For better or worse, I had my first INR spike and a chance to test the theory. Probably due to a combination of diarrhea (gone now) and a topical Miconazole (due to a rash - cream didn't help, must be something else), I measured 6.0 Sunday, while having been in-range or twice +0.2 over in the past 8 months.
My range is 2-3. It was a little shock, but after having read some threads here, suggesting to hold for 2 days, then 1/2 dose, I was not too worried. However, I did some research, and decided to add a Vitamin K booster. There are papers on how a low oral dose of 2.5mg helps bring INR back into range within 24-48 hours for patients in the 5-9 range.
So I bought a bag of spinach, which I enjoyed in a few servings Sunday, with ranch and cheese. Delicious!
I skipped the nightly Coumadin dose. The estimated dose of Vit K in the bag of spinach is about 12 (cups) * 145mcg = 1.74mg.
So, yesterday afternoon, about 27 hours after having started the Vit K booster, I was already down to INR 3.1. So I continued my regular Coumadin dosage right away, since the triggers for the over-anticoagulation are gone.
Maybe I should have consulted nurses and doctors and whatnot, but this was on a Sunday, and if my own investigation results based on confirmed research worked, self-testing @ 24 hours would confirm it, and I could seek professional help right away if I was still out of range. It's doubtful, I would have gotten any better advice on Sunday.
I am open for criticism of any kind, putting myself at risk or what not, but with the ability to self-test as needed, and not taking an impossibly large Vit K dose (I was able to enjoy it after all), I was not too worried. Also, the forum's advice of holding for two days + half dose, would probably also have worked quite well.
On a sidenote, even at 6.0, I did not notice any gum or nose bleeds, or bruising of any sorts. That, I think was most scary to me from this experience.
Karl.
