Saturday, October 27, 2012

Battle of Blood

Fiorella took on the medical establishment yesterday, although it wasn't supposed to be that way.

First, a little background.  Because she has an artificial heart valve, Fio takes coumadin, and her blood "thinness" level, or INR, is closely monitored so it stays between 2 and 3.  In preparation for any surgery, though, she lays off the coumadin so her blood will be thicker and she will heal better.  After the surgery, the coumadin is started up again, although it takes three days for each pill to register.

It's a balancing act: supplying Fio with enough coumadin that her blood will be thin enough that her valve won't clot vs. keeping it thick enough that the new surgery won't bleed out.  For instance, when Fio had the facelift, the coumadin was resumed too enthusiastically so her INR shot up to 3.9, way too thin, and she had a lot of swelling.This wasn't a situation she wanted to repeat so she was pleased when she learned her INR would be regularly monitored as she started up the coumadin again after her hip surgery.

Now comes the drama.  Fio's INR on Tuesday was something like 1.2 and she's been taking a larger than usual dose of coumadin since then.  So, yesterday, ever mindful of that 3.9, she decided it was time to have her INR checked by the Home Health people .  They were agreeable, but couldn't reach the coumadin nurse who was supposed to okay their trip to Fio' s bedside.  Fio couldn't reach her either.  A couple of hours later, Fio called the cardiologist's office and explained the situation.  The coumadin nurse finally called Fio and said she hadn't been able to the cardiologist.  Fio told her that she understood that the nurse herself could okay the INR. but the nurse insisted that the earliest the INR could be checked was Monday.

Fio gave up and prayed that her INR not explode over the weekend.  An hour later, though, she got a call from the Home Health people saying they'd been authorized to come by this morning. God only knows what went on behind the scenes, but this morning Fiorella eagerly awaits the arrival of the finger-prickers.

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