Coumadin

[catwoman]

Marsha,

Your John is to be on coumadin for life. In the end, I was only on it for 2 1/2 months. I have a tissue valve and they weren't upset with me being .1 or .2 below the desired 2.0 to 3.0 range. Many here have stated repeatedly there is little difference between a 1.9 and 2.0.

The small, local clinic I used is staffed by permanent, full time coumadin manager. It is a part of a small to mid size lab. She is very knowledgeable, well trained and does her job well. Her 'boss' is nearby if she should require assistance. I never witnessed any situation she couldn't/didn't handle competently. My cardio was delighted when I agreed to go there and his practice has their own clinic but it's location is far less convenient for me. He started the 'coumadin discussion' with me and I demonstrated to him I had done my reading. He was well satisfied with my understanding and smiled widely when he realized I truly did understand it better than some of his patients who have taken coumadin for 20+ years.

Let's not play the mine is smarter than yours game. Nothing too stupid about many (most) of the doctors and support staff at Mass General Cardiac Care. They get great ratings for a reason.

Nope. John was not put on warfarin for life. He was put on it because of a-fib after his MV repair. Doctors first tried amiodarone and were going to send him on that; I complained, and his surgeon put him on warfarin, since he knew I was on it, home-tested and could adjust my own dosage.

John's a-fib resolved and he got off at 7 months out.

I wasn't referring to a practice or hospital that you may have used.

The "smarter than the average bear" was a favorite saying of one of my best friends, who died 6 years ago. She used it to build self-confidence in others. Meaning, you are smarter than you think and can do more than you believe you can. I'm sorry that it was misconstrued.

 

[catwoman]

I have been avoiding broccoli, which I used to eat a lot of, and no booze. I used to enjoy a glass of wine or two or a beer now and then but nothing on a steady basis.

Jordan:

Are you still avoiding broccoli? Best to just enjoy the foods you've always enjoyed so your doctors can adjust your dosage now to reflect that, rather than getting into range and then adding the foods you've always enjoyed and then having to adjust dosages for the additional foods. Too much yo-yoing.

Two days after I left the hospital, I visited my then-cardiologist's office in Dallas for an INR test. It's a very big practice -- about 12-15 cardios plus several surgeons -- and they have an anticoagulation RN. The RN actually interviewed me about my personal interests, lifetyle, eating habits, other Rxes, etc., then said to just enjoy my favorite foods. This was the summer, and she said she runs into problems with patients who suddenly decide to pig out on salads because it's summertime and hot.

 

[Ross]

Jordan, don't avoid anything that you used to indulge in. Just be as consistent as possible in the things you eat. The idea is to dose the diet you eat, not diet the dose your on. Get that beautiful, tasty, succulent broccoli back in your diet as well as other dark leafy greens and even the alcohol, but be moderate about that.

Be ware, your dosing increases should not be more then 10% at a time and you should be tested no more often then 2 times a week, preferably only once every 7 days. If they test more then this and change doses just as often, you've got a problem manager on your hands.

 

[Ross]

Ross,
My reference to blithely and cavlier is in response to the dismissive way some posts above referenced that most people who are not in range are out of range due to poor coumadin management. While that is sometimes (often) the case, I wished to point out that is not always the case. I felt those references should be counter balanced with other 'viable' explanation for lack of quickly reaching desired INR range.

It would be easy for someone with a new valve to read those posts and say to themselves...... Hmmm, my coumadin clinic must be stupid because I'm not in range. In fact, my clinic was top notch and I was not in range for the reasons I explained. I never like to read only one explanation for any issues when there is more than one very real reason.

It sometimes happens that someone expects to get a tissue valve and is surprised to awaken to the click of a mechanical valve in their chest. They need then to learn about this new drug they will take for life. But, keep in mind, many surgeons prescribe a three month course of coumadin for their tissue valvers, such as me. I did my research and reading prior to my surgery because I expected to either have a repair or tissue replacement but had been advised I would take coumadin at least briefly.

We see it in here every single day. Managers that do not know how to manage Coumadin. The forums are full of cases of it. While sure, not every single one is hopeless, the overwhelming majority of them are clueless. Hard to dispute the facts when they're all around you. All anyone need do is read the stickies in here and educate themselves and they they too, will know when they have a manager that doesn't have a clue. I've seen the clueless at ever single facility I've been too, from the best to hometown. Darn few people "Get it".

Yes, some people have major problems becoming stable. We usually can find a cause for that easily. Not always, but more often then not, it's management that has a person screwed up.

 

[Megan]

hey all- jordan you got the info already you need but my two cents.. its been 6 months post op for me and im still not regular- likely because i have been increasing my exercise lately.. so this week i went to 10 mg 4 times a week and 7.5 mg 3 times a week and this am my inr was 2.6- so this is working for me-for now- but ofcourse with the holidays my exercise has dropped off- so trick for me will be to keep regular with exercise ... diet is steady...good luck!