Opinion Al???

[Creed3]

Hi Al!
My INR has been pretty stable for the last three years give or take a few tweeks. My diet is not the greatest. I have been trying to lose weight for awhile lately and had no luck. My doc also said that it is important to keep weight, cholesterol etc...in check now before it becomes a major issue later. I never really ate the proper veggies and fruits etc...in my diet so I decided to change my entire diet knowing that it would effect my INR. I thought maybe I could just have my medicine tweeked to make up for the diet change. Usually my INR is about 2.7. I have started with the Nutrisystem Foods which are very healthy. A nutritionist friend of mine has told me that studies have proven that Nutrisystem Foods are good. There are green veggies, fruits, pasta, fat, protein, dairy and soy in these foods. Just in the right portions. I had my INR tested a week early because I knew that my INR would be effected. It came back today at 1.7. I usually take 7.5 mg four times a week and 7 mg three times a week of coumadin, which is 51 mg a week. My doc has increased my weekly mgs to 54 for a week and wants to check my INR in a week. I usually take 7 mgs on Friday but he has me taking 10mgs. Saturday and Sunday I will take 7mgs and Monday through Thursday I will take 7.5 mgs. I will be getting my INR drawn either next Thursday or Friday. My question here is do you think that the additional 3 mgs a week will be enough to bring my INR up to at least 2.0? I am supposed to be kept between 2.0 and 3.0. I think my doc is trying to figure out the correct dose change due to the change in diet. I am just wondering if an extra 3 mgs a week will be enough or if it should be more of an increase. I always thought a 10% change was a good standard but he is changing the dose by about 6%. I know every person is different. I just am curious as to what you think.

Thanks & Take Care!
Gail

 

[Karlynn]

Gail, how often do you test? I would be a little concerned too that he's not increasing it more. He may be being cautious that he doesn't swing you the other way. If it were me, I'd test again on Tuesday, just to make sure that it's going up, and at a rate that makes me feel I'll be in range with the given weekly dose.

But then my range is 2.5-3.5, so an INR of 1.7 seems more wicked to me than to someone who's range starts at 2.

Do you know how much soy is in the Nutrisystem meals. Soy does contain K, so I'm not too surprised your INR dropped - depending on what amount of soy is in the products. Soy makes me drop.

 

[ccrawford]

Gail - It would be very hard to try to compute a revised dosage based on your description of your diet changes. I would have bumped your weekly dosage 10% or 5mg and tested again in a week. Once you get settled in on your diet you should stabilize. Hope this helps. Chris

 

[terryj]

My husabnd has been pretty consistent in his INR the past 4 1/2 years also. A few weeks ago he was diagnosed as pre-diabetic and was put on the South Beach diet. We are also wondering what this will do to his INR. He is eating more green veggies and has cut out all bread and nearly all food with sugars. He is going by his PCPs after work to be tested. I am anxious to see what this has done to his INR and how we will need to adjust his coumadin. He has also added weight lifting in addition to his treadmill every night.

 

[terryj]

My husband has been pretty consistent in his INR the past 4 1/2 years also. A few weeks ago he was diagnosed as pre-diabetic and was put on the South Beach diet. We are also wondering what this will do to his INR. He is eating more green veggies and has cut out all bread and nearly all food with sugars. He is going by his PCPs after work to be tested. I am anxious to see what this has done to his INR and how we will need to adjust his coumadin. He has also added weight lifting in addition to his treadmill every night.

 

[Guest]

My guess is that the diet is loaded with vitamin K. I would probably have raised your dose by 20%. That would be about 60 mg/wk.

Sun 10
Mon 5
Tue10
Wed 10
Thu 10
Fri 5
Sat 10

Doctors fear bleeding, patients fear clots.

The new schedule of your doc's gives you a much better chance of being low rather than above 5.0.

 

[RandyL]

Al please advise

Al please advise

I hope you are still on here.
I have been at 7.5 mg a day for agood 3 weeks. My doctor wants to keep me in the 2.0 to 2.5 INR which is prolly ridiculous in itself. He said stay at the 7.5 for a month and then have it checked and come see him..

Last Sat I forgot to take my dose so I went Monday and had myself tested on my own.It was 1.4 Well thewy sent the results to my Doc who then had someone call me and had me do 10 mg Tuesday and go bACK to 7.5 for wed,thur and retest Friday.
Well today it is 1.6 Am I in some danger here beijng so low for a long time? They just called (nurse) said take 10mg today and sat then 7.5 sun and retest Monday..

Please tell me your opinion. I am worried about this and hopefully you will calm me down and tell me it is not an emegency.

 

[Guest]

Yes, there is some danger. How much is impossible to know until the oops moment either arrives or does not.

Mistake number 1 - missing a dose

Mistake number 2 - getting tested on a Monday when you knew you missed on Saturday. It was guaranteed to be low and cause all sorts of reactions from those managing your warfarin.

Mistake number 3 - having you only take slightly more than your normal dose. You needed to take a lot more to make up for what you had missed. I doubt that you would be harmed from taking 10 mg every day until Monday. But you have to remember that it takes about 3 days for an increased dose to show an effect. So don't expect to see too much of a change from only taking and extra 2.5 mg over the next three days.

The biggest favor that you can do for yourself is to figure out some way to minimize forgetting doses. Put one dose (or a weekend's worth) in your car somewhere or do something else to always have one available. You guys who need the biggest doses are at the most risk of clotting when you forget a dose.

Next time try making up the dose you forget on your own. It really sounds like the person monitoring your warfarin does not understand it very well.

DOCTORS FEAR BLEEDING - PATIENTS FEAR CLOTS.

 

[Karlynn]

If I miss a dose, and have missed it by a full 24 hours, I divide the dose up and add it to my next two doses. Depending on what my last INR was, I may also take an extra 1/2 a dose for a third day, then go back to my normal dose.

If I miss a dose (I take mine in the evening at bedtime) and remember the next morning, I take it then. Or even if I remember in the afternoon. I have a morning med (Toprol) and vitamins that I take. I use a weekly pill box with a.m. and p.m. sides, so if I miss the evening dose, I will notice it in the morning.

Like Al said, I then don't test for at least 4 days after the missed dose.

 

[RandyL]

Thank you so much.

I willtake the 10 all weekend and just not worry about it. I can't do anything anyways. Thanks

BTW my adviser is my Cardiologist. I think I need to look for another Doc. He never has been very believable, always wishy washy and changes the dose all the time with no direction Thanks

 

[Guest]

I thought of another way to look at this.

Think of Randy's body as a bank. Each day he puts in $75. One day he forgets to put anything in. He calls a friend who says put in $100 today and the go back to $75 and by the end of the week you will have the same balance as if you had put $75 in every day. DUH!!!

 

[Creed3]

Thanks!

Thanks!

Thanks Al and everyone else for the input. I thought my dose should be raised more than the 3 mgs. I think what I am going to do is do what my pcp told me to do but change my blood draw and have it done a couple days sooner. I will have my INR tested somewhere around Tuesday or Wednesday instead of Thursday or Friday. I just want my pcp to realize sooner than later if the dosage change is working or if it needs to be increased more. I am sure it will need to be increased more.
I think I may have myself a little wine this weekend. Maybe that will help increase the INR slightly....LOL!!!

Take Care Everyone!
Gail

 

[Guest]

Or maybe you just won't care if it is low.

 

[Creed3]

I Do Care!

I Do Care!

Yes I do care if it is too low. I don't know why you would think I wouldn't care. I only need to get my INR up .3 to get to my range. The increase in my dose he gave me will not show up until Tuesday and I won't be able to talk to my pcp until Monday at the earliest. My ideal INR range is 2.5. If I get my INR tested on Tuesday that is about when the increased dosage will start to show up in my bloodwork right? Any increase of the dosage that I would have been given wouldn't show up until Tuesday, right? Whether it be 3 mgs or 10 mgs? I may not completely understand exactly how to manage my coumadin but I don't like being made to feel like I don't care. I am extremely proactive with my docs when it comes to all issues regarding my health. If I have misunderstood the not caring reply I am sorry for reacting this way.
There are no coumadin clinics in my area and my choices for managing my coumadin are pretty much limited. I have already switched my docs several times already and my pcp right now is about the best I have come across in my area. Eventhough I may not agree with him all of the time he always listens to me when I have concerns with what he is suggesting. He also changes his treatments when I am uncomfortable with something.
Again, I am sorry if I have misunderstood the not caring reply. The last thing I want to do is cause any friction here.
Thanks again to everyone for their opinions and replies. They are very much appreciated. I am trying to learn as much as I can and you all are very helpful.

Take Care!
Gail

 

[Guest]

I meant after the wine!!!

 

[Creed3]

Sorry Al!

Sorry Al!

I took your reply the wrong way. I am very sorry. It's just when things aren't right with my INR I get really nervous. Yeah, you are probably right about the wine, I won't be caring much about anything after drinking it. Again I am sorry for my reacting the way I did. Thanks so much for your advice. I really appreciate it.

Take Care!
Gail

 

[Guest]

It is harder to express humor in writing than in person. I was not offended. I throw out a million ideas and every once in awhile one resontates with someone.

 

[Weezie]

Weezie

Weezie

New user here. Really appreciate allodwick's info. I'm an advanced nurse practitioner and have managed patients' anticoag for years; now I'm in same boat due to insane conjunction of events that progressed me from A fib to cardiac arrest and pacer (Sotalol brady'd me down and out to asystole!).
Might add a couple of generalities. People w/ replacement valves should GENERALLY be at 2.5-3.5 and also we who are chronic "a fibbers" and 65+ years. MOST others are fine at 2.0-3.0. Personally, I don't get very anxious for myself over a couple of 10ths either way, but as Al keeps stressing - and you all should keep listening - bleeding can be controlled but once brain cells are gone, they're gone! High is much better than too low. Stroke is the one major concern. I don't even bother with electric razors. If I haven't learned to shave my legs in 67 years w/o cutting off my leg - well, DUH! I'm also very proactive and purchased my own monitor to check against the coag clinic results (sometimes it is a medical assistant and not a nurse who is checking my results). No, I had to pay for it myself because only you "valvers" can get insurance reimbursement although we all share the same risks of hypercoabulability. Worth it to me because I am a "jumper" - probably due to a remote gastric bypass and expected malabsorption. If any of you are "jumpers" it may have something to do with variety of malabsorption reasons other than inconsistent diet; gastroparesis from diabetes, gastric surgery, medications, etc. Remember also that alcohol increases gastric bleeding risks for warfarin users as well as potentiating the dosage. Chronic alcoholism causes brain shrinkage (after years), extra stress upon the blood vessels that connect brain to skull, and increased risk of brain bleed from tension on those vessels, especially if one falls and hits head (doesn't even have to be a hard knock)- and that will have the same results as any "clot" stroke, i.e. death of brain tissue. Changes in diet and doses for most people will show up in results of fingersticks in 3-5 days, not same day, so it always has mystified me why fingersticks are done for some people daily and the dosage is increased or decreased based upon THAT day's results. I think that causes too much "peaking and troughing", and large swings in anticoag levels predispose to "throwing clots". If you use a meter at home it just makes good sense to use the controls and keep the sensor clean - and just hope your clinic does the same. Take your meter in occasionally and let them test it against theirs - insist upon using your code strip and chip in both and that they do QC checks on both just before the test. Also suggest you check w/ Al on this forum - do I sound like a fan? - about med interactions. Prominent in my records is a med allergy and Coumadin use and yet twice in the past two months I have been given prescriptions for antibiotics to which I am allergic, and to one that is HIGHLY interactive w/ Coumadin. Thank God I am an NP, but please, please, please - all of you - get to know med interactions, RX AND OTC. Remember, it is your body and your life. Ask and ask again. My mantra is "If you don't ask the question, the answer is always no." Asking guarantees at least a 50% chance you will get the correct answer. I'll try not so "wordy" next posting.

 

[Guest]

Welcome Weezie,

I have a cousin, Elizabeth who called our Aunt Louise - Weezie and herself Wizzie.

 

[Weezie]

Weezie

Weezie

Did your "Weezie" relative come from Louisiana by any chance? Common nickname there but I've found fairly uncommon in other locales. Mine is for Eloise and I was born in Shreveport to a mom and dad from south Lousiana, mostly raised in south Arkansas. Remember Ouizer in Steel Magnolias; a less common spelling?