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pellicle

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but I think the case could be made for INR checks every 3-4 days based on the information below:
in the past I would test weekly and if some reading was high (and the previous trend was supporting that) I have done what I call an "Ad Hoc" reading mid week and see if its going to return of its own accord (mostly does) or if its staying high I'll make some minor adjustment and then test on my regular day. In the main its come back.

The problem is over-correcting (like watching someone learn how to steer a boat, or do a power slide in a rear wheel drive car)
 

tom in MO

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...there’s just been to much change in my life and it’s unfair 😂 but life goes on just upset I couldn’t celebrate my 21st birthday as I was in critical care for it and now can’t drink alcohol which is very hard for me at this age because that’s what everyone is doing so now I’m not able to do things with my friends and it’s really crap just feels like it’s going to take ages for me to be happy about everything I know I sound ungrateful I don’t mean too!
Not sure why you cannot drink alcohol. Sometimes they tell people on warfarin not to drink, but that is incorrect. I've been told that once by cardiologist's nurse, and after a discussion with the cardiologist, we straightened her out.

The only dangers with warfarin and alcohol are two things. First, if you get falling down drunk and hurt yourself, you will bleed 2-3 times longer before you stop than a "normal" person. This can be a problem if you hit your head or get a severe cut (e.g. go through a plate glass window). Second, if you puke out your warfarin dose, your INR may change a little, but will stable out again after a few days. So don't get so drunk you puke or hurt yourself and you are good to go. You shouldn't get that drunk even if you are not on warfarin.
 

Protimenow

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The ticking is your friend...

Okay, maybe not so much.

It makes it almost impossible to hide behind a door when you play hide and seek (my daughter used to get on the other side of the door and say 'Hi Dad'). It makes it difficult to wear a loud, cheap, mechanical watch -- I once bought an old Ingersol Mickey Mouse watch -- it ticks 6 times a second - and my wifte thought I was having a heart attack. I quickly stopped wearing it.

I was at a press conference, and a person in front of me kept looking back in my direction. He seemed to get more and more annoyed (and I knew why). I aimed my mouth at him, assuming that this would make it even easier for him to hear my tick. After a while, completely annoyed, he looked behind him and shouted 'who's wearing the cheap watch?'

I told him that it's my heart. It felt REALLY good doing that.

As far as the sound - I've pretty much drowned it out. I find that it helps to keep the ears clear, free of wax (the sound seems to get trapped in the inner ear - with a clean ear canal, the sound isn't as loud). Holding your hand over your ear will demonstrate that it seems to get louder.

You get used to it. You CAN drink - if it doesn't interfere with your other meds. You can go out with your friends and drink non-alcoholic stuff - take a bit of kidding from them - but be the designated driver - which they WILL appreciate.

As with others, I strongly recommend getting a meter and self-testing.

And as far as cost goes - keep an eye on eBay - every once in a while you can get one that's very affordably priced.

If it comes with a return policy, you should be able to trust it. These meters are made to do thousands of tests, and to do them accurately. Most 'used' meters are probably safe to use - and quality controls that are built into the strips help to assure that your machine is working properly.

I don't know where you're located - but I have an extra Coag-Sense meter that I may be interested in parting with.
 
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Tinsley99

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Not sure why you cannot drink alcohol. Sometimes they tell people on warfarin not to drink, but that is incorrect. I've been told that once by cardiologist's nurse, and after a discussion with the cardiologist, we straightened her out.

The only dangers with warfarin and alcohol are two things. First, if you get falling down drunk and hurt yourself, you will bleed 2-3 times longer before you stop than a "normal" person. This can be a problem if you hit your head or get a severe cut (e.g. go through a plate glass window). Second, if you puke out your warfarin dose, your INR may change a little, but will stable out again after a few days. So don't get so drunk you puke or hurt yourself and you are good to go. You shouldn't get that drunk even if you are not on warfarin.
Hello I don’t understand how I can drink alcohol I’ve been only have two pints when I do will it not mess with my inr if I have like 5
 

LondonAndy

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Hello I don’t understand how I can drink alcohol I’ve been only have two pints when I do will it not mess with my inr if I have like 5
This is part of the joy of having your own meter - you can experiment with diet, or with drinking alcohol, and see what effect it has on your INR. For example, when I started drinking after surgery, I tested my INR on the day, before I had a few pints. Then I tested again the day after, and 3 days* after. In my case I found that the effect was a minor decrease in INR that did not need an adjustment in my Warfarin dose, but I only had 2 or 3 pints then. I have since had heavier sessions, and again no great effect. But we are all different, so well worth testing yourself.

I also find that eating vegetables high in vitamin K (I am weird, and love Broccoli!) also has little effect. The things that do affect me are having a cold or being on antibiotics - quite significant changes can happen then.

* I chose 3 days because Warfarin takes about three days to have its effect on your INR
 

Tinsley99

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Jan 23, 2020
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The ticking is your friend...

Okay, maybe not so much.

It makes it almost impossible to hide behind a door when you play hide and seek (my daughter used to get on the other side of the door and say 'Hi Dad'). It makes it difficult to wear a loud, cheap, mechanical watch -- I once bought an old Ingersol Mickey Mouse watch -- it ticks 6 times a second - and my wifte thought I was having a heart attack. I quickly stopped wearing it.

I was at a press conference, and a person in front of me kept looking back in my direction. He seemed to get more and more annoyed (and I knew why). I aimed my mouth at him, assuming that this would make it even easier for him to hear my tick. After a while, completely annoyed, he looked behind him and shouted 'who's wearing the cheap watch?'

I told him that it's my heart. It felt REALLY good doing that.

As far as the sound - I've pretty much drowned it out. I find that it helps to keep the ears clear, free of wax (the sound seems to get trapped in the inner ear - with a clean ear canal, the sound isn't as loud). Holding your hand over your ear will demonstrate that it seems to get louder.

You get used to it. You CAN drink - if it doesn't interfere with your other meds. You can go out with your friends and drink non-alcoholic stuff - take a bit of kidding from them - but be the designated driver - which they WILL appreciate.

As with others, I strongly recommend getting a meter and self-testing.

And as far as cost goes - keep an eye on eBay - every once in a while you can get one that's very affordably priced.

If it comes with a return policy, you should be able to trust it. These meters are made to do thousands of tests, and to do them accurately. Most 'used' meters are probably safe to use - and quality controls that are built into the strips help to assure that your machine is working properly.

I don't know where you're located - but I have an extra Coag-Sense meter that I may be interested in parting with.
Hi thank you for that

I would’ve loved to say that to that guy aswell 😂 he must’ve felt so
Bad 😂

I live near Cambridge how much would you want for it?
 

Tinsley99

Member
Joined
Jan 23, 2020
Messages
13
This is part of the joy of having your own meter - you can experiment with diet, or with drinking alcohol, and see what effect it has on your INR. For example, when I started drinking after surgery, I tested my INR on the day, before I had a few pints. Then I tested again the day after, and 3 days* after. In my case I found that the effect was a minor decrease in INR that did not need an adjustment in my Warfarin dose, but I only had 2 or 3 pints then. I have since had heavier sessions, and again no great effect. But we are all different, so well worth testing yourself.

I also find that eating vegetables high in vitamin K (I am weird, and love Broccoli!) also has little effect. The things that do affect me are having a cold or being on antibiotics - quite significant changes can happen then.

* I chose 3 days because Warfarin takes about three days to have its effect on your INR
I’m gunna have to get my own testing kit because it would be nice to have some beers and be chilled out and not stressed out about it just getting the money together first
 

LondonAndy

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I’m gunna have to get my own testing kit because it would be nice to have some beers and be chilled out and not stressed out about it just getting the money together first
If you have to buy your own meter (ie not available from your anticoagulation clinic, or from a local charity) the manufacturer does offer a pay monthly option for UK purchasers, which works out to £12.49 per month. Details at CoaguChek INRange
 

tom in MO

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Hello I don’t understand how I can drink alcohol I’ve been only have two pints when I do will it not mess with my inr if I have like 5
Most of what effects an INR are things like the foods you eat with Vitamin K, the activity in your digestive system and your personal activity. If you drink 5 pints and don't eat dinner because you are fueling your body with alcohol instead of food, this may affect your INR, not the alcohol.

INR and warfarin seems like science but it's really not black and white science. Your INR when on warfarin depends upon what you eat and how your body processes food and warfarin. For example, LondonAndy has significant changes with antibiotics. This is common, but not for me. I was on antibiotics, Cipro, for a few months and didn't have to change my dose at all and I have a narrow range, 2-2.5. For some reason when I go on vacation, my INR sometimes gets out of range, but to tell the truth I don't really know why, other than I sit on my ass driving for 2-3 days and eat fast food :) It comes back in range just by getting to the lake, relaxing for 2 weeks and eating a balanced diet.
 
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Most of what effects an INR are things like the foods you eat with Vitamin K, the activity in your digestive system and your personal activity. If you drink 5 pints and don't eat dinner because you are fueling your body with alcohol instead of food, this may affect your INR, not the alcohol.

... It comes back in range just by getting to the lake, relaxing for 2 weeks and eating a balanced diet.
One of my pharmacists pointed me to an article that says the metabolic system regards both alcohol and warfarin as poisons and processes them at highest priority. His recommendation was to stick to one glass of alcoholic beverage per meal and to keep the alcohol an hour or two away from the warfarin. Doing it that way, my INR has never shifted. Following his advice, I have never tried 5 pints so cannot say what that would do - whether close in time to the warfarin or further away.

Your meter is your friend. Start out slow and TEST, TEST, TEST. Otherwise do what TOM suggests. Moderation, consistency and frequent testing is the key to warfarin. Read "The Coumadin Cookbook" and books like it from the library. Just remember that the main non bleeding, non clotting, side effects from being on Warfarin are actually side effects from vitamin K1 and K2 deficiency.
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I consume exactly 300 mg of K1 a day. However, this is because I have to consume the same amount of carbs per day for other medical issues. We have discovered that a half cup of greens can run from 175 to 250 mg of K1. So if you look it up in the Coumadin Cookbook, you can get a consisten amount of K1 by eating from 1/4 cup to 3/4 cup of greens per day. Your intake from other vegetables is much lower and will affect you less. Of course it affects the carb intake much more so if you are diabetic as well, be careful.
-
I only got my meter last year and so am in the very frequent testing mode as I discover what works and what does not. The advice in old posts on this site is invaluable. Read them and then reread them a few months later.

Walk in Peace,
Scribe With a Lancet
 

Protimenow

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I have a real problem with the Coumadin Cookbook. It gives recipes that completely avoid Vitamin K. This was written in the days when ANY Vitamin K was to be avoided.

Since then, people have gotten more enlightened about Vitamin K. It's okay to take it - just be consistent with it and adjust your warfarin dosage to compensate for its effects. Occasionally binging on Vitamin K WILL lower your INR, but having a low INR for a few days won't put you at risk of stroke -- it takes longer than that for a clot to form.

Also - there are two Vitamin Ks. K1 is the one that disrupts the clotting process. K2 (without a trace of K1) doesn't. The body needs both. A K2 supplement should have no effect on your INR -- I've tried it, and haven't, personally, seen any changes to my INR.
 
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I have a real problem with the Coumadin Cookbook. It gives recipes that completely avoid Vitamin K. This was written in the days when ANY Vitamin K was to be avoided.

Since then, people have gotten more enlightened about Vitamin K. It's okay to take it - just be consistent with it and adjust your warfarin dosage to compensate for its effects. Occasionally binging on Vitamin K WILL lower your INR, but having a low INR for a few days won't put you at risk of stroke -- it takes longer than that for a clot to form.

Also - there are two Vitamin Ks. K1 is the one that disrupts the clotting process. K2 (without a trace of K1) doesn't. The body needs both. A K2 supplement should have no effect on your INR -- I've tried it, and haven't, personally, seen any changes to my INR.
I agree with you that you need K1. I have said elsewhere that the main percieved long term side effects of Warfarin are actually side effects of Vitamin K1 deficiency. The Coumadin Cookbook gives a long list of Vitamin K1 values for foods in an appendix. Since I have a target consumption of 300 mg per day, the list is invaluable to me. I supplement it with data from the US Department of Agriculture data base. I then look at my spreadsheet, see how much K1 I have consumed and take vitamin K1 pills to make up the difference to the nearest 12.5 mg (That is as small as I can split them) My spreadsheet includes K1, K2 values in one area and Carbohydrates, Fats and Protein in grams for each food I consume in another area. I need both sets of data for two different medical reasons. The Coumadin Cookbook recipes are useful for adding food without any K to the foods with known amounts of K1. Usually, I just consume singe food items and am too tired to cook fancy recipes.
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Unlike you, I did get a reaction to K2. It dropped my INR significantly. As a result, I am VERY slowly reintroducing very small amounts of K2 in pill form. I have noticed that K2 is present in highly variable amounts depending on how much it is grass fed. My INR tends to shift in the Fall and Spring as the season goes on. I blame this on the variable K1 and K2 in the green grass in the grass fed products as the seasons march on. My goal with my meter is to slowly adjust to the changes as you suggested elsewhere.

You mentioned "The body needs both" for K1 and K2. It does indeed! Our daughter purchased a copy of "Vitamin K2 And The Calcium Paradox: How a little known vitamin could save your life" From Amazon's writeup - "Dr Kate Rheaume-Bleue is a licensed Doctor of Naturopathic Medicine" So my natural skepticism shot up and I checked her references on the National Institute of Health, PubMed, site.

Recall, "Trust But Verify". My (now retired) endocronologist said that the most dangerous publication in the United States is the New England Journal of Medicine. Every important newspaper, evening news show and magazine in the country headlines their breaking medical research articles. None even notice their many retractions.

The references about Vitamin K2 check out as do the correlations between osteoporosis and atherosclerosis. To oversimplify, K2 drives a natural body system that moves calcium from where it should not be to where it should be. Vitamin D and other minerals also play a role. The body is really a well orchestrated system. There are no single silver bullets to fix the systems but lots of places where a missing ingredient can cause the system to fall apart.

I got my Coag-Sense from Wilburn Medical. They required a prescription but no insurance. I paid more then the eBay price but it was new and came in a bundle with a one year supply of lancets, transfer tubes and test strips. They shipped it to my house. I am still learning to use it. One of their staff said that they cannot sell the CoagUChek except to doctors and medical organizations for rental and that this is a requirement from Roche and not from them. He also indicated that this was why the Coag-Sense was so popular with their customers. They provided good service on their two sales to me. Since I have not needed any warranty service, I cannot speak to that. It works perfectly.

I have a very good laboratory and use the same two phlebotomists. 3 of my Lab readings have had corresponding Coag-Sense readings within 0.2 INR units of the Lab. The other two (The highest and the lowest) were within 0.4. On two occasions, I got the same reading on my Coag-Sense. On these occasions, I got the same (0.2 offset) readings from my lab. When I run the Lab and Coag-Sense through a regression analysis, the resulting Coag-Sense readings predict the Lab readings at less then 0.1 for 4 readings and 1.5 for the fifth (at the lowest reading). I feel like I have won the lottery. When you plot the predicted lab readings from the regression analysis over the actual lab readings you can hardly tell them apart ! - )

Thank you for posting your experience with the Coag-Sense. Mine is the second generation. I cannot say that I am a fan for the experience of using it but I am a super fan of the results. If you have a cooperative lab that will tell you whether and how they have calibrated their Laboratory equipment and what their reagent(s) is, go for it. The Coag-Sense has to be wonderfully calibrated and validated. Apparently, my labs manager had the lab equipment and reagent properly validated. So far, they will not talk with me. The Coag-Sense applications to the FDA indicate that their system is. Go Coag-Sense ! - )

Walk in His Peace,
Scribe With A Lancet
 
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Protimenow

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Wow. What a great post.

I had a fairly long talk with the lab that messed up two tests. They argued that you 'can't compare results between labs.' They just didn't get it. I tried to explain that when they tell a doctor that the patient's INR is 5.1, and it isn't, the doctor will tell the patient to reduce his dosage. For a patient with an INR that's actually 2.7 (or even, maybe, 3.7), reducing the dose could result in the patient's INR dropping below 2. This would put the patient at risk of stroke, pulmonary embolism, or death. But they didn't get it.

As far as Coag-Sense is concerned - that new meter is very nice. If you have questions about how to run a test, send me a private message. (Briefly, my initial challenge was getting the blood into the transfer tube - I suspect that this may also be your issue. I learned that one finger doesn't provide a lot of blood, but another does a good job. Once you've incised your finger, hold the tube to the blood drop, and, instead of holding it horizontally, tip it down a little. That way it isn't fighting against gravity).

I appreciate your information about K1 and K2, and your comments about The Coumadin Cookbook. I may have to dig mine out as a reference.
 

Homeskillet

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OR
Pardon my ignorance here, but, just to simplify, which K vitamin should I be taking—K1–K2–or both?

Either way, is there any specific brand better than others?
 

Warrick

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I take both 100mcg K1 and 45mcg k2 daily and I’ve used the k1 in the past as a bit of an experiment to lower my inr when its been high. 1000mcg dropped it 1.0 inr point but it took 3 days to fully drop and then head up again.

Aside from the usual inr changes and dose adjustments pretty consistantly my daily dose is 9mg daily and has been for several years even prior the vit k.

From another site this explains the vit k supplementation well- “Many people taking Coumadin use the Low Dose Vitamin K Technique, which involves taking low dose Vitamin K supplements (always consult with your doctor before changing your diet or taking supplements!). Here's how it works. For example, on Monday you take your Vitamin K supplement of 100 mcg and eat 50mcg of Vitamin K. That is a total of 150mcg of Vitamin K on Monday. On Tuesday, you take your Vitamin K supplement of 100mcg and eat 100mcg of Vitamin K. That is a total of 200mcg of Vitamin K on Tuesday. From Monday to Tuesday, your Vitamin K total went up by 33%. Now, let's say you didn't take a Vitamin K supplement at all, but still ate 50mcg on Monday, and 100 mcg on Tuesday, then your Vitamin K total would have gone up by 100%! By taking a daily low dose Vitamin K supplement your total Vitamin K changes less day-to-day. Hence, your Warfarin dosages will change less often and your INR will be more consistent."
 
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