The Anonymous Widower

Getting To The Bottom Of My INR Results

Since the start of the hot weather my INR results have not been troublesome but just a bit wayward.

To get a hold on it, I have been testing my INR every day from the 1st of July.

Normally, I take a dose of 4 mg of Warfarin every day and this keeps my INR at around 2.5.

But in the hot weather the INR was drifting towards 2.0, so I was using a dose of 5 mg every so often to nudge it upwards.

I was also drinking heavily in the hot weather, but nothing was stronger than 0.5% alcohol Adnams beer, which I know doesn’t affect my INR and to my body, it is gluten-free. Most of the other drinks were still lemonade, tea and water.

I came to the conclusion, that the water was being boiled out of my body by the heat.

At least, the INR only hit 2.0 a couple of times and never went below it.

On the 14th of September I had the decompensation stroke, I wrote about in I Had A Decompensation Stroke On Saturday.

This is my INR values and Warfarin dose since that day.

  • 14th September – 2.2 – 5
  • 15th September – 2.2 – 5
  • 16th September – 2.2 – 5
  • 17th September – 2.3 – 5
  • 18th September – 2.7 – 4
  • 19th September – 2.9 – 4
  • 20th September – 2.6 – 4
  • 21st September – 2.7 – 4
  • 22nd September – 2.7 – 4
  • 23rd September – 2.5 – 4
  • 24th September – 2.6 – 4
  • 25th September – 2.6 – 4
  • 26th September – 2.6 – 4
  • 27th September – 2.7 – 4
  • 28th September – 2.9 – 4
  • 29th September – 2.8 – 4
  • 30th September – 3.3 – 3
  • 1st October – 2.6 – 4

Note.

  1. I usually measure my INR, when I have a bath at eight in the morning.
  2. I usually take my Warfarin around three in the afternoon.

I do this so that I don’t test my INR too close to taking the drugs.

Note too how the INR rose on the 28th of September and stayed high or higher for two days.

I don’t think I ate anything that would cause the INR to rise and the weather was getting more humid. So was that the cause, or was it the fact that I had a hair-cut on Friday night?

Why should I blame the haircut? After I came out of hospital my hair looked like Einstein’s and it felt very dry.

So do I normally lose water from my body through my hair? Trying to find a connection on the Internet is a nightmare, as they assume I’m asking about hair loss.

I’m not worried about myself, but suppose you are having regular INR tests in hospital every few weeks.

Would a false reading mean that you ended up on the wrong dose?

Conclusion

I will continue to test my own INR, as I feel it is easier.

October 1, 2019 Posted by | Health | , | 2 Comments

Preparing For A No-Deal Brexit

I am doing a few things to make sure, that I survive a no-deal Brexit, as unscathed as possible.

Savings

I keep all of my spare cash in Zopa, moving it in and out as required. Effectively for about seven or eight years now, I have used the first peer-to-peer lender as a high-interest, thirty-day access deposit account.

It has probably paid around five percent before tax in that time and it has safely ridden the peaks and troughs of governments and financial instability.

Today, I calculated how much cash, I need in my current account to see me through to end of the year, and the spare money was tranferred to Zopa. It was a fast painless transaction and now it is available to lend to Zopa’s customers.

Warfarin

Warfarin stops me having another stroke.

As it only comes from Eastbourne, I suspect supply of this comment drug.

But I have enough to last me to until Summer 2019.

INR Testing

I test my own INR, which determines the Warfarin dose.

Today, I ordered enough test strips to get me through to Summer 2019.

Beer

Every time, I go walking around London, I take a large bag, that can hold up to eight bottles of my favourite beer from Marks and Spencer.

Supplies from Adnams in Suffolk seem good at the present and I usually liberate a few from a boring life on the shelves on every trip.

As with other products, I aim to have enough to last me through to Summer 2019, at a rate of three a day.

November 30, 2018 Posted by | Finance, World | , , , , | 2 Comments

In And Out Of The Angel

The area around Angel tube station, is one I visit regularly.

 

  • I shop in the same Marks and Spencer, Boots and Woolworths, that my grandmother used before the Great War.
  • Woolworths is now Waitrose.
  • I visit Chapel Market, as she probably did.
  • I often walk close to where my father was born and past the church where my grandparents married.
  • Perhaps, once a week, I’ll buy myself lunch or dinner in the area.
  • I regularly, use the area to change buses or get on and off the Northern Line.

It’s also an area of memories of life with C and the children around 1970, when we lived in the Barbican and we’d regularly walk up the hill with the children to shop at Marks and Spencer.

But not at the moment. This article on the BBC is entitled Angel Islington flooded by water main burst.

These are pictures I took of the traffic. Or lack of it!

 

There are no buses from Dalston to the Angel, so the only way to go is to go South to Old Street or Moorgate stations and then get the Northern Line up to the Angel.

At least the buses are running the other way, so I can get home easily.

It is a pain, but it will be sorted.

Yesterday, I had to get to Boots to pick up my Warfarin and the pharmacist did as usual, ask me for my yellow book.

I don’t have one, as I see the GP every three months or so, have a chat about my INR and he writes a prescription, which is electronically sent to Boots for me to collect.

To show how stable my INR level is, I’ve now been on 4 mg. a day of Warfarin for over three years now.

Discussing this with the pharamacist, I told her, I put this stability down to being a coeliac on a gluten-free diet.

There are some hints at research in this area at eminent Universities, but with my experience, it seems that if you are on Warfarin, a gluten-free dietmay help to stabilise your INR levels.

 

December 10, 2016 Posted by | Health, Transport | , | Leave a comment

Keep Taking The Medicine

On Sunday, I usually fill up my daily pill-boxes.

I use my old Coaguchek strip containers, which each box having the pills for one day.

Eleven White Boxes

Eleven White Boxes

If I find that I can’t get seven sets of pills, like last Sunday, I know it is time to get my boots out and go to Boots for some more.

The great advantage of individual boxes, is that when I go away, I just take an appropriate number of boxes – two more than the nights I’m away.

Counting out the pills has been a lot easier, since my doctor decided that one pill wasn’t needed any more.

So now, I just put 4 mg. of Warfarin (one blue and one brown), a statin, two other drugs and two vitamin pills in for each day.

I check my own INR and have used 4 mg. a day, for a couple of years now and it tends to hover around the 2.5 level, that I need.

I test myself bi-weekly and only if it is below 2.2 or above 2.8, do I take any action.

Usually, I just stick to the 4 mg. and retest the next day. Very often, it has bounced back, as it was probably something I ate or drunk. Or it could be the weather, as the INR can rise in sun or fall, when you get back to miserable weather.

Some doctors may not like that I choose my own level of drug, but setting the level, is just the sort of problem for which I have a B. Eng degree in |Control Engineering from Liverpool University.

Some of the regimes, I’ve had from doctors and their systems, are pretty complicated and I suspect quite a few patients get confused.

 

November 20, 2016 Posted by | Health | , , , | 1 Comment

Do On-Line Advertisers Waste Their Money?

I monitor my INR using a Coagguchek device. And very good it is too!

But how many times a week do I get an on-line advert for the device? I’ve not counted, but it must be many.

Why does on-line advertising, preach to the converted?

Google needs a better algorithm!

October 22, 2016 Posted by | Computing | , , | 2 Comments

Rain, Beautiful Rain!

I’m feeling so much better today and it must be the break in the weather.

My face and beard doesn’t feel so dry, my gut would score at least 9/10 and my nails feel like real ones. The muck pouring down my throat has eased too!

Strangely, my INR was 2.8 on Wednesday, 2.7 yesterday and 2.1 today. It goes up and down with the weather.

March 25, 2016 Posted by | Health | , | Leave a comment

Warfarin And Lansoprazole

As I said in this post called Fasciitis In My Foot, I’ve got fasciitis in my right foot.

It wasn’t going away so my doctor prescribed 500mg. of Naproxen, night and morning, together with 30mg of Lansoprazole first thing, as I’m on Warfarin.

Normally, I take 4mg. of Warfarin a day, but when I am on other drugs, I test my INR regularly to make sure the drugs aren’t affecting my levels.

After a few days, my INR had gone up from its normal level of around 2.3-2.7 to around 4. So obviously, the new drug combination was raising my INR.

I solved the problem and brought the level of Warfarin down to 3mg. After a few days, my INR had returned to around 2.5.

That was a few weeks ago, but the fasciitis has refused to go away, so I am now back on the Naproxen/Lansoprazole combination, but with only 250mg. of the Naproxen.

My INR has jumped in the same way, but as before reducing the Warfarin dose to 3mg. has brought it back to normal.

I am drawn to two conclusions.

  • The Lansoprazole raises my INR,
  • Regular self-testing of your INR usually picks up problems.

This is very much a repeat of my experiences of taking Terbinafine, which I wrote about Interaction Between Warfarin And Terbinafine. Although that drug dropped the INR.

 

December 29, 2015 Posted by | World | , | 1 Comment

INR Testing Around A Simple Procedure

A couple of weeks ago, my dentist found a small lump in my mouth,so he advised getting it removed and tested to see that it was nothing serious. The procedure was booked to take place on Thursday, the 30th of July and he advised me to make sure my INR was lower than 2.4 and not to take any Warfarin on the day before. Obviously, he didn’t want me to bleed too much, especially as the position of the lump made stitching impossible.

My INR had been 2.6, 2.5 and 2.6 on the Sunday, Monday and Tuesday, taking my normal dose of 4 mg., which as I take it most days, is unsurprisingly my average dose.

On the Tuesday, to lower te INR slightly, I cut my dose to just 1 mg., with the consequence by Wednesday morning the INR had dropped to 2.3. As the doctor had said no Warfarin on the Wednesday, my Control Engineering training said that could drop the INR below 2. So I just took 1 and the INR was 2.1 on the day f the operation.

After the operation, as I wasn’t bleeding I took 3 mg of Warfarin, but by the Friday morning my INR had dropped to 1.6, so that evening I took 6 mg. On the Saturday morning, the INR had gone up a bit to 1.7, so to nudge it towards the desired value of 2.5, I took six that day.

In the week of the operation despite changing the dose to control my INR, I sactually averaged 3.8 mg. over the week.

Since then I’ve taken my normal 4 mg. and my INR has been fairly steady around 2.4.

I think this exercise shows the value of self-testing your INR. Admittedly, I was employing my Control Engineering training and experience to give the doctor what he wanted and keep my INR at a reasonably safe level, but the ability to self-test regularly around an operation must make things better for everybody concerned.

The doctor told me afterwards that I hadn’t bled too much, but then when I’m cut by a professional as opposed to torn in a fall say, I don’t seem to bleed much!

In the end, the lump had been removed and I heard today, that it was totally benign.

 

August 10, 2015 Posted by | Health | , | 3 Comments

INR Results Of A Coeliac Using Warfarin And Taking Terbinafine

This graph shows my INR a period between the 20th of May and the 25th of June.

INR May-June 2014

I should say that I have a degree in Control Engineering from Liverpool University.

My aim here is to keep my INR between two and three, with a target value of 2.5.

Since starting to self test, I normally take around 4 mg. a day of Warfarin, but I have found that five is a better dose for when I’m taking Terbinafine, which has been prescribed by my GP for a fungal infection. The drug is well-known to affect the action of the Warfarin.

So now I take 5 mg. unless the INR is 2.8 or more. In which case I reduce the dose from five to four. On the other hand, if the level is 2.2 or below, I increase it to six.

The average INR value for the period shown was 2.6 with a standard variation of 0.2.

The peak at the beginning of June may have been caused by a B12 injection  or hot weather. Both of which seem to raise my INR.

You will notice that the INR went up around the beginning of June. I can’t be sure, as I don’t have the dates, but this may have been caused by having a B12 injection.

June 25, 2014 Posted by | Health | , | Leave a comment

Interaction Between Warfarin And Terbinafine

A few weeks ago I was prescribed a course of oral Terbinafine to clear up a fungal infection. It seemed to work well, except that there is still some of the tinea in my toe-nails.

But over the time, I was taking the drug, I have felt that my INR was constantly wanting to slip downwards towards and below two.

Luckily I test my INR daily, and use a simple control algorithm to calculate my Warfarin dose. Normally, it is 4 mg, but if it goes below 2.3, I increase it to 5 mg, and if it goes above 2.8, I reduce it to 3 mg. So the algorithm got me taking a lot of 5 mg doses as opposed to the usual4 mg.

Only since I finished the course of Terbinafine has the INR stabilised around 2.5, which is my target value.

I didn’t at first see any link until everything settled after the course finished.  But I decided today to type “Warfarin Terbinafine interaction” into Google. I found this paper from the BMJ entitled Drug points: Serious interaction between warfarin and oral terbinafine.

I think this minor incident shows the value of regular INR testing! Because I was testing daily, as the INR started to drop, my algorithm told me to increase the dose to 5 mg.  In fact my average dose has gone up from 4 to 4.5 mg. in the period that I was taking the Terbinafine.

So there was no harm done at all!

April 25, 2014 Posted by | Health | , , , | 2 Comments