Inr 8.1

[Lorraine]

Don't know what to say other than OH! BOY! Went for my INR test today and INR read 7.8 the first time. I didn't believe her and asked her to take it again and it was 8.1! She told me to hold for 3 days. I started arguing with her because I know 3 days will put me in the dumps. Finally got her to agree I could take 7.5mg on Sunday. I have to go back Monday to test again.

I feel okay, but then I don't know what the sign of a high INR would be other than bleeding either internally or externally. Haven't had a bloody nose. Been eating the same thing but I was a Spring Break for a few days and had some homemade mead but not much. I believe it was grape. Is grapes something I should be avoiding?

Don't have much in vitamin K foods at home here, but will go shopping tomorrow to buy some greens. I'll be able to make my beloved mexican salad which has cilantro and avocado in it.

The only other thing I can think of is I didn't eat my meals at regular intervals while on vacation. I guess that must have effected my INR too. Any thoughts deeply appreciated.

 

[Ross]

Well alrighty then, now we have two people that we can send the mosquitoes too this year. If this keeps up, we can eradicate all of the biting insects before summer hits!

 

[EVELYN]

Whoa, Girlfriend!!!

Have to tell you that every time we go on vacation, Tyce's INR skyrockets.....why???? Who knows!! He still has his one glass of wine a night, just like at home, we're still on the go as much as we are at home.....maybe it's because he eats more....can't figure it out!!! Remember the definition of INR---IT'S NEVER RIGHT.

We just got our new Coaguchek last week, and for the first time in a LOONG time we agreed with our cardio's clinic....that's the good part, the bad part is that he's low....2.2, so he's upping his dose to 5 mg. all week.....of course, it's right before we go on vacation.....who knows what will happen.

Eat that salad and drink that V8.......broccoli, asparagras, spinach and the like. Let us know on Monday.

Evelyn

 

[LUVMyBirman]

Very interesting my dear friend Lorraine

Tell me.... two valve patients in the same city hit an 8.1 Must be something in the air. Maybe an atmosphere disturbance, lol.

Lorraine...I have been on a vicious ride for the past two weeks since the high reading. Only thing I did differently was use Monistat. That had to be it as I did not have or do anything else that would have caused the spike. No wine either

I held my Coumain a few times throughout the two weeks...reduced doses, ran to the lab 4 times to verify with the Coaguchek. INR still refused to come down to normal. They did a complete blood workup. Everything was fine and the levels finally came down to 2.8 yesterday. I look like a pin cushion. Pretty bruises. Now were off on vacation...so I am sure it will be messed up again. I like to relax with a few cocktails during vacation. (As I am sure you did....tee hee) The last few times....... I had a salad 3-4 times during my trip and came back with a perfect INR.

Hope you have luck getting it down.
Take care

 

[RobThatsMe]

Hi Lorraine,

YIKES !!! Good thing you got tested when you did!

Hope you get it back to your target zone soon. Remember, weather temperature changes, activity, booze, sunscreen, ( just kidding about the sunscreen), all have an effect on INR. Vacations can and do cause variation. Seems the times I get my highest readings are when I come back from vacation, or... just after a holiday, like July 4th, Labor Day, Thanksgiving and Christmas. Hmmm.... I think "Partying" also effects INR now that I think about it! hehehehehe

Hmmmmm as far as that mesquito thing Ross talked about. If those pesky insects bite into us, they'll burst! They'd be so full of Coumadin they would fall apart! hehehehe


Rob

 

[Nancy]

Re: Taking Vitamin K

Re: Taking Vitamin K

Prior to Joe's pacemaker implantation, He had to take a Vitamin K injection to get to the surgical INR level. It worked like a charm and very fast, however, post surgery, he was in the hospital for at least 10 days while they tried to get his INR up to the appropriate therapeutic level so he could go home. Same thing happened after his gallbladder bleedout, when he was given Vitamin K, plasma and whatever else they could throw at it. And with Coumadin, it's not a good idea to give a "loading" dose.

Comes down fast, goes up VERY slowly.

So--not something to fool around with.

 

[Ross]

Perhaps you should apply for some Government funding and do a study on this subject! Mr. Lesko says the Government is giving money to anyone including millionaires, so why not?

I just had a scary thought. What if you actually got some answers?

 

[Rain]

YIKES!!

YIKES!!

Hey Lo-Rain!

That's scary!! I love V-8 juice..... when I'm high, I drink lots of it. I don't know how much K is in it... I wrote and asked them, but they said they aren't required to test it. It must be pretty high tho... judging from how my INR reacts to it.

Take care, girlfriend!! Can't wait to see you in Golden!

 

[Guest]

The idea of taking a baseline dose of vitamin K so that small variations in dietary vitamin K intake have little effect is very intriguing. It has to do with percentage of change. If you take a supplement with 100 mcg of vitamin K every day and then you eat another 200 mcg, you have a daily intake of 300 mcg. If for some reason you do not eat as usual and take in only 50 mcg from food then you have made a 50% decrease in that day's intake. BUT if you do not take the supplement and eat 200 mcg per day and for some reason only get 50 mcg, you have a 75% drop in your vitamin K intake. You can see how the supplement could level things out. .NOTE THAT THIS WOULD BE DANGEROUS TO ATTEMPT WITHOUT CLOSE MONITORING.

If you read my new post about warfarin being hard to manage and my idea about iodine intake, there may be a parallel line of reasoning. Perhaps some people never have much variation in their INR is that they take in large amounts of iodine and therefore variations (like a shrimp platter) causes very little percentage change for them.

 

[Guest]

Yes, a lot of people get vitamin K who do not need it. Those who need it often get too much. It does hang around for a long time. 10 mg given IV can make you resistant to warfarin for up to two weeks.

Qualified people - there are no legal restrictions. Billing-wise the insurance companies including Medicare have limitations.

 

[Lorraine]

Hi Everyone,

Thanks for your thoughts! It's a good thing the mosquitoes aren't out yet for there sake! Between Gina and I we could have had many mosquitoes bursting as they bite!

Ross: You just would love to see that wouldn't you, you devil you!

Gina: Is kinda interesting since we're both from the same area! I hope I don't go on that big roller coaster ride! Can't afford the time off work. As it is I'll have to leave work after 5 hours so I can catch a train and be back at my clinic by 4:00pm for my INR test. I do suspect I'll probably have to leave work early another day this week as well. Have a nice vacation and I hope the INR holds steady for you!

Rob: Very interesting! I didn't think about temperature change. I went from the mid forties here last Sunday down to two degrees that night. I had to drive through to what they called snow showers in the UP in Michigan one of the days! I almost got hit by a semi because the roads were so icy and niether of us had much traction the roads were so bad! Of course it was right between Lake Michigan and Lake Superior. Those kind of snow showers are nasty! I've always have been consistant in my booze and never had any problems in the last 3 years, unless it was the homemade Mead I drank up there! I've had that before though with no spikes! So I don't know. Probably a combination of all you mentioned! Also I didn't eat at regular intervals! I'll post tomorrow with my INR results!

Rain: I did buy V-8. I'm drinking a small glass each day. Don't want to drink too much until I see the effect it has had on me Monday, with holding for two days! I do think I'll keep a few small cans around in case this happens again though

I have been eating salads and I'm making my mexican salad today! I can't wait since I love the taste of it so much! It has both cilantro and avocado in it, along with queso rancherito, chiles, onions, tomatoes and barboacoa!

Quetlin: No, after being on this forum for three years and reading all Al has to say, No I don't freak out at 8.1. Now if if stays up, then of course that's a different story! I was more concerned about holding for three days and when I PM Al, he agreed. I told my nurse I would take a small dose today Sunday, because I do tend to bottom out quickly.

Al: Thanks for you're reply. I'll be reporting in tomorrow afternoon with the results! Stay tuned!

 

[Blanche]

Al:

After Al's stroke, the doctors ordered an invasive procedure when his INR was quite high. As a result, he began bleeding out in the middle of the night. I alerted the nurses and they began to administer 2 mg of vitamin K. At the same time, another nurse stopped the bleeding by holding the wound closed with his bare hands. Obviously the nurses didn't understand how long it took Vitamin K to work because over the course of the next two hours they administered 4mg more of Vitamin K. With 6mg of Vitamin K, IV, Al became resistant to Coumadin. Because of this he was hospitalized for 10 days longer than he would have been without the large dose of Vitamin K.

After Al was released from hospital, his INR yo-yoed for about three months. Our interist, who has a Ph.D in biochemistry, said that because vitamin K is a fat soluable vitamin it could stay in the body for months and leach out when fat-rich meals were eaten. He also mentioned the factor VII, a clot forming thing that the body makes, was more abundant. I didn't get that one.

After seeing, first hand, the problems that Vitamin K can cause when misused, even by medical people who should know better, I cringe at the thought of any self-experimentation with Vitamin K.

Kind regards,
Blanche

 

[Peacebella]

Excedrin

Excedrin

Hi, I am new here, had aortic and mitral replacements august 2003. My question is: Last week I had a migraine headache so I took 2 ES excedrins, it cured my headache, but on Saturdy i had the darkest purple bruise on my abdomen. Could it be from the aspirin? I am going tomorrow for coagchek. Thanks for listening...I love this site.

Peace,
Kathie

 

[Guest]

Peacebella
That could have been the reason. Excedrin contains aspirin. It inhibits clot formation in a different way from warfarin. Aspirin and ibuprofen are not good choiced for pain relief when taking warfarin.

There is a phenomenon known as dreaded risks (or something else like that). Bleeding is one of those things. People make irrational decisions to avoid dreaded risks. For example, I read that in the three months after the 9-11 attacks air travel was down about 20%. At the same time interstate highway travel went up about 10%. During Oct, Nov and Dec 2001 it is was found that about 350 more people died on interstates than during those three months of the year before or the year after. So, possibly 350 people died while trying to avoid terrorsits on planes and in the same period of time there were no more terrorist attacks. This is an example of people making an irrational decision to avoid a dreaded risk.

 

[JimChicago]

Blanch writes:
>>>>
[that the internist said:] that because vitamin K is a fat soluable vitamin it could stay in the body for months and leach out when fat-rich meals were eaten.
>>>>>
Is that another variable for INR then - how many fat-rich meals one eats? That's interesting since olive oil which is all fat also has a moderate amount of vit k.
I found myself at times when for some reason on some days I know I didn't get most of my usual vit k intake - drinking a half can of ensure to attempt to compensate - since ensure is supposed to have 25% of RDA for vit k which I guess would make it 25 mcg per can or so.

 

[Blanche]

Quetlin:

My post was a response to Al Lodwick and his coments avbout VitK and warfarin resistance. It was a personal experience that supported his statements.

Albert's experience does evoke many tears. It happened in December 2000. The hospital personnel were attempting to deal with a bleed that was not a direct result of his stroke. He had undergone an angiogram with the hopes that the cause of his stroke could be determined. Unfortunately, his INR was quite high when they did the procedure. The radiologist refused to remove the sheath from his groin that was used to insert the scope (or whatever it is called). The plan was to wait for the cardio in the morning. At midnight, he began to bleed heavily. The angiogram revealed no new information. Al's stroke was diagnosed as being caused by a "Coumadin failure"....his INR was too low....resulting in blood clots reaching the brain.

Although my post was not specifically directed to your recent thoughts about supplementation of VitK, I would like to share some coments that I hope you will find instructive. While I marvel at your inquiring mind and believe your subject to be most interesting, I caution that you take care that your speculations are not viewed as prescriptions or recommendations.
While we all can engage in cursory research with some success, I suspect the area with which you are concerned requires the expertise of a pharmacist or a biochemist to make valid intrepretations of the data. You might also benefit from someone with background and research training to determine the validity and reliability of the information that you are gathering.

For those people who are concerned about obtaining adequate amounts of VitK to sustain bodily functions, I would suggest that they consult with their doctors about taking a daily VitK supplement. However, "using VitK to maintain a personal average when veggies are skipped," or ..."keeping a bottle of VitK to take PRN to keep VitK intake balanced" could yield very negative results. These practices would amount to self-medication and, to my mind, self-experimentation. Simply counting VitK mcgs is not enough. There are too many other extraneous variables that you can't control, not the least of which is getting an accurate count of the mcgs of VitK consumed.

I applaud you for your passion for wanting to know how things work. But, I also cringe at the thought of some newbie trying to level out an INR by popping VitK or other folks taking VitK because they fear that something they have eaten will put their INR out of wack.

Regards,
Blanche

 

[Nancy]

Eating a normal balanced diet (including all of the food groups and all classes of fruits and vegetables) will give adequate amounts of Vitamin K. There will always be daily fluctuations of the level of Coumadin, it's just the nature of the beast. Dwelling on each daily fluctuation of the level can lead to over or under correction of the dosage. You will NEVER get to a point that you will be the same each day. Remember that vitamin K works very fast and Coumadin works very slowly. It is the average that is important, and the trends, i.e., heading up dangerously or heading down dangerously.

Trying to manipulate your INR by ingesting high K things or even worse, ingesting alcohol to try to "even" it out is a BIG mistake. Even if this is done on a daily basis, there are other things which will influence your level of Coumadin, such as activity levels, the condition of your intestinal tract, changing other meds, how your health is on a particular day, if you are having a bout of CHF which involves ascites, and ingesting or absorbing "hidden" sources of Vitamin K.

In my own opinion, testing at 2 week intervals, if the INR is fairly stable, and testing at weekly intervals if it is not, are about right.

These are the things I've observed in Joe's 26 years of being on Coumadin.

 

[Johnny Stephens]

Lorraine, I had a spike like this last year (7.something). I don't think we ever figured out exactly what caused it, but the usual suspects were involved - time off (road trip), change in diet, etc. Only difference was, I started sprouting bruises and nosebleeds.

Took a similar approach, made a small change, tested in a few days to see if it was headed in the right direction, and then retested in a week. I think I must have eaten something in the day or two before that test that multiplies the effect of warfarin, but I've been relatively stable since.

Hoping your test today shows your number headed back toward where it should be.

Johnny

 

[Blanche]

Quetlin:

Anyone can engage in cursory research. That is, we can jump on the net and find quick and dirty answers to anything out hearts desire, such as air fare to SanFrancisco, restaurant recommendations, or maybe even the price of tea in China. I assumed that you were speaking of research in the classical sense. That is, you would formulate a statement of the problem, develop a rational (need for the study), state some hypotheses, do a search of the scientific literature, identify data sources, collect data, analyze data.... If this is so, you probably need someone knowledgeable in the content and another person whose strength is in the research process, research methods, and statistical analysis. You might find medical people and researchers at the University of Arizona. I know several professors who have paid doctoral students at Arizona State to help them design studies and analyze data.

If you wish to do a literature search and present the articles found in their entirety, you don't need any assistance. Post the links and people can read the articles (which would be considered data in a research sense) and draw their own conclusions. I found the ones already posted interesting.

If, however, you want to do a synthesis of the research or a search of the literature to draw conclusions, pose a hypothesis, or answer specific research questions, you would have to manipulate, evaluate, interpret, the data, which in this case, are the articles you gather. You would want to be sure that your data sources (articles) are accurate and that the methods used are appropriate, and conclusions are based on the findings.

Hope this addresses your concerns.

Regards,

Blanche