I am flabbergasted

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For those of you that insist on dieting the dose rather then doing it the right way, we have this:
 
Ross said:
Hey Al Lodwick is out there trying to teach the profession the way it should be and I've heard that some of his classes were filled with pros that pretty much discarded everything he's trying to teach them. They've been taught, most of them, incorrectly, and they are not open to change.
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What about the C.H.E.S.T. guidelines?

That's what my Coumadin Clinic uses and they 'get it'.
Their recommendations fit Al Lodwick's guidelines identically.

I'll have to ask who the authors are. I 'assumed' it was written by Medical Doctors.
 
I think if I ever have to be in the hospital again I'm going to sneak in my own supply of vit k stuff just so they don't mess me up too badly. How 'bout a supply of high soy energy bars?
 
I mean get real folks. Those sparrow portions they serve on the food trays couldn't possible affect your INR to any extent. I really want to know who taught these people this stuff.
 
I seem to recall a Study being cited here on VR.com where it was determined that a Constant Level of Vitamin K produced LESS VARIATION in INR than was obtainable by patients who Avoided Vitamin K.

Does anyone know how to find that study?

Maybe THAT would help to persuade those Medical Providers who are stuck in the 'ways of Olde'...

'AL Capshaw'
 
ALCapshaw2 said:
I seem to recall a Study being cited here on VR.com where it was determined that a Constant Level of Vitamin K produced LESS VARIATION in INR than was obtainable by patients who Avoided Vitamin K.

Does anyone know how to find that study?

Maybe THAT would help to persuade those Medical Providers who are stuck in the 'ways of Olde'...

'AL Capshaw'
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I'd have to check Mr. Lodwick on that one. Thing is, it's the highest eschelons still clinging to this myth. How do you overcome that? I tried writing The Joint Commission on National Patient Safety Goals about the issue, but since I hold no medical license, they aren't interested in anything I had to say.
 
It never ceases to amaze me ..........................

It never ceases to amaze me ..........................

how many care providers are willing and capable, because of their own ignorance, to put patients in harms way and disregard the voice of reason and logic.

Recently I experienced a sub-conjuntive hematoma. (sp). Because I was going on vacation I was concerned about the unsightliness of my eye I called the PCP's office hoping there was a way to remove the red. Of course, warfarin was blamed and my INR was too high anyway. Thankfully she didn't mention Vit. K intake otherwise we would really gotten into it. This particular person does not agree with POC monitoring needless to say. For the learned my INR was exactly where it should be. Well, that was too much for the nurse and she referred me to my INR manager whom advised me to keep my eye moist. She tried to help and did not assign blame.

This fight is continually being fought on fronts where proper management should be common knowledge. There are millions of patients on warfarin and have been for about 50 years. What does it take to get the message out?
 
lance said:
This fight is continually being fought on fronts where proper management should be common knowledge. There are millions of patients on warfarin and have been for about 50 years. What does it take to get the message out?
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Well the message is getting out, but my beef is that they are still clinging to the Vit K diet and in essence, telling people to diet the dose instead of dose the diet. Of course, this only applies to the hospital setting, not a private practice, but with any hope, with the exception of this particular diet thing, it will bleed out into the private arena.

http://www.jointcommission.org/News...+Used+Anticoagulants/applicable_standards.htm
 
ALCapshaw2 said:
I seem to recall a Study being cited here on VR.com where it was determined that a Constant Level of Vitamin K produced LESS VARIATION in INR than was obtainable by patients who Avoided Vitamin K.

Does anyone know how to find that study?

Maybe THAT would help to persuade those Medical Providers who are stuck in the 'ways of Olde'...

'AL Capshaw'
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This seems to answer my question about my uncle's clinic having him take a small dose of vit. K every day and then eat all the green leafys he wants to. Sounds like a plan to me.
 
Cris N said:
http://bloodjournal.hematologylibrary.org/cgi/content/abstract/109/6/2419

The best part of this study is in the last two paragraphs of the text.
http://bloodjournal.hematologylibrary.org/cgi/content/full/104/9/2682
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Not exactly as I remember it, but it'll work. Thank you!

Now compare that study to this statement:

Coumadin is prescribed to prevent blood clots and increase the amount of time it takes your blood to form a clot. This allows the blood to flow more easily through narrowed blood vessels.

You should have a consistent intake of vitamin K (Recommended Dietary Allowance for men is 120 micrograms, women 90 micrograms per day). Avoid supplements with vitamin K as that would interfere with the amount of Coumadin needed to regulate your clotting time. Your clotting time will be periodically tested by your doctor to regulate this medication.

AGAIN, no wonder people are confused. I'd love to know how many people are actually trying to follow this nonsense and wondering why their INR's are all over the place?

Put the Coumadin cookbooks away, throw out the Vit K charts and EAT YOUR VEGGIES.
 
Usually ..................

Usually ..................

I eat a salad every day--but it's not carved in stone.
Recently returned from 2-week holiday in London--did a lot of walking, standing, climbing, etc. Salads not big in pubs and restaurants. Diet totally different, sleep patterns disrupted. INR test result this a.m. shows a substantial drop and so does my spouse's. We have been home a week returning to our "usual" diet and exercise level.
This might just indicate the affect of exercise and diet but I don't understand the time lag. Left my XS at home.:(
So for us the advice to take a Vit K pill everyday in the absence of dietary K is good advice.
 
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Lance - for some reason, when I travel my INR goes high. Just one of the unexplainable things. Last year when a friend and I went to France to visit my daughter for 10 days it was 6.0 after walking all over the place from sun up to sun down. Go figure??? :confused::confused: I've stopped trying to figure out why and just know that I'll need to do a little dosage adjustment in and around travel. I almost left my INRatio at home because I was solidly in middle range. But figured that I got it because it was easy to travel with. I'm glad I did. Sounds like you will too the next time you travel. ;)
 
Now compare that study to this statement:

Coumadin is prescribed to prevent blood clots and increase the amount of time it takes your blood to form a clot. This allows the blood to flow more easily through narrowed blood vessels.

You should have a consistent intake of vitamin K (Recommended Dietary Allowance for men is 120 micrograms, women 90 micrograms per day). Avoid supplements with vitamin K as that would interfere with the amount of Coumadin needed to regulate your clotting time. Your clotting time will be periodically tested by your doctor to regulate this medication.

AGAIN, no wonder people are confused. I'd love to know how many people are actually trying to follow this nonsense and wondering why their INR's are all over the place?

Put the Coumadin cookbooks away, throw out the Vit K charts and EAT YOUR VEGGIES.
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Oh, for heaven's sake... 'Avoid supplements....?????' That's ludicrous. The study in the link actually suggests a supplement might be the right way to go, especially if the patient doesn't get enough Vit K - it's a very stable form of the vit. There was a very interesting part of the study having to do with 2 veggies with fairly high Vit K content. One was more readily absorbed by the body, and the other was not. So even though the content was similar, the effect was not. If a person tried to gauge Vit K intake based on all that they'd go absolutely nuts.

People who avoid Vit. K are depriving themselves of much needed nutrition. While warfarin blocks some of the clotting action of Vit. K it does not block the other actions:

Vitamin K helps the body absorb the beneficial mineral calcium. Recent studies have suggested that vitamin K can help prevent or treat osteoporosis and the loss of bone density. If you have a family history of osteoporosis, it is important to make sure you maintain healthy levels of vitamin K.

Recent studies suggested that vitamin K also has preventive and treatment benefits for cancer. Several human trials have shown that vitamin K may have anticancer effects.

Vitamin K also prevents the hardening of the arteries, which aids in preventing heart disease and heart failure.
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I've mentioned before that I take a multivitamin with the full (or close to it depending on gender and which study you want to go by) RDA of Vit. K. This is what I attribute my mostly stable INR to. It certainly helps keep me at a fairly consistent intake - I am very susceptible to INR swings based on diet. When it gets a little higher than I want it a good dose of coleslaw or broccoli will knock it down quickly. (I'd go with the spinach or brussel sprouts but I'm not a big fan of either of them.)

IMHO it truly does come down to what is repeated here over & over... DOSE THE DIET, DON'T DIET THE DOSE.
 
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