Help, new to this!

[Luana]

Had AVR surgery 3 weeks ago today. Came home 2 weeks ago. I've had 4 INR/PT tests done. The at home tests were done with a finger stick and instant read machine. The ER test was venous blood. I'm taking 4 mg Coumadin.

11-30 INR 8.0 PT 33.9 at home
12-7 INR 8.0 PT 33.9 at home
12-8 INR 5.75 PT 54.5 ER
12-10 INR 7.9 PT 33.8 at home

ER doc said to hold Coumadin dose until test was done again on Friday, which I beleive was per CT surgeon's order. Cardiologist asked to have test done on Thursday instead. Cardiologist's office says hard to believe the first two at home results. I told them they were not sent to a lab, but were read at home and I saw all read outs. Nurse said it still can't be right. Home nurse said she had several people in the office check their levels and they came out as expected, so she thinks machine is ok.

I'm getting concerned about these high results, but maybe I'm over reacting? Cardiologist's office said they would call me today about yesterday's test results, but have not heard a word.

Can anyone offer ideas and/or suggestions? I'm not feeling well at all otherwise, and this feels like one more overwhelming thing for me to be dealing with now when all I want to do is lie down and sleep.
Luana

 

[Ross]

First of all, what other medications are you taking? What is your diet like? How much excercise are you getting? Give us as much information as you can about your daily life and what you do and take. One thing happened to me before and unless they actually check for it, that may be the problem. Have they checked your Hematocrit level? Find out. If it's way out of wack, so will the INR test results be.

 

[Luana]

I am a type 2 diabetic and I take metformin 500 mg for that. Other meds:
levothyroxine 125 mcg
propranolol 40 mg 2x daily
amiodarone 400 mg
and an occasional Percocet 5-325

Just added this week:
furosemide 40 mg
potassium chloride 20 meq

Diet is much lower in veggies and salad as what I'd like. I don't have much fresh stuff in the house right now. Typically it's low-carb. Exercise? Some walking last week, nothing this week. Since last week have had low-grade fever on and off, and lots of SOB, doing something simple like walking to the kitchen, talking on the phone, or getting in bed. I feel really really crummy.

Hematocrit was just done on Tuesday, and it's in normal range.

 

[Freddie]

Why is your diet lower in veggies? Your diet should be the same as it was before surgery.

 

[catwoman]

I am a type 2 diabetic and I take metformin 500 mg for that. Other meds:
levothyroxine 125 mcg
propranolol 40 mg 2x daily
amiodarone 400 mg
and an occasional Percocet 5-325

Just added this week:
furosemide 40 mg
potassium chloride 20 meq

Diet is much lower in veggies and salad as what I'd like. I don't have much fresh stuff in the house right now. Typically it's low-carb. Exercise? Some walking last week, nothing this week. Since last week have had low-grade fever on and off, and lots of SOB, doing something simple like walking to the kitchen, talking on the phone, or getting in bed. I feel really really crummy.

Hematocrit was just done on Tuesday, and it's in normal range.

When did you start the amiodarone?

My guess is that's the culprit, or part of it.

 

[Luana]

Why is your diet lower in veggies? Your diet should be the same as it was before surgery.

Because I live alone and have not been able to grocery shop. I have not been well enough since last week to shop with someone else. I'm having problems getting better.

 

[Freddie]

I'm sorry, I didn't mean to come off as rude and insensitive. Just was wondering why your diet would have changed since surgery.

 

[Ross]

Amiodarone is the culprit here. Your obviously one sensitive to Coumadin to start with and the Amio is amplifying it 100 fold. Best hold on the Coumadin until you fall in range or too low, then start at 2mg per day and see where your at in 4 days. It's going to be difficult but not impossible.

 

[Luana]

Thanks, Ross, that's kind of what I was thinking.
Luana

 

[Luana]

I'm sorry, I didn't mean to come off as rude and insensitive. Just was wondering why your diet would have changed since surgery.

No, you didn't, and I hope I didn't either.
Luana

 

[Bina]

At 3 weeks postop I was still a total wreck and ended up in the ER with a too low INR.
You will probably end up on 2mg daily, the amiodarone is nasty with warfarin.
Can you get more help around the house with daily chores?
Or eat off of paper plates, and ask a neighbor to drop off some supplies.
Things get better.

 

[Lynlw]

Because I live alone and have not been able to grocery shop. I have not been well enough since last week to shop with someone else. I'm having problems getting better.

I can't offer any advice about your INR, BUT I googled and found a grocery store near you (i think) that deleivers and it looks like there is no delivery charge for the first time http://www.vons.com/IFL/Grocery/Store-Locator-Results
1 1101 Pacific Coast Hwy
Seal Beach, CA 90740
Store Phone: 562-370-1937
Store Hours: 5:00 AM-Midnight
Pharmacy Phone:
Pharmacy Hours:

Store Details: Bakery, Deli, Floral, Liquor, Meat, Pharmacy, Produce, Seafood, Starbucks, Video, Fuelstation, DryClean, Sushi Bar, Olive Bar, Digital Photo, DVDPlay Kiosk, Coinmaster, Jamba Juice, Adult Immunizations, Travel Immunizations, 24 hr PayPump, Wi-fi, , Home Grocery Delivery, Deli Catalog, Catering Catalog

1.61 miles Driving Directions

Send Address To: E-mail | Mobile
Current Events:

There might be other options in your area, or maybe if you belong to a church their members might help you out, this just happend to be the first one I found.

I am sorry you are dealing with all of this by yourself.

 

[Bridgette]

It's the Amiodarone alright. I started on it recently and my INR skyrocketed - I am off it now but still having trouble getting the correct Warfarin dose to get back down to around 3.0. The trouble is that Amiodarone stays in your system for quite a long time after you stop taking it.
I hope you get sorted. The grocery delivery thing sounds like a good idea too.

 

[Luana]

Started the amiodarone in the hospital on 11/24. My sister was going to go to the store for me today, but called and said she'd do it tomorrow morning. So that will be good. I've known about the Vons delivery; however, I just got my first disability check the other day; funds have been too low in the checking acct to cover the minimum until it arrived.
Luana

 

[Lynlw]

Started the amiodarone in the hospital on 11/24. My sister was going to go to the store for me today, but called and said she'd do it tomorrow morning. So that will be good. I've known about the Vons delivery; however, I just got my first disability check the other day; funds have been too low in the checking acct to cover the minimum until it arrived.
Luana

Does your sister live close? Would it be possible to stay with her at least until you are feeling a little better, not at SOB, tired ect?

 

[Ross]

Oh boy but am I brain dead or what. I got to thinking about this last night before bed

There is NO WAY you can have an INR of 8.0 and a PT of 33.9 seconds. That would be an INR of around 3.4 on the machine. Your ER draw resembles a real time factor with the INR of 5.7 and 54 seconds. Now if I'm right and your PT's are correct, then you are in range, but your gettting the wrong INR readings.


Every single one of the new machines have an ISI index of 1. Now this chart I'm posting, even I'll dispute, but you can get the meaning of what I'm talking about just by looking at it:

Is this your meter or clinics? If it's yours, did you enter the proper strip code or change the chip? What brand meter is it?

Based on this information, the INR readings of the machine are WRONG. I will side with the ER draw this time. In that event, I'd have you hold ONE dose and then start you back at 10% less for the week. So 4x7=28-10%=2.8 28-2.8=rounded down to the next whole number 25mg for the week. It'll be impossible for you to get a hold of the Doc over the weekend, but if you hold as they suggest, your going to be unprotected and fall too low or basically have no anticoagulation at all. Now you can take my advice, be sure to let the Doc know if you do (I don't care if he throws a fit about someone not having a doctors degree and telling you how to dose) and be safe or you can follow their directions and go unprotected until they figure it out.

 

[ALCapshaw2]

I'm wondering WHO prescribed 400 mg of Amiodarone for you and for How Long?

Some Doc's like to use a Loading Dose of Amiodarone because your cells need to be 'saturated' before it becomes fully effective. I'm thinking this is just for a couple of weeks typically. The 'usual Maintenance Dose' is 200 mg.

Amiodarone can have some nasty side effects (read the Information Sheet you should have received or Google or Search on VR.com to learn more about this drug or ask your Pharmacist) if taken in too large a dose for for too long.

ASK your Cardiologist about reducing your Dose of Amiodarone!
Prolonged use of 400 mg would 'Disturb ME'.

'AL Capshaw'

 

[Lynlw]

Oh boy but am I brain dead or what. I got to thinking about this last night before bed

There is NO WAY you can have an INR of 8.0 and a PT of 33.9 seconds. That would be an INR of around 3.4 on the machine. Your ER draw resembles a real time factor with the INR of 5.7 and 54 seconds. Now if I'm right and your PT's are correct, then you are in range, but your gettting the wrong INR readings.


Every single one of the new machines have an ISI index of 1. Now this chart I'm posting, even I'll dispute, but you can get the meaning of what I'm talking about just by looking at it:

Is this your meter or clinics? If it's yours, did you enter the proper strip code or change the chip? What brand meter is it?

Based on this information, the INR readings of the machine are WRONG. I will side with the ER draw this time. In that event, I'd have you hold ONE dose and then start you back at 10% less for the week. So 4x7=28-10%=2.8 28-2.8=rounded down to the next whole number 25mg for the week. It'll be impossible for you to get a hold of the Doc over the weekend, but if you hold as they suggest, your going to be unprotected and fall too low or basically have no anticoagulation at all. Now you can take my advice, be sure to let the Doc know if you do (I don't care if he throws a fit about someone not having a doctors degree and telling you how to dose) and be safe or you can follow their directions and go unprotected until they figure it out.

I was trying to figure out that night why this pt was so different that the pts for the higher INRs INR 5.75 PT 54.5 ER which were HIGHER INRs but much lower PTs, doesn't make any sense. I couldn't figure out what/why was off, or if it had to do with when INR get to a certain height , the resluts aren't as accurate.

Along with Ross questions, I know the nurse said she tested others with that machine (so I am assuming it was hers) and THEIR results were correct, so I am wonderring about the strips, does she carry the strips around and is using the same pack for everyone, or are there supplies left at your house like a box of strips for her to use and so the strips she is using on you are different ones that she is using in her office where she used her coworkers to check HER machine.

Also since she IS a home nurse, is she checking any other patients INRs right now? and if so what kind of results are they having? I would def call the nurse and ask her these questions, Something is definately NOT right and the proper treatment depends on getting to the bottom of the weird readings

 

[Luana]

Does your sister live close? Would it be possible to stay with her at least until you are feeling a little better, not at SOB, tired ect?

Yes, she lives close, but even though she's retired, she's out and about a lot and it really is better for me to be home. I'm taking things as slowly as I can.
Luana

 

[Luana]

Lyn,
The nurse brings her own strips; there are no supplies at my house.

I've been disappointed in the home health agency in several ways. The first time the nurse came out to do the INR/PT, she did not know what my therapeutic values should be. She tried to get online via her Blackberry, and said she was unable and I said it would be easy enough for me to go to the next room and get on my computer to find out, which I did. This bothered me a lot. I didn't care if she didn't know the values off the top of her head, and had to look at a reference that she carried with her, but to not know and not be able to find out, I find pretty unacceptable.

I have no idea how many other INRs she's checking these days, seems to me it probably should not be any at all.
Luana