Evaluation Questions

[Karlynn]

Hey Al, and all,
A recent post by a new member and a response by Ross got me thinking (hard to believe ).

Can we come up with a list of 5 to 10 top questions (and answers) that Coumadin and would-be Coumadin users could ask of doctors or warfarin management providers in order to evaluate whether or not they know what is needed to provide accurate warfarin management?

What sparked this was Ross' comment that many doctors and professionals don't have accurate information on warfarin and it's management. I thought that if we could have a list of definitive questions, that it might make it easier for people to know, from the start, whether the medical profession knows what they're talking about.

 

[Ross]

1. What should my target INR range be? Watch for those that only give you a .5 window!

2. Scenario-My INR is 2.3 and my target range is 2.5 to 3.5. How much should the dose be increased and how soon should I be retested? If they want to change doses for this, why? If they tell you to retest within the next two days, then you pretty much know this isn't the place to be.

Just some starters-lets hear some others.

 

[Yaps]

Also, when I was discharged, they only mention 'green leafy vegs to be avoided or used regularly) no mention of hidden "k's' , mayonaisse, green tea, ranch dressing, carrots???? ,beef liver?? John was trying to get my iron level up, as I have severe defiencies..my inr dropped below 1%, poor John.. , he was trying so hard.
They did not mention these items...

 

[Guest]

How many warfarin patients do they manage? If they only have 5 or 6, they probably do not see enough to get good at it.

 

[ccrawford]

Karlynn - This thread is starting to talk about items on another current thread dealing with home testing/dosing, so I'd encourage folks to read both. I think people need to be given a source (either written or a web site address if applicable) that deals with all the drugs and herbs that interact with Coumadin. Information that encourages them to be consistent within reason with their diet, encourages them to read the labels and check their interaction booklet BEFORE they start another accross the counter drug. I'd like to see every patient given a diagram showing the curve of the INR for a single dose of Coumadin as well as the effect of a dose every day (awareness of the half life) Finally, I'd like all patients to understand the general question of how often should I be tested (under varying circumstances) Hope this helps. Chris

 

[catwoman]

Also, when I was discharged, they only mention 'green leafy vegs to be avoided or used regularly) no mention of hidden "k's' , mayonaisse, green tea, ranch dressing, carrots???? ,beef liver?? John was trying to get my iron level up, as I have severe defiencies..my inr dropped below 1%, poor John.. , he was trying so hard.
They did not mention these items...

Carrots? Carrots??
Check out www.nutritiondata.com/foods-000104000000000000000-w.html
It's got 999 foods ranked in highest vitamin K content/100 grams to lowest. Dehydrated carrots are fairly high in vitamin K, according to this website, at #110 on the list, but regular carrots fall in the middle -- low enough that I wouldn't worry, unless you eat carrots nonstop. A Big Mac, no cheese, has more vitamin K than carrots.
I have the website bookmarked on my computer at work. Interesting to peruse when work gets boring.

 

[Karlynn]

Carrots? Carrots??
Check out www.nutritiondata.com/foods-000104000000000000000-w.html
It's got 999 foods ranked in highest vitamin K content/100 grams to lowest. Dehydrated carrots are fairly high in vitamin K, according to this website, at #110 on the list, but regular carrots fall in the middle -- low enough that I wouldn't worry, unless you eat carrots nonstop. A Big Mac, no cheese, has more vitamin K than carrots.
I have the website bookmarked on my computer at work. Interesting to peruse when work gets boring.

So what does 100 grams look like? I'm really bad when it comes to estimating size and weight.

 

[Guest]

100 g is about 3 ounces. 1 ounce less than an an uncooked quarter pounder.

There was a report a few years ago about a guy who ate about a pound of carrots daily as an alternative to smoking. He went on a trip to visit his daughter and did not take the carrots on the plane, nor eat them at his daughter's house. I think he caused a bleed, if I remember right, because his INR went way up. Carrots are only moderate in vitamin K content, but if you eat enough of them, they become the same as high.

 

[Ross]

I gotta know, what is it with you people and having to measure and count all this stuff. Just eat and enjoy it! Adjust your dose if you must to accomodate the taste buds, but for God sakes, stop driving yourselves insane with weighing, counting, proportioning etc.

 

[catwoman]

I gotta know, what is it with you people and having to measure and count all this stuff. Just eat and enjoy it! Adjust your dose if you must to accomodate the taste buds, but for God sakes, stop driving yourselves insane with weighing, counting, proportioning etc.

Ross:
I agree. But for comparison purposes and for research, some measurement is required.

I just toss a couple of handfuls of matchstick carrots into salad, along with handfuls of iceburg lettuce, a couple of handfuls of baby greens, a red bell pepper or two, some very thinly sliced red onion, etc., etc. to make a salad. How much vitamin K is there? Who knows? I just eat about the same every day.

This weekend I'll be in the Denver area. I'm going to find a Cracker Barrel Saturday and enjoy a bowl of delicious turnip greens.

 

[catwoman]

100 g is about 3 ounces. 1 ounce less than an an uncooked quarter pounder.

There was a report a few years ago about a guy who ate about a pound of carrots daily as an alternative to smoking. He went on a trip to visit his daughter and did not take the carrots on the plane, nor eat them at his daughter's house. I think he caused a bleed, if I remember right, because his INR went way up. Carrots are only moderate in vitamin K content, but if you eat enough of them, they become the same as high.

Al:
I love carrots -- eat them every day in salads -- but I can't imagine eating a pound every day.
We gave our dog carrots to curb his appetite when he got steroid shots for allergies. Still have a photo of him with the top of the carrot sticking out of his mouth -- looked like he was smoking a carrot!

 

[Barry]

I gotta know, what is it with you people and having to measure and count all this stuff. Just eat and enjoy it! Adjust your dose if you must to accomodate the taste buds, but for God sakes, stop driving yourselves insane with weighing, counting, proportioning etc.

Generally I agree with you. But I think it's a good idea to know what foods are especially high in Vitamin K so that one knows that if you're gonna eat a lot of, say, parsley, you'd better eat a lot of it every day so your dose can be adjusted to it and not binge eat a lot of parsely every once in a while.

Example...

A while back I made some macaroni salad that had way too much parsley in it for my tastes, but I went ahead and ate it anyway. Had I first gone to the link that catwoman gives I wouldn't have put so much parsely in it in the first place.

 

[catwoman]

Barry:
Unless you eat that parsley-laden mac salad 3-4 days before an INR test, you won't have problems.
It would be -- if you started eating it every day without adjusting your dosage.

 

[catwoman]

How many warfarin patients do they manage? If they only have 5 or 6, they probably do not see enough to get good at it.

That's a good point.
Also, how do they draw blood for testing -- finger stick or venous draw?
Are they receptive to home testing, if that's what a new warfarin patient is considering?