My very first question here...

[EricC5Vett]

Hi everybody, I just joined yesterday and am posting my first question here. My doctor and I are not having very much luck getting my PT's to where they belong. Started with 5mg in March, PT's were barely 2. Slowly started to increase, first 7.5 twice a week, then 3 times, then 4 times, then 7.5 every day, then 10mg once a week, then twice, three times, 4 times, now at 10mg every day, and PT's still at 2.2 or 2.3, thats it! I'm obviously inherently resistant to anticoagulation, and worried about it. I get blood work done every 2 weeks, take the Coumadin religiously, never miss a day, also take a baby aspirin every morning. I have read that some people can go as high as 20, 25, or even 30mg a day. Are any of you in this category? My PT's have hardly moved the whole way from 5mg to 10mg daily in small increment increases, and it seems like I'm heading considerably higher. My doctor says that we have to get up to the 3 range SOMEHOW!!! At 25mg a day, this Coumadin stuff will get real expensive, paying for 3 scrips a month (2-10's & a 5). Any input people?
Also, my doc is giving me a real hard time about riding the motorcycle, calling me a future organ donor, etc... I can't be the only person in the world thats on Coumadin and has a motorcycle. I only take it out for a one hour ride about once a week, and wear the best protective gear that money can buy. It's one of my little joys in life, and I'm not willing to give it up. What do all of you have to say about this? Okay, this is long enough, gotta go now...CULAYTR

 

[LUVMyBirman]

Hi Eric,

Welcome. Coumadin can be tough at times. Especially first off finding your dose.

What I learned "the hard way" after two years of constant
bi-weekly or weekly dosage adjustments by my doctor.

Really did nothing other than ride the coaster up/down/sideways. I got so fed up started tracking the changes in graph form and found my own dose. After some convincing they allowed me to try it.

Consistancy is the key. The amount of Vitamin K you consume in your diet will play a large role in your levels. Green leafy veggies, brocolli, spinich, and many others. Also activity and exercise. More activity..... the lower your INR may be.

If they had you on 5mg and you were at 2.0. Good guess may be 6 to 6-1/2 mg straight a day. If you make changes swaying just ever so slighlty it will be difficult to level out. Ask your doctor about trying a straight dose and stay there awhile!

 

[Ross]

Eric what is your diet like anyway? We'll certainly try to get you straightened around. Consistency is the key. Do you drink alcohol? What foods do you eat/like?

As for the motorcycle, the doc is evidently pro NO cycle. My partner in comedy, John Cochran, rides all the time and I'm sure there are others. You must realize that if you should wreck and suffer a concussion, it could be your end. Coumadin and brain bleeds don't go well together. As long as your playing safe, I say enjoy your life. Don't let coumadin dictate how you live your life now. Heck, some of us still use chain saws, cut our lawns, build houses, etc,. All of these things have been warned about. You simply can't stop living because of it.

 

[JimL]

As you start feeling better after surgery, as you become more active, you tend to metabolize the coumadin faster, and so the dosage has to go up. That is normal.

Some people just naturally need a higher dosage than others. But if I were you, I would certainly want to check out the diet side and cut down on any Vitamin K consumption, rather than continue on the high dosage.

 

[Nancy]

Hi Eric-

Nice to see your first question. INR is very annoying at first. It will get more in line eventually, but Coumadin is never on an even keel for very long. You will learn somewhat, how your lifestyle affects the INR. Exercise and diet play a big role in Coumadin management.

In addition to what everyone else has said, check out your diet for hidden sources of Vitamin K. Some of these are: nutritional bars (Luna, etc), Ensure, Boost, Carnation Breakfast, canned diet drinks, diet powders that you mix with milk, most multi-vitamins, and quite a few nutritional supplements, plus vegetable drinks like V-8. I also believe that soy products contain a fair amount of Vitamin K. Check out your consumption of Vitamin E as well.

A lot of the above may not show Vitamin K specifically on the label. Some do, but you really have to read labels and check out ingredients. If things have any green vegetable contents and any other chlorophyll containing ingredients, be wary of that product.

My husband has been on Coumadin for 25 years. His still fluctuates.

One of our members is a Coumadin expert. His name is Al Lodwick and he has a very informative website: warfarinfo.com Everything you ever wanted to know about Coumadin. (I just saw in your profile that this site is what led you here, sorry; I think I'll leave it in this post for others to see).

 

[J.B.]

Would some of you good folks be kind enough to give me your oponion as to wheither there is any difference in Coumadin and Warfarin?

For almost three years I have been using Coumadin, first six months after surgery 5 mg one each day. Had to up it to 7.5 and have not had to change it since.

In the next few days I am going to go to Warfarin, for Insurance purposes. My Dr, and Pharmacist tell me they are the same, with the exception, of one being Generic. Thanks in advance for your input.
J.B.

 

[Lisa in Katy]

I've had two cardiologists since my surgery 5 years ago. Both think that Warfarin has more variance in the actual dosage per pill. My cardiologist forgot to check the "no substitution" box once, so I took Warfarin for about 3 months, and my INR went nuts. We figured out the problem when my doctor asked me to bring the pills to his office and he saw the little bowties (Warfarin) as opposed to the circles (Coumadin) It's not perfect with Coumadin, but it's much better. I've been stable for 6 months now, which is the longest I've gone without at least a minor adjustment.

 

[Ross]

Right now, I'm breaking my own rule. I'm using both Warfarin and Coumadin. So far there is no difference except for the price.

Al has discussed this particular subject here before. Here are some links to past threads on the same question.

http://www.valvereplacement.com/forums/showthread.php?s=&threadid=3572

http://www.valvereplacement.com/forums/showthread.php?s=&threadid=3358

http://www.valvereplacement.com/forums/showthread.php?s=&threadid=2633

 

[Rain]

I named my son Eric Von.

I named my son Eric Von.

Eric, you have an absolutely wonderful name!!

My cardiologist makes the same type of comments about me water skiing, etc.... I tell him.... ?you told me the heart valve was going to SAVE my life!! Now you want me to sit in a rocking chair and be ?consistent? forever? I?m not ready for a ?rocking chair? life! My personal opinion is ... use common sense, be careful and enjoy the ride. I know a lot of people here share my attitude... there are still others who think you should just be happy your alive to sit in the flippin rockin chair.... personal decision.

I think we should all protest about having to pay for TWO prescriptions to achieve the proper coumadin dosage!! I?ve fought like crazy with my insurance company about this.

My insurance company screwed up and sent me warfarin..... So I?m (reluctantly) taking a combination of warfarin & coumadin right now too. But my own past experiences have convinced me to stick with coumadin.

 

[terry40]

Hi Eric

Hi Eric

It took me over 6 months to stabilize on coumadin, I've been in the 3.0 range for 2 months now, what a relief.

I also thought that my dose would never stop going up, I'm on 5 days of 10mg and 2 days of 7.5mg.

I'm very careful with any other meds I take, OTC, and foods I eat, I still have plenty of those green veggies, everyday, consistency is the best.

The motorcycle issue, NJ is not the greatest state to be riding a motorcycle, our traffic is saturated, and there aren't many areas that are considered rural. Though I'm not sure where basking ridge is located. I live in south Jersey, my daughter lives in North Jersey and I have a brother in central NJ, of course we all live near a major city, but we only live once, so be careful.

 

[ajones]

Eric - You should go to my cardiologist. He is in Mountainside, not too far east of you. He rides his own motorcycle so he couldn't very well tell you to stop. His advice to me three years ago was to watch what I do and be careful, but live as normal. Rides through the rolling hills of Somerset and Hunterdon counties must be beautiful.

As to the warfarin/coumadin question, his opinion is that they are both fine but to be consistent on one or the other. In this day and age insurance costs seem to win out unless there is a compelling reason not to take the generic.
Andy

 

[Rich]

Coumadin/Warfarin

Coumadin/Warfarin

J.B.
I have seen problems switching from one to the other.
It happened to my wife when she was on it for several months.
Internal bleeding started shortly after the accidental switch.
I have heard that there are more variances with Warfarin just as Lisa said. I think there is also more than one manufacturer of Warfarin.
My cardiologist told me one or the other is OK but only from the very beginning, once established on either one never switch.
Personally I've been on Coumadin for seven years and once my initial dosage was regulated I have never had to make an adjustment since. That convinced me to stay on Coumadin.
I do however understand why a lot will consider generics with the ridiculous prices out there.
Have you looked into other ways of getting your medications to save some money?

 

[Rich]

Eric,
Youv'e got your life back so go ahead and live it.
Just be a little more cautious these days.

 

[Guest]

We are still looking for a big study that shows there is a difference between Coumadin and warfarin. So far no study has shown any difference.

I have several people who take over 100 mg of warfarin per week.

Warfarin is sold in these strengths 1 - 2 - 2.5 - 3 - 4 - 5 - 6 - 7.5 and 10 mg. You should never have to pay for two prescriptions. If you need 25 mg take 5 X 5 tablets etc. The pharmacist is not doing you any favors by not trying to simplify things.

Some pharmacies try to keep their inventory down by not stocking all of the strengths - so if they tell you that there is no such strength as the one you want - you know you are dealing with a shady operator - get your prescription back and walk out.

Somebody tell me how there can be a town in New Jersey named Mountainside. Sounds like a real estate salesman's hype. Is it like Virginia Beach's Mount Trashmore - the covered over old city dump?

 

[John & Joann]

If the prescription is written 1 or 2 tablets as needed, the pharmacist MUST fill the prescription for the higher number. Therefore you may be getting a higher amount of pills than you will actually use. This will help if you have insurance. It will not help if you pay for your own medicine.

Joann will only use the REAL coumadin. Started on the stuff in 1971 and everyone says "DON'T CHANGE". Had an error from the mail in pharmacy several times that did not read "DAW". They had to replace at their expense.

Joann's INR numbers are fairly constant. Common diet, steady exercise, and VERY accurate dosage on schedule.

If only the atrial flutter and the vascular issues in the leg would be that easy.

Still clicking since 1971! Just like the Timex Watch!

 

[sharon]

coumadin strength

coumadin strength

Al,
Speaking about 25mg - couldn't someone use 2 1/2 of the 10 mg pills as they are scored. I've been cutting my 5 mg for years - in 1/2 and also 1/4. There doesn't seem to be much loss of the pill when I slice it.

 

[Dave]

Warfarin and motorcycles

Warfarin and motorcycles

Hi Eric
Tell your Doctor he needs to get a life ! I had a mitral valve replacement with a St Judes in July 2000. I take 3.5 Warfarin daily and my INR is stable between 2.5 and 3.5, usually average 2.8.
There is nothing that i did before my operation that i can not do now. I drink alcohol in moderation and i eat anything in moderation. I ride a Harley 1340 superglide, and last summer we toured new zealand on the bike, i was on the road every day sometimes for five or six hours with no problems, lets face it if you fall off you might die, but that applies to non warfarin users too. Before the operation I had a private pilot licence for aeroplanes and helicopters, the feds took my medical after the operation, but two years later I got it back and i am flying again.
I think that if you feel ok and you want to do something just get on with it. I just had a very healthy friend die from choking on a piece of food in a hotel room, how dangerous is that !!

Regards
Dave

 

[Christina]

Talking about INR dosages?

Talking about INR dosages?

Hi Eric,

Well, not wanting to outdo anyone here but right now I am trying to stay stable with 154mg Coumadin per week. That is 22mg per day. Last week Tuesday I tested at 2.8. I hope it to be higher this coming Tuesday when I test again.
My pharmacist gave me "Warfarin" one time by mistake and I took it, and my INR went all over the place. I also was told afterwqards by the pharmacist that it was "the same thing", but my doctor told me that the Warfarin has too much "variance" in their pill, and you don't know HOW much you are really getting, so for me it's 'THE REAL THING".
I get a three months supply through the mail from PacifiCare for a $20.00 co-pay. I will have to renew my prescription for the 2mg soon, and will ask for the 4mg and cut the 4 in half so it'll last me longer. Thanks Sharon for the idea..Why didn't I think about that.. DUH!!!

Happy Protiming you all..