drama: inr

Through the Roof
  • Hematopathologist: So what are the problems that you can see in this patient's blood work?
  • Student: It looks like the INR is through the roof. (Blood work = 2.1; N = 0.8-1.2)
  • Hematopathologist: Um...yes, it is elevated but I would not really call it 'through the roof.' When I think 'through the roof' I think an INR of say, 20. That would be through the roof. I would say that the INR is on the second floor.
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Branding job I’ve been working on today, multitasking & crossing things off the ever growing list. Logo & type design for new design/media collective, INR Circle. Straight away we agreed on the design being based around a circle & the 3 letters in all caps, a solid, strong look. Be good to see how things develop.

anonymous asked:

During nursing school rotations, I had a patient who required heparin injections. I noticed slight bruising on his abdomen before administering the medication, made note of it, and proceeded. The next day there was significantly more bruising, and I initially hesitated giving the heparin. His clotting time and other labs were all within normal limits, and after the advice of my preceptor, I gave the medication, and nothing bad happened.

Q: Why was there so much more bruising the second day? I don't know how common this is, if at all.

Thanks, doc!

Hello there, International Nurse of Radical!

Well it’s been years since I’ve had to use heparin (not a huge demand for it in my urgent care, haha), but from what I recall, the beauty of using heparin (or Lovenox, low-molecular-weight heparin) to prevent clotting issues is that it flushes out of the body pretty quickly. So, while the local tissues around the injection site can commonly bruise pretty dramatically, the lab test results will likely be normal the following day. It would require a continuous heparin infusion to keep the clotting labs altered.

If any of the other nurses or hospitalists following my blog want to contribute more to this issue, please use the Disqus box below!

185

Alright, I have no excuses. I finally joined a gym. Thunder thigh, spare tire, your days are numbered. Its tone time! I’m not trying to get ripped and swole, just comfortable and healthy! Maybe some arm and leg definition… Anyway, I’m going to try to eat regularly and see where it gets me.
Joined the gym today but can’t go until Thursday morning because I have an 8:30 doctors appointment tomorrow.

8/15/11
184.4 lbs
~28.1 BMI (overweight)
1.5 INR

3 weeks have passed

Since I last had the guts or energy, time, patience …etc etc to update you. But now, I’ve screwed us both cause not only do I have to freaking write another book because I didn’t update you - you have to now read it. 

forgive me?

A week after posting last, my next INR check was at a 2.2.

Finallllyyyyyyyyyyyyyyyyyyy.

I felt like for once, maybe this dosage was right. That I didn’t have to continuously, every week return to the doctor. I know its bad cause I don’t even have to check in at the front anymore, they just pull up my charts as soon as they see me walk in. 

The week after, we are looking for a stable INR of 2.2 or even higher. If I match the previous week’s INR, I could keep my dosage of a 8.5mg everyday. My INR turned out to be a 1.7

Oh f off coumadin. 

Baffled again, doctors and nurses who crowd around the nurse’s station to see my results are heartbroken. I get bombarded with a million questions about my diet and what I am doing.

Because basically anything that is green in color has Vitamin K. I was told specifically to not eat massive amounts of greens. I was cleared by multiple doctors I was going to be able to consume small small amounts if I chose. And we’re talking like less than a half a cup of greens for the whole week. 

If anyone has ever been told not to do something or eat something, you know what comes next.

The incredible urge to do it.

Now I am not saying I went into every restaurant and ordered every salad on the menu and shoved it in my mouth. But if I wanted a little lettuce on a sandwich or burger, I had it. When I explained this to the doctor, she agreed with me that such a small amount of the greens should not be affecting me this much, but to nonetheless pay more attention to my consumption to absolutely make sure that it is not the greens. My dosage was increased to a 9.0mg everyday. 

Last week, once again - hoping for something good. I was once again disappointed by an INR of 1.9. At this point, the doctor feels like raising my dosage everyday might be too much and to alternate dosages. 

Now she suggested this to me in the beginning and I HATED the idea that my medicine wasn’t going to be consistent and that I would now have to be 1000% vigilant of what my dosage was going to be every night. This time around, I feel like I have no choice. It’s already been about 8 weeks of hell. 

My dosage is now 9mg for 5 days out of the week and 2 days 10mg. 

More importantly, on Tuesday the 8th, I went and saw a Hematologist ( a blood doctor ). I had been waiting for this appointment for over 2 months. I had a series of blood work ups done to let me know if my blood clotting is genetic. This is extremely important to know since this will probably be the answer to the question I’ve had since the beginning of this whole mess. 

Will I have to take blood thinners for the rest of my life? 

My Hematologist was amazing. He was so incredibly smart and gave me a good pre-prognosis concerning the meds. He basically said pending the results of the additional blood tests, since it was an induced pulmonary embolism, he wouldn’t suggest me on blood thinners forever! 

BUUUUT 

this is all pre-blood test speaking. If the results come back for positive genetic susceptibility to blood clots - then we’ll have to revisit the idea of a blood thinning regime . . for forever. I have a follow up on Tuesday, I’ll make sure to update appropriately. 

Hopefully. 

Which finally brings us to Wednesday. My weekly INR check up! I was super excited about it because I felt like the raise in the Coumadin would definitely throw me over the 2.0 range. 

1.9

Yes, I said it. 1.9 

AGAIN, did not even change a bit. So the doctor suggested this week, to not have any greens AT ALL. Not even a bite, a taste, a lick - NOTHING. It seems that my body must be extremely sensitive and that my minimal greens intake is just affecting it to the point where its totally stunting the medicine. 

a kid’s dream diet.

So thats that. I promise not to write any books of this sort anymore because it must be long and laborious for you to read as it is for me to go back into my memory and type. 

I guess, I’ll just update in a few days. Or maybe I’ll sneak in a non-related medical post tomorrow about my puppy, Chewie. 

maybe.

L

WebSeries: Jules and Monty

This webseries is absolutely beautiful and if you have not watched this, you should go watch it now (click here)! A warning… there may be some spoilers but I’ll do my best to keep those to that which is true to the play and not that special to the series. (Side Note: You can check out my iNR video here)

Jules and Monty is a modernized retelling of Shakespeare's Romeo and Juliet. It was written by the two actors who play Jules Caine and Romeo Montgomery, Imogen Browder and Edward Rosini, directed by Evey Reidy (who plays Nancy Mills) and Andy De Leon, and was produced by Tufts University TV.

I loved the way that the writers weaved in some of Shakespeare’s beautiful language. I think having the language placed in the moments of being “in love” or when the characters were inebriated worked quite well and definitely makes the original text accessible to those who do not understand it initially. It also makes it sound a bit more natural in the sense of today’s society. The frat feud was well played as representation of the Capulets (Kappa Alpha Psi) and the Montagues (Mu Tau Gamma).

Notes on the Characters (In Order of Meeting Them in the Series)…
Romeo “Monty” Montgomery - In comparison to Shakespeare’s Romeo, I like Monty better. Monty is goofier and nowhere near as whiney as Shakespeare’s. I liked the fact that in the beginning Monty was trying to be true to whom he was dating instead of whining about how she isn’t interested in him. I like this less hopeless of a romantic version of Romeo.

Rose - I liked how the writers gave the character of Rosaline a shot at being a character instead of someone who seems more like a figment of the imagination.

Mercutio “Mark” Matthews - Definitely just as amusing, if not more than Shakespeare’s Mercutio. When he first appeared on screen, before his name was mentioned, I thought he was going to be Benvolio. I like having Romeo and Mercutio as roommates though. I think it adds to the bond between the characters.

Nancy Mills - I loved Nancy’s sass factor! It made her a character of comic relief and I always found myself cracking up at her super sassy moments. Having this character be a nursing major helps establish that she is meant to be “The Nurse”. I really liked the bond between this character and Jules and how well it was established from the beginning.

Juliet “Jules” Caine - It was really cool seeing Jules grow throughout the series. In the first episode that we meet her (Episode 2) you see how sweet natured she is and how uncomfortable she is in front of the camera - which is normal for most who are starting to vlog. By the end she is very comfortable in front of the camera and is determined to finish what she started.

Tybalt “Ty” Johnson - We don’t see a whole lot of this character, but what we do see I’d say that it is very similar to what is shown of the character in the play. Ty is cocky and confident, but he still had that sense of family responsibility that Tybalt is meant to have. I also like the connection between Ty and Nancy. I think it adds to the story.

Cliff Caines, The Lord of Kappa - Again, a character we do not see very much of. I feel like there was a lot of foreshadowing to what this character does in the end. I know I felt like he was bad news once he truly had screen time. Definitely an interesting take on Lord Capulet.

Pierre - I know this character’s purpose was to fill the Paris slot. Making him from Paris was a clever way to do that. I just don’t remember Shakespeare’s Paris being so much of a creeper. I don’t know if that was the writers’ intent, but I found the character to be a bit of a creeper in the series. Especially towards the end of the series.

I know I left out a few characters, but I didn’t really have anything to say about them, so that’s why.

The Music… I loved all of the songs that they included in each episode. I think it fit each one well and added to the experience.

Camera Notes… The way that they created the vlog style appearance was well done. It definitely had the feel of one who has never vlogged and walked before and the framing got better as the series progressed as you would expect to see as someone is learning the art of vlogging.

To sum all of this up, this beautiful webseries has stolen my heart! It was a perfect balance of literature and modernization. If there was absolutely no cursing (or at least significantly less) I would say that they should show this in high schools when they teach the play. It might actually interest the students a lot more than any movie adaptation or even reading it themselves and they might actually understand it. Anyway, everyone should go check it out! Go! It’s good, I promise!

vimeo

Iron & Resin x Sons Of Trade Introduce The Terrain Pannier