4 weeks post-surgery

[Atreus]

First of all, I want to thank all of you for the valuable information and insight into your experience with the mechanical valve, I posted a few months ago about my concerns about having a mechanical valve at a young age (as in young young age, not medical young age ) and your comments helped me very much. I am slowly but steadily returning to normal activities, I am back on track with my everyday walking, 6-8 km per day Also the pain is decreasing and my mobility is increasing. I am accustomed by now to the sound of the valve, it isn't as loud as I thought it would be. Also, my INR got in range quicker than I expected for now, but so far so good.

I am having a few concerns related to managing my INR at home. I understand that everyone self-tests once per week, but in that week do you keep a constant diet? As in eating the same 3 types of food? Because I mainly eat around 5-6 types of food/ week with different nutrients, should I test after every time I change my "diet"?
Second question, I am aware that if I eat in moderation my INR changes will be minimal, but for example, if I eat once a Mediterranean salad will that affect my INR severely in a short time?
Thank you again all of you, you gave me hope which kept me afloat. Also, your information helped me in arguing with a few doctors who went full war against eating green leaves.

 

[Chuck C]

Thanks for the update and welcome to the other side.

I am having a few concerns related to managing my INR at home. I understand that everyone self-tests once per week, but in that week do you keep a constant diet? As in eating the same 3 types of food?

In my experience, there is no need to worry about the diet, aside from avoiding a very small list of foods, such as grapefruit juice. You should not need to keep a constant diet and you can consume foods rich in vitamin k foods. Do test, and make sure that this is the case for you- know thyself as we say, but it seems that the vast majority here eat what they want. Dose the diet, don't diet the dose. In other words, eat what you want and make small adjustments to your warfarin to stay in proper INR range when needed.

I am aware that if I eat in moderation my INR changes will be minimal, but for example, if I eat once a Mediterranean salad will that affect my INR severely in a short time?

Warfarin has a long half-life. As such, INR tends to usually change very slowly. Unless you have some rare genetic disorder, eating a salad will not severely affect your INR, per your question- not short term, not long term. I eat several Mediterranean salads per week, loaded with vitamin k rich foods. Usually, I eat one large salad per day. Some days I eat two. Some days I don't eat any salad. I have not found any noticeable effect on my INR whether I eat 1, 2 or zero salads per day. Test yourself and know yourself, but I think you will find that others here on warfarin experience the same- we tend to eat what we want and don't generally see diet related fluctuations in our INR. If you do see a change, I would expect it to be very small, if you are like most people.

 

[dick0236]

I agree that there is no need to adjust YOUR normal diet. We all eat a normal diet, just do not binge on food high in vitamin K. A little too much Kale or Spinach won't make your INR go crazy. Try eating your usual foods and see what change there is to your INR.....my bet is there will be little or no change.....and if there is adjust your Warfarin a little. Warfarin management is not "rocket science"....we just make it that way sometimes.

 

[tom in MO]

I eat what I want, when I want and how much I want. I can have breakfast for dinner one day and a tuna fish salad for dinner another. Hot dogs one day and eggplant casserole another. I test about every 2 weeks unless I am out of my range of 2-2.5. It's worked for 10 years now. When I need to adjust, it's usually a one time adjustment but I test again in a week 1.

 

[Superman]

I’m on a strict see-food diet.

I see food. I eat it.

 

[Timmay]

Same here. I eat whatever (except the small list that Chuck mentioned).

If you can, find an experienced mentor to assist you with self-managing. It makes all the difference in the world.

My INR tends to run around a fair amount . Lots of people tend to report that their INR is super consistent. Mine can vary between 2.1 and 3.5. I’m much less reactive to that now as compared to 6 months after surgery. That’s what a mentor can do . Keep you sane. Now I’m more like “meh, I’m still in a safe range”. I’m still the oddball though … testing twice a week.

 

[pellicle]

I see food. I eat it.

I've been to Korea, sometimes what others call food isn't (in my opinion) edible (but yes, I ate it to see)

https://en.wikipedia.org/wiki/Beondegi

 

[pellicle]

Just echoing the sentiments of the other INR testers here:

Because I mainly eat around 5-6 types of food/ week with different nutrients, should I test after every time I change my "diet"?

no and don't bother counting stuff (sitting in front of a plate of rocket with salad dressing, cucumber and fetta cheese atm).

INR undergoes a natural fluctuation, the best you can do is just accept it.

Reach out by "Conversation" if you want a method to monitor and guide your process here (but you will need to take weekly INR measurements and you will need to write it up and you'll also need a gmail account).

 

[Superman]

I've been to Korea, sometimes what others call food isn't (in my opinion) edible (but yes, I ate it to see)

https://en.wikipedia.org/wiki/BeondegiView attachment 889555

Fortunately my diet allows me the flexibility to decide if that which I see is or is not, in fact, food.

 

[DJ-Rae09]

I eat and drink what I want whilst I've been on Wafarin. no changes for me

yes drinking alcohol may elevate it but I just adjust my dose if I'm outside my INR range, all good. The benefits of self testing at home

 

[Atreus]

Thanks for the replies!
I've been on a rollercoaster with my INR in the past weeks, I had an INR of 8,59 because I had to take Prednisone then after listening to my doc about how much Acenocumarol to take I got an INR of 1,22, after some time I managed to get it to 3,42 after 2 weeks I went to do my bloodwork again and is 4,94 which is pretty weird because in the last week, I ate a diet with pretty much vit K in it, it's very tiring to stabilize the dose for the INR.
Currently, my doctor said to alternate 1mg/day and 2mg the next day although I would have liked to take the same dose every day.

 

[pellicle]

Hi

firstly I'd like to say that "there is no dose" ... there just isn't. There is only the dose you need to get you to the target INR. Once you find "your dose" it may well remain pretty constant over time (varying a little around an average).

I've been on a rollercoaster with my INR in the past weeks, I had an INR of 8,59 because I had to take Prednisone then after listening to my doc about how much Acenocumarol to take I got an INR of 1,22, after some time I managed to get it to 3,42 after 2 weeks

one of the issues is that Acenocumarol is just the worst of the whole family of coumarins ... its the worst because its the least forgiving
https://en.wikipedia.org/wiki/Acenocoumarol

Acenocoumarol is an anticoagulant that functions as a vitamin K antagonist (like warfarin). It is a derivative of coumarin and is generic, so is marketed under many brand names worldwide​

It has a very short half life, unlike Warfarin, meaning that there is no residual by this time tomorrow and so determining dose is tricker. You must be certain to take the drug at more or less the same time. Don't make it morning then evening ... that just won't do with that drug.

I went to do my bloodwork again and is 4,94 which is pretty weird because in the last week, I ate a diet with pretty much vit K in it, it's very tiring to stabilize the dose for the INR.

well the problem is manifest in your next sentence.

Currently, my doctor said to alternate 1mg/day and 2mg the next day although I would have liked to take the same dose every day.

bad idea and sadly you have a VERY small dose ... this makes it even more frustrating to manage. If you think about it you are taking double the amount the following day.

Doctors are utterly clueless with drug titration ... its actually miserable and they should be ashamed. Even when I was at Uni the worst dopes in our shared labs with other groups (I did biochem) were doctors. Just fools worried about their Alpha Romeo or their stipend.

Its actually simpler if you follow some rules. Reach out and I'll give you a hand. I have worked with this drug before with another fellow from Bosnia. However you'll need to get a pill splitter.

Best Wishes

 

[Chuck C]

Currently, my doctor said to alternate 1mg/day and 2mg the next day

He is having you double your dosage every other day? That sounds like terrible guidance. It is much easier to have a stable INR dosage, when we have little to no variance in our daily dosage.

I self test, and set my own dosage. If 6.5mg is the proper dosage for me to stay in INR range, I take one 6mg pill and break a 1mg pill in half, so that I take exactly 6.5mg/day. It would probably not be that bad if I took 6mg 1 day, then alternated with 7mg, as this would only represent a 16.7% swing in dosage per day. But, why have a swing at all, when I can just break a 1mg pill in half and take the exact same dosage? For you, since your dosage that he currently has you on is only 1.5mg/day, that 1mg swing represents a 100% increase in your daily dosage on alternating days. That would make stabilizing INR a nightmare.

Not sure what your resourses are in Romania. Do you have any other options for guidance? I see that @pellicle has offered you assistance. He is the man when it comes to stabilizing INR.