Swiss cheese brain update 30/10/08
Well the district nurse came early this morning (before 10am) to take a blood sample to check my INR, so the sample should go off in the first collection to the hospital at lunch time, and I should get the result back this afternoon all being well. I tried to do a test myself just after the nurse had gone for comparison, but my fingers weren’t playing, so I had to wait until after I’d been in the shower when my hands were warmer.
I’m still not sure I got an accurate result though, as I think from the rate at which blood was dripping from my finger, rather than just a nice blob forming, that rather than hitting a capillary I accidentally hit a vein. I managed to get the first big drip onto the test strip though, and it was well within the 15 second limit from lancing to getting it on the test strip. I’m not sure if it was a vein I hit rather than a capillary whether it’d make any difference to the result, but according to the result I got my INR’s now bang on 2.0. I suppose the test will be if the lab result comes back the same. A jump of 0.8 in 2 days is a lot even for me though.
I know in the past it’s always taken a hell of a large dosage to get me back within the therapeutic range initially, but I also know my INR has a tendency to be very unpredictable – sometimes it only takes a tiny change in my warfarin dosage to send my INR either way up or way down, and in the past I’ve even had to have 0.5mg tablets with the standard 1mg, 3mg and 5mg ones to keep it even. I guess part of the problem is that 50% of my Factor V is normal, and 50% of it’s abnormal, lacking the protein that stops the clotting process. I suppose theoretically that the sample could have just happened to have either a lot of the normal, or a lot of the abnormal Factor V in it (I’ve no idea whether it works like that though), but nothing really’s changed to affect my INR that much.
I have reduced my painkillers, but they shouldn’t have any effect on my INR – they’re not drugs which are particularly known to affect INR. The one that does affect my INR a lot is the gabapentin (though I’m on a steady dosage of that), and the anticoagulation clinic always used to say that they always had trouble controlling the INR of people on gabapentin. For some reason it just seems to make INR very unpredictable when you’re on gabapentin. I’ve been very good and resisted the temptation to have a vodka and tonic though (both of which thin blood) to try and get my INR up, and I’ve not been eating any differently, but I have just started a new pack of both 3mg and 5mg warfarin tablets. There was an article in Anticoagulation Europe’s (the UK charity for anticoagulation and platelet therapy) newsletter a couple of months ago about different brands of warfarin, and although theoretically there’s supposed to be a standard amount of the active ingredient in each tablet, they have found that there are variations between the different brands, and that some people can be very sensitive to even small variations in the amounts in the tablets if they’ve been getting one particular brand and then suddenly the pharmacy dispenses a different brand. Anyway, we’ll have to wait and see what the lab result comes out at.
On the positive side, I’m now more or less back on my standard painkillers (which are for my back and other problems, and not particularly IIH), and last night, and this morning….no headache! Wooooo-eeeee!!!
My balance is still off, but I haven’t been feeling quite so dizzy this morning, which is a good sign. Considering I’m still less than a week post-op, I’m feeling pretty good. I’m not really doing much except a bit of pottering around the house and watching daytime TV, and the real test comes when I start doing more, but this is probably the best I’ve felt so soon after a shunt op, so fingers crossed my 2.5 shunts between them are doing their job and will continue to do so!
