Questions for Allodwick

[Perrster]

Al,

I haven't seen your much respected replies lately, but it's good to have you back.

I was diagnosed with Bronchitis (sp?) yesterday and given a 10 day 3x @day prescription of Amoxicillin (500mg) as well as a 4-day run of Zithromax (250mg).

This is my first "nasty cold, etc." episode after becoming a dual valver 19 months ago. I guess I survived my first winter with no incidents. Didn't even do a flu shot!

Cause?:
I think my immune system got all whacked out last weekend when I attended a banquet with about 150 people in one room. At least 100 of them had to be chain smokers and I think the smoke did a number on my immunity. I've heard that smoke can suck the vitamins (C) right out of you?

Any idea how far my INR might "spike" while I'm on this stuff? Will be testing on Monday 11/12.

I haven't noticed anything peculiar except that I AM feeling better already and the throat doesn't hurt so much.

Thanks again.

 

[Guest]

Rarely have I seen an INR go above 5 on most antibiotics. Since I tend to ignore INRs which are below 5, this presents a little problem. Do you hold a dose, continue unchanged or what? Often, I have the person take 1/2 of their regular warfarin dose every other day while on the antibiotic. They take their regular dose the other days. This seems to keep the INR from going too high or low.
One thing to remember about Zithromax is that it takes a very long time to clear from your body. Taking 5 days of it is like taking 10 days of another antibiotic.
If you check your own INRs at home, I'd recommend doing it every 3 days until about the third days after Zithromax is stopped. Adjust about 1/2 tablet of warfarin up or down - not too big of a change.

 

[Christina]

Allodwick,

Great to have you back! I missed your posts as well, because I learned so much from you. You sound like my new doctor who also isn't worried about INR's too much unless they get above 5. Boy, I feel the same way. better to deal with a bloody nose than a clot or stroke.

I'll tell you what happened to my sister in-law. She's 53 and had a stroke about a month ago. She is a long time smoker, but had to quit now. Her neck arteries are 100% & 70% clogged, they can't do anything about the 100%, afraid of another stroke. The other 70% she was operated on last Wednesday) This stroke effected her left side vision. The specialists are not giving her any encouragement that it will ever improve. This stroke means she can no longer drive and operate her business, and she can no longer read. She does see pictures she told us.
She's on Coumadin and it is regulated by her doctor. She's terrified because the INR has already spiked to 11. Blood coming from her nose, her fingernails etc.etc. I am trying to help her.

I feel lucky today!

Christina
Aortic Stenosis
AVR's 8/7/00 & 8/18/00
St.Jude's mechanical
Coumadin 20mg a day.

 

[Guest]

What an awful story. I'm truly sorry for her and you. Is she still in The Netherlands? I'm told that they have the best organized anticoagulation management in the world there.
I hope that she is on aspirin too. When the carotid arteries are clogged it is the best clot preventative. In the arteries, blood is flowing at high pressure and when the arteries are clogged, at high shear forces. In this instance, most clots are started by platelets. Aspirin works better on platelets.
In the veins, the chambers of an irregularly beating heart, and around artificial heart valves, blood tends to stagnate. The clots that form under these conditions are primarily started by thrombin. Warfarin works better on these.