Meat valve & warfarin

[ChouDoufu]

i'm 30 days with a new bovine valve, doctor has me on 4mg/day warfarin.
(actually acitrom, but same thing...) last two PT tests were 2.41 at
discharge (1/16), and 2.29 before returning home (1/31). my happy
range is 2.0-2.5, up to 3.0 is acceptable.

had my first pt test in china this morning, pt time 15.9 sec, pt @ 1.33
i'm assuming this is due to diet changes. (chinese food is loaded with
cabbage and soy and green tea) i'm doing most of my own food prep,
but then dosing the diet is impossible. i'm more of a "i've got a hankerin'
fer xxxxx" dieter. half gallon yogurt for breakfast, two pineapples for
lunch, two pounds stir-fry pea pods for dinner, and a pound or two of
oreos for evening snack. if not diet, maybe the test is invalid, which is
quite possible.

doctor has increased dosage to 5mg/day, with retest is a week.
he advised me to keep taking the imported medicine i brought back,
rather than buying the 2.5mg tabs at the hospital dispensary, which means
cutting them tiny pills into quarters....doable if careful. should have
enough to take me through the 90-day post-op period. only other
med is 20mg simvastatin daily.

for those of you experienced in all this.....does the 20% daily increase in
dosage seem reasonable? (i know, hard to say unless you try....another
test in a week and we'll see.) are people seeing better results upping the
dosage a bit on alternate days rather than daily?

 

[Ross]

Yes sir. It sounds correct. With Warfarin/Coumadin for mechanical valvers, we like to spread it out over the week as evenly as possible so that there is no one particular day that your higher or lower. For me, I take 7.5mg everyday except M-W-F in which I take 5mg on those days.

 

[Jkm7]

I have bovine valve and was prescribed coumadin for 90 days post op. I never reached my 2.0 - 3.0 range and my surgeon finally told me I could stop coumadin after 2 1/2 months. When I stopped, I was already taking 88 mg per week and was headed to higher. My diet, like yours, has tons of veggies and soy and I eat it consistently. My coumadin manager was a modern thinker and understands the drug. She agrees with dose the diet and never told me to stop eating my soy or veggies. She kept adjusting dose up, up, up and as I got more and more active, it was never enough. I think there was less stress about it as I neared the 2 to 2 1/2 month point as they all knew I would be ending soon.

 

[Bridgette]

I have bovine valve and was prescribed coumadin for 90 days post op. I never reached my 2.0 - 3.0 range and my surgeon finally told me I could stop coumadin after 2 1/2 months. When I stopped, I was already taking 88 mg per week and was headed to higher. My diet, like yours, has tons of veggies and soy and I eat it consistently. My coumadin manager was a modern thinker and understands the drug. She agrees with dose the diet and never told me to stop eating my soy or veggies. She kept adjusting dose up, up, up and as I got more and more active, it was never enough. I think there was less stress about it as I neared the 2 to 2 1/2 month point as they all knew I would be ending soon.

It doesn't matter if you take a seemingly "high" dose of Warfarim every day - you take how much you need to get/stay in range. For some people that could be 15 or 20 mg a day even. We're all different.

 

[Jkm7]

Intellectually I am sure you are correct it 'doesn't matter' how much you take. But let me share with you that for ME, it mattered a lot emotionally. It made me very uneasy no matter what anyone assured me it was the 'correct does'. It well appeared I would settle at something like minimum 100 mg a week and there was no making me feel comfortable with that.

If I have to take it in the future, it will be a problem for me unless by then someone can find the right thing to do/say to assure me it is safe and 'doesn't matter'. To me, it mattered a lot.

No one has yet said anything to convince me otherwise. ;( My ears seem unable to hear anything other than blah blah blah to the same mantra no matter how many times I read/hear it.

But that's my problem, and no one else's.

 

[Herb M]

Coumadin/Warfarin is safe as long as you stay within the prescribed range +/_ a few tenths of a point.

Yes it is also a rat poison and rats bleed to death, but they do not even stay close to any safe range. They essentially have a mass overdose of the drug.

I you check, you will find that people have problems with warfarin only if they do not stay close to their theraputic range.

 

[Ross]

Coumadin/Warfarin is safe as long as you stay within the prescribed range +/_ a few tenths of a point.

Yes it is also a rat poison and rats bleed to death, but they do not even stay close to any safe range. They essentially have a mass overdose of the drug.

I you check, you will find that people have problems with warfarin only if they do not stay close to their theraputic range.

And this is what so many people who are not on it, fail to understand. The likelihood of something drastic occuring if compliance is met is practically nil. People are too busy telling others that hitting their heads could cause them to die, being too low will cause them to stroke, making it sound as though this happens to millions everyday and it's just not true.

So for every 10 million prescriptions filled for warfarin, approximately 1 person died with the primary cause of death being anticoagulation.

Reference: Wysowski DK et al. Bleeding Complications with Warfarin Use. Arch Intern Med. 2007;167:1414-9

 

[Jkm7]

No, Ross. With all respect, that does not describe me.

Intellectually I understand I would not bleed to death if I cut my leg shaving in the shower. Had I suffered a severe cut/wound when on coumadin, it would have been a severe bleed even if I had NOT been on ACT. I know the right dose is the amount that keeps a patient in the correct INR range for them.

I know I could eat what I wanted providing I did so consistently.
I know a small cut is simply a small cut either on or off ACT.

But it is all blah blah blah to me when I am tossing down 17 or more mg per day.
I did what I had to do and now thank my lucky stars that for now, I am off it. It wasn't simple for me the way it is for you and others.

So your description about most people who don't take it not understanding the drug does not pertain to everyone..... it does not pertain to me. I understand the drug, the dosing, the lies and untruths about it and the number of medical professional who are ignorant re: coumadin. Still, all that boiled down to gibberish when I had to take so much of it.

If I have to take it in the future, I shall have to deal with it one way or another.


It is my problem, as I said...... no one else's. Everytime my coumadin manager raised my dose, I got more uneasy and no one could assure me there was no reason to worry. I worried.

I genuinely respect and admire those on very high doses who take it all in stride. It was very unsettling for me. (I realize there is no choice but to take the amount one must take.)

 

[Ross]

No, Ross. With all respect, that does not describe me.

Intellectually I understand I would not bleed to death if I cut my leg shaving in the shower. Had I suffered a severe cut/wound when on coumadin, it would have been a severe bleed even if I had NOT been on ACT. I know the right dose is the amount that keeps a patient in the correct INR range for them.

I know I could eat what I wanted providing I did so consistently.
I know a small cut is simply a small cut either on or off ACT.

But it is all blah blah blah to me when I am tossing down 17 or more mg per day.
I did what I had to do and now thank my lucky stars that for now, I am off it. It wasn't simple for me the way it is for you and others.

So your description about most people who don't take it not understanding the drug does not pertain to everyone..... it does not pertain to me. I understand the drug, the dosing, the lies and untruths about it and the number of medical professional who are ignorant re: coumadin. Still, all that boiled down to gibberish when I had to take so much of it.

If I have to take it in the future, I shall have to deal with it one way or another.


It is My problem, as I said...... no one else's.

I genuinely respect and admire those on very high doses who take it all in stride. It was very unsettling for me. (I realize there is no choice but to take the amount one must take.)

I didn't post that for you.

 

[Jkm7]

Okay,
Thanks, Ross.

In the flow of conversation, I thought perhaps your post could have pertained to my post just ahead of yours.

Sorry for misunderstanding. Doesn't change my messasge though.

 

[Karlynn]

I just had to say that every time I read the title of this thread "Meat Valve...." I laugh out loud.

 

[Bridgette]

I'm sure that, emotionally, most of us would prefer not to be taking any drugs at all - I know I'd be happy to be "drug-free".

But, faced with something like this I decided to make the best of it, research and learn, and stay positive about the whole deal. What other choice was there for me? (have/had AF as well as MVP).

I think that we should all keep in mind that Warfarin is literally a life saving drug, whether we like it or not....

And, as for the blah blah same mantra thing - I hear it a lot on this forum, and it's not just about ACT, it's about all sorts of things...tissue valves will last 20-25 years even in younger patients, catheter valve replacement will be available to all in 10 years etc etc...guess we just have to take a lot of it with a grain of salt until it is all proven beyond reasonable doubt, like anything really.

This post is not intended to be confrontational or directed at any one particular person, it's just my musings

Bridgette

 

[Ross]

The other thing thats sparked me and is eating at me is the loss of bassadict69's father. Bad things can and DO happen with this surgery. I know it's my problem, but it seems that too many are making this sound like an appendectomy and not heart surgery.

 

[ChouDoufu]

well, there it is. peapodses! 48 mcg vitamin K per 1 cup serving (160 grams)

soooo, a dinner of 1kg peapods = 300 mcg vit K.

 

[Ross]

well, there it is. peapodses! 48 mcg vitamin K per 1 cup serving (160 grams)

soooo, a dinner of 1kg peapods = 300 mcg vit K.

Throw the measuring idea out the window. It doesn't work. Just eat like you normally do and dose that diet.

 

[ChouDoufu]

dose what diet? i just eat whatever tastes good, and isn't moving (too fast).
i'm ok with increasing the dose, since i've only got two months left to worry about.
will test again monday, and probably have to add another gram or so. i was just
wondering which of the foods i consume contributed to lowering my pt from 2.4 to 1.3.

i know the measuring won't work. one cup of xxx? who eats one cup? i never
measure, just eat until full. and since i live alone here, i am my family. that big
bag of oreos marked 'family size' will make a nice snack tonight.

 

[Ross]

That's like me. They say we can only have 5 brussel sprouts. Maybe they can, but not me. I gotta have at least 15. Same with broccoli, asparagus, spinich, all those nice things.

 

[Jkm7]

Thanks for understanding my concerns and discomfort about having a hard time taking such a large dose and still never reaching my range. I always felt 'safe' here expressing worries and concerns as they apply to our heart issues. I never felt I'd be mocked or belittled.

I know there is the chance I could need warfarin again and it is likely my dose would again be very, very high. Needing such a high dose causes me unease and anxiety. Happy it doesn't for you (and, of course, unless you take 100+ mg per week, it wouldn't or you wouldn't know if it would becuase you aren't in those shoes). Please understand that we all find our stress and distress in different places. It's wonderful how we always try here to support each other. Your stress triggers may be something I can easily dismiss. Mine are easily dismissed by others.

I told another member I would stop participating in this thread but felt the desire to respond this morning.

Thank you.

 

[Ross]

Thanks for understanding my concerns and discomfort about having a hard time taking such a large dose and still never reaching my range. I always felt 'safe' here expressing worries and concerns as they apply to our heart issues. I never felt I'd be mocked or belittled.

I know there is the chance I could need warfarin again and it is likely my dose would again be very, very high. Needing such a high dose causes me unease and anxiety. Happy it doesn't for you (and, of course, unless you take 100+ mg per week, it wouldn't or you wouldn't know if it would becuase you aren't in those shoes). Please understand that we all find our stress and distress in different places. It's wonderful how we always try here to support each other. Your stress triggers may be something I can easily dismiss. Mine are easily dismissed by others.

I told another member I would stop participating in this thread but felt the desire to respond this morning.

Thank you.

Not a big deal. I don't dismiss your worries. Your unusual, but you are not unique. You and Christina are the two that take more then anyone I've ever met to get close to or stay in range. Whatever the dose is that gets you there and keeps you there is correct for you. Sure, maybe you feel like your swallowing half a pound of Decon, but hey.

Don't sweat it. We aren't. I know it bothers you. If I were in the same shoes, perhaps it would trouble me too.

 

[Jkm7]

Yah, okay..... easy, I'll just stop sweating it.

No big deal.