I’m just tired of taking warfarin

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RobNDenver

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I had my valve replaced in 2008. I’d been very diligent about dosing, and testing until about April of this year. I had a little surgery, and bridged with heparin but I am missing doses for weeks at a time. It’s like I just don’t care any longer whether I take my Coumadin, or any other prescribed meds or not. If I go back on the warfarin am I going to loosen up any gunk and cause a stroke? I don’t have a doc to talk to about this, because I don’t really want to confront my ambivalence with him. . . .
 

pellicle

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... If I go back on the warfarin am I going to loosen up any gunk and cause a stroke? I don’t have a doc to talk to about this, because I don’t really want to confront my ambivalence with him. . . .
I can't see how... I think you should strongly consider resuming on your previous dose.

I get sick of having to take antibiotics all the time (and my warfarin) but some things have better outcomes for doing them than not.

I occasionally think I'd like to just drink myself to death, but the first day in the hangover persuades me I'm not "the right stuff" to be an alcoholic.

This question leads me to wonder if you may not be starting to get into depression ... are you ok?
 

Protimenow

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Starting to get into depression?

Rob, if you want do have a stroke because you aren't taking warfarin, there are much better ways to do it. This isn't fair to you, or to the millions of others with mechanical valves who faithfully take their warfarin (yeah, you may wonder how your behavior harms them, but, like it or not, the population of valve recipients is something of a 'family' - and proving that not taking warfarin will, sooner than later, hurt you).

I went for a long time, regrettably, without testing - but I seldom missed a dose.

Maybe it'll be easier for you if you set a goal for yourself -- get a meter, test weekly, and challenge yourself to keep your INR in range.

THEN, you can come onto one of these threads and brag about how well it's going for you -- and we'll all be happy about it.

Warfarin is easy to manage. Having an INR between 2 and 3 isn't a big deal. It won't change your life much (okay, you may get more bruising than if you weren't taking it), but there are millions who live with it and it's not the horror that some people imagine it to be.

I can't convince you to take warfarin. I won't even try. But, please, consider the challenge - to maintain your INR - and convince yourself that you're better off taking warfarin than you would be if you don't.
 

jlcsn2015

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Just think of people that for example have to take insulin injections, there are millions of peoples that figth that battle, no big deal, i feel lucky i only have to take a pill, not a shot, and there is always something to do on this earth, just one smile u give away could make some other person happy, and make yourself happier in the process, just a thought...
 

dick0236

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It's only a hill if you think it's a hill........that's the advice YOU give in your signature.

Your bio doesn't say much about you but I assume you are relatively young since you have a mechanical valve. I was also young (38) when I suffered my stroke due to not taking warfarin for several days. I learned, the hard way, that strokes are forever. Find professional help before something happens that you CAN'T undo.
 

vitdoc

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Rob, I recently saw a pediatrician who had atrial fibrillation and knew she had it. For reasons only known to herself she did not take appropriate anticoagulation and she had a preventable stroke. In her case it wasn't as bad as it could have been since her primary loss was in an area of peripheral vision since the stoke affected the Occipital lobe of the brain which takes care of vision. She did not suffer lose of strength or sensation. But she was not happy and realized she was a total idiot in ignoring her A. Fib.. Most likely you are significantly depressed which is causing you to not treat yourself appropriately. See your doctor who may suggest other help with your issues. You really don't want a major stroke. Then you really will have a reason for depression.
 

Protimenow

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I don't think anyone ever wants even a 'minor' stroke. I had one in 2012 - I was testing regularly, my meter consistently showed an INR of 2.6. The meter - finally removed from the market - was WRONG. In the hospital, my INR was 1.7 - and had been, for who knows HOW MANY weeks. Fortunately, in the United States, we have two reliable, pretty accurate meters - the CoaguChek XS (and some variants that aren't available to most people in the U.S.) and the Coag-Sense. I'm not going to push either one in this message.

My point here, as in my earlier post, is that perhaps you can make a game or challenge out of keeping your INR in range - or as near to a target range as you can. This means, you'll be taking your daily dose, you'll be testing weekly, and you'll be attempting to meet that challenge.

I know. It's often hard to do things that you think you don't want to do. I have things that I keep avoiding, for no good reason. I have some 'elective' medications that may help me, but I probably don't need, and I haven't taken, for fear of interactions, or withdrawal issues or, who knows why? BUT WARFARIN ISN'T ON THAT LIST. I have it in a seven day pill thingy, and take it (and some other stuff) every night.

So - welcome to the world of the depressed - but get over it enough so that skipping warfarin and testing are NOT part of it. You may feel like you're not worth it to yourself, but there are probably others who DO care about you - think about them, and if you can't think of them at least realize how much worse it'll be if skipping warfarin leaves you disabled.

I'm not going to lecture you. I avoid it when people try to lecture me.

But you can have fun (fun?) meeting the 'in range' challenge. (One thought - don't do it for yourself - do it to disappoint the bastards that don't give a **** about you -- keep on going, so you can smile in their faces when you see them, knowing that you're doing better than you think they want you to. If feels good to rub this in their faces). (I know - others reading this will wonder 'what the hell is up with protimenow? And rightly so.)
 
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tom in MO

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I had my valve replaced in 2008. I’d been very diligent about dosing, and testing until about April of this year. I had a little surgery, and bridged with heparin but I am missing doses for weeks at a time. It’s like I just don’t care any longer whether I take my Coumadin, or any other prescribed meds or not. If I go back on the warfarin am I going to loosen up any gunk and cause a stroke? I don’t have a doc to talk to about this, because I don’t really want to confront my ambivalence with him. . . .
I know the feeling. I take 7 meds at once in the evening, two at bed and two in the morning. Some days...f****-it is all that comes to mind. If I do that with the meds before bed, my allergies remind me of the consequences a few times a night, when I wake up and most of the morning. It motivates me the next day to pay attention.

However, as you know, not taking warfarin will give you a stroke sooner or later, which if you are unlucky will be minor and not kill you but leave you incapacitated. That's worse than it is now.

If you've got medical insurance, this may be the time to take advantage of the plan and get some help. Since you know the risk, not taking warfarin is suicidal and you should get some help. I volunteered in a mental hospital and one of the working definitions of mental illness is being a danger to yourself. Please get help!
 

Superman

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Your doctor won’t punish you worse than the outcome of continuing on your current path will.

If you want to live a long healthy life, you’ll resume your medication and testing. If you seriously don’t, friends, advisors, or councilors outside this forum will be a much better help to you than we will.
 

carolinemc

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I had my valve replaced in 2008. I’d been very diligent about dosing, and testing until about April of this year. I had a little surgery, and bridged with heparin but I am missing doses for weeks at a time. It’s like I just don’t care any longer whether I take my Coumadin, or any other prescribed meds or not. If I go back on the warfarin am I going to loosen up any gunk and cause a stroke? I don’t have a doc to talk to about this, because I don’t really want to confront my ambivalence with him. . . .
Honey, I understand a little of what you are saying. But I can tell you from my person experience which is a lot different. I was fired from my city job almost three years ago. No insurance and was able to keep getting refills on warfarin for year. When that ran out, I was in depression about no insurance. I went without warfarin(coumadin) for a few weeks. One day, I went to Truman Medical to get help to get back on my meds. What happened two days before that, at night, I had eye stroke in my left eye. When I got to the hospital and then went to the emergency room, since it is a charity hospital and could not refuse treat me, told me to get admitted into the hospital. I had to go into the hospital to get bridge therapy to get back on the warfarin. Then they figured out the eye stroke. First they said I had a stroke, while I am alert, able to move all limbs, and speak clearly. Then they finally explained the eye stroke. When I got home from the hospital, I did research on eye stroke, that it is common, but not common, meaning it happens but not as common as we think. It was probably from my type 2 Diabetes and being without warfarin. I am now legally blind in the left eye, and with my heart problems and diabetes, I am now on SSDI.
Is that the life you want, being disabled from not taking warfarin? Not a great way to go. I get tired of taking the meds myself, with the diabetes meds. But ask yourself, do I want to be a cripple by my own hand? Heck no. Please get some professional help counseling to get over you depression. Not taking you meds is not a good way. Strokes are very bad, no matter which one strikes. Please promise to get help. You need some help. I know it is not easy, I was depressed from losing a job that provided my health insurance.
Promise me please, @RobNDenver. You will regret not getting help, strokes are not fun.
 

carolinemc

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Rob, I recently saw a pediatrician who had atrial fibrillation and knew she had it. For reasons only known to herself she did not take appropriate anticoagulation and she had a preventable stroke. In her case it wasn't as bad as it could have been since her primary loss was in an area of peripheral vision since the stoke affected the Occipital lobe of the brain which takes care of vision. She did not suffer lose of strength or sensation. But she was not happy and realized she was a total idiot in ignoring her A. Fib.. Most likely you are significantly depressed which is causing you to not treat yourself appropriately. See your doctor who may suggest other help with your issues. You really don't want a major stroke. Then you really will have a reason for depression.
I just Rob about my eye stroke, like the one you mentioned. It made me legally blind in my left eye. I was lucky also. Lost job, lost insurance, but was able to get warfarin for a year, then went without it for a few weeks. Did not know it happened till I did go to the emergency room of a Charity Hospital. First, got me on bridge therapy to get back on the warfarin, then told me I had a stroke, and I am alert, clear thinking, able to speak. move, but had eye stroke. I was lucky in that also. But now am on SSDI. No regrets, I was putting in the paperwork that very night I had the eye stroke. Very ironic. I agree on not taking it to have a major stroke. I have been around stroke victims and it is not easy for them to get nearly normal. Thank you for sharing. I hope he takes out advice and get the help he needs.
 

Enigmalady777

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Just think of people that for example have to take insulin injections, there are millions of peoples that figth that battle, no big deal, i feel lucky i only have to take a pill, not a shot, and there is always something to do on this earth, just one smile u give away could make some other person happy, and make yourself happier in the process, just a thought...
I take insulin injections 4 times a day, and yes, I am used to it, but I'm also sick of taking warfarin. I've been taking insulin for 11 years now, and warfarin a year and a half. I think it's the fact that I have so many dietary restrictions with both being diabetic AND taking the warfarin that gets old. Also with insulin, I can make my own adjustments based on what I'm eating (how many carbs, etc) but with warfarin I have to get a blood draw and wait for the anti-coagulation clinic to contact me for adjustments. Like anything else, eventually you get used to it.
 

tom in MO

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This has been a wake up call. I’m back to taking my Warfarin, and I’ll pop back into this thread from time to time to maintain my motivation to do so. Thanks everyone, for your advice and concern.
Way to go Rob! :) We all get rough spots and sometimes we need help getting back up...
 

Superman

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I take insulin injections 4 times a day, and yes, I am used to it, but I'm also sick of taking warfarin. I've been taking insulin for 11 years now, and warfarin a year and a half. I think it's the fact that I have so many dietary restrictions with both being diabetic AND taking the warfarin that gets old. Also with insulin, I can make my own adjustments based on what I'm eating (how many carbs, etc) but with warfarin I have to get a blood draw and wait for the anti-coagulation clinic to contact me for adjustments. Like anything else, eventually you get used to it.
Sounds like you would benefit greatly from home testing. Takes a lot of the frustration out of INR management. Not sure about the comments on dietary restrictions. I’m nearly 29 years on Warfarin and have always eaten whatever I want.
 

Protimenow

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Enigmalady777 - if you're able to self-test, you should. It beats the hell out of having to go to a doctor's office or anticoagulation clinic (or lab), getting a blood draw, and waiting for a result. You'll know in minutes (or less) what your INR is. Meters aren't particularly expensive, strips aren't too bad (probably not much different than the cost of a trip to a lab or clinic, when you consider the time it takes you, parking fees, gas, etc.) and give you control of the testing process. You can use the clinic as a check on the meter (or, I've seen more recently, see the meter as a check on the lab). If you're on Medicare, Medicare should buy you a meter - and probably refill the strips for you.

As far as diet is concerned, as long as your diet is consistent, you can adjust your warfarin dosage to keep in range. I don't know much about a diabetic diet - but if it means that you eat a LOT of greens, you'll just need a higher dose of warfarin to stay in range -- do this consistently, and diet won't be a problem.

I don't understand getting 'tired' of taking warfarin. Hell, putting one, or a few, warfarins in your mouth must be a hell of a lot easier than testing your blood glucose four times a day. Isn't it?

---

Rob, I'm glad that you've taken all the comments, encouragement, threats, cajolling, and other stuff to heart, and are taking warfarin again.

Good luck. (And please consider self-testing)
 

zelic

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Good article just came out on value of Vit K rich diet and INR levels. Thought I would share with the group.
Green Vegetables, Herbs, and Oils May Help Stabilize Patients Taking Warfarin
Rebecca Voelker, MSJ
JAMA. Published online September 4, 2019. doi:10.1001/jama.2019.13060

With its narrow therapeutic range, warfarin is a tricky drug to use.
Dosing depends on many factors, including interactions with other medications, certain foods, or over-the-counter supplements. Outside of its therapeutic range, warfarin can increase the risk of bleeding or conversely of developing blood clots. Patients had been advised to avoid vitamin K–rich foods so as not to counteract warfarin’s effects, although clinical guidance now recommends consistent intake instead.
Image description not available.
But newer findings have weighed in with another option: increase vitamin K intake to maintain stable anticoagulation, and do it with food. At the American Society for Nutrition’s recent annual meeting, Guylaine Ferland, PhD, a professor of nutrition at the University of Montreal in Canada, reportedfindings from a small study that showed boosting daily dietary vitamin K consumption appears more effective at maintaining stable anticoagulation for patients with a history of warfarin instability than simply offering general dietary advice.
“These are foods most people eat anyway, it’s just that they have to introduce them into their usual diet in a more systematic manner and in perhaps a more well-informed manner,” Ferland said.
Although warfarin has been losing ground to the newer direct oral anticoagulants (DOACs) including apixaban and dabigatran, Ferland said the drug isn’t about to disappear from the anticoagulation landscape. “There remain a number of conditions that will call for warfarin,” such as mechanical heart valves and renal insufficiency, she said. Warfarin also is the drug of choice for antiphospholipid syndrome, noted Paige Christensen, NP, associate medical director of thrombosis and anticoagulation for Intermountain Healthcare in Salt Lake City.
“This conversation and these dietary interests in vitamin K probably aren’t going to go away for a long time,” Christensen added.

Increasing Vitamin K Is Key
The 46 patients in Ferland’s randomized controlled trial had been treated with warfarin for more than 6 months, but their anticoagulation status was in the therapeutic range less than half the time. The study’s primary clinical end point was having warfarin levels in the therapeutic range more than 70% of the time from 4 to 24 weeks. Being in the therapeutic range at least 70% of the time has been associated with a reduced risk of stroke and lower death rates.
About half of the patients received general dietary information. The other half received dietary counseling on specific foods they could eat to increase their vitamin K consumption by 150 μg daily along with recipes and cooking instructions. At the end of the study, 50% of patients in the dietary counseling group met the clinical end point compared with 20% in the control group.
Ferland noted that previous research has shown that higher vitamin K intake was associated with more stable anticoagulation with warfarin. But some studies weren’t randomized or they used a supplement rather than food. “The idea to aim for the same kind of vitamin K you would get with a low-dose supplement but doing this through food was appealing to me,” Ferland explained.
“We think that by increasing daily intake there will be a bit more that is stored in the liver,” she said. “On a day when someone doesn’t eat as much for some reason, the impact on…anticoagulation will not be as dramatic.”
Christensen said she found the study promising. “t makes sense clinically with what we see every day with our patients,” she added. In her practice, clinicians educate patients to keep their vitamin K intake consistent. Compared with avoidance, she said, “patients seem to be more compliant and tended to have more success” in maintaining stable anticoagulation with warfarin.
What’s more, she noted, the variety of foods in the study’s dietary plan provide additional nutrients and they appeal to her patients’ palate.
Kale, Anyone?
Ferland’s study focused on 3 food groups—leafy green vegetables as well as cabbages, broccoli, and lettuces; oils; and fresh or dried herbs. She and her colleagues met with study participants in the intervention group once a month for nutrition talks, a cooking lesson, or other discussions. The participants also received written information about the most commonly consumed green vegetables, oils, and herbs. Ferland and her colleagues came up with easy ways to describe the equivalent of 150 μg of vitamin K in the foods participants were encouraged to eat.
Some of the participants devised their own strategies to get their daily 150 μg. “They would have a smoothie every morning with kale and mango,” Ferland said. “They knew they had their 150 μg and then they could forget about [it] for the rest of the day.”
Given the emphasis on maintaining consistent daily vitamin K intake, it’s important to keep in mind that too much of a certain food can tip the scales. At UC San Diego Health’s anticoagulation clinic, that food often is kale, a vitamin K powerhouse with 531 µg of vitamin K in a cooked, half-cup serving. Clinical pharmacist Megan Lang, PharmD, asks patients upfront when she meets them about their kale intake. The vegetable is so popular in San Diego that Lang said she feels “like kale is on its own island.”
Some of her patients also blend it in smoothies, but for others—those receiving chemotherapy cycles that ruin the appetite for a few days, elderly patients who eat poorly, or college students with erratic eating habits—Lang uses an over-the-counter vitamin K supplement to ensure consistent intake. The supplement is inexpensive and “then [patients] don’t have to worry about grocery shopping,” she added.
More Data
Ferland plans to submit her data for publication, but she’s still crunching data. A question she thinks physicians would like to have answered is whether the dietary intervention would entail increasing patients’ warfarin dosage. “This is what we’re computing,” from patient records during the 6-month study, she said.
A natural next step, she added, is comparing outcomes of patients who take warfarin and follow the increased vitamin K food plan with those who take DOACs. The newer drugs sometimes are considered superior because they have a wider therapeutic range than warfarin, so patients don’t need to be monitored as often and they don’t need to watch their diet as closely. The DOACS are less likely to cause brain bleeds but more likely to result in gastrointestinal bleeding.
The DOACs also are far more expensive. Christensen estimated that the out-of-pocket DOAC cost is $300 to $400 per month compared with $10 to $30 for warfarin. With some insurance plans, warfarin can be had for a $5 co-pay. Depending on insurance coverage, Christensen said the monthly DOAC cost could range between $50 and $250. “For many…it tips them over the edge,” she added. What’s more, the cost of reversing DOACs with a factor Xa inhibitor for patients who experience uncontrolled bleeding is $25 000 to $50 000 at Intermountain Health, Christensen said. Warfarin is reversed with vitamin K.
Ferland said that while the merits of warfarin vs DOACs continue to be debated, her early findings offer a relatively easy, accessible way to boost the likelihood of stabilizing anticoagulation for people who take warfarin. “I’m quite convinced the dietary intervention is beneficial,” she said.
 

Protimenow

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I'm very glad that you shared this It's very interesting. It kind of makes me want to go out, buy some hearts of Romaine, some Iceberg Lettuce, maybe cook up some chicken, and make a nice salad.

A decade ago, the common thinking was to avoid Vitamin K at all costs. There was even a book, The Coumadin Cookbook, with recipes for foods without Vitamin K in them.

The body needs the K vitamins, and many of us have carefully avoided overdoing it with the greens (I know that I have). I'm now taking K2, which isn't involved in the clotting process.

With readily available home meters and home testing, it shouldn't be much of a challenge for many of us to put the greens (and herbs and oils) back into our diets -- keeping them consistent - and hitting a sweet spot for our warfarin dosing.

(I haven't given much thought to my use of olive oil or fresh herbs, and don't think much about any effects on my INR - but, again, the issue is consistency.)
 
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