Bleeding issue

[sharky7]

What we are doing here is to listen to the doctor and advise here, to walk hand in hand. I advise those who are having problems with those kind of doctors, who also do not listen to the patient, to get another cardio who will listen. If you cannot talk to the doctor and he/she only listens to themselves, they make the worst kind of doctors who are in it for the money, although in America, they are not making money like they used to.

SOMETIMES, there is no option to those that do not have the money to choose to go to another "Cardio who will listen", back in 2015 i was told by those the same thing, I was able to listen and did what they said to do, AND I knew then that I had to listen to them.....what did they tell me, I needed a NEW MITRAL VALVE, the advise was to get it done outside the VA system of health care! I didnt even ask why, i did it. And I knew then there were those that I could not help, and that did not have that choice that I did! Bruce Hauser, a good friend that had to deal with that, last time I saw him was in a Hospital Bed and at the VA! And No, I am not in anyway shape or form getting down on the VA.......although it is what it is! I am as I have said, I am USAF/retired federal govt/USA in 2004 and after 31 years! [and damned proud of it.....and would do it all over again, and in a heart beat, yes that was a pun.]

 

[carolinemc]

SOMETIMES, there is no option to those that do not have the money to choose to go to another "Cardio who will listen", back in 2015 i was told by those the same thing, I was able to listen and did what they said to do, AND I knew then that I had to listen to them.....what did they tell me, I needed a NEW MITRAL VALVE, the advise was to get it done outside the VA system of health care! I didnt even ask why, i did it. And I knew then there were those that I could not help, and that did not have that choice that I did! Bruce Hauser, a good friend that had to deal with that, last time I saw him was in a Hospital Bed and at the VA! And No, I am not in anyway shape or form getting down on the VA.......although it is what it is! I am as I have said, I am USAF/retired federal govt/USA in 2004 and after 31 years! [and damned proud of it.....and would do it all over again, and in a heart beat, yes that was a pun.]

I am not referring to VA and if you have problems with their cardio's you can search for one because the Federal Government of Veterans affairs got the okay for Veterans to see regular doctors and they would be covered by the Veterans Administration. That was set a few years ago. The reason was how many were treated by unethical doctors on staff at several VA hospitals. One was even turned into a movie, using the VA in Kansas City , MO back in the 1980's for television. Congrats for your listening to great advice for they knew it was bad there. Congrats for your serving the USA.

 

[pellicle]

Then theres this doctor who considers himself an anticoagulation expert-

Yep, sadly for the patients ... An old saying in Australia is that doctors bury their mistakes. Nobody in the real world would dismiss that, but with due respect to the fantastic work that in the main happens, mistakes happen too.

That is why places like this exist, what I find is the main reason people occasionally feel inclined to say "don't listen to some random person on the internet" is not genuine concern for the question asker, but fundamentally an ad hominem attack on the person providing advice.

I often wonder what happened to that NZ guy with the chest infection.

 

[pellicle]

Then theres this doctor who considers himself an anticoagulation expert-

The article says
"In the commissioner's executive summary it stated: "Dr Moore told HDC that he assumed Mr Hole was taking warfarin for a rhythm disturbance. Dr Moore did not investigate further, and advised him to stop taking it."

That's why we ask here ...

 

[Superman]

Such a sad article you linked. Makes a statement about those who say over and over again to ignore everything you read on this forum by "random posters" and just listen to your doctor.

"... I know the doctor is human .."

Yes. That.

Trust, but verify. When you know someone who works as a medical professional and works closely with other medical professionals, you gain insight into just how human they are.

All Dr’s likely went to school longer than their patients. Not all are smarter than their patients. And this becomes more true as we get more patient specific and less general with issues.

The article says
"In the commissioner's executive summary it stated: "Dr Moore told HDC that he assumed Mr Hole was taking warfarin for a rhythm disturbance. Dr Moore did not investigate further, and advised him to stop taking it."

That's why we ask here ...

I’m still not clear I guess. Did the guy have a mechanical valve? I guess that answers the question, “Does this get quieter over time?”

Too soon?

 

[pellicle]

When you know someone who works as a medical professional and works closely with other medical professionals, you gain insight into just how human they are.

yep ... or when you know a few medical professionals yourself.

I don't think its clear that the guy had any other conditions, but then afib is a cause of strokes ... surely further investigation is warranted. No?

In Australia its pretty rare for a Doctor to encourage you to cease a medication, indeed the opposite can be true: it can be hard to get off.

 

[DaveLee]

You said in a previous post that since your surgery you can no longer eat greens. I wonder which of your medical team told you that. That was bad information. Doctors are human and they make mistakes. There is great value in hearing what others who have a lifetime of experience have to say and sometimes you can learn things that many doctors get wrong, such as it is ok to eat greens if you are on warfarin- most days I eat two large salads loaded with greens.

We should listen to our doctors, but I have found it of great benefit to also listen to people who have lived with my condition for decades and find their collective experience extremely valuable. And, Paul did suggest that he would likely go to the hospital and others have encouraged him to do so. It is not as though he was seeking advice instead of medical attention. Nothing wrong with seeking medical attention, and at the same time ask others if they have experienced the issue.

The line you read " There was NO change in life after the operation except the green stuff " The reason I was told not to eat green stuff at that time was very simple, It would be a bit random. That would make it harder to keep my INR levels constant.

"Paul call your GP and please dont take anything you read hear as FACT". I think you miss read the line. I did not say to ignore the comments. I do agree with seek the opinions of people here and ask your doctor.

 

[Superman]

The line you read " There was NO change in life after the operation except the green stuff " The reason I was told not to eat green stuff at that time was very simple, It would be a bit random. That would make it harder to keep my INR levels constant.

I find random greens not to be an issue if it’s a serving here and there. If I spend two days binging on spinach salad, then nothing, it can impact INR. But still, weekly testing and adjusting can easily account for that as well.

32 plus years and I still don’t give much thought to what I eat outside of normal health and feeble attempts at weight control.

Bang on 3.0 INR (I target 2.5-3.5) this morning when I tested. That’s after a week and a half in Disney World with all that does to a diet. . I was a bit high at 3.8 when we got back, but a minor tweak knocked it back down.

 

[DaveLee]

Even if your cardiologist says that at 71 you’re too old to have an aneurysm repaired? Will you just accept that as fact and not consider any alternatives? Or will you take into consideration the many participants on these boards who have successfully underwent open heart surgery, and with the knowledge of that experience, seek out a second opinion?

Superman that's a great handle I did not take what he said for fact The first thing I did when I returned home was check here. I did get a new Cardiologists 2 or 3 weeks later. In the interview he* went over the last ultra sound pics and he told me the odds are I will die of old age but we will check it every year.

* the new Cardiologists

 

[pellicle]

Hi there

...The reason I was told not to eat green stuff at that time was very simple, It would be a bit random. That would make it harder to keep my INR levels constant.

well firstly I would present this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/the whole thing is worth a read, but the conclusion is IMO sufficient

In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.​

next we need to understand that to make a (clinically) significant variation on INR we need a lot of vitamin K ...

for example this paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770479/
suggests for reversal of INR

>5 but <9

high risk of bleeding

Vitamin K (1–2.5 mg orally; 2–4 mg orally if more urgent reduction needed)

So, lets look at amounts present in high vitamin K foods, from this source:
https://www.ptinr.com/en/home/resources/spinach-and-warfarin.html

One cup of raw spinach has about 144.9 mcg of vitamin K while a cup of cooked spinach has 888.5 mcg of vitamin K.​

there are of course others which provide not significantly different results.

so lets remember that there are one thousand milligrams (mg) in a microgram (mcg) and so lets take 1mg as the lower end and say that 1000mcg are needed or about 7 cups of raw spinach.

Serve that out and look at it and ask "am I going to eat that"

So my point is not just an opinion, its backed by a variety of sources of evidence AND my own measurements of myself over the last 10 years ...

Please, eat well. Manage your dose based on weekly INR measurements and keep a steady hand on the dosage tiller.

Best Wishes

 

[DaveLee]

Hi there



well firstly I would present this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/the whole thing is worth a read, but the conclusion is IMO sufficient

In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.​

next we need to understand that to make a (clinically) significant variation on INR we need a lot of vitamin K ...

for example this paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770479/
suggests for reversal of INR

>5 but <9

high risk of bleeding

Vitamin K (1–2.5 mg orally; 2–4 mg orally if more urgent reduction needed)

So, lets look at amounts present in high vitamin K foods, from this source:
https://www.ptinr.com/en/home/resources/spinach-and-warfarin.html

One cup of raw spinach has about 144.9 mcg of vitamin K while a cup of cooked spinach has 888.5 mcg of vitamin K.​

there are of course others which provide not significantly different results.

so lets remember that there are one thousand milligrams (mg) in a microgram (mcg) and so lets take 1mg as the lower end and say that 1000mcg are needed or about 7 cups of raw spinach.

Serve that out and look at it and ask "am I going to eat that"

So my point is not just an opinion, its backed by a variety of sources of evidence AND my own measurements of myself over the last 10 years ...

Please, eat well. Manage your dose based on weekly INR measurements and keep a steady hand on the dosage tiller.

Best Wishes

Thank You for the info

 

[DaveLee]

Hi there



well firstly I would present this:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/the whole thing is worth a read, but the conclusion is IMO sufficient

In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.​

next we need to understand that to make a (clinically) significant variation on INR we need a lot of vitamin K ...

for example this paper:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770479/
suggests for reversal of INR

>5 but <9

high risk of bleeding

Vitamin K (1–2.5 mg orally; 2–4 mg orally if more urgent reduction needed)

So, lets look at amounts present in high vitamin K foods, from this source:
https://www.ptinr.com/en/home/resources/spinach-and-warfarin.html

One cup of raw spinach has about 144.9 mcg of vitamin K while a cup of cooked spinach has 888.5 mcg of vitamin K.​

there are of course others which provide not significantly different results.

so lets remember that there are one thousand milligrams (mg) in a microgram (mcg) and so lets take 1mg as the lower end and say that 1000mcg are needed or about 7 cups of raw spinach.

Serve that out and look at it and ask "am I going to eat that"

So my point is not just an opinion, its backed by a variety of sources of evidence AND my own measurements of myself over the last 10 years ...

Please, eat well. Manage your dose based on weekly INR measurements and keep a steady hand on the dosage tiller.

Best Wishes

Thanks Dave

 

[pellicle]

Thanks Dave

Well, I'm Pellicle, but you can call me Dave if you like