I think I'm finally stable

[Raverlaw]

Well now that I'm basically three months post op, my INR seems to be stabilizing in range as well.

Monday's test was 3.1 - exactly where I'd like to keep it. Last test, 2 weeks prior was 2.7. And for the last two weeks, I've been exercising a lot, eating 5-6 spinach salads a week, and OF COURSE, sticking to my 1-2 glasses of wine each evening.

MY PCP, more about him in a minute, says to keep on doing what I'm doing, and test every two weeks for a while. So, it looks like I'm done with weekly testing!

My PCP manages my coagulation therapy now. I go to the lab on Monday morning, and call his office on Tuesday. He takes my call PERSONALLY, goes over my chart, tells me my INR, and questions me about diet, etc. since the last test. But get this - he doesn't charge me for this!

Also, he is a big fan of home testing, and will work to help me get a Coagucheck or similar machine approved by BC of California.

This is the same guy who literally saved my life by suggesting that I get a stress echo last October, when I thought I was just suffering from middle age - he was perceptive enough to see that my valve was causing symptoms.

Anyway, I think I've got this warfarin thing under control now.

 

[Georgia]

Knock wood

Knock wood

Oh my gosh - you forgot to knock wood!!! You don't EVER assume you've got this inr thing under control. Take it back quick.

All that aside, congrats - you know you're really recuperating when that inr starts to stabilize. You'll probably have bumps in the road as your activity increases (or it gets hot out, or cold, or Rain's dog digs in the garden) but it's a reason for celebration to get it to stabilize that first time. Congrats

 

[JimL]

Georgia has it right, Bill. INR is It's Never Right. With permission, here's a picture of the chief culprit, the one who is now digging in the recently planted gardens.

 

[Bryan B]

Bill,

Congrats! I love to hear stories about GOOD doctors like yours.

Jim,

Maybe the culprit needs a role model...she would never dig.

 

[xtremlee]

Bill mine is at 2.5 I have tried to tell my stupid dr I need to be at 3 but he said between 2.5 and 3.5 was fine? How much do you take a day? Bill what is your salt intake a day?

 

[Raverlaw]

Lee,

I told mine I wanted to be between 3.0 and 3.5; I'd rather risk bruising than stroking out. I take 5 mg M,W,F & S; 2.5 mg T&TH. When I use up these pills I plan to change to 4 mg per day (as suggested by our resident engineer, Al Capshaw )

I'm not sure what my total salt intake is right now, because I only add up what's on the package labels, not whatever might naturally occur (how do eggs get sodium in them?), but I think I'm right at 1500 mg per day or so.

But I've really been watching what I eat (I'm trying to slim down some) and I pass up on a lot of stuff that I used to eat without a second thought.

 

[Raverlaw]

Bryan,

when Jim first posted that picture, I immediately thought, "where did Jim get that picture of Abby?"

 

[Ross]

Man what are we going to do when we can't blame Rain's dog anymore?

 

[Guest]

Lee,
there is a lot of evidence that a bileaflet, aortic valve does well at INRs between 2 and 3. A lot of people, myself included, use the 2.5 to 3.5 rage because it is just easier to remember. But you should be OK.

Bill,
This is the way it is supposed to work. Eat what you like, limit alcohol a little bit and pass on a few of the things that aren't the best for you.

I owe a lot to my doctor, too. I changed a litlte over a year ago. I watched around the hospital and chose the one whose patients got the best care - which in my estimation means that he/she treats the nurses like partners. He also makes rounds twice a day in the hospital. Since then we have taken care of sleep apnea, a melanoma, and prostate cancer. When my wife said that she didn't like the look of the brown spot on my head, I showed it to him about 11:30 AM. He said, "Come over to the office in an hour and I'll take it off." By a little after 1:00 I was back at work.

 

[Raverlaw]

Al,

Being a small town lawyer, that's the kind of service I try to give to my clients. I often end up discussing issues in the aisle of the grocery store or in the stands at the high school football and basketball games. I see people on very short notice and often go to meet with them at their homes if it is more convenient for them.

I love my PCP because he exhibits the same attitude. I can get him at any hour of the day or night. I rarely do, because I don't want to abuse his generosity, but I like knowing that he's available. He followed my valve replacement very carefully, and even brought his new nurse practitioner in to see me when I visited him two weeks before the surgery (to have a mole removed before going on warfarin); he wanted her to hear what a stenotic bi-cuspid valve sounded like so she could recognize it in other patients.


I know that a lot of us here complain about stupid or un-caring medical professionals - and we run into a lot of them - but I think we should also recognize those who truly do care for their patients and do it well.

 

[Guest]

I agree - only bad news gets published.

Once we were visiting a friend who is a doctor is Taos. I asked what it was like practicing in a small place (he is from NY). He said that he loved it. He said that he could give the medical history of about half the people in the restaurant.

 

[Rain]

Knock on wood........ QUICK!

Knock on wood........ QUICK!

Bryan!!

Your Abby looks just like my Onyx! She?s beautiful! I think Onyx is taller and skinnier... but their faces look just alike!

We just love Onyx, he's certainly a part of the family. I snapped this picture of Sara and Onyx on Easter. Sara was telling him (very sternly), ?Onyx, you can help me find the eggs... but you CAN?T pick them up!! You break them with your teeth.? Not only does Onyx think he?s human... I think Sara does too!! lol

Bill, Georgia?s right..... you better knock on wood real QUICK!

 

[Rush20]

Bill, congrats on the INR stabilization. I'm hoping to join you soon. I am currently frustrated with my INR lowering below 2.0. I was stable between 2.5 and 2.7 the first three months post op. As I close in on 9 months, my activity level has increased significantly. Now that summer is here I play softball two nights per week, treadmill one day per week, bike one day per week and lift weights two days per week. I enjoy the routine, however I think all this "blood flow" is lowering my INR.

I try to keep my diet sensible, however my 2004 INRs have been 1.7 - 2.0 - 2.2 - 2.2 - 2.5 - 2.2 - 1.9 and as of yesterday 2.0. Funny, how I dropped from 2.5 down to 2.2 in early April once my physical activity increased.

As of today, I'm now up to 6mg per day vs. 6mg three days per week and 4mg four days per week. I hope that helps, plus it's easier to remember.

One question, you indicate you eat spinach salads on a regular basis. Doesn't the vitamin K in spinach lower your INR? I know the key is consistency, however I thought we are supposed to moderate dark green leafy vegetables. Confused...

 

[Raverlaw]

Rush,

My eye doctor has me eating lots of dark leafy greens to help ward off/slow down the process of macular degeneration in my eyes.

I'm sure it does lower my INR, but I try to eat the greens daily to be consistent, and my dosage reflects that. If I stopped eating the salads tomorrow, and didn't change my dose, my INR would go up.

Same analysis goes for exercise (daily) and alcohol (wine daily). I just aim to be consistent in the amounts of each so that my warfarin dose doesn't have to be changed.

 

[catwoman]

Allen:

I take 6mg a day mainly because I eat 2 (fair-sized) salads a day. Mine are iceberg, romaine hearts w/ radishes, red, yellow & orange bell peppers, red onions, tomatoes, sometimes a little avocado. If I was into spinach salads, no doubt I'd be taking a higher dose of Coumadin. I'd be eating them regularly, not once or twice a week.
My INR has pretty much been 3.4-3.6.
When I travel on weekends showing my cats, I scout for a salad for lunch on Saturday & Sunday. Convention centers tend to have mostly nachos, hotdogs, burgers, BBQ (mostly fat stuff!) instead of soup and salads. I end up having to eat a big salad for dinner those nights to compensate.

 

[Bryan B]

Rain,

Onyx is beautiful too (I love the expressive faces poodles have)! The males tend to be a bit larger than the females. Abby weighs 60lbs, her sister weighs about 50lbs (my sister owns her sister Gabby ), and her brother weighs about 80lbs (my sister's friend owns her brother Beau ). My sister gave her to me as a surprise Christmas present 6+ years ago. She has lived with my parents since I moved to Nashville almost 2 years ago since I travel so much (they are retired and she loves it there...spoiled rotten ).

And to get this post somewhere near topic (but not about Coumadin), she was a very big part of my recovery after surgery. She didn't leave my side when I came home, and once I started feeling better she never hesitated to encourage me to take her outside in an effort to help me exercise.

 

[Guest]

The phenomenon of the INR dropping insomeone who recovers from valve surgery is quite well known. As you become more active, the heart pumps more efficiently. This results in more passes of the blood carrying warfarin through your liver where it is metabolized. I have seen people get their INR down to 1.0 with increased activity.

It is very hard to convince people that, "You're feeling better, well then I am going to have to give your more medication." I had a letter to the editor about this published in the American Journal of Cardiology about 5 years ago.

I get very concerned about an INR that is more than 0.2 units below the desired range. I usually have these prople back in a week to 10 days for another INR check because the level needs to be aggressively raised. You are in much more danger with a low INR than you are with anything between 3.5 and 5.0.