Need dosing advice, please??

[mecretired]

You won't believe this, but---. Yesterday I got into some hornets and they promptly swarmed me.:eek2: I got stung 10-12 times--neck and ears VERY painful--red and swollen. Fortunately I don't have any allergies to stings. I used cortisone cream (otc) and took a hydrocodeine pill due to the pain (didn't help). Anyway, I knew I should check my inr this am--4.4. To put this in perspective inr's have been as follows: 10/16 2.6, 10/23 2.5, 10/30 2.4, 11/4 3.6 (not sure what this was about, but I ignored the slightly high #). I take 10mg per day. I don't want to do anything drastic since I know what caused the high reading and it was a one-time event. In fact, I'm wondering if I should do anything. Suggestions??

 

[dick0236]

I'd halve my next dose(5mg) and recheck in a week if you have a range of 2.5-3.5....or one dose(10mg) and recheck in one week if you have a range of 2-3......and I bet that did sting.

 

[mecretired]

Thanks, Dick. Yes, my range is 2.5-3.5. They didn't just sting--they hurt. Even now--over 24 hours later--a couple of places feel like a really bad bruise. I've been stung lots of times, but it has never felt like this. Halving the dose tonight sounds good. That was my first thought. But I didn't want to do anything drastic and start bouncing. Thanks, again.

 

[pellicle]

I take 10mg per day. I don't want to do anything drastic since I know what caused the high reading and it was a one-time event. In fact, I'm wondering if I should do anything. Suggestions??

The medical advice in Australia (and in MIMMS) is if its the same day (like you take in the morning and missed it) take 1/2 the days dose in the evening and continue as normal. If you miss a dose do not take that with the next days dose just continue as normal.

Some time ago I developed a simple mathematical model for examining this. When I missed a dose now and then I've had the chance to examine its predictions with daily measurements on my coaguchek XS. Essentially a variety of scenarios all lead to the same thing of your INR being back to where it 'would have been all things being equal' (if that is even possible) within 3 days.

See http://www.valvereplacement.org/forums/showthread.php?41411-Oops-missed-dose&p=535366#post535366
missed dose model (Left axis is my dose in mg {column graph} Right axis is my INR {as a line graph})

bottom graph is take half with next dose model
I've found that my INR follows more closely the 3 period average but I leave both lines there as its often between them.

 

[Protimenow]

I don't know that I would wait a full week to retest. By that time, the effects of today's half dose would have gone away, and your test in a week will probably show what your INR is normally, based on the dose that you regularly take.

Although it may take a while for the INR to drop because you might be taking 1/2 dose, you may still see a drop tomorrow or the day after tomorrow. Also -- if something strange happens to your INR today (perhaps a delayed reaction to the venom), you really wouldn't know about it because you're not testing your INR to find out.

If it was me, and I had enough strips, I'd consider testing tomorrow or the day after.

(OTOH -- a 4.4 on a CoaguChek XS, in my recent history, was actually more like a 3.8 at a lab. The CoaguChek XS has been documented as overstating INRs around 4 and above. I don't know that I'd really stress too much about a 4.4 -- you're probably not at a risk of massive hemorrhaging, and the meter may be somewhat overreporting, so your concerns may not be as extreme as you might think. Personally, I've had CoaguChek XS and InRatio report high 4s when the lab and my Coag-Sense meter more accurately(?) reported something just north of 3.6 or so).

 

[mecretired]

My CoaguChek XS has always been within .2 of the lab, but I'm not terribly concerned about the 4.4. I'm not sure if the rise was due to the venom or the cortisone or both. Do either of them have a lasting effect or are they already out of my system? A couple of the places still hurt. I think I will take 5mg tonight and regular 10mg after that and test end of the week? Testing tomorrow would just tell me if my inr was already coming down--but by then I would already have taken the half dose. But that would probably be good to know. Thanks. It is so reassuring to know I can count on my VR friends.

 

[pellicle]

I think I will take 5mg tonight and regular 10mg after that and test end of the week?

seems a good strategy to me. Hope the stings feel better soon. I got 'bush whacked' in the front lawn a few years ago with a nest that I just didn't see till I whacked it with the mower handlebar.

I've never run backwards so fast ... till I hit the fence. ;-)

 

[Freddie]

For the bites, try something like Reactine or Aerius both are a antihistamine along with Aveeno Baby lotion. Aveeno has oatmeal in it and it's recommend from doctors for those who have chicken pox.

A couple of a weeks ago I had a itchy rash which came from no where and lasted three weeks. I did get a prescription of 1% cortisone, used Aerius and the Aveeno, personally I think the Aveeno worked better than the cortisone in my case.

And/or you could try putting on a onion skin. Peel an onion and carefully pull off that thin layer of skin within the onion and place that on the bite. It is rather 'cooling' and the purpose is to draw out the stinger.

Good luck

 

[clay_from_nj]

We always keep some benadryl cream in the medicine cabinet. Nasty mosquito bite? Rub a little in and in a few minutes the itch is gone for good.

 

[mecretired]

INR was 3.1 this morning. Hope it doesn't go too low due to half dose on Mon night. I'm still perplexed by my reaction to the stings. They didn't sting, burn or even itch. They just HURT really bad for about 24 hours. It might have been due to the location of the stings--ear and side of neck--or the number of stings--maybe 10-12. Anyway, I now have a healthy respect (fear) of hornets. Thanks again for the advice and comments.