My INR Ups And Downs
If you look at my INR Results, you’ll see that over the last few days from the 12th to the 20th of August my INR has swung up and down like a yo-yo. The nine readings in order have been.
2.6, 2.5, 2.7, 2.6, 2.3, 2.6, 2.2, 2.1, 3.0
The average though over that period is almost 2.5, which is my target and I’ve taken an average of 4 mg. of Warfarin. So there’s no obvious reason for the variation between 2.1 and 3. My gammy left hand too, has been a bit variable in its ability, although, it’s probably working as well as it has since the stroke.
What worries me though, is suppose you’re having your INR tested every three weeks or more in the traditional way. From my experience, you could get any number you fancy, all of which will be in the required range and you might then end up on a dose that is not the best for you.
I feel a lot happier, that I have control of my testing and dosage.
It’s Just Not Good Enough!
On Sunday morning, I heard a guy called the Casual Hopper on BBC Radio 5. As he was raising money for a reputable cancer-related charity, I thought I might send him a donation.
So I logged in to his Just Giving page and donated, using my John Lewis Partnership card. I got an acknowledgement from Just Giving, as expected. However, a few minutes later, I got a message from them saying that the payment had been rejected. Now as I’d just paid my credit card bill, I knew that I was some thousands of pounds below my credit card limit.
I then attempted to login to my Partnership card account and found the problem. Their system was down and I couldn’t log in.
I have managed to login this morning, but there is no trace of the payment to the Casual Hopper. In fact, there is no trace of any payments made by the account and I used the card twice yesterday in Sainsburys and Waitrose.
If we can use our cards on a 24-hour basis, surely we ought to be able to see the information in a likewise manner.
After all, if I missed a payment, they’d be on me like a ton of bricks.
It’s just not good enough!
Especially, as it’s caused grief and extra work to a whole series of people like the Casual Hopper, Just Giving and of course myself.
Things I Really Want For My Birthday
Today is my birthday and a few years ago, I didn’t think I’d make the next one, let alone the fourth after my stroke.
I’m happy living here in leafy Dalston at the eastern edge of Hackney, but there are a few things, I want for my birthday.
The first is that, I’d love to get my breathing back to the level it was when I lived with C. All I’ve got is a permanently runny nose, just like I had as a child. Perhaps, it’s just London, although it really started after C died and got a lot worse when I had the stroke. If I look back on the last few years, there are times, when it goes, but why does it go. Two doctors have said it’s hay fever, but then another has said, I’ve no allergy except gluten. Certainly, the sea seems to make it better. So perhaps, I need to find an attractive widow, who lives by the coast in say Liverpool or Brighton.
I’d also like my bathroom finished, as it’s been a long time since the first builders started and then effectively gave up or went bust. The job started with the removal of the old bathroom in October last year.
I’d also like some stacking chairs for my living room to go with my table.
At least I’m getting one thing, I really really want and that is having supper in Arbutus.
But I suppose the best birthday present is outside my control. I did think about going to see the World Athletics Championships in Moscow this week. I didn’t, but I didn’t know that Mo Farah would be running in the final tonight. If I had, it might have swayed me.
But knowing my luck, he won’t win tonight! If it had been tomorrow, he’d have walked it.
Variations In Daily INR
To illustrate the changes you get in INR, I’ve made a graph of my last fourteen readings.
INR 1-14 August
As you can see the level goes up and down, but stays within the limits of 2 and 3, with an average of about 2.5.
Does Jam Count As One Of Your Five-A-Day?
Apparently, according to this article in the Daily Mail, one in five Scots do!
but then I admit, that I do like Dundee lamb chops. But then they are gluten-free!
I’m Going To Follow David Cameron
On Wednesday, I seemed to get a bruise on my left wrist.
My Bruised Left Wrist
So I think, I’m going to follow David Cameron’s example and not where a watch. but then Sam Cameron doesn’t either and neither did my late wife.
Conclusions From Self Testing My INR Daily
Tomorrow, it will be eleven weeks since I started self testing my INR on a daily basis. The results are here.
I should say that after I had my stroke, an eminent cardiologist said that if I got my Warfarin right, I wouldn’t have another stroke.
So can I come to any conclusions from the tests I have been taking?
I did miss one day early on, but otherwise I’ve taken the test successfully on a daily basis.
I’ve now developed a daily routine in the morning, where I do my stretching and exercises after checking my computer, then have a shower and breakfast, before doing the washing-up by hand, which warms my hands. I then take the test and only rarely do I fail first time and need a second strip.
So the first conclusion, is develop a routine for when you do your tests, that suits your personality and lifestyle.
One thing that you notice from the tests, is that there is quite a large variation between days. A change of 0.5 in the INR, either up or down is not uncommon. This is not a problem, but it could with some people worry them and then they might start to chase their target INR, by constantly changing the dose.
Hot days incidentally, do seem to try to force the INR upwards and although you won’t find this on the Internet, a medical professional has told me that it happens.
I use a very simple manual algorithm, based on my training and experience as a Control Engineer. I know from when I was living in Suffolk, that a Warfarin level of 4 mg. a day is about right to meet my target of 2.5. So I use a simple algorithm, summarised as follows.
INR less than or equal to 2.2, take 5 mg.
INR higher than or equal to 2.8, take 3 mg.
INR between 2.2 and 2,8, take 4 mg.
So how has my INR behaved?
If I look at the average value of the last 28 days, it is 2.56 and this rolling 28 day average has been within 0.1 of 2.5 for the last seven weeks. I couldn’t calculate it before, as I didn’t have enough data. An interesting figure is that the standard deviation of the readings is about 0.3. Effectively this says that nearly all of the readings are within 2.2 and 2.8, which is within my target range of between 2 and 3.
So as the patient, I think I could safely say that my simple algorithm works.
But perhaps what is most interesting is that the 28 day average for the dose I’m taking is around 3.8 mg. So rounding this to the nearest tablets, that means if I can’t take a reading for some reason, then I should take 4 mg.
So I can conclude that the daily testing has given me a very sensible daily dose, which is virtually the same, as I took, when the tests were done by nurses, hospitals and laboratories, at great expense to the NHS.
So should all those going on Warfarin be assessed to see, if they could self-test their INR levels?
I believe they should! And it’s not just me!
An organisation called the Anticoagulation Self-Monitoring Alliance is pushing for more self testing. Be cynical if you like, but it is part-funded by Roche, who make the self testing meters.
On the other hand, how many diabetics test their blood sugar levels regularly and have a better lifestyle because of it?
French Think About Beach Smoking Ban
The French Minister for health has said, that she might like to ban smoking on beaches. It’s reported here on the BBC. This is the first paragraph.
A call by France’s health minister for local authorities to ban smoking in parks and on beaches has sparked debate as a heat wave grips the country.
Marisol Touraine told the Journal du Dimanche newspaper she wanted to see more tobacco-free zones, to protect children’s health.
The Socialist minister said she hoped smoking would also be banned outside schools and on university campuses.
According to the article, there is actually a ban at La Ciotat near Marseilles, where they say it has been well-received.
In my view, anything that cuts smoking is a good idea.
Not One Of My Problems!
This story about treatment for varicose veins shows how a lot of medical treatments are going to get more hi-tech. This is the first bit.
People with varicose veins should be offered laser or heat treatment, say new guidelines for England and Wales.
The National Institute for Health and Care Excellence (NICE) says, in most cases, surgery should be a last resort.
Both my parents had bad varicose veins, with my mother’s being particularly bad. She had them operated on at the old Highlands Hospital in Winchmore Hill in the mid-1950s. The strange thing about that operation was that the surgeon was an Indian lady, who did her ward rounds in a sari. I don’t think, I actually saw the surgeon, as eleven-year-old children weren’t allowed to visit their parents in hospital in those days, but my father would recall if her surgery was as as good as her looks, then my mother would be fine.
It’s strange, but you don’t seem to see the awful varicose veins you did fifty years ago!
I certainly don’t seem to have inherited them from my parents!
The Birth Of Our First Son
With the birth of the baby to the Duchess of Cambridge expected within a day or so, it is perhaps a good time to tell the true story of our first son’s birth in 1969.
Our circumstances just before the birth on the 16th of July, were a bit chaotic to say the least. I did outline them to a certain degree in this post about waiting for Apollo 11.
To summarise, we had no hospital for the birth, were living with C’s mother in Barnet and the baby was four weeks overdue.
C thought it would be a good idea to go and sit in St. James’s Park, as it was getting rather oppressive with her mother, who had no idea or experience about childbirth as C had been adopted. Mother felt she should be in the Victoria Maternity Hospital in Barnet. You never told C what to do, if it was against her wishes. Especially, if you were her mother!
It was a lovely day and we sat in deck chairs in the Park until about five o’clock, when C said that she thought she was in labour. As I said in the other post, she decided she was going to the old Middlesex Hospital, where because of her imminent state, she was seen by a doctor and admitted as an emergency.
As I said in Part 2 of the waiting for Apollo 11 story, I stayed all night and nothing happened, except that about midnight the contractions stopped. C always said she was telling me to go back to her mother’s and get some sleep, but whether I was being loyal or stubborn, I don’t know and I just stayed.
I went to work on the Monday and the evening was another of waiting, with the odd contraction thrown in.
Part 3 gives the full story of the birth, with our first son being born soon after midnight.
Only after we had returned to her mother’s did C reveal the truth about what had happened. Until about four or five hours after they broke the waters, did she ever have a proper contraction.
She had fooled the doctors, so she could get into her chosen hospital.
I doubt the Duchess of Cambridge is faking!
The Anonymous Widower 