bruising applying ice (20 minutes on then 20 minutes off) wouldn't hurt.
It may help to relief some of the pain along with some Tylenol.

Good Luck

 

[carolinemc]

Ouch, that is a big hurt. Hugs for you today. Feel better soon.

 

[gerrychuck]

Thanks for the good wishes and the advice. As a physical therapist for the past 33 years, I certainly have been using ice Unfortunately, it hasn't made much difference. It's going to be interesting going back to work tomorrow after 2 weeks off...on crutches. I'm already bracing myself for all the patients telling me I need a good physio (hahaha), imagining somehow that I've never heard that one before! Sigh....

 

[Protimenow]

And, poor guy, you probably have to act AS IF you HADN'T heard that before.

At least doing this much shouldn't have much effect on your INR.

 

[gerrychuck]

And, poor guy, you probably have to act AS IF you HADN'T heard that before.

At least doing this much shouldn't have much effect on your INR.

Oh, heck, no, I'm not that gracious! Actually, I went back into the gym first thing in the morning with my crutches and informed all present that the first one to crack "that" joke thinking it was original was going to get the business end of one of my crutches in a very sensitive spot. Worked too...well, for the morning. Walked in to the gym with the afternoon group, and a guy on the treadmill cracked the joke before I could utter my threats. The things I have to endure