After years of stable numbers joining planet fitness is lowering my INR it seems

[baradonai]

Hi all. It's been a long while since I've been here. The new site looks good!
I'm a 53 year old male. 10 years ago I received a St. Jude Mitral valve. Within a year, we had my warfarin numbers pretty stable with only an occasional adjustment. Everything has been hunker-dorey as they say. I go to a coumadin clinic to get the tests. They use a CoagucheckXS.
Novemeber/December of last year my numbers were up and down a bit and we thought that it was probably diet with all the holiday eating.
In January I got the family a membership at a local gym and we've been exercising an hour or so twice a week to start. That's the only new thing in my life that I know of.
Since then my numbers have been dropping and we've been upping the dosage. On 3/27 my inr was 2.1 so we upped the dosage from about 60.00 to 67.5mg (adding one additional 7.5mg tablet a week)
Just got tested today and my inr was 1.9! We're adding another 7.5 to the week and checking next Friday.

It's either the exercise, bad warfarin or something about my 53 year old body is changing and requiring the higher dose.

I have found several posts searching exercise and INR and it does seem to lower the number with some people
. The RN running the clinic doesn't think it does. Anyone have any links to something concrete we can read?

Thanks all.
Marty

 

[Boomanchu]

I'm 11 weeks post MVR with a St Judes. I'm just starting to feel pretty good as I get back into shape but the Metoprolol and Amioderone keep me spacey. I hope I don't start having the same problem as I really want to work as hard as I can to get back into shape. My INR took less than 2 weeks to get into range and now it never changes.

 

[pellicle]

Hi

I'm a 53 year old male. 10 years ago I received a St. Jude Mitral valve. Within a year, we had my warfarin numbers pretty stable with only an occasional adjustment. Everything has been hunker-dorey as they say. I go to a coumadin clinic to get the tests. They use a CoagucheckXS.
...
It's either the exercise, bad warfarin or something about my 53 year old body is changing and requiring the higher dose.

I have found several posts searching exercise and INR and it does seem to lower the number with some people
. The RN running the clinic doesn't think it does. Anyone have any links to something concrete we can read?

I guess that we are the researchers ... I've recently started using a vivovit band to more accurately work out my active Kcal and see if there is a correlation. I would be happy to work with you on assembling some data, please email me at hotmail.com if you are interested (pellicle at hotmail)

Best Wishes

 

[dick0236]

It's either the exercise, bad warfarin or something about my 53 year old body is changing and requiring the higher dose.

Thanks all.
Marty

I doubt that exercising a few hours per week would affect your INR. I have gym exercised six or so hours per week for the past 10-12 years with no effect on INR.

I hope we have no "bad" warfarin in circulation.....but a few years ago I had some fluctuation in my INR that may have been due to a change in the brand of warfarin I was taking. Many pharmacies now purchase warfarin from labs around the world to get the lowest price. These labs all manufacture to the FDA standards.......but the allowable drug tolerance can mean some difference between brands. I now use only one brand with few warfarin adjustments. My pharmacist agreed that it was a good idea, especially for drugs like warfarin.

Changes in the body due to age and activity may make for some change in warfarin needs. I've gone from 70mg/wk(young man) to about half that(old man).

Have you considered "home self testing"? More frequent testing helps identify "why did that happen" before it becomes an issue.

 

[T in YVR]

I work out regularly and there is absolutely no doubt in my mind that exercise affects my INR (lowers it). When I have hit periods of less activity, my INR goes back up on the same dosage, and I have to adjust my dose down slightly. As Dick says, working out 2-3 hours a week is not that much, so I'd be surprised if it affected your INR on its own. Maybe its a combination of things...
Tony

 

[RobThatsMe]

When exercising you increase your rate of metabolism, and if building muscle, this also will keep your metabolism level higher even when not exercising.
This means your liver functions a little more as well, thus effecting your INR level,( it will lower it), as it processes the Coumadin out of your system faster.

Rob

 

[big_L]

I really believe that working out will lower your INR. I don't have evidence to prove it, as I've always worked out 30 minutes four mornings a week.

 

[baradonai]

Thanks all. I am beginning to think it is the exercise. The nurse that does the testing mentioned the possibility of getting an in home tester. The last time I looked into it, the copay was going to be a little difficult for me. We've changed insurance. It may be better now.

 

[Boomanchu]

Can someone tell me how much a home INR tester costs?

 

[pellicle]

Can someone tell me how much a home INR tester costs?

you can pick up a "barely used" Coaguchek XS on eBay for a few hundred ... strips from online medical shops work out to be about $130 for 24 strips.

Last year I thought I'd summarise my current practice into a blog post
http://cjeastwd.blogspot.com.au/2014/09/managing-my-inr.html

best wishes

 

[pellicle]

Thanks all. I am beginning to think it is the exercise. The nurse that does the testing mentioned the possibility of getting an in home tester. The last time I looked into it, the copay was going to be a little difficult for me. We've changed insurance. It may be better now.

I got sick and tired of waiting at clinics and being late for work, so I reckon it paid me to just buy one. When I look at the obsession with putting every little thing on insurance it somehow feels a little "socialist" to me.

also Id id a linear regression on the data on my metabolism factor (part of my simple model for INR) and got about 70% correlation between my metabolism (NB INR) and my active KCal. So there is no doubt in my mind that the two are related (exersize and metabolism/INR) .. obviously it is not the only factor, but if it varies (IE you do not have a regular routine) then that can cause swings in INR that are larger than the usual background noise.

 

[tom in MO]

Marty, It could be age changing your metabolism. After I turned 50 I had some dramatic changes. The first was allergies. I never had them before, now I am on three different prescription medications. Also I got arthritis and a more "irritable" bowel. Your testosterone levels drop as well. All of these are natural changes in the way your body works. The changes could be affecting your INR.

Boomanchu, The deal with home testing machines is really weird and can change year to year and provider to provider. Right now I have a monitor and only pay for the supplies. When I asked the provider who owned my monitor they said I did. They gave it to me for free. My cardiologist's nurse said that a lot of times the INR machine is free, you pay for supplies. That's could be why you cannot buy strips easily on-line.

My mother in law passed away a few years ago and we found her monitor in the house a couple of months ago. Nobody ever asked for it to be returned (like the other medical equipment she had at home) so I bet hers was free as well. On the other hand, I have another medical device, that is rent to own. They did not tell me that until I asked, but after 18 months I own it.

 

[bocco]

After my surgery at 55 I stabilized pretty quickly. Then a few weeks later when I got back in the gym my INR number did start to drop and I had to increse my dosage about 25%. Over all I think you will ultimately be more stable with exercise and the higher dose.

 

[pellicle]

Hi

pardon me Tom, but I'm confused ...

... That's could be why you cannot buy strips easily on-line.

Of course I don't live in the USA, but a google revealed oooodles of suppliers

http://www.mohawkmedicalmall.com/Co...Prothrombin/?gclid=CKbp46XE-cQCFdgmvQodTL0A_A
http://wilburnmedicalusa.com/coaguchek?gclid=CIrB-afE-cQCFYYGvAodb0MAOw

then there is ebay ...

 

[tom in MO]

Hi

pardon me Tom, but I'm confused ...



Of course I don't live in the USA, but a google revealed oooodles of suppliers

http://www.mohawkmedicalmall.com/Co...Prothrombin/?gclid=CKbp46XE-cQCFdgmvQodTL0A_A
http://wilburnmedicalusa.com/coaguchek?gclid=CIrB-afE-cQCFYYGvAodb0MAOw

then there is ebay ...

There was a thread awhile back where people complained about not being able to get CoagucheckXS strips outside of an insurance company and doctor referral. You cannot just buy them at the drug store.. I tried to get them directly from Roche, but they would not sell me the strips alone. They also said that in the US you need a presciption for them. Seems stupid, since there is no risk in measuring your INR, its the coumadin that will kill ya : )

My cardio's nurse told me that she has one patient that buys her own and it was hard for her to get an independent source. If I wanted, the nurse offered to get me the name of the supplier. I did not go down that route, since I will have my deductible paid up this year, strips are not too expensive on my insurance.

 

[pellicle]

Hi there

There was a thread awhile back where people complained about not being able to get CoagucheckXS strips outside of an insurance company and doctor referral.

yes, I think I recall that ... I've not tried those phone numbers but if they are new and in boxes and unopened why not? Here in Australia chemist shops (drug stores) often don't even know such a device exists. I've had no trouble buying online.

I also recall threads here where people buy of ebay and get them even cheaper because the package has been dammaged (but the item is unopened).

I thought I'd post this because I know people read things here, don't ask questions and take what they read at face value. I'd personally hate to discourage someone from self testing.

 

[tom in MO]

Well the way the US works, my strips cost $500 for 12. This can be a significant barrier to home testing. However, since I fullfilled my deductible this year early on, the same 12 strips still cost $500, but my out of pocket is only $50. I am lucky, my current firm has a deductible of $300, which I blew with this years echo.

 

[tom in MO]

Well the way the US works, my strips cost $500 for 12 from the provider authorized by my insurance company. This can be a significant barrier to home testing since a blood draw/test is free from the same insurance plan. However, since I fullfilled my deductible this year early on, the same 12 strips still cost $500, but my out of pocket is only $50 ($4 a strip). I am lucky, my current firm has a deductible of $300, which I blew with this years echo.

 

[pellicle]

Well the way the US works, my strips cost $500 for 12. This can be a significant barrier to home testing.

indeed, but they can be purchased online in the USA directly for around US$99 for 24 strips. As there are people who are uninsured going direct to a reputable seller reduces that barrier enormously (was my implicit point). Further even someone on a social welfare scheme such as insurance you are not unable to buy strips at a much lower cost and test at greater frequencies if you wished (I regard insurance as social welfare schemes that you pay for privately and the costs are socialized among the members and the profits are kept private) .

There are as I understand it poorer people in the USA who have had heart surgery to replace a valve but are on their own when it comes to many things such as monitoring.