My INR For August 2013
As August is now finished, I can show a graph of my daily INR tests for August 2013.
My INR For August 2013
The average INR for the month was 2.5 with a standard deviation of 0.3. This is well within the range of 2 to 3 and the average was spot-on the target of 2.5.
Having once been told by an eminent cardiologist, that if I got the Warfarin level right, I probably wouldn’t have another stroke, I try to make sure I get it right.
What is interesting is that my average Warfarin dose for month is exactly 4 mg. a day.
The more I look at these results, the more I believe that daily self-testing is the best way to control INR.
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.
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?
Do We Sometimes Push Technology Too Far?
I like proven technology, as often some of the things done fifty years or so ago, may not have been very good at the time, but somehow over time they have proved themselves to be reliable and economic.
The classioc is the Inter City 125 train, introduced as a stop-gap in 1976. But it is only one of a number of classic designs, that just never get replaced.
A personal old idea that affects me is Warfarin, which I take every day to thin my blood and stop myself having another stroke. There are more modern drugs, but I’ve heard cardilogists say that now is not the time to change, as we don’t know enough about the side effects of new drugs yet.
And that is the crux of the matter! When anything has been used for years, we have a vast knowledge base to make sure, that it doesn’t bite us or even worse.
So I was rather pleased to see this report that says the new Airbus A350 will use more traditional batteries than the Boeing 787. Before you use new technology in something as critical as an airliner, you must prove it as thoroughly as possible.
The problem with proving aircraft parts as compared to that of says cars, buses or trains, is that the aircraft leaves the ground and does other things land-based machines don’t.
I remember, my next door neighbour in London, when I was a child, a Mr. Gibbon, saying that if Ford wanted to test a new truck axle, they’d fit a few in trucks and give them to a contractor, who was known to break anything. If he couldn’t break any,then it was probably a better axle. But you can’t give aircraft to bad airlines and let them do the testing!
What worries me about these plane batteries, is how many other new ideas are incorporated, that haven’t been completely tested? Aviation is littered with mistakes, where new designs have failed.
On the other hand, look at this wing of the baby Airbus 319/320/321, on which I flew to Stockholm.
Airbus A320 Wing
Go back twenty years or so and the design of a wing would be similar, but you can see developments like the wing-tips, that make the wings more efficient, have now become commonplace.
Holy Crap
This product got a plug on Have I Got News For You, tonight.
I thought it was a spoof, but if it is, the web site is a masterpiece of misleading information.
It is actually a gluten-free breakfast cereal. The product page is here and I only have one problem with it and that is that it contains cranberries, which are a no-no if you are on Warfarin.
My other problem might be putting on a lumberjack shirt and high heels to eat it.
An Afternoon Of Rhinitis
Yesterday was fairly typical of what I go through. My nose seems to run from the time I get up until I go to bed.
An Afternoon Of Rhinitis
The picture shows all the tissues I got through in a couple of hours.
It used to be bad when I was a child, I can remember my mother constantly boiling up handkerchiefs on the stove, both for myself and my father, who was similarly effected.
But it’s never been as bad as this.
It seems to have started when I was in hospital in Hong Kong, and it just seems to be getting worse and worse.
Could it be long term effects of the Warfarin?
Rat Poison And Sprouts Don’t Mix
This cautionary tale about mixing brussels sprouts with anti-coagulant drugs, like Warfarin, should be noted.
The trouble is that I like my sprouts, so I’ll go easy on them over Christmas.
I think though, I’ll do a before and after INR test.
I feel a bit of scientific research coming on!
Offering Pineapple on the Tube
Coming back from Oxford Street today, I took a bus to Euston, where I picked up my supper in the Marks & Spencer there.
I had read somewhere that pineapple chunks are good when you have a dry mouth like I have, so I bought some to have with my supper and keep in the fridge to snack on.
There were signalling problems when I got to the Victoria line and by the time the train moved off it was very hot. So I took out the pineapple chunks and ate a few.
I offered them round and there were no takers.
When I got home, I then had a thought that they might react with my warfarin. They don’t.
92 Clubs – Day 45 – A Day Off
I had to visit the doctor for my Warfarin check, so I took the day off.
Perhaps, I’m slacking, but I only have three more clubs to visit.
92 Clubs – Day 38 – A Day Off
This was another doctor’s day, essentially to have my INR levels checked. But there was a machine failure, so I’ll have to have them checked next Monday.
I should say that my INR levels and Warfarin intake has now been the same for nearly eighteen months.
The Anonymous Widower 