Hi John, As
@pellicle explained the initial dose usually increases.
Your AC therapy is in the very early stages, given time you will stabilise, as an example i was initially 10mg daily then eventually stabilised at 15mg daily
Culling your greens is a poor idea, the greens are good for you, just dose the diet.
7.5 to 5 is not as good as the equal daily dose you are now on.
the alternating dose gives you more peaks and troughs than a stable daily dose, if you end up on more than 7.5mg then consider equalling out the dosage rather than alternating it.
good luck mate
Years ago (before 2009), before I knew a lot about self-testing or the variability of INR if you don't take the same daily dose, I was doing like johnmarkos is doing - 7.5 mg one day, 5 mg the next. Ignorantly, I hadn't had my INR tested for many months - but I was lucky. I didn't have any negative events during that time without testing.
I know better now.
As leadville said, your INR will fluctuate if you take a different dose each day. Depending on the day of the week that you test, there will be a fluctuation, based on the dose you took 3 (or so, the half-life of warfarin seems to vary from person to person) days earlier. Taking the same dose daily gives you a more accurate picture of your INR.
Also -- I don't know what plan you've got for coverage (or none) of your own meter and strips. Your cardiologist is partly right - it takes a while for your body to determine the appropriate dosage to keep your INR in range. However - even if you're waiting for that to happen, you can monitor changes using your own meter. Also, while you're watching your INR normalize, you'll be going through the very small learning curve, so you'll be ready to self-test once you've established your dosage.
Meters are made to work, for any number of tests, with each test being accurate. The same meter may be used in an anticoagulation clinic, doing hundreds of tests a week, or they could have belonged to grandpa, who just died, and have a dozen test results on them. Either way, the meter should work.
Manufacturers of these meters have way too much to lose if their meters become inaccurate. You'll find meters - mostly CoaguChek XS, and often the meter that I use, the Coag-Sense, on Ebay. There is sometimes a wide range of prices. Sometimes a person sells Grandpa's meter, which Medicare paid for and doesn't want returned (who doesn't know what these sell for and just wants to get rid of it or see it going to someone who needs it), or meters that a hospital or clinic sold or auctioned off once they were amortized (about 3 years), or from dealers who sometime came into them. If you buy a meter, it's a good idea to buy from a seller who guarantees it - or at least guarantees against DOA. For the most part, any meter you get - that isn't already described as 'not working' or 'as is,' should work for you.
I've gotten all my meters (with one exception) on eBay. I've gotten many of my test strips on eBay. I haven't been disappointed by any of them. (Just be careful NOT to buy a Coaguchek S (it's discontinued and no strips are available for it), or an InRatio (a machine with numerous FDA complaints, that caused me to have a TIA, and that has been removed from the market).
In addition to the CoaguChek XS, there's also the Roche InRange - a meter with a better display and more features than the CoaguChek XS, but not supposed to be available in the United States (although some vendors ARE selling it). It takes XS strips and is 'sexier' than the XS, but the important thing - testing blood as accurately as the XS - is one of the capabilities of the new meter (which you CAN get on eBay).
The Coag-Sense is now available in two models: what they're calling the PT1, and a new, much higher-tech, PT2. (I have an extra PT1, if you're interested). The PT1 is their original model - it's larger than the PT2, runs on battery or charger, and has a monochrome display. The advantage to this, though, is that it's ready to use as soon as you press the power button. The PT2 is smaller, records 2000 tests, has bluetooth, Wi-Fi, an Ethernet port, and an NFC reader to read the lot number of the strips that you're using. It has a color display, and is a pleasure to use. If there are any firmware updates, these can be automatically downloaded via Wi-Fi. It takes a bit longer from power button push until ready to test, but it's usually worth the minute or so wait. In my testing the results of the two meters, with blood taken minutes apart, were nearly identical (a requirement for FDA approval), with equal INRs and a difference of .1 seconds.
Until you get the hang of testing with the Coag-Sense (not a big deal), the CoagChek XS may be slightly easier at first. One other difference - the XS strips start to degrade as soon as you pull them out of their container. If you don't deposit blood within five or ten minutes (I forget the number) of removing the strip from the container, the strip becomes unusable. The Coag-Sense strip is different - it can last for hours (or days) - even after you remove it from its foil pouch. The test method is different from the XS - it uses a rotating wheel built into the strip and, once you apply blood to the collection well, the blood mixes with the reagent, and the wheel spins until it is stopped by a clot. A sensor detects when the clot forms, and the meter reports prothrombin time and INR. Until you deposit the blood, the strip isn't activated, so it's harder to waste strips. Opened, but unused strips can be stored in a ziploc or similar bag.
I didn't mean to give a tutorial and review of the two meters available in the U.S.. My point is this : if you can, get yourself a meter. Self-Test. If you have to use a service, you can compare your meter's results to those of their meters (or blood draws). If you HAVE to use a service, where you self-test and call in the results, I guess you may have to - but if there's a high co-pay for the service, or if you don't like them gouging your insurance carrier, it may not make much sense. You can do it yourself.
There are many resources on this site (especially Pellicle) that can help you self-manage.
Again - sorry about this long message - but, for me, it's very important that anyone who NEEDS a meter HAS a meter, and that weekly testing can be done.
