warfarin dose advice

[mully]

Hi I've written here before about how when I changed GP (after a house move)

My GP refused to reinstate my prescription for warfarin which I have taken for 18yrs

It's been 2 yrs (without warfarin I have had a swollen leg and recently and a TIA and my DR has been told in no uncertain terms by the stoke specialist to put me back on warfarin for life

So he reluctantly phoned and has told me to take 6mg Saturday and 6mg Sunday then visit the GP surgery Monday

I wont see him for 7 days after that and they will not allow self testing

My question is Isn't this rather a high dose I thought you were meant to start low and slow after 4 days find a baseline and then work up from here to desired INR level I dare not quiz him at the moment

Thanks for any replies

[mully]

AH Ha just found the answer to my own question 6mg is OK so he may be horribly negligent hanging up on me in the middle of a stroke because he was angry that I couldn't speak properly his words were "pull yourself together or I will hang up" and he did haha

[HollyHeski Administrator in reply to mully]

Hi, can't help with the warfarin but just wanted to say well done in sticking to your guns and getting put back on.Really not happy to hear a GP hanging up on a patient- can you change?

I had a fall out with a GP and wrote in requesting to change, due to a difference in my care plan. Dont have to be nasty but I don't hold much confidence with this one of yours.

[lupus-support1 Administrator in reply to mully]

I would report him. I am being serious. You were in the middle of a stroke that could have been far more serious. This doctor could do this again not only to you but to someone else. He should be reported to the GMC - the General Medical Council.

This isn't about retaliation, but he is a danger to patients.

Be well!

Ros

[mully in reply to lupus-support1]

Thanks for all the replies As soon as GP surgeries start taking new patients I will change practice I have only spoken to my GP 3 times in 3 yrs so hardly a troublesome patient but this last time he was just so horrible he had never met nor read my notes but told me stroke is painless and it sounded like trigeminal neuralgia partway through the call the pain became so severe I could no longer talk so he told me to pull myself together or he would hang up he rang back 3 times over the course of an hour and spoke to my husband asking can she talk yet (has she pulled herself together) My husband explained I could not move my left side see out of my left eye and couldn't talk Not once did he suggest an ambulance on his last call my husband said I am going to call an ambulance and the DR said they were very busy and I would be wasting their time as he was convinced it was trigeminal neuralgia Amublance arrived gave me aspirin and morphine and surprise surprise it was a stroke

[LindaMorrell in reply to mully]

Oh my how shocking. I do understand talking to some doctors is like walking on egg shells. Keep looking for a better doctor stay positive you will get there

[Bagpuss01 in reply to lupus-support1]

I too would report him, that's outrageous. You do need to stick to your guns. My first stroke, I was dribbling, face slant, unable to lift arm, confused. Went to my doctor and was told it was migraine, and given pain killers. Then 4 days later it happened again. Went back again said at 39 I was too young to have a stroke, it was a migraine. This time I refused to move from my seat until he referred me. Guess what, the MRI showed a stroke.We know our own bodies, they don't always.

Good luck.

[justlymostly]

I think 6 is fine for starters, definitely find another GP who knows about haematology if not Aps. I hope things improve for you soon. x

[dottiedoris]

OMG, I’m so sorry to hear that you’ve had such bad treatment at the hands of your GP. I think my sentiments echo everyone else’s on here. You must change GP’s ASAP and report him. Whether he’s competent at warfarin dosing or not, then the fact that there's so little faith in him is enough to be asking to get dosed at your local hospital instead or via the community team - is this something that can be done in your area? If not, ask to be referred to a haematologist. If your GP won’t, then you can either speak to your consultant that treated you at the hospital or pay for an initial private appointment then switch back to the NHS (this absolutely can be done!). In terms of the stroke - it’s interesting to see how many of us have had them - I too had a stroke at 36 and it was put down as a hemiplegic migraine as apparently I could see lights (when I got home I realised the light was from the tv!). 10 years on my face still droops when I get tired.

[WendyWoo50]

I’m so sorry u had that experience. If u r ever in doubt ring an ambulance as opposed to ur GP. I’d change GP ASAP

Do u have a Haematologist? I think it would be a good idea to find a good one in ur area. Maybe ask for suggestions.

I started on 5mg of Warfarin, I eventually took 20mg to attempt to keep my INR around my target of 4. (Most APS patients do better with a higher target INR)

Please take care and find a good specialist 💋 x

[GinaD]

"First: Do no harm."???? Yep. Time to officially complain. Again -not just for yourself, but for others.

[BTR1963]

Your GP sounds about as useful as Harold Shipman. I’d find a new GP ASAP and report him to the BMA.

[mully]

Thank you for your replies No local GP's are taking new patients at the moment I presume because of covid As soon as things open up again I fully intend to change GP Then let the war begin I have recently discovered that an unnamed doctor (so far) Falsified my notes and signed to say I had had an extra-long new patient consultation on joining the practice and a face to face consultation to discuss my medication every 6 months None of this happened

[KateEsq]

Are they not doing bridging therapy with heparin to restart you on warfarin? I believe there can be a counterintuitive risk of clotting when stating warfarin without bridging therapy.

Six mg sounds fine to me. It's been a while since I've been restarted on warfarin and I require an unusually high dose of warfarin to stay even in the 2-3 INR range, so I'm not the best person to gauge. I'm currently on 20 mg a day and for over a year was taking 35 mg a day.

My other concern is that waiting seven days after your first INR check seems a little too long to me when restarting warfarin. I believe I was going in twice a week when restarting warfarin until it had reached a stable number. Then it was once a week or maybe every two weeks if it was really stable. However, it might be due to covid precautions that they only want to do it once a week.

I hope everything goes well and I wish you luck and fortitude in dealing with that doctor. May a better doctor come your way soon!