INR Swing

[Freddie]

If green veggies bring your INR down and alcohol helps in keeping your INR in range, what foods (if any) work in the same way as alcohol.

Without changing my dosage - 4 weeks ago my INR was 2.8, Two weeks ago it was 2.4 and today (Wednesday) my INR was 3.4. All tests were done by the lab and I've increased my intake of greens and activity in the past two weeks....this just doesn't make sense to me. I even asked the lab tech "are you sure thats right?" She laughed and said "yes".
I'm confused.....again But then again what else is new.

 

[greg]

Freddie,
The clue might be in the increase of activity. I had some increased readings a while back that were traced to a healthier diet and weight loss. It was explained to me (on this sight) that coumadin is fat soluable and therefor less fat for the coumadin means more for the blood, or something like that.
I've recently started a weight lifting program and am seeing the same type of change. My body has traded in some fat for muscle and my INR, that used to be stable in the 2.5 range, went up to 3.3 on Tuesday.
There are a lot smarter people here than me to correct any bad info I've given you. I bet you will hear from them soon.
A good anti-coag plan might be to eat lettuce and drink Jim Beam......

 

[Philip B]

Range

Range

I'm not sure where the idea about alcohol keeping you within range comes from. I don't agree with that part of your post.

One of the biggest factors in your INR is your metabolic rate. In other words, how quickly your body metabolizes coumadin. Yes, what you eat and drink affects INR. Personally, I find that how much physical activity and exercise I do has a bigger effect on swings in my INR than what I'm eating or drinking.

Like you, I've gone for several weeks consistently within range and had a swing occur for no reason that I could think of. Lots of things can affect your metabolism.

-Philip

 

[ctyguy]

I have been told to look at it this way. The good things you do (exercise, eating veggies) lower your INR. Bad things (alcohol, laying around) raises it. Im still new to the game, 11 weeks post op but my INR has been pretty much in range for the last 8 weeks. At my last check my INR had gone from 2.4 to 2.0 so they bumped my coumadin UP by 10%. In the last few weeks I've been alot more active, running 3 times a week, working out in the yard, and eating more salads as I've noticed the weight I lost due to the surgery has been creeping back on again.

Hope that helps some...

 

[catwoman]

Rain -- one of our longtime vr.com members -- has joked, halfway seriously, that INR stands for It's Never Right.

Prescribing information for Coumadin lists alcohol as one of the exogenous factor for both increased and decreased INRs.
Perhaps it depends on how much you imbibe, what kind of alcohol (wine vs. beer vs. hard liquor), if it's on the rocks or straight up, if you get extra olives (after all, they're green!) in a martini, if a Blood Mary is made with V-8 (which supposedly has vitamin K) or with plain ol' tomato juice, etc., etc.

 

[dick0236]

To: Freddie

To: Freddie

If you figure out a way to maintain your INR level within a NARROW range, please let the rest of us know . Most physicians are comfortable with a range 2.5 to 3.5. That's 3.0 +/- 20%. The tolerance is 20% because the medical profession knows it is not necessary, or possible, to always stay in a close range. For me, 2.5 to 3.5 is my target and unless I get outside, <2.3 or >3.8, I don't make changes.

I've been on the INR system since its inception. I have had good habits and bad habits, been employed and retired, gone thru a bunch of spring, summer, fall, winter seasons, been active and a "couch potato", ate balanced and unbalanced meals. With all the variables in life, it is difficult to single out what causes INR to fluctuate. Go with the flo. Good judgement is the key.

 

[cjune1961]

INR Swing

I have been on warfarin for 15 months and it is never right! My range is 2.5-3.5, lately have been tested with finger pricks in the lab monthly, I graduated, two months ago was 2.4, last month was 2.5, this past week was 2.0. Nurse told me to increase to 15mgs on Tuesday the day of the test and 10 mgs on Wednesday, 7.5 the rest of the week. Previously was 7.5 every day. Was this the right way? I go back next Tuesday, and she said to take 7.5 six days and 10mgs on Wednesdays for awhile, she said my body got used to the dosage I was taking and needed a change. Too many ups and downs, I thought I was doing okay and do not like this monthy checking. And to kick it, I was just told I could start eating small salads and portions of green vegetables recently, have not had any up until two months ago after my avr surgery. I do not exercise so much except for up and down stairs at work, trying to work on that, and do not drink alcoholic beverages.

 

[Cooker]

Narrow window is impossible for me......if I can stay between 2.5 and 5.0 I'm happy....3.5 is my warm fuzzy but everyone is different

 

[catwoman]

cjune1961:

Your body does not "get used to a dosage" and need a change.
Perhaps the nurse meant that a dosage works for you because of various factors (food, meds, Rxes, activity level, any concurrent illness/disease, age) and suddenly there's a change in one of the above, or you forget to take your rat poison or you err when putting your pills in your weekly pillbox or .... and the list goes on.
If she really does mean that your body "gets used" to a dosage ... , aarrgghh!

 

[KristyW]

Too many ups and downs, I thought I was doing okay and do not like this monthy checking. :

Cjune

If you are on Warfarin for a mechanical heart valve, you should NEVER check your INR less than once a month! A few of our members check every six weeks, but many many more check weekly or every 2 weeks. So that is something that you are going to have to come to terms with. As far as your INR...it is NOT a static number. You can do 2 tests within minutes of each other and get different results. Please try to think of this as a range. Most of us feel anything between 2.5 & 4.0 is acceptable, 4.0 - 5.0 means I should think about reducing my weekly dose by 5 - 10%. If I'm below 2.0 I immediately increase my dose 5-10%. 2.0-2.5...well, that's a retest in a week and see what's up.

I want you to please understand that you will need to have blood tests at least monthly if your INR is in range, more often if it's not for as long as you are taking Coumadin/warfarin.

I'm surprised that no one has told you this.

 

[Karlynn]

I have been on warfarin for 15 months and it is never right! My range is 2.5-3.5, lately have been tested with finger pricks in the lab monthly, I graduated, two months ago was 2.4, last month was 2.5, this past week was 2.0. Nurse told me to increase to 15mgs on Tuesday the day of the test and 10 mgs on Wednesday, 7.5 the rest of the week. Previously was 7.5 every day. Was this the right way? I go back next Tuesday, and she said to take 7.5 six days and 10mgs on Wednesdays for awhile, she said my body got used to the dosage I was taking and needed a change. Too many ups and downs, I thought I was doing okay and do not like this monthy checking. And to kick it, I was just told I could start eating small salads and portions of green vegetables recently, have not had any up until two months ago after my avr surgery. I do not exercise so much except for up and down stairs at work, trying to work on that, and do not drink alcoholic beverages.

Dosage adjustments should be made by taking your total dose for the week and reducing or increasing by a certain %, depending on how much warfarin you take and how far out of range you are.

Your manager bumped your dose initially, but she is then basically having you go back to your original dose for the week with only a 2.5 increase - which comes out to less than a 1.5% increase - so basically no increase at all. Since you are at or below the low point of your range I'd have done at least a 10% increase. I'd probably do 8/day to start.

The verbage that your manager is using with you tells me that she really doesn't know what she's doing. Kristy is right - you don't get used to a dose.

If anyone is telling you to not eat certain things, they are operating in the ancient world. (But unfortunately there are a lot who do.) Eat what you want, what you normally eat, and let our dose be adjusted accordingly. Most people's eating habits don't vary to the point where it greatly affects their INR.

I suggest you go to www.warfarinfo.com and start reading. Just a like a diabetic must learn why they do certain things and how to calculate their insulin dosage based on that, it's really in our own best interest and safety to be able to do the same with warfarin. It really isn't hard. Getting past the mind set that it's a dangerous drug that only trained professionals can handle
is the biggest hurdle. Once you learn - you'll wonder how so many trained professionals can get it wrong.

 

[KristyW]

The verbage that your manager is using with you tells me that she really doesn't know what she's doing. Kristy is right - you don't get used to a dose.

Actually it was Marsha that said that, but she's still right.

CJune...I'm very concerned about what you've been told. Do you have a mechanical valve? If so, did anyone explain how the testing works for INR? Did they tell you that you will need to have blood tests at least once a month when you are IN RANGE and more often when you're out of range for as long as you are on Coumadin/warfarin?

Maybe you should start a new thread. We're hijacking Freddie's.

 

[Freddie]

Don't worry about hijacking this thread.... its for everyone who has a concern regarding INR swing.
Me....I was curious what foods if any can "up" ones INR.

Please continue with this thread......inquiry minds need to know :

 

[Philip B]

Old Advice

Old Advice

Lots of previous posts regarding this topic give the same old advice: dose your diet rather than trying to control your INR with your diet.

As noted in a previous post, I run for weeks at a time within my range (2.5-3.5) and experience a low spike from time to time. For example, after running INR's within range for four weeks, last week's jumped to 5.1. A very small adjustment in coumadin dosage brought me in this week at 3.0. It's really much easier to adjust with dosage rather trying to manipulate it with what I eat or drink. Adjustments are no big deal.

-Philip

 

[cjune1961]

INR Swing

Freddie, I did not mean to barge in on your question. I have just been struggling with this for what seems like so long, and your post seemed to echo my questions. I was saying that I have been going to the lab once a month, if I dip on my number, then I will go back the next week or two. There has been a lot of miscommunication between the staff and myself apparently. I go in and tell them about what I have read on this site, and it has been helpful to understand the medicine and its new meaning in my life after having found valvereplacement.com. I have been to Al Lodwick's site and have printed out a wide variety of his answers to questions. Very helpful there too. Just as an example, I found out on here that increased physical activity leads to decreasing the warfarin, and I told my nurse and now she works around that and also my having started to eating more veggies. Also, I have a St. Judes mechanical. I do appreciate all of the input from here and hope to learn more. I do not have the same kind of problems or what led to some difficult symptons and surgeries as most of the people here and I thank the lord that my lot wasn't as difficult to deal with. This place is really an eye opener to the large array of heart conditions that people deal with. Sorry for being long winded and again, I am appreciative. Carla.

 

[Freddie]

cjune1961

cjune1961

Carla,
There is not need to feel that you barge in on my question.......this is what this forum/thread is for.... to ask questions.

Glad to have started it for you

 

[Susan BAV]

Well, I don't know that I will be able to find it if I look for it but I recall reading here--and I believe in an independent study elsewhere--that INRs are often more stable among people whose regular vitamin K intake is higher rather than lower.

Anyone else recall this?

 

[Ross]

I have been on warfarin for 15 months and it is never right! My range is 2.5-3.5, lately have been tested with finger pricks in the lab monthly, I graduated, two months ago was 2.4, last month was 2.5, this past week was 2.0. Nurse told me to increase to 15mgs on Tuesday the day of the test and 10 mgs on Wednesday, 7.5 the rest of the week. Previously was 7.5 every day. Was this the right way? I go back next Tuesday, and she said to take 7.5 six days and 10mgs on Wednesdays for awhile, she said my body got used to the dosage I was taking and needed a change. Too many ups and downs, I thought I was doing okay and do not like this monthy checking. And to kick it, I was just told I could start eating small salads and portions of green vegetables recently, have not had any up until two months ago after my avr surgery. I do not exercise so much except for up and down stairs at work, trying to work on that, and do not drink alcoholic beverages.

Others have said it, but I need more post count cause I'm lagging, so I'll post too.

First off, eat what you like in the amounts you always did pre Coumadin. Get your diet back to normal, then dose that diet. Never get caught up in the game of dieting the dose that your on.

Secondly, your INR might well have been fine with no change whatsoever. It fluctuates now and then and you may have just had a blah period or the test may have been wrong too. I think testing less then every two weeks, at least for me, is too long. I can get out of range pretty good in 2 weeks time. 1 month might be dangerous, at least for me. I know many people only test once a month, but I don't agree with it. If I'm anywhere between 2.0 and 4.0 I'm happy. My range is 2.5 to 3.5.

 

[KristyW]

I found out on here that increased physical activity leads to decreasing the warfarin, Carla.

Oops...that's backwards Carla. An Increase in activity will lead to a decrease in your INR, which in turn results in an increased dose of warfarin.

Freddie,
As far as consuming something that will increase your INR...it seems that mostly medications & some supplements will do that, most everything else that you consume will decrease it.

Now there are things that will increase bleeding time that does not affect INR, garlic oil, fish oil, alcohol & aspirin to name a few.

 

[Christina]

If green veggies bring your INR down and alcohol helps in keeping your INR in range, what foods (if any) work in the same way as alcohol.

Without changing my dosage - 4 weeks ago my INR was 2.8, Two weeks ago it was 2.4 and today (Wednesday) my INR was 3.4. All tests were done by the lab and I've increased my intake of greens and activity in the past two weeks....this just doesn't make sense to me. I even asked the lab tech "are you sure thats right?" She laughed and said "yes".
I'm confused.....again But then again what else is new.

Freddie... I.N.R stands for: "IT'S NEVER RIGHT"..