Dosing Logic

[Ross]

I forgot to mention that AL Lodwick is a member of VR.com and monitored the AntiCagulation Forum for several years while he was running his Clinic.

I believe he will still respond to e-mail inquiries when he isn't giving lectures to Medical Professionals (and interested patients) on 'How to (properly) Manage AntiCoagulation'.

Ross even posted a picture of Himself having dinner with AL Lodwick when AL was 'in the neighborhood'. This might be a good time and place to re-post that photo Ross

'AL Capshaw'

 

[catwoman]

Well, when that's a significant portion of what you're eating, all those little critters might make a difference, especially on a really slow metabolism. I did read Al L.s stuff on probiotics, which is what made me decide to eat something else until I've got a better idea of what's going on. I also have really good questions to ask when I go in again.

BigOwl:

Some food ( no pun intended) for thought from www.mybloodthinner.org (shudder on the website name!):

Q: How, if at all, should I change my diet now that I?m taking a blood thinner?

A: Because the dose of your blood thinner has been set to maintain a desired range, the most important thing to remember here is that consistency is key. From the time you start taking your blood thinner, you should try to eat a normal, healthy diet. Like some medicines, vitamins, and herbal supplements, certain foods are known to interact with blood thinners. In particular, foods rich in vitamin K such as spinach and broccoli can have a clotting effect on the blood. This does not mean that you should stop eating spinach and other leafy greens if you already eat them on a regular basis. Just be sure that you eat a normal, balanced diet maintaining a consistent level of foods containing vitamin K. If possible, it?s a good idea to talk with a dietician about your overall diet before you start taking a blood thinner.

So, if you normally enjoy yogurt, go ahead and eat it now. If you avoid yogurt now and incorporate it in a couple of weeks, it means you'll have to make another adjustment for that tiny bump on down the road.
Best to just eat as much of your normal diet as possible, even though many patients have diminished appetites in the first few weeks post-op. I certainly did -- enough to lose 24 pounds within 3-4 weeks.

 

[catwoman]

Ross:

Thanks for sharing the photo!
I had planned to be in Colorado Springs this weekend for a show. Al was to be in town and we had e-mailed about possibly getting together for dinner, if things worked out.
However, I'm going to St. Louis instead. At least I may get to see my niece and her twins.

 

[Ross]

Blood thinner=Blasphemy.

They seem to have a misconception of consistency too. With Coumadin, consistency simply means no sudden binging or major change in your diet. I bet no one here eats the same amount of Vit K each day. I always get a kick out of the new folks, after being told this stuff, and they start using Vit k charts and other nonsense trying to control their Vit K intake. Hasn't worked for anyone yet.

 

[BigOwl]

Thanks for posting the photo--what a pair of cuties

I am eating yoghurt--just not the probiotic stuff (regular yoghurt usually only has one or two cultures in it). Just trying to eat anything is such a chore now that I'm not holding back on much, really--but I'm not eating very much due to lack of appetite (I had a bowl of whole grain hot cereal this morning--about a half a cup, and 6 cherries; it filled me up to stuffing range!). I figure that my job now is to stay as healthy as I can under the circumstances, and then start adding foods and activities and adjusting doses after I actually get to a therapeutic level. I forgot to call in yesterday about the bridging--but see the cardio on Tuesday and that'll be part of the conversation.

Re: anticoagulation vs "blood thinning"--I'm going to be writing a rant for my Owl of Athena blog (it's about things educational) on the continuing use of bad metaphors in science. I'm not sure why people have gotten lazy (anticoagulation probably has too many syllables), but even medical people use it. One doc I talked to in the hospital laughed when I called him on it, and said that he'd fundamentally given up fighting that battle. I advised him not to.

I wrote my master's thesis on "Science and Scientific Models in American Literary Naturalism" and it was about how writers in the early 20th century grabbed onto even the most scurrilous scientific theories (like "degeneration," an idea that came out of Social Darwinism--not the real thing--and was used to justify everything from racist practices in the US to Nazi death camps). People like to use scientific jargon and theories to help them write stories, whether or not they understand the real underlying principles. But this is an example of the other side of the coin. Anticoagulation isn't a metaphor; it's straightforward, descriptive terminology. "Blood thinning" is a metaphor--a bad one--that attempts to make the concept easier to understand to the lay public. It doesn't help because it leads people to misunderstand what's actually going on.

I think part of this is happening because of 1) a general anti-intellectual climate that makes people suspicious of "big words"--or words whose origins aren't immediately clear to folks who don't know Greek and Latin and 2) a general dumbing down of language in general. When my students call me on a term I use in a lecture, or if I use a word they don't understand, I hand them my compact edition of the Oxford English Dictionary and a magnifying glass (I carry both on a cart I haul around school to hold all my art history tools).

It may well be up to us to become pests about this issue. My students used to get lectures on having their cholesterol levels checked, and now they'd better be careful about using "blood thinner" in my presence!

 

[Marty]

Tissue or mechanical?

Tissue or mechanical?

BigOwl, Generally the older you are, the more likely they are to recommend tissue. Tissue lasts longer in older people and Coumadin is more difficult to regulate.

I had my surgery when I was 73- 10 years ago. I asked my surgeon why he didn't install a tissue valve. He said I was the subject of an intense discussion among the 10 heart surgeons at Inova Fairfax and finally mechanical carried the day. Now I'm glad that I don't have to worry about needing a new valve. I've got enough other problems. I also remember my surgeon stating that the newer tissue valves lasted longer but he had one that malfunctioned after two years.

 

[Ross]

As for the yogurt and probiotics, I eat them too. Great middle of the night snack! Thing is, I don't do it consistently, as they seem to want us believe consistently means. I may have 4 a week, 1 the next, none the next, then maybe still none the next week. No change in INR at all.

Your going to find that consistency when applied with this stuff, simply means don't sit down with a bag of spinich or brussel sprouts or you fill the high vit k item with your own, and then not expect to see your numbers drop a little bit. If you listen to the Coumadin Cookbook, you can only have 5 brussels sprouts per day. Well maybe a sparrow can, but not this toothless old man, I gotta have at least 12. Now if I sat down and ate nothing but brussels all day long, then I deserve the drop that's going to occur, but this nonsense of watching every little thing that enters your mouth under normal circumstances is complete garbage. And yes, Doctors are still out there professing this very thing to this day. We just jumped on one not too long ago. There is another guy Dr. Gourmet, writing books professing this myth also. The longer your on ACT, the more insane stuff you see.

 

[Bina]

Ross, you eat your 12 Br. sprouts, and I'll eat my sparrow serving of 3-5.
My Danactive yogurt consumption is kind of sporadic too....I go through phases.

 

[Ross]

Ross, you eat your 12 Br. sprouts, and I'll eat my sparrow serving of 3-5.
My Danactive yogurt consumption is kind of sporadic too....I go through phases.

It's just emphasising the point that diet has little to do with INR. Far less then the medical world makes it sound.

 

[Bina]

Yep, a long time ago you taught me to stop worrying about the K in every little thing....

 

[Ross]

If your higher then 5, I'll worry a little bit, but I sure wouldn't panic about it. As we see in another thread, some incompetent is advising a person with an INR of 3.9 to hold dose because she might have a brain bleed. Give me a friggin break!

 

[Herb M]

None of my doctors over the years have ever mentioned food. I think they did not know much about it.

 

[Ross]

None of my doctors over the years have ever mentioned food. I think they did not know much about it.

Or they did and know it's not an issue.

 

[BigOwl]

BigOwl, Generally the older you are, the more likely they are to recommend tissue. Tissue lasts longer in older people and Coumadin is more difficult to regulate.

I know that, but there seems to be a weird group in the Dallas area that think they're going to be living to 100 or so and don't want another surgery. That was kind of my thinking, too (but then I'd already had one, and two is enough for me). My grandmother lived to be 104 and I want to beat her record.

Ross--I think they're misquoting the Greeks here about "consistency." The key was moderation (no whole bags of spinach no matter what)--nothing to excess.

I'm really interested in the food thing in part because I'm kind of obsessed by it right now--I actually tasted the ham in my sandwich today--but because I teach in a school with a culinary arts program and frequently help out with presentations on the anthropology of food. And since I've been managing diabetes (my A1C has never been above 6) by simply paying attention to my diet, I'm pretty sure that my Mediterranean-based eating habits will work out just fine. I'll be back on probiotics soon enough, but right my problem is just getting enough fruit and veg to keep me from shriveling up. I've lost about 5 pounds since I left the hospital, but I am eating regular, small meals and feel fine, so I must be doing something right.

 

[Freddie]

If your higher then 5, I'll worry a little bit, but I sure wouldn't panic about it. As we see in another thread, some incompetent is advising a person with an INR of 3.9 to hold dose because she might have a brain bleed. Give me a friggin break!

Breath Ross, Breath.

 

[Ross]

Breath Ross, Breath.

I'm trying, but have you ever given birth to a cow before?

 

[BigOwl]

I just found out something interesting. My father's last surviving sibling (the youngest of three others), with whom I'm in pretty frequent contact, just sent me a message containing this information:

I also am on Coumadin - warfarin - with the same levels and I run pretty much OK with 22mg per week and get checked once a month but I've been on that crap for 10 years now. When I started I was told to "STAY AWAY'' from Vitamin K and that meant all the things I liked. Now they have changed their mind. Just last week I was told to get an over the counter 100 mcg Vitamin K and take one a day and eat all the good stuff again. I use to mix a little Vodka with my grapefruit juice but I doubt I will start that again.

I just got the message, so I don't know why he's on it (a-fib's the most common reason, right?), but thought y'all'd be interested in the info he's getting. (The levels he refers to are the same as mine--2.5 to 3.5.)

Edit: Later e-mail confirmed that A-fib's the reason he's on it.

 

[COLLEEN S]

monkeys throwing darts at a board.

LMAO!!!

 

[COLLEEN S]

monkeys throwing darts at a board.

LMAO!!!

You must know the RNs at my coumadin clinic!!!LMAO!!!

 

[heartfelt]

Hey, I've stopped telling the "monkeys throwing darts" at my clinic the truth. I've taken to lying about my INR levels b/c I always get yelled at or am blamed for my levels not being exactly where they should be. When I tell them I am w/in range there are no recriminating phone calls and I either try to figure out how to get w/in range (I'm still practicing and am still on the learning curve with this Ross) or come here and ask for help. So far no one has yelled at me nor made me feel badly here when I've asked for help. I just tested and my INR was 1.8 (I'm like you Cooker and would rather see it a bit high than too low). Do you think I could take 81mg of aspirin now to help adjust things since I don't take my coumadin until bedtime? I don't even know how the INR sunk so low; my range is 2.5-3.5. I sure don't want to end up in a hospital!!!!!

Overheard someone saying they couldn't eat this, that, or the other thing b/c of coumadin and I told them what I've learned here and suggested they dial in this forum and find out the truth about warfarin/coumadin dosing. I would probably be dead if I hadn't found you guys! I was at my wit's end when I found this place. I can't say I'm cheerful about being on this hideous drug, but you all have shown me it's manageable and that, thanks to you and no thanks to my cardio, I can still have quality of life, and someone even mentioned to remember the obvious, that it's keeping me alive.
heartfelt