Help....Warfarin

[Krista]

HI...I am new to this site..In fact today is my first time here. I have found alot of helpful information, but am still very confused about Warfarin. No one gave me any information or nor did I get any kind of education on this drug. I love salads but don't want to eat them everyday. Is there some kind of formula that helps you know what to balance differant foods with? For instance can I have a salad one day and the next day have something else that has Vit.K in it. I am so darn confussed. I love to have a glass of wine once in a while, but don't know if thats o.k or not. I am really mad that the hospital did not educate me on this before they let me come home. I am teaching myself just though reading, but I still don't understand...I hope everyone is doing well. Its very nice to have a place to come to where people understand where you are comming from...Krista

 

[Nancy]

Hi Krista-

Welcome to the site.

Joe's been on Coumadin for almost 28 years. Just eat as you would normally. Don't do anything outlandish, just a normal healthy diet. And yes, people can have wine and stuff in moderation.

There are many other things that can affect your INR, such as exercise, getting a cold, having intestinal disturbances, and sometimes you just can't ever figure out what causes differences in the INR. You will drive yourself crazy trying to get the "perfect score" with the INR. You just want to have it be in range.

Your doctor adjusts the dosage to YOU, you do not adjust your life for the INR, unless you are doing something wildly unusual.

A couple of things that have gotten some people into trouble because they werenm't aware. The following things have large amount of vitamin K which is sort of the antidote for Coumadin.

Boost
Ensure
Carnation Instant Breakfast
many other diet supplements--you have to read the labels
Power bars
Luna bars and others like that--again read the labels
V-8 juice has it and doesn't show it on the label
any "health" type drink that shows greenies in the contents such as alfalfa sprouts, wheat grass and the like
Some health foods have algae added that can have vitamin K in it

So, go have fun with your life. Eat normally and moderately and have a good person monitoring you.

You'll do fine.

 

[geebee]

Wlcome Krista,
I have been on coumadin for 24 years and received no instructions when I started other than regular blood tests.
I did not change anything in my lifestyle (diet, exercise, etc.) and, therefore, my coumadin dosage was adjusted to me.
That would be my suggestion to you. Don't change anything in your lifestyle that you want to keep but be sure and get regular tests to determine the coumadin dosage appropriate to your life.
Be sure and check out Al Lodwick's website: http://www.warfarinfo.com - a "must see" source of information for those on coumadin.
Good luck and smiles,
Gina

 

[Guest]

Krista - you got good advice from the others.

Pam - if he only drinks during Broncos games it will be a long dry spell.

I have one patient who really parties during Bronos games. She has a rectal bleed the next day. Says she doesn't want to be the only one sober when the rest are all drunk.

 

[Krista]

thanks

thanks

Thanks to all of you who have responed to me. Pam I am going to kick back a bit and have a glass of wine. I will let the Warfarin adjust to me, like everyone says instead of me adjusting to it. I test again tomorrow and will ask the doctor about his thinking on the home testing. I don't know if I can figure out how to test at home when at this point, I can't even figure out what to eat...LOL....Krista

 

[bvdr]

Krista, sure you can get the hang of testing at home. You will catch on to the whole warfarin thing before you know it. You will because you want to and are interested in maintaining maximal independence. You are in good company because so many of have gone through the same thing as you are going through now.

By the way, welcome to this site. I hope you stick around and join the family. I don't think we have anyone else with the name of Krista.

 

[William]

Hi Krista, I know it can be so confusing. I'm a new to this also with just about on my 6 weeks on Coumadin and am finding ways of living with it. I did eat a lot of green vegs and drink more then my doctor would want to hear. I've found some vegs aren't that high on vit K and have worked moderation (I hate that word) into my dose of alcohol. The best advise was said earlier, read the labels. Will

 

[ALCapshaw2]

Krista -

WHO is managing your coumadin / INR?

My recommendation is to find a good Coumadin Clinic if available, otherwise a doctor who REALLY knows how to manage coumadin (MANY do NOT).

Second, I highly recommend that you read Al Lodwick's website, www.warfarinfo.com and maybe even buy his book and dosing guide. I'm surprised (AMAZED) that no one has mentioned that yet.

Someone made a really good point about eating vitamin K vs. not eating vitamin K:

If you consume NO vitamin K, then ANY intake of vitamin K is like going from dark to light (a BIG change) whereas if you eat a moderate amount of vitamin K (regardless of the source) every day, a change in amount is more like changing from a 50 watt light to a 100 watt light, a noticable but less drastic difference.

I like that analogy!

'AL'

 

[bvdr]

Al, you are so right about mentioning Al's website!

Krista, you will find wonderful information there. Al also watches over our coumadin forum here on our boards and has helped us all out many times.

 

[John & Joann]

33+ years for Joann on Coumadin. No Booze, but everything is the same as before Coumadin. The real answer is to be consistent with your diet and lifestyle.

Joann INR stays VERY consistent. She uses a Coumadin Clinic when we are home and a local hospital that sends the results to the Coumadin Clinic when we are in our RV. You build coumadin around your lifestye and life WILL go on.

 

[Karlynn]

Krista,
I've been on Coumadin (warfarin) for 13 years. I've been a member of this site for a year and a half. I've learned more about warfarin in the last 1.5 years than the other 11.5 combined. You will catch on. I would highly recommend running your INR and dosage changes past us here (and Al) because not all doctors/nurses know how to manage it well. If you keep getting a "thumbs up" here, you can be assured your doctor is managing it well. I highly recommend getting Al's book that he sells through his site. It has a lot of information in it. Also bookmark his site on your computer.

The key is consistancy. If you love salad, you don't have to have it every day, just keep it conisistant through your week. Don't binge drink on one day and go without for the next month. (but don't binge drink every day either!!!! )

 

[Guest]

Pam, alcohol is alcohol. The only difference between beer and wine is the taste that is mixed with it.

I wasn't criticizing Jake - my son is a friend of his and I've been to a game on his tickets and sat with his family. I don't go to stuff if I have to pay. My son is friends with many players on many of the teams. He probably got the last Jersey autographed by Larry Walker before he was traded - then he gave it to the kid in his junior golf program who was the most improved for the year.

 

[Raverlaw]

Krista,

I've been on warfarin for 11 months now. My INR varies, but not too drastically.

My philosophy is to eat and drink what I want to (in moderation, as with all things) and to try to be consistent. For instance, I drink a glass or two of red wine daily. I rarely skip a day, and I rarely have more than two glasses.

I love spinach salads, and have them 3-4 times a week; more if they're small. You get the idea.

As Nancy said, watch out for hidden sources of Vit. K that you might not eat every day - they can throw a wrench in the works, but as Al mentioned, if you eat fairly high and consistent levels of foods with Vit. K, a little extra won't make so much difference.

Warfarin is the only alternative open to us for the foreseeable future, so we just have to learn how to make the best of it.

 

[jimrh]

Coumadin dosage

Coumadin dosage

I'm an engineer who designs control systems. Therefore I'd like to arrive at a constant dosage level that always keeps INR on target. So far, it hasn't worked. What I have discovered is that if I keep 4mg and 5mg tablets on hand I can make up any needed dosage (usually 7.0 to 8.5) in steps of 0.5 mg with just two tablets. (they break into 2.0 and 2.5 mg halves). My first coumadin adviser used to try to level it using 5mg tablets. The routine was just too complex. This way I can take the same amount every day instead of keeping track of odd numbered days or M-W-F or whatever cuckoo scheme they threw at me.
Jim

 

[jimrh]

hasn't worked?

hasn't worked?

When I said it hasn't worked, what I mean is that the dosage varies occasionally when I test. Still, I maintain the same dosage for about three weeks, then change it a little for the next three weeks. I'm just now applying to home test, so I should be able to keep a tighter rein on it.
Jim

 

[Nancy]

Jim-

I wish you a lot of luck trying to get a constant level with a drug that just doesn't want to do it. I think that everyone who's on Coumadin for all these years has tried. Some succeed more than others, but still the nature of the beast is to vary.

There are just too many things that affect Coumadin, and it's not all related to what you eat or drink. Some of it is related to your own personal health, metabolism, exercise level, medications including over the counter, injections, weight gain or loss, the health of your digestive system on any given day, atmospheric temperatures and even what territorial height you might be traveling through.

That's why so many people call INR "it's never right".

 

[Guest]

Doctors (except for Marty) are the worst patients. They always want to fool with their own dosage for what seems like no rational reason.

Engineers are the next worst. They always have a rational system for an irrational drug. Give up Jim. Trying to keep your INR exact is like trying to drive across the US while keeping your gas tank exactly half full.

Here are "some" of the variables you will have to deal with:
The amount of vitamin K in foods you eat - not only the exact portion size but rhe natural variation in how much vitamin K the plant produces.
Your heart rate - the more times your heart beats the more trips the blood makes through your liver, so the fater the warfarin is metabolized,
Other medications that you take - some stimulate metabolism of warfarin, some slow metabolism, some prevent it from getting absorbed.
Alcohol consumption - extra drinks on a short term will increase the INR, continuous heavy drinking will stimulate metabolism of warfarin until the liver starts to fail them warfarin will be nmetabolized more slowly
Warfarin prevents the manufacture of vitamin K dependent clotting factors by the body, it does nothing about those already circulating. So the effect of a dose can take 3 to 5 days to manifest itself.
The reason it can be 3 to 5 days is that there are different alleles of the enzymes in your liver that metabolize the warfarin, so the apparent half-life of warfarin will vary from person to person.
The ambient temperature may have an effect on the INR. Some studies show that it does and some show that it does not, so you will have to figure out whether or not it does for you.
The effect of a warfarin dosgae change on the INR is non-linear. It appears to be a asymptotic curve as the dose approaches ideal, but this is not certain because it is too hard to control for all of the other variables.
The INR testing devices are not very accurate. You can test a second sample of blood from the same draw and get an answer that will routinely be 0.2 units different - sometimes way more different than that.

Getting the same INR for three consecutive tests happens about as often as getting the same three numbers on a slot machine.

Here is the most effective control system - don't let your INR get more than 0.2 units below your desired range and don't let it go above 5.0. Then you will have few problems. "Few" not "no" problems.

 

[Sherry]

...but YESYESYES...Peyton is OOOOOOOut! Go Patriots!!!!

Ouch, Pam. We here in the Hoosier state are still not over that embarrassing loss

I've been on it for going on eight years, and the advice here is right on target. There are so many variables working against a level INR, that it's not easy to get one. As Al and Nancy mentioned, there's no logic to it. I'm jumping for joy because my reading this afternoon was the second in range that I've had in three weeks. Woo hoo...

 

[Marty]

I learned from Al that trying to keep your INR on an optimum number is like taking a 500 mile car trip and keeping your gas tank always half full!