2nd Mitral Valve Replacement Next Week

[Superman]

Thank you once again every one! Have learned a ton on this forum.

Quick follow-up question (don't mean to drag this thread out):

It sounded like the lady @ the Coumadin Clinic yesterday was saying that if I alter my diet in any way I need to let them know. Does this mean that if I go w.out donuts, cookies or cake for a few weeks, then all of the sudden get a craving for them - this will throw my INR into a tail-spin & I need call the clinic?

Same concept w. soft drinks, etc.

Similarly, after I recover I intend to get back into the gym lifting weights. This will involve pre-workout drinks, post-protein powder, etc. This will obviously be an alteration into my diet since surgery (there's really little need for these items right now). Will this alter my INR also?

Or, is she only referring to foods rich in vitamin K?

Thank you again!

Usually the altered diet question helps them know what may have led to changes in INR. For example, I don't tell them up front that I'm planning on drinking that bottle of cranberry juice I treat myself to once in a while. However, if my INR goes from 3.2 to 4.1 in a week - I will think back and consider what I may have done differently and inform them. Then, we work together to determine if I need to change my dose, or stop drinking juice.

I've had it where I missed a dose, and I knew it would impact my INR. Coumadin clinic's initial response would be to increase my standard dosing absent another explanation. However, with the information that I missed a dose, they can make a more informed recommendation that might not include a permanent change, but rather a small bump to get me back in range.

With diet, did you finish that bunch of spinach you bought, so can we expect your INR to recover at your current dose? Or are you making that a permanent part of your diet, so we know we need to increase your dose going forward?

In reality, there are small unexplained changes every week. I've been altering between 3.3 and 2.7 INR for the past three or four weeks. I don't know why. My dose has been 6 mg daily. No real changes that I can think of. That's a 0.6 INR swing, 10% either way of the mean with no identifiable driver. But I don't sit here on random Thursday worrying about what I'll eat tonight or what my INR is right at this moment. I've got real life to take care of.

 

[pellicle]

I've got real life to take care of.

Where I just came from that was faces to feed, nappies to change and screaming to stop... More pressing for sure

 

[judy bee]

I'm doing ok Homeskillet though a bit shaken after a 2 day ICU stay last week with a racing heart

 

[MartinF]

Homeskillet, I'll try to answer a couple of your questions/concerns.

In 2015 I did several day hikes in the Sierras between 8,500 and 11,000 feet. No issues.
In 2016 I did a multi-day hike with a 45 lb. backpack up to 11,000 feet and did have some breathing issues. I was in better physical shape in 2015.
I don't think warfarin was a factor.

I have my INR checked at the local Lab Corp. It's been in range most of the time in the past 4 years. When it does go out of range, they schedule a test in 2 weeks and if that is good they stretch it out to about 5 weeks. My range is 2-3 and it's hit 1.9 a couple times recently but was above 2 the next reading. I have had no problem with the longer blood tests. I'm sure everyone is different and I try to keep my diet consistent. They should test every week or two and then as the INR stabilizes and stays in range they should stretch it out. Many people here do self testing. For me with a tissue valve I think my condition isn't as critical as a mechanical valve recipient. Maybe self testing is a better route for you.

Hope this helps calm some of your concerns.

 

[pellicle]

Hi

Just wondering

.... For me with a tissue valve I think my condition isn't as critical as a mechanical valve recipient.

Was the reason for you being on warfarin afib or something else?

 

[Homeskillet]

Yep, there is a ton of uniformed and misleading info floating around about warfarin. Most things, in moderation, will not dramatically affect INR. Coffee, cookies, etc have never affected my INR. Not sure about the ingredients in some power drinks.....check ingredients and/or check INR to see if any affect. My first rule of managing INR is "dose the diet......do not diet the dose". Self-testing makes INR management very simple. I've found that keeping a consistent level warfarin in my system is the key. Take your pill at the same time each day (you choose a convenient time) and buy yourself a seven day pill box...... missed dosing or overdosing is the biggest problem with warfarin.

Yes, forgetting a dose is a key concern for me. Told my wife tonight that I need her to keep some Coumadin in her purse at all times so that if we're out late eating I can still take it close to the same time. I do wonder if there's a "grace" time period each night (e.g., 1, 2, 3 hours?) of taking my daily dose.

Or, what if I somehow completely miss a dose - what on earth do I do then? ER?

Also read that warfarin is actually rat poison! Say what??

Honestly, really just having a hard time w. all of this right now.

 

[Homeskillet]

Homeskillet, I'll try to answer a couple of your questions/concerns.

In 2015 I did several day hikes in the Sierras between 8,500 and 11,000 feet. No issues.
In 2016 I did a multi-day hike with a 45 lb. backpack up to 11,000 feet and did have some breathing issues. I was in better physical shape in 2015.
I don't think warfarin was a factor.

I have my INR checked at the local Lab Corp. It's been in range most of the time in the past 4 years. When it does go out of range, they schedule a test in 2 weeks and if that is good they stretch it out to about 5 weeks. My range is 2-3 and it's hit 1.9 a couple times recently but was above 2 the next reading. I have had no problem with the longer blood tests. I'm sure everyone is different and I try to keep my diet consistent. They should test every week or two and then as the INR stabilizes and stays in range they should stretch it out. Many people here do self testing. For me with a tissue valve I think my condition isn't as critical as a mechanical valve recipient. Maybe self testing is a better route for you.

Hope this helps calm some of your concerns.

Very helpful. Thank you.

I am also wondering if stress is a major INR changer? I have read conflicting reports on this. As a pastor, stress is an every day affair for me (since I have not only my own issues, but also every other church members problems).

 

[Homeskillet]

Usually the altered diet question helps them know what may have led to changes in INR. For example, I don't tell them up front that I'm planning on drinking that bottle of cranberry juice I treat myself to once in a while. However, if my INR goes from 3.2 to 4.1 in a week - I will think back and consider what I may have done differently and inform them. Then, we work together to determine if I need to change my dose, or stop drinking juice.

I've had it where I missed a dose, and I knew it would impact my INR. Coumadin clinic's initial response would be to increase my standard dosing absent another explanation. However, with the information that I missed a dose, they can make a more informed recommendation that might not include a permanent change, but rather a small bump to get me back in range.

With diet, did you finish that bunch of spinach you bought, so can we expect your INR to recover at your current dose? Or are you making that a permanent part of your diet, so we know we need to increase your dose going forward?

In reality, there are small unexplained changes every week. I've been altering between 3.3 and 2.7 INR for the past three or four weeks. I don't know why. My dose has been 6 mg daily. No real changes that I can think of. That's a 0.6 INR swing, 10% either way of the mean with no identifiable driver. But I don't sit here on random Thursday worrying about what I'll eat tonight or what my INR is right at this moment. I've got real life to take care of.

Gotcha! Good stuff to know.

 

[dornole]

Interesting article with more info on the development of Coumadin

http://www.drugsdb.com/blog/coming-upon-coumadin-how-warfarin-was-discovered.html

 

[Warrick]

Interesting article with more info on the development of Coumadin

http://www.drugsdb.com/blog/coming-upon-coumadin-how-warfarin-was-discovered.html

Neat article, thanks

 

[Superman]

Yes, forgetting a dose is a key concern for me. Told my wife tonight that I need her to keep some Coumadin in her purse at all times so that if we're out late eating I can still take it close to the same time. I do wonder if there's a "grace" time period each night (e.g., 1, 2, 3 hours?) of taking my daily dose.

Or, what if I somehow completely miss a dose - what on earth do I do then? ER?

Also read that warfarin is actually rat poison! Say what??

Honestly, really just having a hard time w. all of this right now.

First off, the "take it in the evening" standard is just a thing that came about. I honestly don't know why. Very early on, I knew evenings wouldn't work for me. I was barely 18, I had a job after school, I had friends I was going to hang out with, I knew morning would be the most consistent time. Even with that, though, I've never been a clock puncher on that. If I get up at 6:00, I take it before I leave the house. I've never resisted an opportunity to sleep in though, and sometimes that meant 9:00 or later, in my younger years. Point being, if you have a time of day that you know you're more likely to be in the same place, then make that your time. Don't let them force you into the evening shift if it will be harder to stay consistent. Over 26 years later, I'm still correcting the Coumadin Clinic when they say, "Okay, for tonight's dose..."

I think it might be because it's viewed as an "elderly with heart problem" drug, and all patients are at home getting ready for Wheel of Fortune and Jeopardy, back to back - so 7:00 PM is perfect! But besides pellicle, who really knows?

Second - regarding missing a dose. Happens to everyone at one time or other. I promise, you will do it too. And you will survive. There are a few ways to deal. If I think of it early enough, I'll just take it when I remember. If I don't remember until the evening, I might take a half dose, then start back normal the next morning. If I miss completely, I might just resume my regular dosing (depending what my last INR was), then be sure to test in a couple days. At an INR of 3 or better, I've got some downside wiggle room to absorb a miss. I have never called or gone in to ER over a missed dose.

The only time I went to urgent care in over 26 years due to Coumadin was when I did two really stupid things. One I didn't know was stupid. First, I had gone two months or more since my last test. Prior to that, I had been stable for months on the same dose. Home testing didn't exist at the time, and I didn't make time to get to the lab. The second thing was only stupid because of the first. I chose that time to get on a glass a day of cranberry juice kick. My urine had become a dark brown color, indicating blood. Turns out my INR had spiked to around 10!

Notice though, that bad things didn't just happen because I was on Warfarin. They happened because I was an irresponsible patient. And the juice wasn't the problem either. It was the lack of testing. Had I been testing frequently, I would have changed my dose as soon as I showed and INR over 3.5. It never would have climbed that high.

 

[dick0236]

Notice though, that bad things didn't just happen because I was on Warfarin. They happened because I was an irresponsible patient. .

I agree with everything Superman says. He and I have both been on warfarin for a long time and I referenced his quote above to reinforce that problems with warfarin are usually due to irresponsibility on the part of the patient. My one, and ONLY, bad experience with warfarin was my own irresponsible behavior.......the drug did not jump up and bite me for no reason......but I'm a quick learner and I learned to be responsible real quick.

 

[MartinF]

Pellicle,

After I went off warfarin 6 months after my surgery I had shortness of breath on one of my evening walks. This was about 7 weeks after going off warfarin. A week before that I noticed a slight difference in my walking and running but thought it was just a bad day. The next day after the shortness of breath I felt normal but didn't walk. That night I was breathing heavy and went to the doctor the next morning. End of story was I ended up in the hospital and tests found my leaflet had thickened so it didn't move (stenosis). I had fluid in my lungs. The surgeon visited me and said he saw this one other time and put me on heparin. I remember after about 4 days I noticed a change. I was put on warfarin after that and was able to do a hard walk a week after the 6 day hospital stay so I knew it was better. I had a TEE after that and all was normal again. I recently changed cardiologists and the new one was around the hospital during my surgery and knows the surgeon. He told me that my body reacted to the valve or something on the surface of it. So I guess the warfarin keeps my body from trying to cover up the foreign material. It's a somewhat rare reaction according to the cardiologist. That was 4 years ago and no problems since. That's why I'm on warfarin. I did have afib a couple days after the surgery but it was only for about 30 minutes and the nurses said it was common for mitral valve replacements. I'm on a beta blocker to help reduce the possibility of getting afib.

Martin