I posted a note on Small Talk about a newly published heart book. I got a copy of "Your Heart/An Owner's Guide," by John A. Elefteriades, M.D., professor of cardiothoracic surgery & professor of surgery @ Yale University School of Medicine, and Lawrence S. Cohen, M.D., Ebenezer K. Hunt professor of Medicine @ the same school.
I got the book as a freebie -- it was sent to our newspaper in hopes we would do a review. Guess we won't, or it's already been done (which I doubt).
I liked what the authors wrote about Coumadin; i.e., they're sane, intelligent doctors!
(They also come across as neither blatantly pro or con on mechanical vs. tissue valves.)
They explain Coumadin very well, how it works.
From the book:
"There are devices available that permit patients to check their own INR from a pinprick performed at home (in the way that diabetics check their blood sugar). In some trial programs, patients have adjusted their own Coumadin doses (again, like diabetics with their insulin). The consistency and accuracy of dose adjustment in trial programs have been fine, in some cases even better than with traditional doctor-based adjustments. These home INR testing systems are currently expensive, and have not been welcomed by the insurance industry. We anticipate, however, that within several years, many, if not most, patients will be testing their own INRs at home."
also -- about green vegetables in your diet:
"Broccoli and other green vegetables contain large amounts of vitamin K. This common vitamin is the substrate from which your liver makes the clotting proteins. Binging, or consuming an extraordinary volume of such vegetables, could overwhelm the ability of Coumadin to regulate your INR. Your Coumadin manuals will emphasize this possibility.
However, your authors have never, in decades of clinical practice, actually encountered an instance in which dietary intake of vegetables was a problem. Generally, you should plan to eat as you desire; your diet will automatically be accommodated in your INR testing and your Coumadin dosing. If you have an exceptionally large intake of green vegetables on a regular basis, discuss this with your doctors."
What they're saying is "Dose the diet, not diet the dose." I suppose you would need to tell your doctors if you eat a heckuvalot of green veggies, just in case your regular eating habits are disrupted.
Coumadin and periods
"You can expect your periods to be a bit heavier. But as long as your uterus is healthy, you should not have excessive bleeding from Coumadin." (But the authors advise older women beyond menopause & menopausal women to consult a doctor if they experience bleeding while on Coumadin.)
Pregnancy & Coumadin
"Some young women of childlbearing age require an artificial heart valve and need to be treated with Coumadin. For these women, becoming pregnant may be somewhat difficult, but it is definitely possible, and reasonably safe if done properly."
It mentions the adjustments to make -- substituting heparin for Coumadin, using Lovenox.
Emphasizes "careful coordination between your obstetrician and your cardiologist."
Albeit, they don't refer to Coumadin/warfarin in every situation as an anticoagulant; they do in quite a few places, but not in every instance. After all, the general population recognizes the term blood thinner rather than anticoagulant. There are places where they use "anticoagulant, or blood thinner."
They state that they prefer to keep aortic valve patients in a range of 1.8-2.2, which I believe is too low & too small of a range. (I will e-mail them, asking why such a small range and why those numbers.)
I got the book as a freebie -- it was sent to our newspaper in hopes we would do a review. Guess we won't, or it's already been done (which I doubt).
I liked what the authors wrote about Coumadin; i.e., they're sane, intelligent doctors!
(They also come across as neither blatantly pro or con on mechanical vs. tissue valves.)
They explain Coumadin very well, how it works.
From the book:
"There are devices available that permit patients to check their own INR from a pinprick performed at home (in the way that diabetics check their blood sugar). In some trial programs, patients have adjusted their own Coumadin doses (again, like diabetics with their insulin). The consistency and accuracy of dose adjustment in trial programs have been fine, in some cases even better than with traditional doctor-based adjustments. These home INR testing systems are currently expensive, and have not been welcomed by the insurance industry. We anticipate, however, that within several years, many, if not most, patients will be testing their own INRs at home."
also -- about green vegetables in your diet:
"Broccoli and other green vegetables contain large amounts of vitamin K. This common vitamin is the substrate from which your liver makes the clotting proteins. Binging, or consuming an extraordinary volume of such vegetables, could overwhelm the ability of Coumadin to regulate your INR. Your Coumadin manuals will emphasize this possibility.
However, your authors have never, in decades of clinical practice, actually encountered an instance in which dietary intake of vegetables was a problem. Generally, you should plan to eat as you desire; your diet will automatically be accommodated in your INR testing and your Coumadin dosing. If you have an exceptionally large intake of green vegetables on a regular basis, discuss this with your doctors."
What they're saying is "Dose the diet, not diet the dose." I suppose you would need to tell your doctors if you eat a heckuvalot of green veggies, just in case your regular eating habits are disrupted.
Coumadin and periods
"You can expect your periods to be a bit heavier. But as long as your uterus is healthy, you should not have excessive bleeding from Coumadin." (But the authors advise older women beyond menopause & menopausal women to consult a doctor if they experience bleeding while on Coumadin.)
Pregnancy & Coumadin
"Some young women of childlbearing age require an artificial heart valve and need to be treated with Coumadin. For these women, becoming pregnant may be somewhat difficult, but it is definitely possible, and reasonably safe if done properly."
It mentions the adjustments to make -- substituting heparin for Coumadin, using Lovenox.
Emphasizes "careful coordination between your obstetrician and your cardiologist."
Albeit, they don't refer to Coumadin/warfarin in every situation as an anticoagulant; they do in quite a few places, but not in every instance. After all, the general population recognizes the term blood thinner rather than anticoagulant. There are places where they use "anticoagulant, or blood thinner."
They state that they prefer to keep aortic valve patients in a range of 1.8-2.2, which I believe is too low & too small of a range. (I will e-mail them, asking why such a small range and why those numbers.)
