GYM and Weight Loss

[Gary Miller]

[FONT=&quot]Hello again,
I don't post very often anymore as it’s been 3 + years since AVR and life is busy again with new grandchildren and my wife's health issues (Stage 4 COPD). I was dealing with some scary shortness of breath and balance issues that made me uneasy at times. I was overweight and frankly out of shape, spending so much time with the COPD issues and neglecting the GYM. I decided to start my old GYM routine and lose some weight. 37 lbs. latter and level 15 on the elliptical for 30 min 5 days a week, I do feel much better and some of my issues are much better (No BP med anymore and only occasionally dizzy) but my INR went completely out of range now for almost 7 weeks. it started by going from 2.6 to 2.0 to 1.8 to 1.6 to 1.3 with me constantly increasing my warfarin. I have always been concerned about the amount I take daily. Now I'm up from 11 mg to14.5 mg a day and only back to 1.8 INR. I received the letter from On-X reducing the INR to 1.5 - 2.0, like most of you here I think the study was not as conclusive as they advertise and am much more comfortable with the 2.0 to 3.0 range! The question remains, is it the exercise, the weight loss, or both, and will it return to normal dosage if I cut back on them? I've been taking 14.5 for the last 2 weeks and will bump that up to 15 mg tonight. 15 mg really concerns me should that be required for the rest of my life. I read somewhere that 100 mg a week warfarin is considered to be warfarin resistant and would cause health issues with calcium and bones. As always your input is greatly appreciated. [/FONT]

 

[MethodAir]

My warfarin dose has increased as my health and exercise amount has increased. 6 months out from surgery I'm taking about 5.75 mgs a day. After surgery, I was taking 2.5 mgs.

 

[pellicle]

Hi

My warfarin dose has increased as my health and exercise amount has increased. 6 months out from surgery I'm taking about 5.75 mgs a day. After surgery, I was taking 2.5 mgs.

I think its pretty common in the months after surgery to have an increase in dose to maintain the same INR. I think its less so in the years that follow. Soon after I was home and "stable" on my INR I was taking ~4mg a day ... over the months it rose to 7 with occasional 8mg doses. The following year from surgery I got sick of them (mis)managing me and all the vein draws and wasted time at lab waiting rooms, so I took to managing myself. Since then my dose has stabilised to 7.25mg daily (I alternate 7mg and 7.5mg daily)

Gary, you mention:

I read somewhere that 100 mg a week warfarin is considered to be warfarin resistant and would cause health issues with calcium and bones. As always your input is greatly appreciated

I've seen stuff like that on "sites" but never on anything science based (like a peer reviewed journal). By "sites" I mean that you can find anything on the WWW, its worse than TV ... you can find "proof" that the Apollo landings were a hoax or that "Aliens abducted my daughter"

I'm curious if you have changed brands of warfarin and indeed which brand you are using. When I read this:

I've been taking 14.5 for the last 2 weeks and will bump that up to 15 mg tonight. 15 mg really concerns me should that be required for the rest of my life.

it could be for instance that there is a different "mix" of warfarin in there. I don't want to bog this down with technical stuff but there are different isomers of warfarin and each has different half lifes in the body (NB wikipedia).

Warfarin consists of a racemic mixture of two active enantiomers—R- and S- forms—each of which is cleared by different pathways. S-warfarin is 2-5 times more potent than the R-isomer in producing an anticoagulant response

So if your brand was a genreic that would be the first thing on my "investigation" list.

have a follow up of my linked articles (you don't need a chemistry degree to understand them, they are written for about high school level) and please post more with doses and INR if you want more suggestions.

quick last question : you aren't splitting your dose are you? I mean you take it all at the same time?

 

[Gary Miller]

No, I take my Coumadin (have been taking brand name Coumadin, says Coumadin/Warfarin Sodium tablets since AVR) at 5 pm daily. I'm going to check my meter on Monday as its been 8 months since last comparison with lab and its 3 + years old. Testing INR tomorrow, hoping for 2.0 or better.

 

[pellicle]

Hi

No, I take my Coumadin (have been taking brand name Coumadin, says Coumadin/Warfarin Sodium tablets since AVR) at 5 pm daily. I'm going to check my meter on Monday as its been 8 months since last comparison with lab and its 3 + years old. Testing INR tomorrow, hoping for 2.0 or better.

okedoke ... was just asking the obvious questions (and attempting to explain why). I took my INR this morning (I do this every Saturday) and my INR was 3.8 when its average is 2.6 ... this is by far the highest reading ever for me. I've done nothing different. I had a cold 2 weeks ago, where my INR fell to 2.1 and has then started creeping back up (2.8 last week).

I've done really nothing different, except perhaps less exersize this week ...

FWIW my practice under such situations is to monitor again on Wed and not alter my dose at all, to see where it will head to with no intervention. If it trends down again (which is what I expect) I'll put it under "natural outliers" make no adjustments and move on.

My machine is about the same age as yours, but its really the strips where it all happens. So to me : as long as the device is not filthy looking / powers up ok / passes its power up self tests = all good to go.

let us know how it goes

 

[Gary Miller]

2.1 this morning. Its going the right way, but again, 15mg last night. I'm taking Pellicle's advise, going back to 14.5mg, and checking again on Wednesday. Like everyone on ACT, I've had ups and downs ranging from .5 to .8 variations at times. This constant downward trend to 1.3 was pretty concerning even with the On-X valve. Imagine not being able to test at home and adjust dosage immediately as needed. A lot of us have experienced ill informed and incompetent people in ACT management. Either the medical community or regulation authority are not looking at, or gathering enough statistics to adequately train the Doctor's and nurses on ACT management. Hopefully this is some kind of internal chemistry change that will return to normal soon.