Help me Mr. Wizard

[mimmidoe]

Al and all,
Im back. After 24 years of Coumadin therapy, Im finally riding that roller coaster. Tonight Im truly baffled. I had an INR of 8.9 on 10/17, found out after having a flu shot. My arm blew up.

Skipped 2 evening doses, and ate LOTS of broccoli and greens. By the 19th, I was down to 3.4 (didn't believe it, checked it twice). On the 21st, I was at 3.6. I SKIPPED my dose on the 22nd, took 5 mg on the 23rd, and today Im at 4.1!!!!

It makes NO sense. HOW can I have taken a lower dosage, and have a higher INR?? Help??!! Anyone have any suggestions. No other change in meds, no big change in diet....

My arm is black, blue and green from shoulder almost to the elbow. When do I do something about that?? It continues to leak. I now have a blown up bruise on the top of my hand, and Im going to bed with an ice pack on it, because it hurts. I dont even know how I did it.

Anyone have any input? Im wondering about my cholesterol medicine.... maybe affecting my liver?? Of course tomorrow is Friday, and clinics are closed..... labs are closed over the weekend. What to do??
Mindy

 

[LUVMyBirman]

Hi Mindy,

Sorry to hear you are on a little bit of a ride with the Coumadin.

My suggestion is to call your physician ASAP about your arm. Infected injection site, hematoma?

Take care and keep us posted.

 

[Guest]

Flu shots make the INR go up, so I think your 8.9 was caused by that. It only goes up for a day or two, so you only see it from about day 3 to 5 after getting the flu shot. Most people do not think that the flu shot raises the INR because it does so for only such a short period of time that it is hard to catch. But after 15,000 or so patients, I see about 3 or 4 every year.

I think that you need to be seen about your hematoma.

The liver function test is not something to worry about over the weekend. The recommendations are rather vague as to what to do about it. They say something like -- if the ALT (liver test) is three times higher than normal and then remains at that level for three consecutive months, consideration should be given to stopping the drug (usually a -statin) or switching to another agent. So getting a liver function test STAT is not mandatory.

We just added lipid management to our clinic services this week, so I have been reading up on this and the doctors have been quizzing me in the halls to see if I know what I am talking about. One even did not believe me that this was the recommendation. He said, "Show me where it says that." I showed him the reference in the PDR and he is now one of our most influential backers.

 

[mimmidoe]

Thanks all!
As always, you are a wealth of information. Al, that is the first I have ever heard of a INR going up after a flu shot. I think folks that get them regularly should know this. I was getting in the car to drive to Houston (for a friend), and decided to test. Dont think a four day road trip was appropriate with an INR that high.

The Lovenox info was good also. Went to the website, and am afraid they "hysteria" is similar to the recent one over HRT. I, like Gina, have had Lovenox lots of times, without problem. Guess it is all a crap shoot, and you just take your chances.

Thanks for the info! It is greatly appreciated, and it is comforting to know you guys are there, even for an old Veteran!

mindy