Taking Warfarin and diet

[Thwdp]

Hi - I am new to the site and I have been reading through it - but there is so much here I thought I would post my question while I ploughed on looking for my particular concerns.

I have been diagnosed recenlty (and unexpectedly) with Moderate Aortic Stenosis and Regurgitation (only 40 years old, although congenital I didn't know, so was slightly taken aback) and I have been advised to have a mechanical valve fitted in 7 weeks time

Obvioulsy concerned about a whole heap of things - But I would like to start with how unstable or reactive is warfarin?

Do you have to eat exactly the same things (Vit K orientated) every day? or is it more a weekly thing? If I eat Brocilli three days a week every week is that fine or do I need to eat it every day or not at all?

Same question for Alcohol - if I drink 2 glasses of wine 3 times a week and then one night have 6 glasses how will that affect me? (apart from the general feeling of well being which comes with inebriation ) How will it affect my INR I mean.

How quickly does INR drop/rise and how quickly can that lead to clotting and then stroke?

Sorry if this is a lot to ask, and/or seem petty in the grand scheme of what I, or any of you are facing, but sorting out these little things would help me deal with the bigger picture.

Many thanks in advance

Thwdp

 

[Lisa in Katy]

First, welcome! I'm surprised that they are recommending surgery in 7 weeks time if you're only moderate. I assume you are having symptoms.

Anyway, as long as you eat a regular diet, the Coumadin is adjusted to fit your diet, and you are good. Broccoli a couple of days a week is fine.

I would not recommend drinking 6 of anything. Two reasons - yes it could cause you to be more at risk of bleeding and it could cause you to be more at risk of falling, which if bad enough, could cause a problem.

 

[Thwdp]

Hi Lisa

Thanks for the response and the welcome.

I have no outward symptoms but my Left Ventricle has increased in size recently.

I have just re-read my post and the times frames are a bit mis-leading - sorry. I was diagnosed just over a year and a half ago (recent to me) and was told I probably had 15 years before needing surgery but was to be monitored each year. In March they noticed an increase in my LV and scheduled a half year check last month and saw a further increase. This, they said, was a trend and to avoid further damage to the heart they recommended surgery. The surgery takes place in 7 weeks from now.

I have only been finding out this week that warfarin/coumadin is more complicated than I was told, and I have not had a chance to ask these questions to my GP or Cardiologist yet.

In terms of the broccoli bit - do you have experience on how quickly INR levels change? If I am having a weekly check (further down the road after the op) what is the propensity for my INR to drop during that week and cause a blood clot in between checks? Or does it not happen that fast?

Good point about the drinking - I hadn't even considered falling over or bumping into things etc.

 

[Cooker]

Welcome to the zoo ... Everyone is different ... some have a hard time and some have an easy time staying in range ... I am lucky to be one of the stable (watch it!) ... I eat what I want, do what I want and adjust the dose if needed ... I wish you well in your upcoming surgery!!!

 

[Ross]

Diet actually plays a very small roll in INR management. So long as you eat the way you always have and dose that for that diet, your not going to have problems. Unfortunately, there are some managers out there telling people to avoid green vegetables and other sources of vit k which is wrong. Your body needs those nutrients just the same as always.

You'd have to really pig out on a single source of vit k to make a marked decrease in your INR. Binging is what it's called. Don't bing eat things or if you do, be prepared to adjust your dose to match your new diet.

As far as clotting goes, any time your below an INR of 2.0, your risking a clot. The risk is small, but it's a risk nonetheless. Why tempt fate when it's so easily managed by those that do know how to manage it?

There are a host of things that will cause INR rise and fall. Nearly everything really. Some antibiotics, increased energy and activity, other drugs or herbal supplements etc. but all in all, it's very easily managed once you've grasped the concept.

Two sayings to remember.
1. Dose the diet, do not diet the dose your on.
2. You can replace blood cells but you cannot replace brain cells. Better to be too high with the INR then too low.

 

[catwoman]

I don't know exactly (percentagewise) how much diet affects your INR vs. activity/exercise level vs. other Rxes and OTCs and herbals vs. illness/physical condition/age.

Warfarin (Coumadin) is a slow-loading drug. It takes about 72 hours for a dosage change to be reflected in the INR. Therefore, it stands to reason that if you pig out one day on broccoli (broccoli/spinach omlette for breakfast, beef-broccoli stir-fry for lunch and have broccoli/cheese/rice side dish at dinner) but go back to a normal eating pattern, it shouldn't affect you all that much.

However, if you tend to be a fairly consistent person -- which most people probably are, you would be OK. We're not talking holidays and special occasions.

Alcohol can be dehydrating, has empty calories and can cause you to stumble, fall if you have too much. In the right amount, it's OK and can be heart-healthy. I do drink on occasion -- a margarita or two, martini, glass of wine, but that's all.

My INR has been fairly consistent since late April, when I got my 2nd INR monitor (INRatio). I tested yesterday at work -- while multi-tasking on the computer and answering phone calls!!! -- and it was 3.0. Two weeks ago it was 3.3; three weeks prior to that it was 3.1. My INRs have been 2.7-3.5 in the last 6 months.

As far as warfaring being "complicated," it can present challenges for some situations (surgeries, for example), but in everyday life it does not.
That is, unless you don't understand anticoagulation therapy management. And there are some medical professionals out there like that. They have other fish to fry, so to speak, and just don't have time or inclination or enough warfarin patients in their practice to really think and want to learn how to handle warfarin.

 

[dick0236]

I have never thought of warfarin as a "complicated" drug. I have been on the drug for 41+ years. Most of those years were "pre-internet", when info, good or bad, was not easily available. Warfarin dosing requires:
1. Take the drug as prescribed. Don't skip or double up doses. A "pill box" is an easy way to stay on correct dosing.
2. Test frequently. I test every two weeks or so. INR can change for seemingly no apparent reason. However, INR changes normally come with changes in other medication usage, personal habits or exercise, significant diet change, etc.
3. Live a normal life using ONLY good judgement (which I have not always done). Seldom has warfarin interfered with my life or activities.

It could be worse. I understand that "diabetics" have a more stringent regimen they must follow to stay in "insulin" range.

Welcome to this site and I wish you a successful surgery.

 

[Thwdp]

Thank you so much guys - the thought that it does not affect your lives as much as I feared and you have not found it as complicated as I was thinking it could be, is very encouraging.

Ross - I like your points to remember very much, thanks.
Catwoman - understanding that it takes 72 hours for a new dose to take affect is very helpful
Dick0236 - your right there are always people worse off
Cooker - it is good to know it doesn't seem to limit you, you sound like you just dose accordingly

Thank you all - I am starting to feel a little more relaxed after hearing from you on this, I really appreciate it.

 

[Ross]

Thank you so much guys - the thought that it does not affect your lives as much as I feared and you have not found it as complicated as I was thinking it could be, is very encouraging.

Ross - I like your points to remember very much, thanks.
Catwoman - understanding that it takes 72 hours for a new dose to take affect is very helpful
Dick0236 - your right there are always people worse off
Cooker - it is good to know it doesn't seem to limit you, you sound like you just dose accordingly

Thank you all - I am starting to feel a little more relaxed after hearing from you on this, I really appreciate it.

Were not surprised. Every new person that comes in has been told all sorts of stories and myths. We are somewhat of a new breed of Coumadin patients and we only make up about 5% of the total taking the drug and that is, we are self dosers and self testers. It will become more common as time goes by and there are replacements being worked on as we speak that might well be on the market within the next 5 years, but don't get your hopes up. That's lesson number 2!

If you want the TRUTH and no nonsense info on Coumadin, see Al Lodwicks site at www.warfarinfo.com