Wrist Injury

Whilst standing on a step ladder, i slipped and fell and landed fairly heavily on my wrist.  It was the sort of thing that's happened before, and will happen again - nothing too major.  Wrist hurt a bit, i was sure it would be fine the next day.

Unfortunately, due to my girlfriend being away, my diet had changed and my INR was up around 4.0.  So it decided to make a meal out of the injury.

It swelled up and turned purple in a really bad bruise.  I went to see the sports physio who checked it out and concluded it wasn't broken or fractured, and I should keep an eye on it.  7 days later it was on the road to recovery.

This shows how a minor injury, blunt force trauma type, mixed with high INR, can cause havoc.

Highest INR to date - 4.2

My girlfriend went off on holiday for 2 weeks and left me home alone.  This changed quite a few lifestyle factors that would affect warfarin.  I drank more alcohol in the evenings, either alone with the TV or out with friends ... and I ate much less vegetables.

The INR started climbing almost immediately, and sods law says that I had a pharmacy test 4 days in.   Just long enough for INR to get too high, and not long enough for me to have got it back under control.

The pharmacy had no record of the real history because they only record their own tests, and I keep mine secret anyway.  They looked up the algorithm of what to do in the situation where INR > 4.  The algorithm was quite different whether my range was "2.0 - 3.0" or "2.5 - 3.5".  Remember my range is a bit custom at 2.5 - 3.0.  She decided to go with the algorithm of "2.5 - 3.5" which recommended simply a small dose cut and wait it out.  The alternative algorithm for "2.0 - 3.0" recommended skipping a dose and then reducing the dose 10%.  I was sent home and told to reduce 10% and not to skip a dose.  I ignored this, skipped the dose.

On the next evening's test the 4.2 had dropped to 2.3 which was a tad low, but proves the algorithm had worked as it should.  I then pretty much left my dose as it was before and tried to eat a bit more greens!  At this point i'm typically consuming somewhere around 7mg or 8mg mark.

This shows the test results and dosages for the period, the worst period of time to date:

The Pharmacy and P.A.M.S.

Since the initial appointment with the hospital I had been promised that the administration of my warfarin could eventually be handed to the local chemist, under the administration of Boots Chemists, so that I don't need to travel to hospital.  I was told this could only happen once I was stable.

I filled in all the paperwork, and then phoned and chased to get it put through.  Nobody had any idea about it, then the paperwork was apparently lost.  I filled it in again, and this time was told I needed 3 stable tests to be put through. At this point, 1 more test to go.

Upon having that final test, I still heard nothing, then heard that they didn't use the process with Valve Replacements so I was stuck with going to the hospital.  This is a big deal because it's typically taking 90 minutes, plus travel of 30 minutes, at a time I have no control over - and this will be eating into work time once i'm back at work.

Then, out of the blue, i got a letter saying i'm accepted and should attend my local pharmacy!  Not sure where that came from, but I later learned that they had only just started accepting valve replacement cases.  My local pharmacy is less than 5 minutes away, and they can see me at 9am each time, so this is great.

On my first attendance, I immediately realised that this was a world apart from the hospital, so much better.  A more individual approach to each patient.  However, it was equally clear that the computer ruled the roost - all calculations were issued by the computer based on the test results entered.  As a result, it needed a bit of fudging, especially as it didn't accept my slightly custom INR range of 2.5-3.0.