The answer as to why my INR was low yesterday….. the beginning of a flare. Today I was hit with spells of dizziness that landed me back at Dr. C’s office. Dizziness was one of the things on the list he told me I should return before Friday if I started experiencing. So when I started having dizzy spells this morning around 11 I called and got his last available appointment at 4.
I spent the day between the before the appointment taking it easy. Doug and I watched How To Train Your Dragon, ate lunch and assembled my Medical Bracelet that finally arrived. Stay Tuned for a separate post dedicated to it! I continued to have dizzy spells throughout the afternoon, even after eating, and making sure I had adequate fluids. We thought it might be my blood pressure dipping too low so we checked it at one point and it was 123/77. Yesterday at my appointment it was 130/86.
Doug and I got to Dr. C’s office and went in after Mellow called as he got off work. I signed in and we sat down to wait for the check in process. A little later I was called up and one of the ladies signed me in. It never fails when this lady checks me in she argues with me over if I have a copay at their office or not. Even though she can clearly see on their copy of my card I have no copay for my PCP. The convo this afternoon went like this
Receptionist: “Do you have a copay today?”
Receptionist: “Are you sure?”
Me: “Lady I’m here at least every other week, I’m pretty sure I know what my copays are.”
Receptionist: “Are you here for a physical?”
Receptionist: “Are you sure?”
Me: “You can see the reason for my visit on your screen.”
Receptionist: “Are you sure you don’t have a copay?”
Me: Blank stare on my face
I’m usually a lot nicer and chattier with the front desk ladies. Dizziness does not make for a friendly version of me though. The lady that usually checks me in was quietly smirking behind this lady at our exchange. At one point she mouthed, ‘I am so sorry.’ Finally she finished her line of questioning and printed off my paperwork for the nurse and let me go sit back down. Which was great, because I was starting to get really dizzy standing there, and I told her that a couple of times. It would not have been good if I had of fallen out in the floor.
A different nurse processed me for this appointment, a nurse I had never worked with. I’m so use to Cindy, Dr. C’s main nurse that it always catches me off guard when a different nurse calls my name. She came to the waiting room says “Nicole” I just sat there assuming she was asking for someone else. After several seconds in a more urgent tone she goes “Nicole Davis!” Oh that’s ME! Doug and I stood up and followed her to the scales. Weight was down a lb from yesterday. Then off to the room we went. No fever, good sign. Pulse was okay, O2 was good. BP was 116/77, even lower than it was earlier in the day. I mentioned to the nurse that Dr. C probably wanted my INR checked and she said she would go ask Cindy. She left said that he was running a little behind and told me to be patient and hang tight. We are good at entertaining ourselves while waiting in the rooms at appointments so it was all good.
We were busy chatting when Doug pointed out that my butterfly rash had returned. My face had felt warm for a little while, I took a look and sure enough there it was across both cheeks and bridge of my nose. A few minutes later we heard Dr. C ask Cindy if they had gotten an INR on me, they told him no and in he came. “What happened?” ……Wait is this a repeat of yesterday? “I missed you so I came back.” I blurted out. Yea I’m an awkward individual. Then I told him about the dizziness and he pointed out the butterfly rash, asked about the level of joint pain which were hurting a good bit. Then he asked if I had increased the amount of time I was spending in the sun over the last few days, activity level, and questions about other known triggers of Lupus flares. He then said Cindy would be in to get an INR and that if it was any lower than it was yesterday we would be doing a Lovenox Bridge while we rebounded to my target range. I was so happy he brought this up because if he hadn’t, I was going to suggest it myself. He said other than that we were looking at doing another round of steroids because it was becoming evident we were dealing with another Lupus flare. Why on earth my INR drops like this when I flare, I have no idea but it’s a definite pattern that we have documented.
He went out to take care of another patient or something while Cindy came in to check my INR. To our surprise it was 2.7. It was up a whole 0.4 points from yesterday! When Dr. C got back to the room he said luckily we didn’t have to do the Lovenox bridge, but we would keep that in mind for future dips like this. He did tell me to go ahead and do the extra day of 17.5mg tonight as planned. Then I go back to my regular doses the rest of the week. It was the end of the day so he sat and talked to me a bit. He gave my medical bracelet his stamp of approval. He also is sending a referral to another Dermatologist that accepts my insurance. Apparently the one my Rheumatologist wants me to see doesn’t take my insurance, even though my insurance says he does, that makes no sense to me. The appointment at least calmed the worry that my INR had fallen even lower than it was yesterday, confirmed that I was flaring again, and allowed us to discuss a few things at a leisurely pace since I was the last patient there for the day. It’s up to me if I want to take Prednisone or if I want to ride this flare out since it’s not as severe as my last one. We will see how I feel tomorrow and I’ll make a decision about the steroids for tomorrow in the morning. They come with their own risks and issues so we try not to use them unless I absolutely need them.
He told me I could either keep my INR check on Friday, move it to monday and he’d be fine with that or I could move it to Tuesday, but he wouldn’t be all that happy with that but it was up to me. I am leaving it on Friday and we will go from there. I left out a bunch of things. I’m tired and my brain isn’t processing properly. I guess after being on a tilt a whirl all day that is to be expected.