More Info/Clarifications

Sort of in response to Magie's post of yesterday(?), I thought I'd clear up a couple of things.

INR = International Normalized Ratio

This is a calculated number based on a test for the time it takes your blood to clot. For normal, everyday, walking-around-healthy humans, this number should be around 1.0, but could be in the range of 0.8 to 1.2. The lower the number, the faster the blood will clot. This number will vary in that range on a day-to-day basis for everyone depending on their diet, liquid intake, and a number of other factors.  If a normal, everyday, walking-around-healthy person had an INR of over 1.5 (or under 0.8), their doc would definitely start paying attention.

For people with "clotting issues," this number needs to be driven higher with medications. Examples:

• As folks get older (and more sedentary and less cardiovascular and have more clogging in their arteries), they are more likely to develop blood clots. These could be in the form of Deep Vein Thrombosis (DVT) from sitting on that long drive or long flight to visit their grandkids or just sitting in their recliner feeling generally crappy for a few hours. This is why most docs have their elder patients start taking "baby aspirin" (81 mg) daily, because aspirin has an anticoagulant effect for protection from clots. The smallest of clots that get to the heart will cause a heart attack or, if they get to the brain, will cause a stroke.
• Folks with specific medical conditions such as Atrial Fibrillation (AF, like Rader Bob has experienced a few times) will be prescribed a stronger anticoagulant like Coumadin (aka Warfarin or "Rat Poison") to get their INR up into the 2.0 to 3.0 range. (AF tends to cause clots to form in the atrium because the blood is not being actively moved through the system.)
• Folks who have had heart attacks or bypass surgery will also be prescribed with anticoagulants to keep their INR up around 2.5 to 3.5.
• People with mechanical hearts will be given strong anticoagulants to keep their INR up around 4.0. (The mechanical heart is more likely to damage blood cells and induce clotting.)

So, with Rader Bob's history of AF and his INR down at 1.1, his doc has asked him to increase his dosage of Rat Poison and to get his INR checked again in two weeks.

Hope that helps!

s

30 Packets Have Been Used

Last night we applied the 30th packet of Aldara to Bob's left hand, left temple area, and head. The part applied to the hand was mixed with some Tazorac. As you can see from the photos, the pharmaceuticals have been doing a real number on the areas where they have been applied. As you could guess, the areas are quite tender and Bob is very happy to not have any more applications.

Today Bob had his INR checked at Dr. Galli's office and the reading was 1.1 where they want it to be between 2 and 3. (Dr. Galli may change his coumadin dosage but he was not in when the test was done.) That is probably why the displacement of a scab on his arm yesterday (when we went to the audiologist) caused blood to run down his arm onto his watch band. We were waiting for the audiologist to get back from lunch when I noticed the blood. Fortunately we were able to take care of things with a tissue and it has not bled any more.

Bob after 3 weeks of Aldera creme

On Monday, 29 June, Bob had an appointment with the dermatologist, Dr. Cho. By June 26 Bob was complaining mightily about the tenderness his right temple. He was occasionally having blood run down his face from the irritated area. At night he was getting blood on the pillow case. We finally switched to having a dark towel over the pillow case so minimize Magie's chore of washing the pillow case and zip pillow covers every day.

Dr. Cho loved the damage to the right temple of Bob's face (as in - hooray the creme is doing its job). So we can stop putting Aldera on that part and start putting it on the left temple area instead. He also gave us some samples of a gel called Tazorac to add to the Aldera being put on the hand since the hand is not reacting enough to the Aldera alone. Any Aldera left over in the little packet is to go on the left temple area and on the top of his head. We are to continue for 3 weeks (Monday through Friday) with the Aldera and Tazorac and return in 8 weeks. By that time Dr. Cho expects Bob's skin to have recovered from all these treatments. We are to call if there are any problems or questions in the meantime.

Bob's right temple was very tender so he is most happy to not have any more Aldera applied there.