Thanks, Kim, I hadn't seen the link between Vit. K and Ensure! It may be more hazardous to be a 3-month "casual visitor" to the ACT world than to be a resident, because I haven't researched it the way I would have, if I expected to stay "forever".
My 3-month need for the C is not just old-fashioned prophylaxis for the tissue AVR; it's triggered by the "Simplici-T" Dacron ring that was added to my (otherwise unaltered) MV. My MV had been regurgitating under the harsh environment it was operating in, while my failing BAV was both stenotic (~0.8cm2) AND regurgitating (and my LV was compensating). There was some discussion with me (and presumably some "over my dead body", esp. after my TEE) about the extent to which the MV would recover on its own after the BAV was replaced. I was initially told the possibilities ranged from "leave it" to "repair it", then they shifted to EXclude "leave it", and to INclude "replace it". They settled on "repair it", with the ring.
Unfortunately, the team forgot to mention to me that the ring necessitates 3 months of ACT. I'm still a bit puzzled about that. I'm told that Dacron on the MV needs 3 months of ACT, although Dacron on the AV or the Aorta does not, because the MV operates in a lower-pressure environment than the AV, and is therefore more likely to form clots. I'm picturing the ring on the OUTside of the MV, not in the heart's blood-flow at all, so I'm assuming the concern is with the parts of the stitches that are anchoring the ring to the outside of the MV, which penetrate the wall of the MV and present rough edges inside the MV, on which clots might form. After a while (3 months?), scar tissue and the like will smooth over those stitches, and I'll be down near a normal clot-throwing risk again.
If I've got the picture wrong, somebody please straighten me out.
Anyhoo, since one stroke is too many, it's probably pretty important that my INR be in the right range for these 3 months. So far, despite a prescription for TWICE WEEKLY INR testing, my GP and I have NOT done a good job of keeping me in my therapeutic range (2.5-3.0). More like "I'm bipolar, but on the average I'm fine!"
And mostly on the low side, apparently.
I was tested (and found low) Wed. PPM / Thurs AAM in the ER, and my regular lab won't open again until Wednesday, so I'll be curious to see how well my guesstimated boost to my dosage has been doing. I have NEVER noticed a single sign of excessive INR in my 3-ish weeks post-op, while I've been mostly taking 4 ml/d, and more recently 5 ml/d, of generic Warfarin. (I forget the brand.) Not one nosebleed, etc., etc.
BTW, for the ACT mavens: Since I was measured at 1.8 last Wed. night, I threw in one extra 2ml pill immediately, so 6 ml for Wednesday, and switched my daily dose from 4 ml to 5 ml until further notice. I also stopped drinking Ensure. (BTW, I do NOT see Vit. K listed on the Ensure label. It goes from B12 to Pantothenic Acid to Calcium. . .)
