Warfarin and holiday

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Nick Drew

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Oct 31, 2022
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Just writing really to get this off my chest but any comments welcome. Approx. one year since my ON-X was fitted and set about a cruise up to the Fjords in Norway for a week last week.
3 other couples with us all of whom i would describe as pretty heavy drinkers. Formerly a regular weekend drinker but now take it a lot easier these days i found it difficult to not join in.
Had a couple of nights off and drank some non alcoholics (pretty poor choice on board really) but drank moderately and a couple of nights moderately to not moderately! Took my Coagchek machine and measured INR on the Friday morning and was spot on 2.5.This is not to say that i recommend drinking on cruises although it is good fun! I am booked on another next year but just two of us and i am now back to watching what i drink. Ate anything and everything (i do not eat meat) and still ok check wise. Just to say i let myself go a bit and it seems no harm done, certainly felt better mentally as first holiday since 3 monthsoff for the operation last year!
 

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I've seen no impact on my INR due to alcohol consumption. I was told 12 years ago by the hospital pharmacist's, warfarin instructor that alcohol doesn't interact with your warfarin and impact your INR unless you throw up the warfarin. The FDA's copy of the patient packaging instructions does not list any contraindications with alcohol. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/009218s107lbl.pdf
 
It depends on what you're drinking. A LOT of red wines MIGHT have an effect on INR because of the tannins in the wines -- or so I've read.

My 'drinking' is very rare, and usually something pretty innocuous -- White Zinfandel or something similar.
 
Nick
Took my Coagchek machine and measured INR on the Friday morning and was spot on 2.5
great outcome and welcome to life on warfarin ... you can also have a few. Do some experiments where you plan how many, stick to that and measure INR. Look for
  • how long it takes to peak and return,
  • use the above finding to repeat the experiment to see how many drinks moves your INR out of comfortable range (that'd be 3.5 in my view)
  • what happens on drinking a second day
  • what happens when having one drink a day every day for a week
Enjoy the experiments too, but be rigorous in your approach, it is science we're talking about ;-)
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Cheers 🍻
 
Just writing really to get this off my chest but any comments welcome. Approx. one year since my ON-X was fitted and set about a cruise up to the Fjords in Norway for a week last week.
3 other couples with us all of whom i would describe as pretty heavy drinkers. Formerly a regular weekend drinker but now take it a lot easier these days i found it difficult to not join in.
Had a couple of nights off and drank some non alcoholics (pretty poor choice on board really) but drank moderately and a couple of nights moderately to not moderately! Took my Coagchek machine and measured INR on the Friday morning and was spot on 2.5.This is not to say that i recommend drinking on cruises although it is good fun! I am booked on another next year but just two of us and i am now back to watching what i drink. Ate anything and everything (i do not eat meat) and still ok check wise. Just to say i let myself go a bit and it seems no harm done, certainly felt better mentally as first holiday since 3 monthsoff for the operation last year!
We spend a lot of time at the beach, generally lounging and enjoying our group of friends. Our daily routine prior to my surgery was to gather up the chairs and head down and usually drink a few beers throughout the day. As my mother in law would say, we try to pace ourselves by also drinking water throughout. Usually the evening is topped off with a specialty frozen drink and then a glass or two of wine on the back balcony. The first vacation following surgery was close to one year later (my diagnosis was given by my Dr. on the second the last day of vacation) and we proceeded as usual. I'd intended to offset my alcohol intake with some greens during the week (following my nurse's advice), but never followed through. I ended up passing blood in my urine by the last day of vacation. Could have been coincidental, could have been because of a high INR, I'm not sure as I don't self test. I called the nurse, scheduled a visit but it was a few days later.

The following year I definitely cut back and have pretty much followed that routine since. We're returning in July again as usual with our usual group of friends, but I intend to follow through with upping the greens in my diet. Nothing like having blood in your urine to put a damper on vacation and to scare the hell out of you.
 
Instead of wondering why you had blood in your urine, why don't you self test? Maybe test before your vacation and during the vacation, if you're concerned about your INR?

Meters and strips are fairly inexpensive on eBay if you don't already self test.

Also, if you don't already use one, get a 7 day pill box. This can help to keel you from accidentally taking a double dose (it happens).
 
Blood in the urine can be a sign of things other than a high INR. I've had it and the problem was not at all related to my INR. An elevated INR just means you see the symptoms earlier. It can be you have a bladder stone, it is also an early sign of cancer per my urologist.
 
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I also find my INR goes up on holiday, and I put it down to a combination of more alcohol (but moderate levels, not drunken) and the change of diet. Using my CoaguChek to monitor INR level means I don't worry about it - just adjust the dose accordingly, and test every few days instead of my usual weekly. Happy Holidays!
 
Just back from 3 weeks in Europe and as it has in the past, my INR was slightly elevated. Based on past experience, I expected this and test very 5 days or so. I reduced my dose slightly for the duration of travel and carried on. I don’t know what exactly causes my INR to increase when travelling, likely the fact that I don’t eat my daily spinach salad while away. It could also be less intense workouts, or maybe it’s the extra glasses of wine lol. Regardless, I find it easy to manage if I test and make slight adjustments before it gets to far out of wack.
 
Just writing really to get this off my chest but any comments welcome. Approx. one year since my ON-X was fitted and set about a cruise up to the Fjords in Norway for a week last week.
3 other couples with us all of whom i would describe as pretty heavy drinkers. Formerly a regular weekend drinker but now take it a lot easier these days i found it difficult to not join in.
Had a couple of nights off and drank some non alcoholics (pretty poor choice on board really) but drank moderately and a couple of nights moderately to not moderately! Took my Coagchek machine and measured INR on the Friday morning and was spot on 2.5.This is not to say that i recommend drinking on sunset cruises although it is good fun! I am booked on another next year but just two of us and i am now back to watching what i drink. Ate anything and everything (i do not eat meat) and still ok check wise. Just to say i let myself go a bit and it seems no harm done, certainly felt better mentally as first holiday since 3 monthsoff for the operation last year!
Thanks for sharing your experience. Sounds like a bit of a challenge balancing fun with health concerns. Glad to hear your INR was steady, and you had a good time overall!
 
I suspect water (influence on the gut bacteria) and change of routine.
Maybe, too, it's different bacteria in the food - your gut bacteria (and the way it deals with warfarin) may have been different from what's around in your food in your home country. I suspect that the gut bacteria may slightly vary from Continent to Continent and from cuisine to cuisine.
Of course, I could be full of crap, too.
 
Then where would gut bacteria come from? Raw foods - fruits, vegetables, etc. will have local bacteria on their skin unless they're, perhaps, put into boiling water to kill the stuff on them. Yeast spores (yeah, not bacteria) are in the air, as are, I suspect all kinds of other things that could conceivably add to a person's gut bacteria.

And unless food is heated to a high enough temperature, for a long enough time (possibly making it somewhat inedible), there may still be bacteria in the food.

We're still seeing cases of E.Coli in food and Listeria in milk, and frequently have recalls because of these bacteria (so they don't really get into the food chain). Other, 'friendly', bacteria may still find itself in the food chain.

I suspect that local produce and other items WILL have some local bacteria.
 
… Sounds like a bit of a challenge balancing fun with health concerns.

I wanted to reply on this comment in particular.

If you self-manage, no … double no … and triple no. It is not a challenge at all in this case. In fact, it is the exact opposite. When you self-manage it is actually empowering, comforting, and in lots of cases, fun. Self-managing is an anxiety destroyer. It takes away worry, doubt, and even problems.

When in doubt - stop doubting and just test. It’s so easy. I still don’t understand why diabetics do this all of the time and many mech valvers do not.
 

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