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Im wondering if and what the corolation is between INR level and Mental state.
My grandfather is in a memorey care unit. The Dr has had a hard time getting his INR numbers into the normal range and keeping them there. This is an ongoing issue that i am dealing with trying to correct. If it wouldnt be so tramtic I would consider moving him to another facility but that isnt the point of the post.
So my grandfathers INR has gotten very low (below 1.0) it has also gotten quite high (over 4) and every where in between. I have noticed that when his number is low that he is much LESS confused, much more logical and more like his old self (tho not really his old self) . The higher his INR is the more confused and irrational he becomes. He plans and plots thigns (like he is going to move home and comes up with the story he is going to tell the staff to be allowed to leave) much more while he has Higher numbers, he lies. When his numbers are in the normal range he is still confused and still lies and make up his escape plans. but its not as bad as when his number issuper high.
He is sneakiy and lies and tricks people. He somehow managed to see a comercial for a stairlift on tv (i guess the comercial plays on the tv alot), write down the number, call the company and schedule an appointment for them to come to his condo (that he moved from into the memorey care facility) to talk to them about putting a chairlift in, then he called one of his buddies and asked him to pick him up tomorrow and take him to his condo because he is being discharged soom (he isnt being discharged) and needs to meet with the stairlift people. The friend was caught off guard and aggreed. And called me after he hung up with my grandpa because he wasnt aure what was going on and wanted to find out.
The friend is going to call an hour before the time he is supposed to pick him up and tell my grandoa he is sick. the friend had asked what company when he spoke to my grandpa so i was able to call and cancle the appointment and ill have a friend call and pretend to be the company and say they need to cancle.
His INR was 3.8 2 days ago.
No - high INR should not cause a sudden behavioral change that goes away when the INR goes back down.
High INR is very dangerous though and can cause bleeding in the brain. Disaster. Bleeding in the brain can cause weakness, confusion or behavioral changes, but it wouldn't go away quickly.
Is he in the hospital or an assisted living facility? It is EXTREMELY DANGEROUS to have fluctuating INR like this. Who is managing this? You must talk to his doctor as this cannot continue. Either someone is messing up his medicines, or not checking his INR frequently enough. People on Coumadin must be careful and consistent with their medicines and their diet as both of these can effect the INR. Or it may be too risky to even have him on Coumadin.
My father is on Coumadin. We check his INR every week at home. We watch the INR carefully any time he changes his dose of any other medicine. Jumping from INR 1.0 to 4 is really dangerous.
There is one possibility..... Is someone giving him medicines intermittently that affect his behavior? If so, these might be affecting his INR. For example, if he becomes very agitated, maybe they give him a medicine that calms him down... And maybe this medicine makes his INR drop as an I intended side effect. Then his behavior improves, and they stop this calming medicine .... So his INR goes back up, and he gets more agitated and We cycle again....
Hope this makes sense.
Unfortunately dementia can fluctuate, so chances are the behavior doesn't have anything to do with the INR.
It doesn't jump from the high to the low. It slowly swings from low to high. Like each blood draw it creeps up and up and up. And eventually it get way to high then it drop down and goes lower and lower and lower each blood draw.
The dr is an idiot is all I can figure. I've talked to the nurses many times but it doesn't seem to be helping.
Before he moved to this memory car facility his INR was managers over the phone by his hospital with had an anticoagulant department and his blood draws were done at his dr. When his number would increase or decrease a little he would have more frequent blood draws. But when his numbers were staying the same he would go up to 6 weeks between inr's.
Now it's done weekly by the staff. They draw his blood. Then call the dr (that comes to the facility once a week.) and give him results over the phone and he tells them if they need to change the dosage or not. They only call when above 3 or below 2. Which is stupid IMO.
The hospital department that used to monitor his INR won't do it if the person lives in assisted living facility.
I guess I need to start composing louder and to more higher up people about his INR.
My guess is the dr has several facilities where he is the dr that goes to the facility once a week or whatever. And he has way to many patients and is doing a half ass job. So that he can make more money.
At least since the changes are happening slowly that is a little less dangerous, but then it is even more disappointing that people aren't noticing trends and fixing things before they get worse.
I would ask to speak to the doctor. Ask when he/she will next be at the facility. Ask - why is the INR so unstable, and are any of his medications interacting with coumadin and describe the behavioral changes. I would use words like "danger", "bleeding risk and blood clot risk with unstable INR". They say that coumadin is one of the most dangerous medications that exist and is responsible for a large percentage of Emergency Room visits. You don't want your father to wind up there.
Does your Dad still have a primary care doctor that he sees outside of the facility, or a memory doctor? Why is your Dad even on coumadin and who wrote the prescription? I would bring this issue up next time he is at one of these doctor's appointments and tell what is going on. It is time that THOSE doctors that know your father better think about a change, and they can write the prescription/change in plan to the doctor in the facility. Maybe he shouldn't even be on coumadin anymore and should take an aspirin every day. Or maybe he should be switched to one of the new medicines that thins the blood like coumadin but is more stable and you don't have to check the INR every week. Or maybe he is on another medicine that is interacting with coumadin and causing all this problem and the doctors need to figure out how to make it stop.
This is now becoming too dangerous for your father. And there are other options.
And unfortunately, this happens all the time in facilities. They are all understaffed, people are burned out and overworked. You have to be vigilant for your family members.
He needs a better doctor. I think he needs anxiety meds or something IF HE"S that way regardless of the INR.
IF YOU SEE THIS CHANGE WITH THE INR NUMBER ELEVATED DO NOT TAKE NO FOR AN ANSWER FROM HIS CAREGIVERS. SOMETHING IS CAUSE AND EFFECT and it's not "his condition" or anxiety.
My client gets bad on sugar AND if she eats junk all night. You cannot TAKE her in the morning and she is more delusional and has lots of dreams.
I don't know about INR numbers but I do know that you can get a doctor to see him in the memory care if you can find one. And those docs usually work with a nursing agency to do the bloods etc. Did you sign something that prohibits that?
EVERY single person blamed "the disease progression" for my client's behavior. Family, friends, doctor, nurses, her ALF.
IT WASN'T IT WAS A UTI JUST LIKE I KEPT SAYING FOR FOUR MONTHS.
My client's ALF allows private care but it's not a memory care center.
Just like I had to become a UTI expert for my client, you have to become an INR expert now.
It took me FOUR MONTHS to get a proper urinalysis culture done and FINALLY, just as I predicted we found out that the class of antibiotic she was on was wrong for her specific bacteria.
She has since gone back to last Sept stage of dementia instead of acting like a zombie or on LSD while they were giving her stupid low dose wrong treatment OVER THE PHONE.
This sounds environmental to ME, not his body. Something they're doing or not doing or doing wrong.
There's still a lot of debate on the subject of statin drugs (for high cholesterol) and memory impairment but I for one have seen it happen to an elderly couple I once knew. The husband had been put on Lipitor, a few months later, he started forgetting names, dates, addresses. Doctors started him on Aricept or some other memory enhancing drug yet he continued to get worse. He started to forget his wife's name, what he was doing, where he lived. The progression was nearly so complete, the wife had to consider placing him into a memory unit. In desperation, they tried doctor after doctor until one finally suggested at there was an outside chance this could be caused by his cholesterol meds.
Sure enough..........within a month after stopping, memory started to improve and after 6 months, he was almost back to normal. In the meantime, several doctors had told her to just prepare for the worst.......it was all just the progression of his misdiagnosed Alzheimer's. If she'd taken those earlier doctors at their word, her husband would have spent the remainder of his days lost in space and her alone.
Moral of the story: Doctors are human, they don't know everything, they don't even understand the exact mechanism of half the drugs the prescribe. If something just doesn't feel right to you, follow your instincts and keep pushing the search. The right answer isn't always the most convenient one.
My experience is that the nursing home doctors who visit many different homes are not really that good at individual patient care. It's not great they won't allow personal doctors into the places. Are you allowed to take him out to see his old doctor? If so, do that, even if you have to pay for medical transport, and ask about this problem. Take the test results along. Maybe he will change the medicine.
There's still a lot of debate on the subject of statin drugs (for high cholesterol) and memory impairment but I for one have seen it happen to an elderly couple I once knew. The husband had been put on Lipitor, a few months later, he started forgetting names, dates, addresses. Doctors started him on Aricept or some other memory enhancing drug yet he continued to get worse. He started to forget his wife's name, what he was doing, where he lived. The progression was nearly so complete, the wife had to consider placing him into a memory unit. In desperation, they tried doctor after doctor until one finally suggested at there was an outside chance this could be caused by his cholesterol meds.
Sure enough..........within a month after stopping, memory started to improve and after 6 months, he was almost back to normal. In the meantime, several doctors had told her to just prepare for the worst.......it was all just the progression of his misdiagnosed Alzheimer's. If she'd taken those earlier doctors at their word, her husband would have spent the remainder of his days lost in space and her alone.
Moral of the story: Doctors are human, they don't know everything, they don't even understand the exact mechanism of half the drugs the prescribe. If something just doesn't feel right to you, follow your instincts and keep pushing the search. The right answer isn't always the most convenient one.
Best of Luck
O.M.G. Just when you think you've heard it all, or that you're "tough on them" or whatever...you hear something like this.
I'm in shock, really.
And yes, I also think it's because they don't see the patient all the time or really know them. So it's just too easy to write it off as "the condition" in the 15 minutes they allocate.
My client fell with her UTI. (she never falls unless she has one.) She complained about pain behind her ear where she landed on her head after shattering the entire glass end table.
They took her to the ER (without me) but KNEW they were supposed to do a urine culture when they got there. (they being the CNA that went who works at the ALF)
NO tests of any sort not even a Cat scan and sent her back with a "diagnosis" of "fell".
He has a PCP that is about 45 mins away, which is fne. i can drive him there but his PCP is about to retire and has cut his days down to 2 times a week and it sooo hard to get an appointment with him.
The coumidian was perscribed by his cardiologist, who i like alot and i feel is a great dr. We are actuall wanting to explorer some other options but before a decision is made his Cardiologist wanted to preformsome sort of out patient procedure so that we are better able to choose a plan of action. but to do the procedure he wants my GF inr to be in the normal range and be consistantly within the range for several weeks. Which doest seem to haappen. his cardiologist was not happy with how his numbers had been so up and down and made a oder to have my GF start to be monitored thru the hospitals anticoagulation like he used to be.(his drs and hospital are all thru the universty of michigan) but the anti coagulation departm,ent wont over see people that are in assisted living facilites.
runswithscissors we have an appt coming up Aug 8th with neuro physc and i plan to deff talk to them then about axeinty meds. he deff is having problems with axeinty.
He has a PCP that is about 45 mins away, which is fne. i can drive him there but his PCP is about to retire and has cut his days down to 2 times a week and it sooo hard to get an appointment with him.
The coumidian was perscribed by his cardiologist, who i like alot and i feel is a great dr. We are actuall wanting to explorer some other options but before a decision is made his Cardiologist wanted to preformsome sort of out patient procedure so that we are better able to choose a plan of action. but to do the procedure he wants my GF inr to be in the normal range and be consistantly within the range for several weeks. Which doest seem to haappen. his cardiologist was not happy with how his numbers had been so up and down and made a oder to have my GF start to be monitored thru the hospitals anticoagulation like he used to be.(his drs and hospital are all thru the universty of michigan) but the anti coagulation departm,ent wont over see people that are in assisted living facilites.
runswithscissors we have an appt coming up Aug 8th with neuro physc and i plan to deff talk to them then about axeinty meds. he deff is having problems with axeinty.
Here's the problem: You don't have anyone there who can really see what's going on.
The cardiologist should have enough experience to be able to tell you if this is a "normal" problem or something odd.
These patients won't always take their meds. Especially "ON TIME".
My client was famous for that initially, for a few months.
NOW, I don't know much about the blood thinner family, but it stand to reason that if they are not getting his medication administration right, that there may be issues in his levels and readings.
I've seen NURSES leave my client's meds on HER TABLE and walk out.
They are NOT supposed to do that, they KNOW she's paying for ADMINISTRATION meaning WATCHING her take them on time (or getting her to)...
AND I'VE SEEN THEM CHART IT AS HER TAKING THEM WHEN IN REALITY THEY DIDN'T SEE HER TAKE THEM AND SHOULD NOT BE CHARTING IT.
I remember this Coumadin debate with him months ago I think before he went to memory care and that idiot ER doc was "counseling" you that it may be better to "yada yada yada" when it wasn't even his place to do so.
So I really don't have any issue with the coumadin etc. My mother took it and had no problems with levels AND SHE HAD A STROKE 3 DAYS AFTER STOPPING IT because she insisted on some elective surgery and that was the end for her. A year wasting away in skilled nursing after that stroke before she died.
So THAT IS KEY. NO STROKES!!! I live in fear of my client having a stroke WITH dementia and having to live in a prison of her mind where she can't communicate and probably just has to be doped up forever to keep her from her brain torturing her. How would you even KNOW if they had mental issues if they can't speak? I don't even wanna think about it.
My issue is when there's a MYSTERY it needs to be figured out and it's hard to do so. IF indeed it is a mystery.
Because like you said, it's impacting his entire quality of life if spiking levels are making him anxious and FIXATED.
Fixations are common and that's when the calming drugs need to be considered to give them some relieve from that fixation.
For example, if nobody was monitoring my clients junk food, (any why WOULD you, really, it seems like a simple benign thing)...they wouldn't have known that she pigged out and ate a POUND of crap all night long and wasn't able to sleep and had crazy dreams that made her delusional when she woke up. They would just say "oh its the progression of the disease".
But tracking her history of this happening regularly we KNOW why it happened now (my mistake for leaving all that junk accessible). I knew she ate it because I prepared the ONE POUND mix and left it in the cabinet at 7PM when I left and by morning it was almost completely gone PLUS two or three other things like these Gerber baby yogurt oatmeal servings I store in there for something to "snack" on. A couple of times she's even eaten the dog's food (LOL) but at least it was the small topper packages that are primarily chicken in salmon juice so it's protein!
So two days of TWO Ativans per day instead of one (one in the evening at bedtime) worked on her and now the fixation is gone.
For now.
Just telling you all this to illustrate how some micromanaging is necessary and even THEN, you're not too sure of everything. It's your best instinct so follow YOURS.
Since he can afford it what about getting a visiting nurse/CNA to go there and monitor his stuff? But it's a big challenge to build the rapport AND see exactly what's going on. They should be there EXACTLY when his meds are due, too. To watch him TAKE THEM. (just a GUESS here).
Maybe he refuses. Maybe HE THROWS THEM OUT. It's not unusual. They think it's better to die OR they think someone's trying to kill them, or they think the nurses don't know what his doctor REALLY said, or whatever delusion they come up with at the time.
Maybe they'd get some info IE your MOTHER calling or showing up instigating or whatever.
Last edited by runswithscissors; 07-21-2014 at 06:39 AM..
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