Tag Archives: Monitoring INR levels

To Thin or Not Too Thin Part 2

If you don’t already know about the saga of my DVT (deep vein thrombosis/blood clot), please check out my first blog posts:  I’ll take a little “rat poison” with that!, Be Careful Around Sharp Objects, and To Thin or Not Too Thin (Part 1).

As in To Thin or Not Too Thin (Part 1), I apologize for this post seeming a little too long or rambling.

My doctor walks into the room. She is wearing a lab coat over a very smart outfit and carrying a small laptop computer. To my relief she does not walk directly over to the sink and lather up with the antibacterial soap! Instead she immediately tells me that her MA has advised her of my numerous allergies and sensitivities. She asks me if my mask helps and if I need to wear it year-round. I tell her that I wear it year-round but only in public where I need to protect myself from chemicals in fragrances and cleaning solutions. She also asks me if I have ever had a diagnosis of Mastocytosis (one of the mast cell diseases, is a rare disorder of both children and adults caused by the presence of too many mast cells (mastocytes) and CD34+ mast cell precursors). I tell her that I have not.

The doctor (hematologist) sits down with her laptop on the exam table and faces me while I sit in the chair. She beings discussing the ultrasound report from my right leg. The report leads her to believe that maybe this DVT was not new and perhaps in the final stages of healing (something my internist told me when I also had him review the report). I tell the doctor that my father had recently passed away and that I had spent three weeks sitting at his bedside in the hospital and later in a hospice house. I spent as many as ten hours sitting by his side during the night. Based on my history, she believes that this is most likely the cause of the clot. Also if this clot was not a new one, it is possible with all the stress I was under and the grief I was going through that I did not pay any attention to earlier pain or symptoms. The doctor tells me that she is going to speak to the radiologist and see if they can determine if it was an older DVT or truly an acute thrombosis.  It was possible that I might not need any more Warfarin or in the worst case scenario I would need a low dose of Warfarin for three months (not six months). I discussed with her the doses given to me and my intuitive feeling that I needed to take a lesser dose. She agreed that I was correct.

We then began going over my lab results. I had three lab results that had me scared about my DVT and the possibility of future DVT development. The first lab she goes over with me is the Factor Five mutation. She tells me that since there is only one copy and because I am not a smoker or taking hormones, there was very little chance that this was the cause of my DVT. The doctor then discusses my MTHFR mutation. Again since I only have one copy of this she does not feel that is a factor in my DVT. Lastly she discusses my Protein S lab. Even though my level is below the norm (which can also happen during a DVT episode) and because I had a test years earlier saying I did not suffer from Protein S Deficiency) it also was most likely not a factor in my DVT and my Protein S Antigen Activity was normal. We will recheck my level a month after I have discontinued the Warfarin and see what it shows. 

The doctor orders one more lab for me to have done before we meet again in a week (this coming Friday). I am asked to have a D-Dimer (is a fibrin degradation product (or FDP), a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. It is so named because it contains two crosslinked D fragments of the fibrin protein) and we will discuss the result of this, my next INR and the conversation with the radiologist at my appointment.

At the end of the appointment the doctor asks me when I had my most recent mammogram and if I had ever had a colonoscopy. I explained the colonoscopy issue (just the breathing the stuff one has to drink makes me ill) and my issue with my entire vein swelling and becoming hot and hard with a catheter. She suggested that I should just do a stool specimen for blood and if I should do the colonoscopy that I should go to a University Hospital like Stanford or USCF where they could better monitor me for a reaction or an issue. She was adamant that I not have one done locally as they would be totally unprepared to deal with any issues that might arise.

All in all I feel that the wait and all the over stimulation I enjoyed during the visit was well worth it. This doctor was knowledgeable, quoted the most recent findings on DVT and Warfarin, and completely understood my sensitivities (or at the very least did not make me feel uncomfortable). I am thrilled to have her as my doctor and as the one to manage my Warfarin and INR levels, which I am now only doing once a week.