Can I drink a damn beer?

[Warfarinking]

I'm 26 and had open heart surgery at the age of 21. I had my aortic valve replaced with a mechanical valve and I'm now on Warfarin (coumadin). I see my doctor 1-2 times a month, depending on how stable I am and my inr range is between 2.5 - 3.5. I've been fairly stable throughout my time but not drinking has gotten to a point were I feel it's getting involved with my social life. I go out roughly twice a week to bars and clubs or sometimes just to hangout and I'm always the odd person out. I'm the dude who can't drink then I'm always being questioned about it and it turns into this huge deal and in the end, It's me sitting there with a cup of water while everyone else is playing drinking games and having a good time.

Yeah, I probably let this get to me more than I should but I feel like I've been asking this question since day 1 and no one has really given be a straight answer. Some say you can drink, others say no and some say to be consistent (now I have to drink all the time because I drank once or twice in a week?).

My question is, can I drink or not? how much can I drink? and is there a difference in drinking a beer vs taking a shot (does beer affect inr more than a shot would?).

I have girls asking me to drink and I'm tired of just sitting there with a cup of water. I'm not saying I want to get super drunk, I just want to be able to drink a beer or two once a week without worrying about bleeding through my eyes.

Thank you.

 

[Boomanchu]

Surprisingly moderate drinking has little effect on INR. I was told by my cardio and surgeon from day one it was fine as long as I didn't drink heavily. I just like a couple beers now and then. Just gotta remember that alcohol in excess isn't good for your heart so, just how much are you planning to drink?

 

[Warfarinking]

Surprisingly moderate drinking has little effect on INR. I was told by my cardio and surgeon from day one it was fine as long as I didn't drink heavily. I just like a couple beers now and then. Just gotta remember that alcohol in excess isn't good for your heart so, just how much are you planning to drink?

Not much, I just want to be able to drink 1-2 beers without having to worry about my INR increasing drastically.

 

[Agian]

I'm surprised you're seeing your doctor 2-4 times a week. Did you mean a month?
Why can't you drink a damn beer? I thought it was wine that affected INR.

 

[Warfarinking]

I'm surprised you're seeing your doctor 2-4 times a week. Did you mean a month?
Why can't you drink a damn beer? I thought it was wine that affected INR.

Sorry yes, I meant 1-2 times a month! I'm not sure..is that true?

 

[Agian]

I think that's what people here have said, don't take my word for it though. We have a few experts on Warfarin here who should tune in pretty soon. I suspect there's a lot of stuff written about alcohol's effects on INR.
Enjoy your youth.

 

[Boomanchu]

I can tell you that three or four beers has no effect on my INR. It was a concern so Ive tested before and after with no or very very little change in INR. I love beer to no end but don't enjoy feeling drunk so I figure I'm plenty safe with what I enjoy and imagine you can enjoy yourself without " bleeding out your eyes "

 

[cldlhd]

Feel the need to have one now for some reason....

 

[Freddie]

Go and enjoy your beer with your friends, limiting yourself to one or two isn't going hurt.
My surgeon told me to drink red wine with my supper every night....one problem, I don't like wine.
Plus nothing is better than a cold beer on a hot day, don't deprive yourself of that. (Plus the second beer is really never better than the first)

 

[pellicle]

Dear WarfarinKing

most certainly. You will find oooooodddddlleeesss of threads here on exactly that topic if you search using google.

Generally most of us on warfarin (me included) recommend drinking sensibly, as long as you don't get falling down drunk real often. The reason for that is that falls may cause you to whack you head and if you were inclined to have a brain bleed then being on warfarin will make it that bit worse than if you weren't on warfarin.

Also, are you self monitoring or at least in touch with your INR? If you're monitoring then you'll know your INR pretty close to correctly most of the time and in the past where such falling down advice comes from many people did NOT know their INR and may have even been 4 or higher. Making a bleed worse again.


Also please consider choosing another name as you knowledge does not seem to deserve the title "King" ;-)

For myself , I have a glass of wine most night, often enough in the week 2 and lastnight 3 scotches ... I usually have a beer soon after getting home from work before my glass of wine with dinner. Last night I was at a friends and had a few single malt whiskeys (after the beer).

 

[cewilk]

I've done my fair share of binge drinking throughout college and even after college. I sense that you and I probably have a similar group of friends where going out to bars and/or getting together at someone's house to hang out and drink is pretty much the norm.
From about age 19-25, I drank pretty heavily in social situations (yes I drank underage ). Now that I am 27, all that has slowed down significantly due to getting older, but also because I too am on lifelong Coumadin for my mech aortic valve. Since being on Coumadin I have also found myself being the sober guy among all my friends, but I don't really care about that anymore and it has actually been saving me some money! Haha. I still would like to be able to drink a bit more excessively and not be worried about my INR, but those days are done (I'll admit, some of my most favorite and surprisingly memorable memories have been when I was hammered drunk with my friends)

My insurance covered me for a home test monitor and I get 6 test strips/month sent to me (each strip is about $10-$12 value). I wanted to be able to test myself more frequently at my own leisure to see how different quantities of alcohol affected my INR. I searched on Amazon and bought 48 additional strips for a solid value so I could test myself more frequently. Right now I take my INR once/week and call it in to my doc. Sometimes I'll take my INR 2-3 more times during the week if I want to see if certain things affect my INR (my index and middle fingers stay sore! )

The most alcohol I've consumed in one outing since being on coumadin was (4) 12 oz beers, a bourbon and sprite (1.25 oz shot), and then a straight up shot of fireball (cinnamon whiskey, 1.25oz shot). This was spaced out over about 4 hours. When I got home I took my INR and it had not changed from my last reading. I took it again after about 36 hours and had not consumed any alcohol and it remained unaffected.

I am not saying you would have the same experience, but I'd say you're ok to have a few drinks in order to avoid feeling singled out by being the only one not having an alcoholic beverage. Of course I don't know your friends, but I would hope they don't guilt you into drinking even after knowing you have to take Coumadin for your mech valve. If you can get a home test kit I think you could do what I'm doing and feel much better and safer about it and figure out what you can safely consume without altering your INR.

 

[pellicle]

Sometimes I'll take my INR 2-3 more times during the week if I want to see if certain things affect my INR (my index and middle fingers stay sore! )

Make sure you are lancing the side not the pad. Injury will over time cause loss of feeling at the lancing point.

Also, perhaps you are lancing too deep. The gentle rubber band really helps make shallower less painful lances and gets more blood.

 

[Protimenow]

There's a lot of misinformatin/disinformation out there. Doctors who don't know much about warfarin are giving bad advice, or using stuff (often incorrect) that they learned in Med school decades ago. Who told you that you absolutely can't drink anything alcoholic? It probably wasn't your cariologist or cardiac surgeon, who SHOULD be up to date on anticoagulation management.

Alcohol in moderation shouldn't be a problem. Pellicle's advice not to drink so much that you'll fall and hit your head is good advice.

There's an old thread about red wine and anticoagulation. There are factors in red wine that have been shown to affect INR, but a few ounces shouldn't make a difference.

If you take other medications, you may have more of an issue with the effects of alcohol than you would with warfarin. (For example, some of the blood pressure medications or 'heat' drugs have warnings about taking the drug and drinking, so you may check on the interaction with these). And if you ARE taking one of these other drugs, it may be easier to explain why you aren't drinking by saying 'I have high blood pressure and can't drink when I'm on medicatin' than it is to say 'I've had heart surgery and can't drink' and then have to go through the long explanation about your heart, your surgery, why you take coumadin, etc., etc. (although some women may want to see your 'battle scar').

Having your own monitor and self-testing provide a great way to vefity whether or not your beer(s) have had any impact on your INR. And even if it DID< you probably won't want to change your dose -- just keep an eye on your drinking the next time out. (If your INR goes up a bit, just have a salad or something green, and this should bring it down a little).

Until a few years ago, common 'facts' said that you can't eat ANYTHING that has vitamin K in it. THee was even a cookbook that had K-free recipes -- THe coumadin Cookbook. Research finally showed that this concept was incorrect -- yes, Vitamin K can reduce your INR, but researchers found that it was also necessary for other critical processes in your body, and that a certain amount actually HELPED to regulate INR. So - thinking about INR management changes over time.

And I suspect that any total prohibition regarding alcohol is just plain bad advice from a well meaning, but ultimately misinformed, person.

Have your beer. Enjoy your time our (or at home), and test your INR if you have any concerns about it.

 

[DachsieMom]

Not to take over the post, but thanks for the finger picture! I will hopefully start home testing in a few weeks and was wondering about the effect to constant pricking of your index finger (although I suppose you can alternate fingers). I figure it must be better than pricking your vein every week for the next 50 years!

 

[MrsBray]

My coumidin nurse told me if I really really wanted to eat all that spinach in one sitting that I should have a cocktail or two to go along with it. Along the lines of thinking that many tattoo parlors won't do tattoos on people who have been drinking (they bleed more), it seems that if you really want those 2-4 beers, maybe you should have a good dark green salad that same day? Just my two cents, something to discuss with your coumidin therapist/nurse/someone who knows what they're talking about.

 

[pellicle]

Hi

Not to take over the post, but thanks for the finger picture! I will hopefully start home testing in a few weeks and was wondering about the effect to constant pricking of your index finger (although I suppose you can alternate fingers). I figure it must be better than pricking your vein every week for the next 50 years!

indeed, actually think for a moment about the diabetics ... they need to prick their fingers as much as 4 or 5 times a day every day. We just have to do it once a week (perhaps twice or three times if we are observing and learning). Those guys are the ones to "learn from" in terms of finger sticks

Actually on the subject of "someone who knows what they are talking about" that would be home testers who document and review. If you think about it the people at the INR clinic rarely are involved closely with patients, rarely follow up on information and just regurgitate what they are taught (which is simplified AKA dumbed down). Its seldom that a person there will be truly interested, keep in the current readings and know the results of what happens by actually observing it. This board is filled with data on how poor professional anticoagulation is. They do a great job of selling up themselves with their presentation and reliance on the medical industry to be expert by association.

Home testers on the other hand (especially if they record and review) quickly become experts in themselves and how they react.

Why rely on someone else to be the expert when you can be the expert.

 

[Protimenow]

As usual, Pellicle's points are right on target. Those of us who self-test and self-manage put our lives on ehe line each time we make a decision about dosing and dosing changes. Each time we test, we make a determination whether or not to stay with the current dosing, or to make minor changes -- and most of the time, a conservative approach is a correct one.

Labs, clinics, underinformed physicians, or other 'professionals' who make these decisions for us don't see the patients who go home and die of a stroke because, between monthly tests, their INRs drop too low for whatever reason, and stay low enough to cause a clot to form and break off. These people don't return so, to the clinician, it's a case of a client dropping out of the program. They may not see the patient whose INR goes too high -- a trip to the Emergency room or another doctor usually resolves the issue and, of course, the issue is defined as 'patient noncompliance' or 'accidental patient overdose.' It's those of us, to whom the stakes are personal, who maintain records of date of test, dosing, INR, and any factors that may have caused an INR to change, who probably are more reliable sources of evidence backed information.

I personally think that it's somewhat important to occasionally check your meter's results against a lab's results (although the meter manufacturers probably have much more to lose if their meters return wrong results than a lab would).

As far as comparing our fingersticks to the many fingersticks of diabetics, I'm not sure that this is a very good comparison. THe volume of blood required for a blood glucose test is miniscule when compared to the amount needed to test INR. A diabetic finger stick will not produce enough blood for INR testing. Although any fingerstick can be mildly painful, there are more nerves to cut through and damage when making a deeper incision for INR testing than there are for blood sugar.

If I had a choice of testing my blood glucose five times a day, or my INR one time a week, I would probably choose INR. I'm not sure about 'learning about fingersticks from diabetics' because it's much easier to hit a capillary that provides the small sample needed than it is to go deeper and get the right amount of blood for INR testing.

Just some thoughts...

 

[pellicle]

Hi Protime ... thanks for the kind words

As far as comparing our fingersticks to the many fingersticks of diabetics, I'm not sure that this is a very good comparison. THe volume of blood required for a blood glucose test is miniscule when compared to the amount needed to test INR.

its sort of yes and no. True we need more blood, and having insufficient blood is fed back to you quick smart with a Coagucheck where it sounds its error ... from the Roche documents:

9. How does the underdosing detection work?


The complete fill of the capillary is detected by the current flow between two electrodes on the test strip. If the capillary is not completely filled an error message (error number 5) will appear on the display.

so basically if you get enough then you've got enough.

When I first started home testing my biggest frustration was those error 5's - which of course means a wasted strip and *** another finger.

Frequently I would just dial up the depth of the lance deeper and deeper and it hurt. Yet I often didn't get enough blood to satisfy the other rule which is the 15 second rule (or that you should apply the blood to the strip within 15 seconds of lancing).

Often it would just not bleed well for the first 10 seconds (and then continue to bleed well after I was sick of it).

I settled on a process to minimise lance depth and maximise yield in a short time.

As you probably know I use a gentle 'pressure bandage' approach which is like a torniquet but different. After I went this way 2 things happened:
1) I was always able to get a good sized blood sample
2) I got much more consistent reads between my tests (both on myself and with vein draws at the labs)

3) my finger hurt less

OK ... there are three things

I think its important to not wind on the band too tight (perhaps triggering something) and to start away from the lance site and wind towards it. I use a small rubber band so that I can control the tension more eaily.

[ link ]


done this way I find that I can start my pressure wrap, lance and have the blood on the strip in 10 seconds - consistently

Best bit is that it seems to bleed far less afterwards

 

[Boomanchu]

I started using the rubber band after seeing this and fine it not only speeds things up but I don't lose strips because I don't get a large enough drop and end up with an error message. My strips are cheap but so am I so wasting one on a bad try I figure cost me two beers each time

 

[marc_kowal]

I'm just an occasional drinker, and whenever I have a beer or two there's no change in my INR that I've noticed.

~Marc