Upcoming Appointment with Hematologist

[mlewis30]

About two months ago my INR and my body's reaction to Warfarin became erratic and unpredictable for no obvious reasons. I am testing almost every other day and adjusting warfarin intake. I've asked to see a hematologist to seek some more information. Has anybody gone this route? What should I be looking for, or asking for? What kind of results did you experience? Or, am I wasting my time?

Thanks

 

[dick0236]

By testing every day, or every other day, you are testing before the Warfarin is fully metabolized and then making dosing changes based on the INR numbers you get is the probable reason for your erratic INR. I'd suggest you see the Hematologist and tell him/her what you are doing. I think he/she will tell you to stop testing more than 1X week.

 

[pellicle]

Hi

About two months ago my INR and my body's reaction to Warfarin became erratic and unpredictable for no obvious reasons.

what is important is the actual variance here. Also if you've been "chasing it"

I am testing almost every other day and adjusting warfarin intake. I've asked to see a hematologist to seek some more information. Has anybody gone this route? What should I be looking for, or asking for? What kind of results did you experience? Or, am I wasting my time?

Thanks

I haven't but there are other issues (such as the endocrine system Cytochrome P450 or even something as mundane as vitamin K in the body.


PM me if you want to work through points

 

[carolinemc]

About two months ago my INR and my body's reaction to Warfarin became erratic and unpredictable for no obvious reasons. I am testing almost every other day and adjusting warfarin intake. I've asked to see a hematologist to seek some more information. Has anybody gone this route? What should I be looking for, or asking for? What kind of results did you experience? Or, am I wasting my time?

Thanks

Testing too much, the horror is testing everyday. It has not had the chance to metabolize in your system. You need to adjust then test 5 to 7 days. You are not giving it a chance and over medicating on the metformin.

 

[mlewis30]

I understand the issues with too much testing, but it didn't start that way. It has been as low as 1.3 to 5.8. I will try and create a presentable chart out of my hand written notes and send that.

 

[pellicle]

Good morning

I understand the issues with too much testing,

What are those issues?

but it didn't start that way. It has been as low as 1.3 to 5.8.

OK, that's interesting, but

• How are you certain things you didn't miss any doses (nb what is your system of checks)
• Have you been sick (say COVID)
• How often are you testing
• Are you self testing

 

[pellicle]

5.8

Just FYI

http://cjeastwd.blogspot.com/2021/05/grapefruit-and-warfarin.html

 

[mlewis30]

Re: over testing can lead to "chasing" the desired INR # and constantly altering dosage prematurely. I do have a morning routine that I stick with, it is possible I missed a dose, but unlikely. I did get Covid late July, and that is when INR went sub 2.0, and led to a couple days of Lovenox. Even before Covid, my system changed to how it responded to the warfarin, sometimes acting hypersensitive, and then at times almost "resistant". I have dealt with changes in metabolism in the past, and this is not like that. This is not me chasing the INR on my own, the coag clinic has overseen it all (just more guessing). Yes, I self test. I a live on an island, and it is a full day to travel to neighboring island to nearest lab. I recently checked my machine against theirs, and a blood draw, and my machine was fine. Until I get this figured out, I was wondering what a hematologist can offer?

 

[pellicle]

Hi

Re: over testing can lead to "chasing" the desired INR # and constantly altering dosage prematurely.

key point bolded ... testing informs it does not force you to make a change

I do have a morning routine that I stick with, it is possible I missed a dose

unless you have:

• a pill box which is labelled by day
• a routine (and an alarm to remind you)
• a place to without fail see that pillbox during the day and an obvious way to see if you took it (leave the lid open after taking)

then its not simply possible its probable.

I did get Covid late July, and that is when INR went sub 2.0

a good explanation for the low

, and led to a couple days of Lovenox.

this signals to me you don't have a good grip on your actual INR recovery rate nor on your dose management (very common, so I'm not chiding you here). I would give you a method of operation to work on that

Even before Covid, my system changed to how it responded to the warfarin, sometimes acting hypersensitive, and then at times almost "resistant".

interesting, but I'd need data for that ...
how long have you been on warfarin?

This is not me chasing the INR on my own, the coag clinic has overseen it all (just more guessing).

I didn't accuse you of that but in a total absence of background I had to ask.

Yes, I self test.

excellent

I a live on an island, and it is a full day to travel to neighboring island to nearest lab. I recently checked my machine against theirs, and a blood draw, and my machine was fine.

Until I get this figured out, I was wondering what a hematologist can offer?

very little IMO

I've already suggested avenues in our message conversation.

Best Wishes

 

[mlewis30]

I wasn't at all insinuating that you were blaming me for chasing, sorry it sounded that way. Just frustration. I have been on warfarin for 16-months.

 

[pellicle]

I wasn't at all insinuating that you were blaming me for chasing, sorry it sounded that way. Just frustration

Just me attempting to be sensitive. Apparently I upset people without knowing what I said.

16 months is just long enough to begin getting complacent.

I strongly recommend my suggestions in the message chain.

 

[mlewis30]

Not the case here. I know you are trying to help. I will implement your advice, and deeply appreciate the concern. Next time, we can talk about motorcycles.

 

[pellicle]

Next time, we can talk about motorcycles.

Just spotted this.

I'm notifications driven, I don't get one if you don't reply or "at mention" me.

Type @ then without a space begin typing a name , select the one you want

Eg @mlewis30

Sold the KTM, owner already crashed it. Down to two ATM