Medicare requirements

[Janet L.]

Hi Freddie,

Thanks for the welcome. I hope I can help others on the forum in the ways that I have been helped here.

Janet

 

[Bina]

Hi Janet and welcome.
I also use the Coagucheck XS and am happily in range 99% of the time. No joke.
Every 2 weeks I am absolutely excited to test myself. I am also self dosing and report to my doc.

 

[netmiff]

I too (or is that that three??) have the Coaguchek XS, I still test weekly.
I am a bit of a worry-wart, I am just over a year out and I have been having other issues - UTI in August, antibiotics for that, diarrhea (only since surgery and really, really bad); we have been trying to find out what's causing the diarrhea and switching meds around. When it got really bad, gastro had me on immodium, that made a difference in my warfarin dosing of 2 mg a day, and just 10 days ago, I got the OK to taper of the beta blocker .... so, weekly testing for me for another wee while, but the last while I have been stable.

I do my test, and e-mail my doctor directly at "thrombosis service" at the hospital where I had my surgery; Most times all I get from him is a curt "OK" back , but he did say one time (after a fiasco in emergency when I hit 6.4 or so) that I "was getting it".

I don't drive, and own my own store which is open 7 days/week in summer, so not having to line up in a lab only to end up with a bruise is absolute freedom for me! I hate bloodwork, I have veins that run away from needles, and they have a hard time with my arms.

 

[Janet L.]

Hi Janet and welcome.
I also use the Coagucheck XS and am happily in range 99% of the time. No joke.
Every 2 weeks I am absolutely excited to test myself. I am also self dosing and report to my doc.

Hi Bina,

Thank you for the welcome.

I think I will begin testing every two weeks and see how it goes. Do you ever go to the lab for a routine INR check? Do you ever find it necessary to check your Coaguchek XS for accuracy?

 

[Janet L.]

I too (or is that that three??) have the Coaguchek XS, I still test weekly.
I am a bit of a worry-wart, I am just over a year out and I have been having other issues - UTI in August, antibiotics for that, diarrhea (only since surgery and really, really bad); we have been trying to find out what's causing the diarrhea and switching meds around. When it got really bad, gastro had me on immodium, that made a difference in my warfarin dosing of 2 mg a day, and just 10 days ago, I got the OK to taper of the beta blocker .... so, weekly testing for me for another wee while, but the last while I have been stable.

Hello Netmiff,
I have had problems in the past with very high INRs (as high as 8! once), mostly caused by antibiotic interactions. I now do not ever take a new drug without first checking for interactions with warfarin at
http://www.drugs.com/drug_interactions.html

I have had trouble with Monistat, Cipro and some other antibiotic that began with A (can't remember what it was right now). My INR also decreases by about 0.5 when I generally increase my amount of exercise from my previously normal routine. When I have high anxiety or do not eat regularly, my INR goes up by about 0.6 to 0.8.

Everybody is different. Each has to watch his/her own changes in habits and over time, it becomes apparent what triggers a change in INR. Being aware of the things I mentioned in the last paragraph (besides monitoring how much vitamin K I consume) has helped me stay in range pretty consistently.

Recently, I read that cranberry juice increases INR. I eat cranberries without any problem... maybe I don't consume enough of them to make a difference.


Janet

 

[Ross]

Being aware of the things I mentioned in the last paragraph (besides monitoring how much vitamin K I consume) has helped me stay in range pretty consistently.

Recently, I read that cranberry juice increases INR. I eat cranberries without any problem... maybe I don't consume enough of them to make a difference.


Janet

There is no need to monitor your vit k intake unless your binge eating vit k items. Monitoring intake has done nothing for anyone except drive them crazy. Dose the diet, don't diet the dose.

Cranberry juice has been cleared of any evil impact on INR. Drink away!

Might want to use this link for interactions with Coumadin. Much easier to get along with:

http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

 

[Janet L.]

There is no need to monitor your vit k intake unless your binge eating vit k items. Monitoring intake has done nothing for anyone except drive them crazy. Dose the diet, don't diet the dose.

Cranberry juice has been cleared of any evil impact on INR. Drink away!

Well, I'd love to have spinach or kale or Swiss chard now and then, but I did notice a change in INR even with a single normal portion of spinach. The key words are "now and then"; if I ate them regularly, there'd be no problem. It's easier for me to avoid the high vit K foods (those that I'd only eat now and then) than to fool with my warfarin dosage.

That's good news about cranberry juice, though my preference in the cranberry department is the berry and it seems it was never suspect.

Thanks for the information!

 

[Blanche]

The more greens the better for me

The more greens the better for me

Janet:

Albert takes Coumadin because he has a mechanical Mitral valve. I take Coumadin because I have A-Fib, but no replaced valves.

We eat anything and everything we like. I buy spinach, broccoli, cabbage,and several kinds of lettuce every week...and we eat them plus other kinds of foods that contain vitamin K every week.

When our INR's get out of wack, it's usually because of antibiotics. Yesterday my INR was 5.2. I have been taking a strong antibiotic. I still had salad and broccoli for dinner last night....and the leftovers for breakfast today.

Dose the diet rather than dieting the dose. We do home test.

Kind regards,

Blanche

 

[Ross]

Well, I'd love to have spinach or kale or Swiss chard now and then, but I did notice a change in INR even with a single normal portion of spinach. The key words are "now and then"; if I ate them regularly, there'd be no problem. It's easier for me to avoid the high vit K foods (those that I'd only eat now and then) than to fool with my warfarin dosage.

I have one question. What was your INR before you ate your spinach and what was it after?

That's good news about cranberry juice, though my preference in the cranberry department is the berry and it seems it was never suspect.

Thanks for the information!

As you wish, but you got it backwards. Eat the diet your normally would eat, including high vit k items. Once the dose is adjusted for that diet, you'll seldom ever adjust it again except for those special occasions such as some antibiotics etc.

There are still a ton of professionals that haven't gotten the message about Cranberry juice. The funny thing is, the big scare on it was over virtually nothing to start with. See these links for more info:

http://www.warfarinfo.com/cranberry.htm

http://www.ptinr.com/data/templates/article.aspx?a=462&z=1

http://www.ptinr.com/data/templates/article.aspx?a=354&z=1

http://www.ptinr.com/data/templates/article.aspx?a=654&z=1

 

[Janet L.]

Might want to use this link for interactions with Coumadin. Much easier to get along with:

http://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

Thank you. I bookmarked the site.

 

[Janet L.]

As you wish, but you got it backwards. Eat the diet your normally would eat, including high vit k items. Once the dose is adjusted for that diet, you'll seldom ever adjust it again except for those special occasions such as some antibiotics etc.

There are still a ton of professionals that haven't gotten the message about Cranberry juice. The funny thing is, the big scare on it was over virtually nothing to start with. See these links for more info:

http://www.warfarinfo.com/cranberry.htm

http://www.ptinr.com/data/templates/article.aspx?a=462&z=1

http://www.ptinr.com/data/templates/article.aspx?a=354&z=1

http://www.ptinr.com/data/templates/article.aspx?a=654&z=1

The problem for me with Vit K foods is that I would have to make an effort to be conistent. One day I will decide to eat a healthier diet and I will make up my mind to include dark greens regularly. Then, there will be no problem and I'll be healthier for it!

(Haven't read your cranberry juice links yet... but I will...)

 

[Janet L.]

Janet:


We eat anything and everything we like. I buy spinach, broccoli, cabbage,and several kinds of lettuce every week...and we eat them plus other kinds of foods that contain vitamin K every week.


Dose the diet rather than dieting the dose. We do home test.

Kind regards,

Blanche

Oh, how I envy your nutritionally sound diet! This site is going to get me to eat right, I can tell. You have no trouble with vit K because, wisely, you eat it regularly. I should. I must. I will...

 

[Ross]

Just for your info, I'm anything but consistent and the greens are still accounted for. Diet is a very small part of your INR. More likely something else causing changes.

 

[Janet L.]

Just for your info, I'm anything but consistent and the greens are still accounted for. Diet is a very small part of your INR. More likely something else causing changes.

Now that is certainly good news to me! I will have to experiment... (Now that I have the home monitor I am more willing to try.) I've been avoiding dark greens (other than broccoli) for eleven years!

 

[Dina]

Eat the diet your normally would eat, including high vit k items. Once the dose is adjusted for that diet

There are still a ton of professionals that haven't gotten the message about Cranberry juice.

And vit k veggies
At my first post-op visit the nurse practitioner tried to tell me that
I wasn't reaching my target because I was eating broccoli
I said if that is so then why couldn't they reach the target while in the
hospital for 10 days,when I wasn't eating greens? Maybe its the dosage..duhhh!

 

[Janet L.]

As you wish, but you got it backwards. Eat the diet your normally would eat, including high vit k items. Once the dose is adjusted for that diet, you'll seldom ever adjust it again except for those special occasions such as some antibiotics etc.

There are still a ton of professionals that haven't gotten the message about Cranberry juice. The funny thing is, the big scare on it was over virtually nothing to start with. See these links for more info:

http://www.warfarinfo.com/cranberry.htm

http://www.ptinr.com/data/templates/article.aspx?a=462&z=1

http://www.ptinr.com/data/templates/article.aspx?a=354&z=1

http://www.ptinr.com/data/templates/article.aspx?a=654&z=1

Looks like the researches gave up on the idea of interactions between cranberry juice and warfarin quite a while ago. Strange that I only noticed the warning on the drug statement that came with a recent warfarin prescription.

In my online wanderings, I came across this suggestion that while on warfarin, having too little vitamin K in one's diet is ill-advised. I found the explanation interesting:
http://www.clotcare.com/clotcare/vitaminkandwarfarin.aspx

 

[Janet L.]

And vit k veggies
At my first post-op visit the nurse practitioner tried to tell me that
I wasn't reaching my target because I was eating broccoli
I said if that is so then why couldn't they reach the target while in the
hospital for 10 days,when I wasn't eating greens? Maybe its the dosage..duhhh!

That's why I'm trying to educate myself. The professionals are too busy with other things, I guess, to worry about understanding warfarin dosing. It's easier for them to say, "No greens", than to understand and explain how it all really works.

 

[Dina]

That's why I'm trying to educate myself. The professionals are too busy with other things, I guess, to worry about understanding warfarin dosing. It's easier for them to say, "No greens", than to understand and explain how it all really works.

Yeah, and I am really glad that eating greens is an option for us, I happen
to love broccoli,kale,etc and would hate to give it up. So as long as we try to
keep our greens intake static and not vary greatly from day to day,it's
good. I was one of those weird kids who actually ate their spinach
Dina

 

[Janet L.]

Yes, Dina, I agree, keep it static and eat what you like!