Inr

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LoveMyBraveHeart

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Hi


you're welcome ... its public after all ;-)



myself I totally despise most apps (and I'm a software developer) for these reasons (link) and the situation has only become worse since 2012 when I wrote that. So my most sincere advice is "use a spread sheet" and store that on your computer AND also on a cloud storage.

I use a spread sheet for my INR tracking and if you wish I am happy to asssist you to set one up. Sure a piece of paper works but I am certain that you'll find (for instance) graphing stuff is critical to understanding what's happening and making decisions, and no piece of paper does that without you making a lot of effort. I use Excel but you can also use Open Office (now called Libre Office) across platforms (Mac, PC, Unix) and its free.

Best Wishes
Do you have an example of your (or something similar) spreadsheet that I could peek at? I would be using Excel. Would love to set one up. I hope all of the info gets a little less overwhelming...right now there are so many medications to count and numbers and appointments to remember it makes my head spin at times, and I am semi-savvy in the medical stuff (in the animal world, not human)
 

pellicle

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Do you have an example of your (or something similar) spreadsheet that I could peek at? I would be using Excel. Would love to set one up.
I of course do, so please PM me with your email and I'll send you one ... I would also prefer to be able to explain a few things of important nuance in that sheet which I've found seems to be counter intuitive to some.

I hope all of the info gets a little less overwhelming...right now there are so many medications to count and numbers and appointments to remember it makes my head spin at times
LOL ... it will

and I am semi-savvy in the medical stuff (in the animal world, not human)
the biology of all creatures is largely similar.

I find that visual representation of data (you know, graphs which we teach kids in grade 5 and on) is critical to humans, we can't understand things without seeing. Hence the important role of "medical imaging" (well and everything from the microscope on...)
 

Protimenow

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I currently have 1 mg, 4 mg, 5 mg and 7.5 mg warfarin available. Each has its own color, so it's fairly easy to tell which strength you're using. One trick I recently figured out -- I'm writing the dose on the cap, so it takes a bit of the guesswork away when I'm making up my dose.

I've used Coumadin and Warfarin. My pharmacy tried to give me Jantoven (another generic of coumadin), but I wasn't able to regulate my INR with it. The pharmacy knows what I use and does NOT give me Jantoven.

I also use a computer spreadsheet, and store it in the cloud, and sometimes on a flash drive. I've been keeping the spreadsheet since 2009, when I first started self-management and got my first meter.

I record time, date, which device (or practice) was used to test the blood, dose, and any other information that may be relevant (change in diet, activity, etc.). I'm using Excel, but there are a few good open source office apps - LibreOffice (mentioned by Pellicle) is good -- I think Open Office (from Apache) is not the same as LibreOffice (but they may have changed things since I last checked). (LibreOffice is, I think, an Italian product that supports dozens of languages. I've been using/testing it since version 2.0 (I think). It's now up to version 6.2)

It's not hard to set these up, and I also urge you to use it to keep track of 'things.'
 

Agian

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absolutely it must be "what's in there".

Anecdotally if you work in Bars in Australia you'll find that more fights start with Rum than Scotch Whiskey (and not just because of consumed volume) it is / was known as "Dutch Courage" in the British Empire for some centuries.
Yes, I've noticed that. Tia Maria turns me into an animal.
 

Protimenow

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LibreOffice and Apache Open Office are 'cousins,' built on core code that Oracle released for development by other organizations in 2010. Both are, in essence, based on the same bones, but have had different structural elements added to them.

The Apache Foundation offers an open source version that they call Apache Open Office.
The Document Foundation offers LibreOffice.

For accuracy's sake, the only 'Open Office' is the one that carries the Apache name -- although LibreOffice apparently has many more users. (I've tried both -- but my primary Suite is still Microsoft Office 2010. -- BTW - I"ve been using Microsoft Word since 1986, when I wrote a book about it. This was before Microsoft even had Windows. It was fully character-based, with no graphics and not many bells and whistles - it seemed to work a bit more easily with a strange new device called a mouse.

I got a big scoop for the weekly magazine where I was L. A. Bureau Chief by getting a pre-release copy of Microsoft Word for Windows. It WAS a big deal.
 

Warrick

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I use an app called INR Log which was created by a NZ haemotologist, it has a daily reminder you can set ,Ive been using it since the start of the year and quite like it, it doesnt tell you dosing but you can enter test results and dose and it will tell you what dose for each day, I find it simple and does what I want with a flash graph 😀
B5010F56-E3DC-4003-AFCC-8A1EE609F669.png
 
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LondonAndy

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Here in the UK I was prescribed 1mg, 3mg and 5mg Warfarin pills from the outset, on the basis that variations in INR are normal and there will be times when you need to adjust your dose, whether temporarily or longer term. With this combination you can make any normal dose of course - I have never taken a half tablet, instead taking alternating doses (eg 6mg one day, 7mg the next, and repeat). But having said that I see nothing negative about taking half pills if that results in a consistent INR.

The things that affect my INR are particularly:
* Infections (lowers it)
* Colds/flu (lowers)
* Antibiotics (raises)

Both diet (very variable) and alcohol seem to have small effects, though my alcohol consumption is moderate. I did ask the hospital pharmacist whether different types of alcohol had different effects on INR, and she said no, that it was alcohol itself.

absolutely it must be "what's in there".

Anecdotally if you work in Bars in Australia you'll find that more fights start with Rum than Scotch Whiskey (and not just because of consumed volume) it is / was known as "Dutch Courage" in the British Empire for some centuries.

So I find that aside from the pure alcohol response there are others. I always encourage good scientific exploration (in moderation) of this.
Over here it seems to be lager that causes aggression, particularly at football (soccer) matches, and consequently it has been banned from consumption on the terraces. However, ales / bitter are still permitted at rugby matches, and when I used to help run a real ale festival, with 3,000 people in a barn and live rock (and other) music we never had fights in the crowd! (I am thinking the gassy type of pumped lager, not bottled continental lagers).
 
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gerrychuck

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Wow! thank you. I just printed the blog post. I'm hoping I can find an app or something that will help track data...I'm not very technologically savvy. I will keep this printed post for future reference (along with all my other printed notes of research :geek:)
I have tried a couple of iOS apps on my ipod in the past which got the job done but were much less than ideal. I am now using an android app called My INR, and it is much better; very quick and easy to use, and allows you to both input and retrieve info very simply. It's free, so worth checking out. There are a bunch of these apps out there, most of which I haven't tried; this one worked well so I stuck with it for the past 2 years.
 

Protimenow

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LondonAndy -- there's nothing inherently wrong with alternating doses. I used to do that for years.
Just be aware that your INR will fluctuate day to day, based on the dose you took three days earlier. This is a reason that taking the same dose daily is advised. If you take alternating doses, you may also want to check your INR on two consecutive days, and probably figure that the average of the two is probably what your real INR is - so that you don't make any adjustments based on 'high' or 'low' INRs.

Going with half pills, and using the same dose every day makes it easier to determine what your actual INR is.
 

tom in MO

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Love My Brave Heart:

In the US, unless you ask you will get 30 pills of warfarin. However due to the nature of warfarin dosing, they will prescribe 60 pills if you ask. That's what I do. I find 1, 2 and 5 the most useful and right now am doing 1 and 5.

You don't need an app to track your INR. A piece of paper and pencil works just fine. I use the little book that came with the meter. They send me a new one if I ask. Some meters store the information. From a practical standpoint, you just need your last few readings. Attributed to Aristotle "It is the mark of an instructed mind to rest easy with that level of precision which the decision requires and not to try an exactness which is unnecessary for the problem."

A few things I read said that keeping the dose the same every day is useful because patients forget which dose for which day. There was no pharmacological reason.
 

Protimenow

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Tom: I have to disagree with you in a few areas.

I maintain my INR information in a spreadsheet on my computer, and frequently save it to the Cloud or to a flash drive. I've kept records since 2009.

It's useful to me for many reasons:

If my INR should suddenly spike or drop out of range, I can look back to other times when the same thing may have happened. It helps me to see if there's something that caused a similar event.

I can look at a history of self-testing versus blood draw -- which meter(s) I used, which labs were used. This history is useful.

Through the years, I've tested with many meters. For a year or so, I was in search of the most accurate meter - comparing the results of one meter to the next, with readings within minutes of each other, and frequent blood draws. If I recorded this on paper, and lost the paper, I would have no history of those tests.

A spreadsheet is also useful if you need to convince your doctor that you know what the hell you're doing, in regards to testing and dosing (even if the dosing advice comes from the doctor or a clinic). Without a solid record, it's more difficult to prove your ability, or to demonstrate history.

I STRONGLY advise keeping the data in a spreadsheet.

Your other comment about the same dose daily is NOT because patients may forget which dose for which day (this is also a valid point) - rather, it's because if you alternate your dosing, your test results will also change from day to day, based on your dose three days earlier (and other factors). With the SAME daily dose, your INR should be the same from day to day.

(If you DO alternate doses, try testing your INR for a few consecutive days, and you'll see what I mean. Possibly changing your dose because of a 'high' or 'low' in your INR can create more problems than it solves, and can launch you into an INR Roller Coaster).
 

pellicle

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Hi Tom

You don't need an app to track your INR. A piece of paper and pencil works just fine.
this is quite true, and adding a little graph paper (or even using a primary school graph paper book) can make that even more informative because we (humans) gain a lot from seeing graphs more than seeing raw numbers.

The issues I see with this is that IF you are self managing and IF you do not have a rock solid INR then you WILL need more value addding of that raw data and that's where everyone in science (including your INR managers) turn to computers to crunch numbers. I recently bought a Thinkpad X220 for $100 and installed Ubuntu on it for my "down in town" laptop (I'm typing on it now) and it also has access to all the free software that I mentioned earlier (like LibreOffice) and this enables one to for very little cost have access to quite powerful analysis tools for evaluating your INR and evaluating your dose and making sound decisions on how to actually respond to a situation. (*aside from coming here and writing a panic stricken note about how my INR has varied).

For those who's INR is super solid never variant then management is a no brainer .... for many of us its actually a bit of a head scratch.

A few things I read said that keeping the dose the same every day is useful because patients forget which dose for which day. There was no pharmacological reason.
if you ask a pharmacologist this they'll perhaps say something like this: "A stable dose will enable you to make better understandings of what is going on and in your body with the disposal of warfarin (which is the primary issue of how effective it is at interfering with your vitamin K recycling which is how it actually effects your INR), by making that variance in dose smaller (from dose to dose) you can then make a clearer decision about what to do. If the dose is varying wildly you need to understand the half life of warfarin and this will make any estimations of residual warfarin harder to grasp making harder to estimate what your actual drug levels were at earlier times leading to outcomes you face and are trying to remediate now. These things will include such mechanisms as how the P450 enzyme production is regulated and how it senses the levels of toxin (warfarin) in your system and what it does to remove them."

I'm sure however for anyone who has a simple stable INR that its not really significant or important to do more than just write down what your dose is ... so you don't forget what it is from week to week when setting out your pill box. Even more so if you have your local pharmacy doing it all for you (but then how would they know your dose for the target INR if it changed without a feedback system to them?)
 
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