Finally, an update on me.

[SarahL]

Hello everyone, sorry its taken me so long to update, but ive been feeling so bad lately. Ive talked to evelyn and she suggested i post my problem.
IVe been going to the coumadin clinic at my doctors office to have my blood checked. Well last monday i went and my level was at a 4.8 the doctor told me not to take anymore coumadin until i saw her on wednesday. I saw her on wednesday and had my blood checked again and it was at 4.2. She again told me not to take anymore coumadin until i saw her friday. I saw her friday and my blood was checked again and it was at 3.8. She told me not to take any coumadin this weekend until i see her tomorrow for my blood check again. So i have not taken any coumadin since monday. Does this sound right to anyone? I ve been listening to her and doing what she tells me as she is the doctor and i assume she knows what she is talking about, but it just does not sound right to me not to take any coumadine. I dont want to have a stroke.

This surgery for me has been awful. First they send me home from the hospital way to soon, then i wind up back in the hospital because they overmedicated me on blood pressure pills etc. All last week i couldnt keep anything down. I still have a hard time eating, but i force myself to eat when i take my pills. My incisions have gotten infected, but have since gotten better with antibiotics . All i seem to do latelly is cry at the drop of a hat. I told my mom the other day i think i was better off before they did the surgery on me because i just cant seem to bounce back back as quickly as i should have.

I hope someone can help me with the coumadin things. I just dont think this doctor really knows what she is talking about .

 

[Bina]

Sarah, this is very sad.
You may want to post about your INR and Coumadin on the AntiCoagulation Section.
Meanwhile, I don't think it is possible to stop Coumadin for so many days and still have a high-ish INR reading. You need to be tested somewhere else or on another machine.

I agree that many patients get sent home too soon, but it is helpful to encourage patients to move around and get back into their routine.
I was also given a too high dose of BP meds, I was a wreck. My home nurse sent me to the ER and the dose was adjusted there. Don't be shy to mention this to your doc.

My incision also got a nasty surface infection from the steri strips which got stuck at the top and bottom.
I know it's very depressing to have all these things going on. The post op depression is very common and will pass. Spring is coming, hang in there.

 

[catwoman]

Sarah:

Something is not right with your test results.

I'm sure this will be moved to the Anticoagulation Forum. There are a number of longtime warfarin patients there who can offer their 2 cents' worth.

 

[JimL]

If your INR tomorrow is not very low, I would think a second test would be in order. I have at various times had a standing order at the hospital lab for an INR test. I usually have to wait around 45-60 mnutes, but then I can get the results. I encourage you to go for a second test if your INR isn't close to what would be expected after seven days off coumadin.

 

[JimL]

And I completely agree with Oaktree. First get the INR test from your doctor. Only if the INR wasn't close to what is expected (under 2.0????), then have your doctor write a standing order for an INR at the hospital lab. If your doctor truly understands coumadin, she should have no trouble with that.

 

[Ross]

Well, I see that Catwoman and Bina disagree with me, which in a way proves my point that reasonable people who are experienced with coumadin can disagree in certain situations.

I see three critical questions of fact that, if known, could potentially resolve the difference of opinion, and we might all end up in agreement.

1) What is your prescribed target range?

2) Is there any reason to distrust the accuracy of the INR results that were obtained? Personally, I would tend to trust them at this point because they are steadily going down, as they should under conditions of no coumadin. I guess you could test your INR by a different method as a check, but then you would be left to wonder if the new result differed because it was more accurate or because it had been three days, with you off coumadin, since the last test.

3) Are you still on antibiotics? Perhaps the INR is not dropping as fast as some might expect because the bacteria in your gut are either still being actively killed off, or the because your course of antibiotics has not been completed long enough for the gut bacteria population to recover.

You don't necessarily need to answer these questions for us, I am merely offering this for you to consider.

I would need to know all of the above. Either the lab is plain wacked or something your taking caused the rise and slow drop. You should have been at 1.0 3 days after stopping it.

 

[Karlynn]

I'm totally confused as well. A week off of Coumadin should have you at 1.0. There is obviously something amiss - bacteria, drugs you're taking, or the doctors testing has an inherent problem they don't know about. (Easily checked if they are testing others on Coumadin and having the same issue.)

The one thing I thought of was having the doctor run a liver function blood test. If your liver is working below par, this could be a reason.

I also disagree with telling you to hold the weekend with a 3.8. I can understand being confused as what dose to put you on, but 3.8 is not too high, even if your range is 2 - 3. However, with an aortic valve, you don't need to be quite as vigilant as those of us with mitral valves replaced.

I'm so sorry you are still feeling unwell. I know this is very discouraging for you. Hang in there - it will get figured out.

 

[WayneGM]

I can't offer any information or insight our you INR, but I wanted to offer you my best wishes. Sorry you are still going through this. I'm sure this is very discouraging, but hang in there. I'm sure it will be resolved soon.

 

[Karlynn]

I think if the test/lab was flawed that the doctor - if they do even a less than 10 a week and a few repeats, would be able to ascertain that. So at this point, I think it's highly unlikely, but still within the realm of possibility - just farther down on the list.

Her body, for whatever reason, isn't metabolizing the Coumadin well, so it's hanging around. I would have expected her test to be 1.0 on Friday.

Has anyone emailed Al Lodwick. I'd be very interested on his take on this.

Sarah - it's frustrating, but, once again, hang in there!

 

[EVELYN]

Hi SarahL

It's Evelyn.....Maybe you should let everyone know when you started and finished the antibiotics, what they were, the range you're supposed to be (I thought you told me 2.5 t0 3.5), and exactly what the coumadin clinic nurse practitioner (not dr) told you to do. That might help everyone get a handle on it. As I mentioned to you on the phone, I am worried about you off warfarin for a full week.....it just doesn't sound right to me.

Evelyn

 

[Ross]

Everything is premature at this point. We need more information and even with it, may not be able to put a finger on it. Just rest easy, it gets better and this isn't going to last forever.

 

[Susan BAV]

I don't know if this has been mentioned. But are you--or have you been--on anything else, Sarah, like Lovenox or Heparin?

For those of you on anticoagulation therapy, could Sarah still be having a high reading if she has something else [like those mentioned] in her system?

 

[Ross]

I don't know if this has been mentioned. But are you--or have you been--on anything else, Sarah, like Lovenox or Heparin?

For those of you on anticoagulation therapy, could Sarah still be having a high reading if she has something else [like those mentioned] in her system?

Heprin and Lovenox do not show up in an INR test. They have a special test for those PPT Partial Prothrombin Time instead of simply Prothrombin time or PT/INR.

 

[VikiVix]

Whew!!

Whew!!

Hi Sarah!
Now I can pull out the couple of gray hairs I got while wondering how you are.
Is your valve tissue or mechanical? Hang in there....things will get better.
If you have any questions, dont for get to ask all of us. We're here for you and you're in my prayers.
Have faith and every day try to notice even the smallest thing that feels even an itsy bit better and you will look forward to the next day for another itsy of feeling better.
Viki

 

[zipper2]

sarah,sorry to hear about your difficulty here
i was given heperin when coumadin had to be
stopped and it whackoed my inr`s if they give
you something ,to fix something else it could effect
your inr`s but only you and your dr could know for
sure.Im sorry to hear your issues and hope you are
better soon.


zipper2

 

[witzkeyman]

My INR was 4.2 and my doctor not to take Coumadin for 3 days. he said that it's much more dangerous with a high INR and my brain could bleed with a high INR. I listen to him from now on, but am still skeptical. my INR is now 2.6, but I've developed hives. going to my PCP tomorrow.

 

[Karlynn]

For those of you that are new to Coumadin or have taken it for a while but still feel very unfamiliar - please read the stickies on the Anti-Coag forum

4.2 is not a dangerous INR. MOST people should not be holding any doses for it, unless there is bleeding present.

witzkeyman - as you learned on your previous thread - your doctor is way off base and is not following protocol. I doubt that your hives are from the Coumadin. Coumadin allergies are extremely rare and most likely would have surfaced when you started taking it. Don't let your PCP look at it first. If Coumadin allergies were common the protocol would be to try someone out on it before committing them to a valve that required them to take it for life.

Sarah - your case is stumping us all. I'm sure we all will learn from it.

 

[catwoman]

Well, I see that Catwoman and Bina disagree with me, which in a way proves my point that reasonable people who are experienced with coumadin can disagree in certain situations.

Sarah et al:

What I meant (and did not state) is that something is not right with her INR results because typically, normally, an INR would drop more than her results are showing when you hold a dose or two. Therefore, the INR results are not typical. Sarah has held more than just a dose or two.

My guess is, as others have also suggested, is that you are extremely sensitive to warfarin. You should have shown a significant drop in your INR after being off as long as you have been.

We here fully understand with the dynamics of OHS, the frustration at not "bouncing back" (few people do that!) from surgery, the discomfort, the depression and other emotions pre-op and post-op.

There is no one-size-fits-all schedule for recovery. Everyone is different, based on pre-op condition, extent of surgery, surgical complications, post-op complications, etc.
Once your doctor gets down to what's going on with your INR and can get you stabilized on that, you'll feel better mentally.
In time, you will feel getter physically. Time is a great Rx. If only we could just fast-forward through the crummy stuff to when we're back to "normal."