Good INR's?

[Perrster]

I have noticed we usually post problems (which are good, because we learn from them too), but I am wondering what others have to say about their INR's on a more positive note and especially how you "maintain" it?

I really do hate the blood tests and I look forward to the next 10 years or sooner(?) when we'll see new drugs like Exanta (see MATXR's thread on Protimes and Coaguchecks Obsolete) and not have to take Protimes or watch vitamin K in our food.

In the meantime, we all have to deal with Coumadin as best as we can. I commend all of you who use the Protime Microcoagulation system and do your own monitoring. I am dependent on my Coumadin Clinic which has turned into a fine resource for me with very professional, caring people. The nurse even called me over the Labor Day holiday weekend to tell me that my PT test was OK. I had seen her late on Friday and she didn't want me to wait for the results until Tuesday.

My INR was very good with my Protime reading at 2.9 and now I don' t have to re-test for a month! Thank God for small favors.

I am close to 17 months post-op with dual MV/AV St. Jude's replacements and have since been fairly consistent with my Coumadin therapy (2.5 x 3 days) and (5.0 x 4 days). I kept no records until the first of this year when my Coumadin Clinic opened. Unfortunately, I did not learn of VR.com until sometime in the spring. Anyway, I'm here today and hope to be for many more, God willing and the valves don't quit!

Here's what I've been doing for "maintenance." (I think it was Bob Gleason who indicated we are high-maintenance people, but we deserve it!):

- remember to be consistent
- take medications, vitamins, and supplements at the same time every day with tons of water
- take no OTC drugs (occasionally only Tylenol and Rolaids). My clinic has steered me clear of Rolaids for a 2-hour window before or after taking Coumadin. Antacids can have a counter affect on Coumadin.
- schedule PT tests at the same time of the day if they are 2 weeks or 30 days apart
- call the clinic if I have any questions or doubts about food or a medication
- maintain exercise routine and always try to walk 1 to 2 miles per day
- diet is a biggy! I have drastically cut my Vit K intake and pass on salads, dressings and anything that I know is high in Vit K. I quit alcohol and turned to N/A beer. Fruits are now my preferred snack food. I keep a Vit.K chart in my wallet if I have doubts
- I don't think the weather is a factor right now, but we will see after I take Christmas vacation this year in Ft. Lauderdale, FL.
- say silent prayers for Hank, all VR.com resources and people on this site needing it

I am also waging war against cholesterol and blood pressure levels. I have virtually eliminated red meat and gone to lower fat or no cheese and milk products. I eat more chicken than any man can take! I order fish or turkey burgers when I go out. Soy Milk is substituted whenever possible plus Soy protein snack bars. I re-test my cholesterol (conveniently at the same time as my next Protime test) to see how the battle is going after 3 months of the above. I will let you all know how it turns out.

Take care Coumadiners, and thank you for your support.

PerryA

 

[LUVMyBirman]

Ok, lets try a more positive spin.

Can speak for myself and maybe a few others that we do complain way too much about our INR's. It one of my favorite subjects as it is a challenge... one thing that I have always loved.

Perry, sounds like you have it all figured out. Learned something new too....was not aware of the antacid interactions. And, like you.... I have omitted almost everything high in K. Do try to squeeze in an iceberg salad once or twice a week. My trick to consistency...take an extra 1/2 mg for the day. Has not failed me yet. Not condoning this... but had to find a way to get some greens in. Tried to be consistant and eat a salad every day...but that did not work. Like to eat things when I have a taste for them. Come on Exantra!!!

Hoping we have the opportunity to meet in Nashville. If not, maybe Chicago around Thanksgiving. Got to get the hubby well first. He still insists he will be well enough having his surgery late this month for me to go. Doctor say 4-6 weeks. Can't leave him high and dry with our five year old and 3 month old puppy during recovery. Can you inagine? Taking it day be day. Will keep my reservation in place and hope for the best!

Take care,

 

[TSH]

Good idea about being positive. I'll be the first to admit that I was abit obsessive about the INR thing for the first few months after AVR in Aug. of 99. But now I rarely think about. I've been very fortunate to have had no problems keeping my INR consistent (between 2 and 3). In fact, for a period of 3 months, my INR was 2.62, 2.62, and 2.64 consecutively. And I eat whatever I want. My only limitation is no more than 3 alcoholic drinks per day.

While I'll welcome a new drug with no diet interactions, Coumadin is not really a life issue for me.

 

[Perrster]

Good for you!

Good for you!

It's good to hear this!

I have no idea why I am so obsessed with it, just am!

And you eat whatever you like too! Do you THINK about your INR when indulging in a beautiful green salad? Or do you try to limit them in a weekly meal balance act? I've practically given up salads! And, it was a sad day when I went cold turkey from my favorite beer. I had a bad episode from a few too many at a golf outing last summer and quit the following Monday! I was truly clueless about alcohol interaction with Coumadin.

Thanks for the news. You've given me hope and I shall try to be less obsessed about it!

PerryA

 

[Lorraine]

PerryA,

As you know I have been very obsessive about my INR. I will keep a positive attitude though. I go for a test Monday. Luckily I only have to get that pin prick, and I get my results within minutes.
I too steer away from vitamin K. I miss my cilantro the most because I use to make this real good mexican salad with cilantro, beef, serrano peepers, avocado, onions, cheese and tomatoes. I only make it once a month now, eat a small portion of it with tortillas and give the rest to my neighbor. It kills me because I really liked the taste.
Another question. You mention you eat fish. I thought fish was high in vitamin k, or does that only pertain to some types of fish.
What does beer to the Coumadin? I love my beer and have not given it up totally. I never drank more than four or five if I was drinking. Never was a big drinker, just love the taste.
On on real positive note: I Love Life
And I'm glad we have all connected!

 

[Christina]

I am so happy with my new doctor, I can't describe it!
I did an INR test Wednesday, and called it in on Thursday since the office was closed Wednesday afternoon. My INR was 4.2, so a little on the high side maybe.
The nurse called back and I was told to keep the dosage the same, 19mg a day. I also would have agreed to lower it to 18mg a day.
He is NOT afraid of a higher INR and I am so happy about that. The other doctor would have ordered me to hold the Coumadin for a day, and than I would have plummeted again. He had me on such crazy dosages.
I eat whatever strikes my fancy, but keep it healthy! I love broccoli, spinach, salads, but don't go overboard with it. I also have days when I don't touch a salad, it all depends what I want.
I am not much of a drinker, but do enjoy a margarita several times a year, plus I will have a good glas of wine once or twice a week. If I drink a little too much I get a headache, so I don't do that. I haven't noticed any changes in the INR because of the wine.
Yes, my advise is to keep the diet steady and consistant, and try to find a doctor who is on your side of health.

Christina
Aortic Stenosis
AVR 8/7/00 and 8/18/00
St. Jude's mechanical
Coumadin 19mg a day.

 

[Andrew Harriss]

Great post PerryA
I never worried too much about my INR until I joined the Website a few months ago! My target of 2.5-3.5 was usually met but it would also move up and down within. I just assumed subtle diet changes was the cause. I have a good Coumadin Care Center here but I do know of one lab error that occurred on me. I didn't get much advice except watch the broccoli aka Vit K.
I eat very healthful foods albeit maybe too much. I love greens and all veggies. I make sure I get the rda of Potassium for heart rhythm. Weight is under good control. Lipid profile is great..170 total/83 ldl/tri-g 40. I drink several glasses of wine at Dinner and the best thing I was able to do was RETIRE which eliminated tons of stress from travel and monthly Board whippings in CH. I spend lots of time with my Grandsons and my new Lab.Great therapy!
It's interesting that my Cardio once told me that there was some rising sentiment in the MD community that anti coagulation might not even be required for Mechanical AVR's due to the strong blood flow across the aortic valve. He's a well known Dr in this area from Harvard Medical but of course he put me on the drug!
I'm also a firm believer in the P.A.C.E. theory...Positive Attitude Changes Everything. There's a great health magazine called Prevention with lots of good tips. Sounds like you already get it.
Good luck and look forward to more posts.

Andy Harriss

 

[TSH]

PerryA,

I eat salads. Not very consistently though, but sometimes lots of them. Never have had a problem. Alcohol seems to thin my blood, and I usually have one drink every day or so. Maybe that helps. But my INR is always acceptable.

Maybe one reason I don't worry about it too much is because I've heard and read so many opinions on the proper INR range. Initially, my surgeon said 1.8 to 2 would be acceptable because my artificial valve is in the aortic position and because the valve used was one of the larger sized St. Jude valves. Other docs have said 2.5-3.5 is the appropriate range. Who knows. I figure that if my blood gets too thick, it won't be for long since I take the Coumadin everday.

 

[Perrster]

Thank you for your support!

Thank you for your support!

I think what it all comes down to is what's acceptable to us individually and personal choice for the lifestyle we maintain while on Coumadin.

It is very reassuring to see replies from folks who have to take Coumadin and don't let it control them. That's my goal and as soon as I survive my impending dental work, my goal will be achieved.

I forgot to mention that I have ordered the "Coumadin Cookbook." Has anyone else tried it? Oddly enough, Barnes & Noble had to back order it for me. Are there that many people out there using it?! Would you laugh if I posted some good recipes from time to time?

Your responses about alcohol are leading me to think I could do a couple of glasses of wine with dinner and not hurt anything. The only reason I quit beer was because I was stupid and overdid it at a golf outing and don't want to re-live that bad experience. Aren't there some antioxidant benefits of wine that I may be missing anyway? On the contrary, in the Patient's Guide to Using Coumadin, Dupont recommends avoiding alcohol. Again, I think it's an individual choice and depends on one's level of tolerance. Pass me the Chardonney, please!

Lorraine, I don't think common edible fish is high in Vit K although there could be a few types that are (maybe it's eel, or turtle, or some other ugly, squiggly aquatic critter?). I do know that Shrimp and Crayfish are cholesterol killers. The Patient's Guide to Using Coumadin has an extensive list of high to low Vit K food items in it. I have reproduced it in a reduced form and keep it in my wallet for continuous reference. I would be happy to make you a copy.

More P.A.C.E. to come.

Thanks again, everyone.

PerryA

 

[Nancy]

Vitamin K food lists

Vitamin K food lists

A while back I posted 2 links to vitamin K food lists. Just do a search on the word vitamin, don't add the K because it messes up the search.

 

[RobThatsMe]

Hi Perry,

I have been on Coumadin now for 1 1/2 yrs and drink several beers a day. My doctor told me that 2 or 3 a day is not a problem. In fact, even if we didn't have any health concerns doctors will only say 2 or 3 a day, becuase that is what the American Heart Association guidelines say. He also said, to remember that with Coumidin consistancy is the key.. so.. if you are going to drink... drink regularly! hehehehe..

From what I have read about alcohol and Coumadin, it seems that it can effect people differently. It may either Raise or Lower your INR, there is deffinate answer. Guess I am lucky because I have had no major swings in INR from any of my indulgence.

I usually only have 2 per night during the work week, but on the wekends.. on the lak,,,in my boat.. I just don't count how many I have.. I enjoy the day..

Raising my glass to your good health,

Rob

 

[TSH]

Cheers to you too, Rob. I'm glad to see I'm not the only one that has a couple of extra (over the limit) beers on the weekend.

 

[ticktock]

woah nellie

woah nellie

Perry, et.al
Today is the 23rd anniversary of my first AVR. I was 23 at the time. Thats a coiincidence. Anyway, I have been on Coumadin since. I eat what I WANT! In all honesty, I pay no attention. OR maybe I pay attention, but it has just become habit. I dont load up on green vegetables, although brocoli is my favorite. I have wine when I want it, and beer too. My protime remains pretty stable, and I have done extremely well.

If I have to give up eating, along with all the other stuff, well... that would be too much to ask. And someone wrote about Cilantro. My goodness that seasoning is used in such small quantities, surely it cant be THAT bad!! I would have some, just in moderation.

As far as booze, I have this figured out. It isnt the BOOZE per say. Its the fear that we Coumadiners will have two too many, fall down and have a bleed in our bean (head). Or some other significant place. Maybe thats the deal, and all this is a conspiracy!
mindy

 

[LUVMyBirman]

Hi Mindy....

Boy do you have the right attitude. And after so many years rightfully so!

Was laughing about the 'boozing' and the possibility of injury. Picture this...after a few drinks we were window shopping in Hawaii passed a jewelry store with a lot of things that caught my eye. What girl would not want to stop and look? Anyway...upon gazing into the window I bumped my head and caught the attention of everyone in the store. How stupid and embarrassed I felt. Thought you all would appreciate the humor. No wise cracks Bob G

 

[ticktock]

jewelry

jewelry

Gina
Got a good laugh outta that one. Trying to get a little TOO close to that jewelry?? uh huh!! Well, on a similar note... get a load of this!! I had a date (years ago) with someone I was very interested in. (ie; trying to impress). He had a two seater sportscar, very small. This was before seatbelts were the law.

SO, he takes me to this restaurant out in the boonies, and is kind of lost. It is dark. He is quizzing me about my "condition" and the "blood thinners" and says, so "as long as you dont hit your head really hard, you are probably ok?". of course I say, yeah, thats right. Well, not 5 seconds later, he slams on his brakes for a stop sign that he nearly missed, i slid out of the seat, and my head bashes into the windshield! i was laughing so hard, i think he was afraid I had stroked and was "outta my head". The timing was comical!!! I had forgotten that, thanks for another laugh!

 

[Perrster]

This Bud's for Coumadiners!

This Bud's for Coumadiners!

Or Miller, or Coors, or whatever...I raise my glass to all of you in good health! Thanks again for the these excellent replies.

Cheers!

Perry A

 

[Dave]

Coumadin

Coumadin

I have been reading all the threads on Coumadin, and pardon my ignorance but I am on Warfarin, is it the same stuff. Its just that we never hear the name Coumadin down under(New Zealand) if it is different, is it better than Warfarin. I was also interested to hear of the daily doses some people are taking. I think someone was taking 19MG per day, boy that sounds like a lot compared to the 4MG i take to maintain an INR of 2.5 to 3.0?
I know that some medications have a de stabilising effect with warfarin, when I was post op for a Mitral valve I was on Amioderone for six weeks, and my INR was all over the place. Now 13 months later, I only take warfarin and zocor for colestral, and everything is fine.
Someone mentioned the possibility of a new blood thining drug without any diet restraints, is this going to be a reality?

 

[Perrster]

Greetings, down under!

Greetings, down under!

Dave,

I think Coumadin and Warfarin are basically the same. I take the "generic" Warfarin version made by BARR, alternating days of 2.5 and 5.0 strengths. I do know that one should not switch brands (consistency!), so we must be careful of what we get from our pharmacists.

Have you visited the warfarin.com site linked here on vr.com? Al Lodwick is an expert on Warfarin. He has been very gracious to keep up with us yo-yo's and answer many questions. Check out the story of how warfarin got its name!

Exanta is the new drug being researched. See MATXR's string "Protimes and Coaguchecks Obsolete" under the mian Coumadin heading.

Lastly, where are you located in New Zealand? My daughter visited your country two years ago with a youth group and loved it.

Take care.

PerryA

 

[Dave]

PerryA
Thankyou for your response on the Warfarin, I will look at the sites.
I live in Dunedin, New Zealand, that is well south in the south island on the east coast. I was born here, and it is a nice place to live, but it gets a bit cold in the winter. I have travelled many times in the USA, mostly on business and i think it has some really nice places too, and the people have always been really good to us.
I watched the news in horror this morning, we are all deeply saddened by the horrific events of the last few hours.
Cheers Dave

 

[DickV]

I've read alot of bullshit reports about the comparison of Coumadin and and the generic, all biased one way or the other. Many of us on thei site have had problems with the generic, resulting in our INR's jumping all over the place only to stabilize after returning to Coumadin. I was told the drug is pretty basic but the problem may be some generic brands may not hit their dosages as tight as Coumadin, in other words, is 5mg really 5mg.

You'd think rather than test patients in lab trials, they would just do random sampling of both in labs and check for accuracy in quality and doseage but it is not in any companies' interest to do so. You should all not put too much faith in anything your read. Listen to your body and go with your basic instinct. If you start having INR stability issues on a generic, switch to Coumadin and see if it helps. If not, switch back. I went from Coumadin to a generic, back to Coumadin and it was a wild ride.