Foods on warfarin

[Chuck C]

Thanks to those who 'kindly' prompted me to get my level checked

I'm glad that other members have encouraged you to get your INR checked. I do hope that you continue to check at least monthly. 6 months is a long time to go between checks. Small drifts in INR can happen and over months small drifts can become large drifts and can equate to large periods of time spent out of range.

I just had the Protime/INR tested a couple hours ago and have the results already.
PROTIME Seconds = 35
INR = 3.0

Excellent!

 

[ThomasM]

I don't know too much about how to check the INR from home, but I want to look into it. It would be easier to check on a regular basis.

 

[pellicle]

I don't know too much about how to check the INR from home, but I want to look into it. It would be easier to check on a regular basis.

I use a Roche Coaguchek, its like this:


and in detail the strips look like this:


I have a blog post on the more general stuff here (in this 8 year old post):
https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
if you're interested everything on my Blog relating to INR is at this link:
https://cjeastwd.blogspot.com/search/label/INR
HTH

 

[pellicle]

Hi

I hope my portions of the conversation are not going off topic as to hijack the thread...

I would suggest to not worry about that, find a thread here that's got any length to it and it'll drift.

Firstly, I should be getting my blood tested on a monthly basis, permitting the levels are stable. Thanks to those who 'kindly' prompted me to get my level checked.

not sure why the 'kindly' is quoted like that ... feels a bit passive agressive to me. I'm one who's always prefered 100% honesty but often defer to less ... as it seems the script writers of this scene also understand



accordingly I find your approach so far to be a bit prickly and communication not forthcoming despite accusations to me of being rude but not having the decency to either point it out (as I asked for) or apologise for a misunderstanding.

Well, anyway, never mind.

Funny, I am a bit of a worrier and you would think I would get it checked more often? I just had the Protime/INR tested a couple hours ago and have the results already.

yes, one would ... but then you seem to have been getting by fine these last 37 years and why do you need to learn anything?

PROTIME Seconds = 35
INR = 3.0
(not bad for an uneducated individual )

(sigh; as I mentioned ... passive aggressive)

I wonder if you got those values off the report from a lab or from a coaguchek (as it toggles between reporting one or the other). To make any correlation between INR and PT you need to know the ISI for the clotting reagent used. This will become apparent when you visit this calculator.

This is part of why nobody uses PT now and we (the international medical community at large) all use INR.

These values are just about perfect.

no doubt due to your excellent management and knowing everything by feel.

Nevermind.

PS: since I don't come here to argue meaninglessly with people

https://www.valvereplacement.org/threads/making-vr-that-bit-nicer.888377/
Best Wishes.

 

[carolinemc]

Good morning

well based on your later assertion that you are willing to listen (which your post didn't seem to suggest, nor your later replies which contained claims of saying "you felt I had good things to say" but when asked where they were you as yet have not answered) I thought I'd have another attempt at discussion, communication and perhaps guidance.

first and foremost, this is not a US only forum, cultural communications vary across the globe and the english speaking world is bigger than I think you imagine (many in Europe, India and then the other Colonies like Canada and Australia for starters). Australians are not like Canadians we are more direct (Superman called it blunt, but I can demonstrate blunt if asked. Its worth noting Australians are rank amateurs at Blunt when compared to the Finns and I lived there for over 10 years all up), if you had identified as Japanese I would have spoken to you as my sensei (先生 which means you're experience predates mine).

So, firstly I'd like to address this:

This is called survivor bias,

Another kind of survivorship bias would involve thinking that an incident was not all that dangerous because everyone communicated with afterwards survived. Even if one knew that some people are dead, they would not have their voice to add to the conversation, leading to bias in the conversation.​

its well documented where people think "I did something right" when indeed it was just the stats. The stats show that some people doing everything wrong can be somehow (probably metabolically) an outlier and never even take their warfarin. I recommend you read this post and the associated links

https://www.valvereplacement.org/threads/how-long-can-you-go-without-it.887951/
However despite you (and them) getting off so far in your game of "INR Russian roulette" not everyone does:

View attachment 888710

the key points in there are: irregular warfarin therapy and low INR. I'm not saying you're irregular but we just don't know (and you know the old saying about ASSUME

I prefer to be explicit rather than make and Ass out of anyone.



this of course brings me to the fact that PT is no longer used because it is meaningless. We now use INR which is constructed differently (I can go into that if you wish, but you could start your own reading here)


I did and I guessed that was some sort of "standing on laurels" rather than addressing the argument or the statements or supplying anything like reasons.

You yourself commented that you didn't think it was the ideal method. Now if you like I can discuss more things which you may or may not know about the possibility of an INR deviance, the reasons for the target in INR being what it is (Eg target INR = 2.5 for aortic valve and no other predisposing factors).

Lastly I'm sorry if I have not provided the required deference to age / reverence to wisdom or other cultural (mysterious to me) requirements to be deemed politeでございます but unless you tell me what's needed I can only guess. Please accept the flowers and rainbows below as an indication of my respectfulness and courtesy in intention.

View attachment 888711

Best wishes

And since he also had irregular visits the heart doctor, I would assume.

 

[ThomasM]

And since he also had irregular visits the heart doctor, I would assume.

No, assumptions often get people the wrong message, as I get my annual check up every year. This Sept I have a
Complete cardiac ultrasound exam (2D with spectral and color flow Doppler) sched'd.

 

[Protimenow]

Don't schedule your meals. Enjoy your meals and when you test adjust your dosage. It is that simple.
If you are around 3.0 INR and test weekly or biweekly you will have to binge on greens seriously to bring that number down into danger zone.
Remember when we go for procedures, we stop warfarin and it takes 3 to 4 days to get down to the level of needing to bridge.
So long as you do not stay below therapeutic level for a significant amount of time.
Now if you are one of those who aims for 1.5 to 2.0, the disregard all above.
If you have been avoiding greens like the coronavirus also disregard but if you have a well balanced diet. Your body understands you love your greens. Keep enjoying them.

Now go get some fresh collard greens, remove the mainstem, roll the leaves and finely slice them. Saute onions and garlic in coconut oil (don't mention saturated fat) add the greens with beef bullion and let the cook down stirring so often.

frozen greens have huge chunks of the main stem and that's unappetizing.

Bon apetite.

I gave up bridging a while ago. The doctors who prescribe it don't seem to know enough about how quickly our INRs get back into range (about 3 days), to make bridging necessary. I made the mistake of listening to my cardiologist a year or so ago, bought 10 vials for about $10 a vial, but didn't need them.
I've seen reports that say that you can't form a clot in only 3 or 4 days at below 1.0.
It'll take a lot of convincing to get me to bridge again - unless for some reason I have to keep INR low for more than a few days.

 

[Protimenow]

no, that's pretty much what most of us here do ... why would we be amazed?


not a good plan ... get a Coaguchek and test weekly. If you don't ... well then you're just waiting to become a statistic of "Usual Care" rates of stroke or life threatening bleeds and contributing to the "bad name" warfarin gets.

Get a used Coaguchek while they're cheap (at least in the USA)

Take care of yourself properly (and that you still use PT instead of INR suggests you've been badly educated on this)

Best Wishes

Pellicle is right. I went for about two years without testing, and I was damned lucky.
I started self-testing and maintained my INR. I used a defective machine, it showed an INR of 2.6, and I had a small stroke.

When you self test you may find that your INR fluctuates.

In the U.S., two vendors have CoaguChek XS meters for $29.95. They're missing a back cover and strip guide (apparently Roche's way of disabling them), but it's easy to use a strip to 'trick' the interlock on the guide so you can run a test. One of the people here asked Roche for the strip guide and battery, and was sent one.

I bought two of these meters - one was brand new, only had three tests recorded (probably quality control at the factory), and it still had the plastic on the screen.

As others have, and probably will, I urge you to consider the risks of NOT testing regularly, consider the costs of testing vs. the cost of a stroke or death, and get yourself on a self testing (and maybe self managing program). You really don't want to be sorry that you didn't heed this advice.

 

[Protimenow]

I try to test weekly. Sometimes I'll go as much as 10 - 14 or so days.

Doing monthly tests may seem reassuring, but give you no idea of what your INR was, or how it may have swung, during the month. While it may be somewhat safe to assume that if your habits and diet were consistent during the month, it isn't always reflected in a stable INR. It may be safe to make the assumption that what's good now will stay good, it's also not a big deal to do an easy self test to assure yourself that your INR remains in range.

I've been self testing since 2009, when I was able to get my first meter - a Protime that used strips requiring refrigeration, and a doctor to buy them.

I've had my valve for almost 31 years.

My own laziness (not testing the same day each week) is disturbing to me, but I am careful to test regularly - even if my dosing and INR are close.

If my INR DOES drop - and occasionally it will - I change my dose and test daily (although the half life of warfarin is around 3 days, sometimes the next day it will change slightly). I don't wait a WEEK to retest.

 

[pellicle]

My own laziness (not testing the same day each week) is disturbing to me, but I am careful to test regularly - even if my dosing and INR are close.

to me its like wearing a seatbelt (which btw are mandatory nationally in Australia) but there are times when I don't bother (4WD'ing off road, private property {sort of off road}, just going over to a mates a block from here with a load of stuff in the back...)

Safety is all about risk assessment ... and if you fail to assess properly (at least with INR) its only you who gets hurt (so no problem).

 

[ThomasM]

I eat pretty much what I want, my weight is good, and I feel healthy anyway. These are the last 15 blood draws to check my PT/INR value:


3.0
2.3
2.7
2.4
2.7
2.7
2.5
2.7
3.3
2.8
2.6
2.1
2.5
2.5
3.1

 

[Protimenow]

to me its like wearing a seatbelt (which btw are mandatory nationally in Australia) but there are times when I don't bother (4WD'ing off road, private property {sort of off road}, just going over to a mates a block from here with a load of stuff in the back...)

Safety is all about risk assessment ... and if you fail to assess properly (at least with INR) its only you who gets hurt (so no problem).

It's not only me who gets hurt. My wife gets hurt. People who count on me - even as a friend - get hurt.
The risk isn't only to myself unless I live by myself on an island.
If I don't just drop dead, it's also a cost to hospitals, insurance, caregivers, etc.

None of us live on an island, so it's important to regularly keep a handle on our INRs.

I'm jumping off now - I have an INR to test.

 

[Protimenow]

I eat pretty much what I want, my weight is good, and I feel healthy anyway. These are the last 15 blood draws to check my PT/INR value:


3.0
2.3
2.7
2.4
2.7
2.7
2.5
2.7
3.3
2.8
2.6
2.1
2.5
2.5
3.1

Without test dates, this information isn't of much value. It only shows your INR's values at the time your INR was tested - there's no hint about what may have happened to your INR BETWEEN tests.

 

[ThomasM]

Without test dates, this information isn't of much value. It only shows your INR's values at the time your INR was tested - there's no hint about what may have happened to your INR BETWEEN tests.

Yes it would be better if the dates were in there, but that still wouldn't tell what's happening between tests. I'm supposed to get my blood tested monthly as per doctor's orders, or sooner if it is out of range. 35 years of doing this!

 

[Chuck C]

None of us live on an island

Careful now. Pellicle lives on an island

 

[pellicle]

It's not only me who gets hurt. My wife gets hurt. People who count on me - even as a friend - get hurt.

good point ... I forgot about that aspect.

 

[pellicle]

Pellicle lives on an island

I was torn between the response I gave and the mandatory confounding from the deep south, and boy am I further south than any of your countrymen ;-)

 

[pellicle]

but that still wouldn't tell what's happening between tests.

true, but if the tests are weekly then you can be pretty confident that its either transient (so no problem because of "that graph" or you'll catch it at the test ... and if you ever want to know you can do "spot checks".

Just working the numbers if you found you were INR = 4.7 then the risk of event is about 47 events per 100 years. This would suggest a 50% chance of an event per year. So you'd have to be "that" high for that to be evident.
In contrast an INR of 1.5 would give you 26 years before an event was likely so about 4 events per year. This means that if your were low between the periods of a week and back up again we could call that 3 days ... 3/365 which roughly will will work out to a 0.2% chance of a risk in that period. Naturally the longer you unknowingly stay there will increase that risk. Also by testing 52 times in a year (instead of 2) you'll get a much clearer picture of if the tide is out or the tide is in than just going to the beach twice a year.

Its always good to be able to calculate the risks and data helps that.

 

[Chuck C]

and boy am I further south than any of your countrymen ;-)

I never thought of it that way. You are the southerner of all southerners. At least until we get a member from Antarctica.

 

[pellicle]

I never thought of it that way. You are the southerner of all southerners. At least until we get a member from Antarctica.

given the medicals required for that (and yes I've applied) I doubt you'll get such a member here ;-)