Swiss cheese brain update 29/10/08
Improvement today though. Having forgotten to take my strong painkillers last night before I went to bed, today I dropped the dosage of my strong painkillers slightly, with no particular ill effects, and in fact tonight for a couple of hours now I’ve had no headache at all! Bliss!
Getting my warfarin dosage for today following yesterday’s INR test though has been rather a headache. There are only two doctors at the practice I go to, and one’s off sick, and it’s the other’s half day, leaving only the nurse practitioner on duty this afternoon. It was my own fault because I forgot to ring back this morning to find out my dosage (though the receptionist had already told me my INR was 1.2). Of course the nurse practitioner’s not trained in working out warfarin dosages (though I know she’s doing a course on it later in the month, as the anticoagulation clinic’s closing down early next year and all patients on anticoagulants will be transferred to being monitored by their GPs, so local surgeries are having to get themselves ready to take over the INR clinics) so she ended up ringing the hospital for their advice. We thought it’d probably be easier for her to get someone to talk to as a fellow medical professional rather than me ringing as a patient, but it still took her ages to get someone to talk to.
Eventually the answer came back that I should take 10mg tonight and have my INR checked again tomorrow, so it looks like I’m getting another visit from the district nurse, (who’s lovely anyway, and brought me loads of spare dressings yesterday, as the supposedly waterproof ones the hospital gave me are crap and come unstuck with the slightest bit of water on them if you’re not careful in the shower). I really should have been on 10mg for a couple of days re-starting the warfarin – though I think they probably said 9mg because they’d asked what my normal warfarin dosage is, and it’s been 9mg for the last couple of months, and I guess if they’re not particularly au fait with warfarin and FVL, and acting without guidance from haematology they probably thought that 9mg would be okay. Personally I’d think that with my INR currently so low, I could probably do with more than 10mg for a couple of days judging from previous experience, as it usually takes a fairly high sustained dosage of warfarin to get me unto the therapeutic range initially.
If I have it checked again tomorrow it’s not really going to reflect the higher dosage anyway, as it takes 48 hours for warfarin to reach it’s peak effectiveness, but I’ve got the district nurse coming again on Friday anyway to take the staples/stitches out, so I guess she can re-check my INR on Friday, or I can of course check it again myself. As I suspected, the test I did yesterday was way out with the delay in getting the blood sample on the test strip, but I want to try and do the same tomorrow and do a test at roughly the same time as the district nurse so we can establish whether I’m getting the same readings from my machine as from the lab tests. Hopefully it’ll have gone up a bit tomorrow though because otherwise I’m liable to find myself on Clexane/tinzaparin injections again, because my INR’s been well below the therapeutic range for over a week now, and if it’s too low for too long I’m at risk of developing clots, particularly as I’m not very active at the moment due to the op. *sigh*
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