We’re headed down to N.N. this morning. I have to get my blood checked. The PT-INR is the blood test that measures how quickly blood clots. My target is between 2 and 3, which is thin enough to discourage blood clots that could cause a stroke but not thin enough to cause nose bleeds or bruising or hemorrhaging of any sort. Most healthy people test at 1, which indicates that the blood is clotting as it should.
People who are in atrial fibrillation (A-Fib) have an increased risk of stroke because the heart is beating out of rhythm, and it can’t pump all the blood out of the upper chamber of the heart. The blood that remains behind pools there and increases the likelihood of blood clots forming which increase the risk of stroke.
I’m hoping that I’m on target today. This has been a little more difficult than I expected. I’m not accustomed to not getting results when I really throw myself into anything that requires discipline. It’s my strong suit. I can stick to something like glue once I make up my mind, and I’ve made up my mind. Still, this thing seems to elude me… at least in a consistent way, and the doctors want consistency. I need to be on target every week, not just once in a while.
Vitamin K (found in large amounts in leafy greens, broccoli, Brussels sprouts, etc.) reduces the effects of the Coumadin. I can have some and must have some vitamin K, but it has to be limited and the amount consumed must be fairly equal every week, otherwise I will not hit my target and the dosage must be continually adjusted. This is not good.
When I notice bruises in the shower, I wonder if my PT reading is too high – meaning too thin. When I don’t see bruises, I wonder if it’s too low – too thick. Then when I think I’m right on track, I’ll suddenly feel my nose running. I reach for a tissue and blow and it comes away tinged with a rosy hue – a reminder that my body doesn’t work just right anymore. That delicate balance has been corrupted.
I have a friend who has been on Coumadin for many years. He asked me to call him if it ever bothered me emotionally, and he would talk to me about it. I didn’t know what he meant, but now I do. I need to go to the dentist but I’ll have to come off the Coumadin. This scares me because of the risk of stroke. I know someone who went off the Coumadin for surgery and had a stroke.
This is something that I’ll have to deal with forever, but then I think of my sister and how she went to chemo treatments over and over for many weeks. She vomited constantly and lost 70 pounds and finally died but only after unbelievable suffering. That gives me perspective. This is not chemo or stage four cancer for heaven’s sake.
I did very well last week . I was right on target, and I’m hoping for a good reading today. The doctor told me I’ll be on Coumadin for the rest of my life, and once I’ve successfully regulated its effects, I’ll only have to be checked once a month. So I have to figure this out, and I’m the only one who can do it.
Herman wants to do it for me so much. I can feel it. Every week they give me a printout at the doctor’s office. It records my PT-INR reading and my dosage for each day of the following week. Herm saves every single paper. He has all of them. He keeps them in a folder and when he gets frustrated, he walks behind me with the folder, giving me his ideas of how we can fix this.
Herm knows how much vitamin K is in every vegetable now. He set his telephone to ring at 8:30 every night to make sure I don’t forget to take my Coumadin. He’s a bit of a helicopter, but he’s my helicopter and everybody should have someone like him. Herman makes me feel very much like the Velveteen Rabbit after he was loved enough to become “Real.”
So, I think I’ve had the right amount of vitamin K this week. Not too much… not too little. Hopefully I’ll be Goldilocks this week and be just right.
We’re off to N.N. now. Wish me luck.
Excerpt from Velveteen Rabbit or How Toys Become Real
by Margery Williams
After the Velveteen Rabbit asked the Skin Horse, “What is real?”
“Real isn’t how you are made,” said the Skin Horse. “It’s a thing that happens to you. When a child loves you for a long, long time, not just to play with, but REALLY loves you, then you become Real.”
“Does it hurt?” asked the Rabbit.
“Sometimes,” said the Skin Horse, for he was always truthful. “When you are Real you don’t mind being hurt.”
“Does it happen all at once, like being wound up,” he asked, “or bit by bit?”
“It doesn’t happen all at once,” said the Skin Horse. “You become. It takes a long time. That’s why it doesn’t happen often to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby. But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.”