Hidden Sources of Vitamin K

[Guest]

This past week I saw a 27-year-old woman who started eating 3 Luna nutrition bars for women every day. They lowered her INR to 1.3 and she had a stroke. I checked at the grocery store today and Luna bars each contain 100% of the recommended daily allowance for vitamin K.

If you are having trouble keeping your INR in range please, look at my page http://www.warfarinfo.com/vitamin-K.htm for some more clues about hidden sources of vitamin K.

 

[Ross]

Thanks again Al

It seems that someone needs to go out and round up all sources of this stuff and publish it.

 

[LUVMyBirman]

Yes, thanks Al!

Want to hear a good one? After my MVR I had Coumadin induced tamponade. Anyway....on my second visit to the hospital for my percardical window surgery I was extremly malnourished. My doctor ordered Ensure as an addition to my meal plan. I was sitting in the hospital for 7 days and my INR would not budge. At that point you have to imagine I became board out of my mind. So....during one of my "meal supplementaions" I read the back of the Ensure can. Loaded with Vit K. I knew it was an antagonist to the Coumadin so I refused to drink it. Within a few hours my doctor came in and said "so I hear you don't want to drink my Ensure" I said your darn right. How long do you plan on letting my sit here waiting for my INR to stabilize? She said....oh I am sorry was not aware it contained Vit K! Ahhhh, and your a doctor, LOL. Scary. That was after they almost managed to kill me by mismanaging my Coumadin!

 

[Ross]

Gina, the worst part is that this type of thing still continues. They tried like mad to get me to drink it while I was in the hospital in July. I kept refusing it. Besides that stuff tastes nasty to me. I'm telling you, if your not your own advocate and have learned this information, your flirting with trouble. These Doctors do not know what they are telling us to do most of the time. It is scary!

 

[LUVMyBirman]

Isn't the that truth Ross! They were trying to push the Ensure off on you too! Did you tell them why you were refusing it?

The longer we sit in the hospital...more we learn. What was to be a 5-7 day stay turned into 30 for me. I know it was much much longer for you.. Hey I found a local hospital with internet and cable access in the room! Hope I don't have to use it....but might as well be connected.

 

[Nancy]

Joe, too!

The hospitals have also tried to make Joe drink Ensure and Boost while they were trying to get his INR up, after Heparin.

When I brought it to two dietician's attention (I asked them to see me) in two different hospitals, they weren't aware of the Vitamin K content. Then they did some kind of "tap dance" around the fact that lots of foods have Vitamin K.

Aren't they the ones who are supposed to be monitoring everything patients get to eat and drink and making sure they don't get interreactions???

Why does a patient or patient's wife/husband have to tell these professionals something they should know?

This should be taught in all dietary/nutritional courses.

Better yet, why don't the manufacturers make a product without Vitamin K, for people who are on anticoagulation. There are lots of hospitalized people who are on Coumadin.

Al, that's a horrible story. What a tragedy, that poor young woman.

 

[TSH]

Al,

I've got to ask out of curiosity: Was the woman a mechanical valve recipient?

 

[ShezaGirlie]

Slim-Fast

Slim-Fast

Yep, Nancy along with all the rest are certainly correct. We must be our own best health advocates and be on the watch constantly. Good for you Gina and Ross for taking charge in the hospital!

While traveling recently I grabbed a couple of cans of Slim-Fast in lieu of airport fast food and thinking this would be 'healthy' as most vitamins are in it. After all, don't people 'live' on this to lose weight?

Well, I perused the nutrition facts and found where a 340ml can contains 25% of the daily value of VITAMIN K! Wow, four cans and you're at 100% of vitimin K for the day based on a 2,000 calorie diet. AKA - 'stroke city' for us Coumadin people!

Of course now, if my INR gets too high -- I could pop just one of those cans and hope to lower it some....right or wrong folks?

 

[Nancy]

Hi Girlie-

Some may disagree with me, but if your INR is too high, you should let the person who monitors it decide what to do about it. It's just too iffy to do it with diet. It's always better to be as precise as possible about your regulation.

 

[LUVMyBirman]

I have to agree with Nancy to a certain degree. On the other hand.... in the past letting my doctor decide was almost fatal once. And close to fatal two other times. That was three hospital stays because I let them "handle" it.

I have since moved and have new doctors. I also self test and know what works for me. My doctor just asks I call in my results every so often. If I get slightly out of control adjustments are made by yours truly. Have it down to and exact science with far better control than any doctor ever did.

 

[Christina]

Ditti to what Gina just wrote. Yours truly does her own adjusting here as well, even when the doctor says to hold for 24-48 hours. When he's adjusted the Coumadin in the past and told me to hold for 48 hours, my INR went to the bottom. Can't let that happen again. Too scared to have another clot and have to go under the knife again. I've learned how my body reacts now and when the INR is a bit out of control, I adjust the dose to half. Test again in 3 days and it's always been good. I have it down to an exact science now just like Gina. My doctor is happy with me. I just saw him last week. LOL!!
I haven't been to a lab in almost two years.
Christina
________________________
AVR's 8/7/00 & 8/18/00
Tucson, AZ
INR home testing via Protime

 

[ShezaGirlie]

Ditto, Ditto...

Ditto, Ditto...

Double dipping you girls Gina and Christina -- agreed, agreed!

I also have been 'self-regulating' for almost three years and know my body and how outside influences can make a difference with an INR reading.

My cardiologist trusts my knowledge and in fact has told me a couple of times how much he enjoys having a patient who is intellectually informed on their medical situation and the ramifications involved.

Respectfully Nancy, believe me -- I am as 'precise' as possible.


__________________

 

[Guest]

The lady had Antithrombin III deficiency. She had a stroke before, so she knew what was happening. She got good treatment quickly and is OK. She was the last person that I saw today. She used the exact words ShezaGirlie used - I was trying to do something healthy.

Part of the reason that there is so much confusion about what to do is that the American College of Chest Physicians (the standard setters for warfarin use) are very vague about the use of vitamin K. There just is no real good information out there as to what to do. Think of the old west - each lawman set his own rules. That is where we are with vitamin K. It looks like oral is better than injectable. The FDA says if you use injectable, don't use it IV. The ACCP says that if you have to use vitamin K by injection use it IV. Most doctors use vitamin K 10 mg and inject it IV. This makes people resistant to warfarin for up to 2 weeks. ACCP says use 1 or 2 mg IV. Today the Journal of Emergency Medicine reported the case of a person who was given a 1 mg IV dose of vitamin K that caused death almost instantly. (I've only seen the abstract so far-the librarian is getting the entire article from another hospital for me.) But I think that the person was not even bleeding. I never recommend vitamin K for someone who is not bleeding. But lots of ERs inject it just because docs worry about bleeding as a possibility.

The first time we heard someone say that she recommended a salad for her patients who had a slightly elevated INR, we all laughed. But the more we thought about it, the more it makes sense. I now recommend it all the time for INRs in the 5 or 6 range. It seems a whole lot safer than an IV injection and probably works just as well.

I do a lot of warfarin dosing in the hospital for people who are on the rehab floor. Most are on Ensure. So I just work around that because they need the nutrition. However, we are aware of its vitamin K content. But what happens is that when they go home and are no longer drinking it, we have to lower their warfarin doses.

 

[Rain]

I know self dosing is not best for everyone...

I know self dosing is not best for everyone...

BUT.... I also know I am the person who best understands my body and its reaction to coumadin. I've been monitoring my own INR for over two years with my cardios approval. For the most part he and I would take the same action when an adjustment is needed anyway. But he doesn't know my body like I do. All he knows is what the results are...

Last Friday at 4:00 pm I went to the hospital lab to have blood drawn, and of course took my machine with me. (I?ve been having problems with it). The lab results came back at 8.57... (my machine was 2.2!) They immediately paged my cardio. My cardio called me and told me to hold my coumadin over the weekend and retest Monday. I told him I don?t want to do that. I have NO spots on my body, I have no bruises, I don?t have that yucky blood taste in the back of my throat, no blood when I blow my nose, whatever the other zillion things are that happen to me when my INR gets high are not happening to me and I think their reading is wrong. Finally, we comprimised and agreed I would take a half dose until Monday and retest.... well.... I KNEW it wasn?t right and I went back the very next morning 9:30 am and did another arm draw and another test with my machine... GUESS WHAT?!!! Machine 2.6 Lab 2.9 That?s more like it! I went home and took my regular dose.

I?m happy to hear Al say that he lowers a somewhat high INR with salad or whatever..... I've found that to be a LOT better than changing my dose and setting myself up for another roller coaster ride. I've always hated rollercoasters!

 

[Marty]

THE 10% SOLUTION

THE 10% SOLUTION

Friends, don't forget the 10% solution. If your doctor has never heard of it, let him in on a very useful secret. Also, Rain, remember I mentioned Dr. Ansell saying if there was a wide discrepancy between the lab and your Protime, your Protime had just as good a chance as being right as the lab.

 

[Rain]

My machine or the lab....

My machine or the lab....

I know, Marty. I was afraid to believe it at the time. However, I totally agree now.

I?m actually beginning to think my machine is accurate and the lab has a problem. And you know what... I called them back later to ask them if other people?s INR?s were coming back within range... or was it just mine all out of whack... and the lady told me first that everyone else?s was coming back fine and then she told me that they ran a second test on my blood and it came back 6 point something! Shouldn?t it have came back with the same result both times? I guess maybe it could be lower because the blood had been drawn for a longer period of time or something...?? I don?t know, but instead of comforting me or what ever she thought she was doing.. it just left me with more questions.

I'm going to test my machine against my cardio's coaguchek on the 11th. We'll see how that turns out. If it's good then I'm declaring my protime machine in good health.

 

[Guest]

They did another test and got a 6.X and didn't tell your doctor? That would make a huge difference in deciding whether or not to hold warfarin over the weekend.

Be sure that you point this out to the doctor and ask him to take it up with the pathologist at the lab. That amounts to a coverup.

The pathologist will talk to the techs. I doubt that the tech will get more than a "talking to" but something should be done.

 

[Rain]

I called my doctor.

I called my doctor.

I called my doctor back and told him. He seemed a little surprised too. No one was really admitting to me that it was abnormal. That's why I wondered. It didn't seem right to me.
The other wierd thing is... even my machine went up 2/10 between the two tests.... and I hadn't taken any coumadin between the two tests.... wierd. Just way weird. I don't understand it. I did clean my finger with an alcohol pad ... maybe that's the clue.

I just hope it comes in close with my cardios... if it does, I'm gonna stop worrying about it.

Thanks a mill, Al!

 

[Ross]

From my last rant about the lab getting 1.3 and me thinking they inverted the numbers, I maintained my same dose(Contrary to what they told me to do) and retested at 3.3. The nurse wanted me to drop another 10%. I don't think so. Looking at all my graphs and results, another 10% will put me in the 2.0 area. I think I'll stay where I am and see what the next result is. Heck, I'm in range, why change?

 

[ccrawford]

Don't forget your vitamin

Don't forget your vitamin

As an additional item to check, look at the information on the back of your vitamin bottle. Some vitamins have a significant level of vitamin K content (which I just recently discovered on my Centrum Silver bottle) This by itself, may not be a problem if you consistantly take your vitamin every day. If you are forgetful, then you have another variable to worry about. Chris