INR Swing

[aussigal]

Found this little chart that shows the downward effect vit.K foods have.... I have found some medications increase your INR. I know my Cholesterol med is one that does

 

[duncanjo]

Never thought of this. Thanks for the good info. I'm on week 6 post, on warfarin and this is good information im sure in the near furtue iii have a question like this.

joe
mech valve 04apr08

 

[Ross]

Found this little chart that shows the downward effect vit.K foods have.... I have found some medications increase your INR. I know my Cholesterol med is one that does

I'm not so sure about the accuracy of that chart. I eat way more then 200mcg and it doesn't affect my INR that much. I have to think that it's an individual thing just like Coumadin dosing. Depends on how we metabolize stuff.

 

[Freddie]

So...how much is a microgram?????
This is one measurment I haven't been able to find.......quanity??

 

[Ross]

So...how much is a microgram?????
This is one measurment I haven't been able to find.......quanity??

My question to you is, why do you care? If you think you can count this crap and plan INR management around it, your dead wrong. QAS has a chart over there that should be taken down. All it does is support the idea of counting mcg instead of simply eating like you normally do and dosing that diet. They seem to want people to diet their dose, which is 100% opposite of the way it should be done.

Google is your friend!

In the metric system, a microgram is 1/1,000,000 of a gram (1 × 10-6), or 1/1000 of a milligram, is one of the smallest units of weight/mass commonly used. The abbreviation μg is often used in scientific literature, but JCAHO recommends that hospitals do not use this abbreviation in handwritten orders due to the risk that the greek letter μ could be mistaken for an m, resulting in a thousandfold overdose. The abbreviation mcg is recommended instead.[1]

 

[ALCapshaw2]

So...how much is a microgram?????
This is one measurment I haven't been able to find.......quanity??

1 microgram = one millionth of a gram = 1/1000000 gram

a gram is a metric unit of mass

mass is weight divided by the acceleration of gravity,
i.e. mass is constant, regardless of the acceleration of gravity, regardless of location such as on earth, on the moon, or in free space.

 

[Karlynn]

Keep your INR at the high end of your range and eat what you want. This week I had salad 3 times made with baby field greens and baby spinach. (I also put in tomatoes, bacon, scallions, zucchini, celery and carrots! It was delicious!) Next week I probably won't because I ran out of the greens.

Edit: Oops - make that 4 times - I went out to lunch with friends and had this incredible salad with baby greens, goat cheese, cranberries, pecans, smoked chicken and balsamic dressing!

People can't maintain the type of scrutiny of their foods that some Coumadin Mangers make them think they need to maintain. And it's not necessary.

Dose the diet!

 

[Ross]

I think it sucks that we try so hard to get people to dose the diet and our counterpart is trying to get them to diet their dose.

I will shoot anyone using this chart to manage their coumadin. Wanna drive yourself insane? Watch what happens to those using it.

http://www.ptinr.com/docs/VitKfoodDiary.doc

 

[Freddie]

1 microgram = one millionth of a gram = 1/1000000 gram

a gram is a metric unit of mass

Being in Canada I know metric.
but, 1/1000000 gram is like a grain of sand.
My problem is converting this into a measurement that one can actually use in day-to-use.

 

[Bina]

1 microgram = one millionth of a gram = 1/1000000 gram

a gram is a metric unit of mass

mass is weight divided by the acceleration of gravity,
i.e. mass is constant, regardless of the acceleration of gravity, regardless of location such as on earth, on the moon, or in free space.

Am I reading a flashback to the seventies???

 

[Jkm7]

I think it sucks that we try so hard to get people to dose the diet and our counterpart is trying to get them to diet their dose.

I will shoot anyone using this chart to manage their coumadin. Wanna drive yourself insane? Watch what happens to those using it.

http://www.ptinr.com/docs/VitKfoodDiary.doc

While I was only on warfarin a little over 2 months post op, I was grateful my cardio agreed with my dose the diet way of thinking. He told me he has been advocating that for 20 years while most of his contemporaries did not agree.

I eat a great many leafy greens and continued to do so while on warfain.

 

[Guest]

I've been stable at 40 mgs of coumadin a week for about 2 months now, in spite of my increased activity, as Ross says, I've found my sweet spot. I checked my INR on May 8th, it was 2.3, while in PA went to visit my mother, forgot to take my daily dose of coumadin, was going to go back to my sisters to get it, my mom takes warfarin, took 5 mgs of hers, tested this morning, 2.6. I eat what I want when I want. I'm testing weekly, calling in my INR monthly.

 

[perrypiratesdad]

I tend to agree with Ross.

I remember when I had my AVR. I was supposed to have the Ross back in 1997, but when I came out of surgery and woke up, I remember being given the news that I had been given a mecha The next few days I remember being a little aprehensive about it because I was afraid I would have to adjust how I ate and everything.

At that time, I would normally have a spinach salad for lunch, and from what I was reading, it contained high values of Vit K in it. I was disheartened by that fact and I was worried I was going to have to start giving up some healthy things that I liked.

I remember my Doctor coming in and we talked abolut this and told me "rubbish!". He said the key to everything was consistency... not counting how much Vit K I had, but trying to stay consistent. If I wanted a bunch of Vit K in my diet, fine, as long as I try and keep it consistent. If I wanted just a little, same thing.

Since then, I try and do just that, but knowing, it is absolutly next to impossible to keep my Vit K levels exactly the same from day to day. You just can't do it. You have to accept that. I test about every week and a half to every week. I can go months on end and be in my INR zone, and then all of a sudden, I have a swing. So what! I don't worry myself about that swing (unless it is really major [INR = 9.2], but I have only had that happen once), and I just rechechk in a few days. If still high, I look at it, analyze it, come up with what I think my adjustment should be, make the change, and then call my Dr's office to notify them of such. Most of the times though, it doesn't call for me doing anything other than testing again a little sooner to see if it came under control on its own.

To reitterate what Ross said though, managing your INR through diet is crazy. Just try and keep things consistent (not scientificaly consistent though) and you should be fine.

- John

 

[Karlynn]

Amen John! That's how I look at it too. And your doctor is a breath of fresh air. Most caution against anything green! My MIL was sent home after a hip replacment with a weekly diet of what greens she could include - 3 small dinner salads, 2 - 1/2 cup serviings of brocolli etc etc. I told her to tear up the freakin' diet sheet. But of course she didn't - because a nurse told her she had to follow it so she wouldn't bleed to death. Forget the advice from her daughter-in-law who had taken the drug for 14 years (at that time).

 

[perrypiratesdad]

...because a nurse told her she had to follow it so she wouldn't bleed to death....

I love when I hear "because the nurse said...you will bleed to death". Don't get me wrong, nurse's are great, but some people just throw common sense out the window at times. The nurse is looking out for your health, but that doesn't mean you are going to spontaneously burst into a pool of blood if you eat something with Vit K in it.

I remember when I was in the hospital for pneumonia after my AVR, the nurse read me the riot act because I was using a disposable razor to shave with. She went on about how I could cut myself and bleed to death, etc. I just looked at her and said, "Are you done? Good, now, name one person for me that has ever died from bleeding to death because they were taking Coumadin and shaving?" She just said "well, but it could happen." And I said "Yes, but my chances are greater that I will get shot or stabbed and bleed to death first".

Just because you take Coumadin doesn't make you something that has to be treated with kid gloves. Go ahead, bump your shins, shave with a disposable razor, (heck I tried a straight razor once just so I could say I did it... and I didn't even cut myself), rock climb, roller blade, do whatever. Just use common sense and you should be fine.

 

[Ross]

I love when I hear "because the nurse said...you will bleed to death". Don't get me wrong, nurse's are great, but some people just throw common sense out the window at times. The nurse is looking out for your health, but that doesn't mean you are going to spontaneously burst into a pool of blood if you eat something with Vit K in it.

I don't know John. I got into pretty intensely with the Head Nutritionist at my hospital during the last stay. I get my food tray and there is a flag on my tray saying Coumadin Diet. I look at this tray and there is virtually nothing there with vit k. As close to zero as zero gets. My Doctor called her up to my room and all 3 of us went at it and she finally agreed that as long as a person ate a fairly consistent diet, their INR would likely be fine. Imagine that---Coumadin Diet.

 

[perrypiratesdad]

I don't know John.

Well Ross, if you find someone who bursts into a pool of blood, please let us know. Maybe that nurse witnessed it.... it would make a great horror flick though. I wonder what the title of that movie would be?

 

[Susan BAV]

Well, I don't know that I will be able to find it if I look for it but I recall reading here--and I believe in an independent study elsewhere--that INRs are often more stable among people whose regular vitamin K intake is higher rather than lower.

Anyone else recall this?

I looked up some information in regard to this comment and hope you find it helpful, Freddie:

http://www.warfarinfo.com/vitamin-K.htm

Using Vitamin K to Smooth-Out Fluctuating INRs

"If you walk into a dark room and switch on a 3-way light you notice a huge increase in the amount of light. If you switch to the next higher level, you do not notice as much change even though the increase is the same number of watts.

It appears that a similar thing happens when someone takes in very little vitamin K from eating vegetables. If this person then gets a little more vitamin K than usual, the INR can be thrown off. To get around this, some warfarin managers have tested giving people a known amount of vitamin K. Then they managed whether or not the INRs became more consistent.

A study done in the UK followed 70 people who had unstable INRs. They were divided into two groups – those getting 150 mcg of vitamin K daily and those getting a placebo. The people getting the vitamin K had more consistent INRs than the people getting the placebo. Each person’s INRs for 6 months on the study were compared with their INRs for 6 months before the study.

It appears that taking a known amount of vitamin K daily and adjusting the warfarin dose upward to accommodate this, results in more stable INRs.

Reference: Sconce E. et al. Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin. Blood. 2006; Nov 16. (E Pub Ahead of Print)."

There was also some interesting info on this A-fib site:

http://www.stopafib.org/anticoagulant.cfm