Okay, what is wrong??

[Christina L]

Hi all,

I have been on Coumadin for six weeks. The highest my INR has gotten was 1.9. Today it was 1.5. I have been on 10 mg a day except for 7.5 mg on Monday. What gives???

Also my heart rate is lowering (was in cardiac rehab today) but my blood pressure before exercise was something like 130/84 and after exercise and cool-down was 134/88. The nurse said nothing to worry about - my heart is getting used to its new way of working, but...am kind of concerned. Has anyone had to be on medication after surgery to get their blood pressure down??

Did anyone else have either of these problems - an INR that took "forever" to go up or a high blood pressure for a while after the surgery??

I have not had a bout of a-fib for six weeks now. I would like to know what you all think - should I ask my doc to just "give up" on the Coumadin or what?? Do I need to be on it? I am on Rythmol also and really don't want to be taken off that just yet.

Otherwise, I started back to work full time just today and should be working right now - ha (work at home doing medical transcription) - am feeling VERY tired, but am plugging along. Gotta pay those bills.

Thanks all.

Christina L.

 

[medtronic of borg]

food?

food?

Have you taken a very close look at your diet. You may need to cut back on things high with Vit. K for a bit . To help the Dr's get it within range. I start by cutting the stuff I least like but still eating.

Med

 

[Christina L]

Okay, my diet has consisted mostly of protein - chicken, a little red meat (twice a week), salmon, eggs, potatoes, banana and orange with plain yogurt in the morning, some bread, some frozen vegetables, a rare salad (used to live on salad but no taste for them right now) maybe once or twice a week. I do drink some decaf tea and decaf coffee and herbal teas. I also DO take vitamins - B-multi, vit E, magnesium, calcium, zinc, probiotics but not every day. Also, do olive oil and butter have an effect - do use those to cook with.

All you Coumadin experts out there, help!!

Christina L.

 

[medtronic of borg]

?

?

well then they may push your levels. My niece is on 15mg dly.
Let me know what he says would ya.
Med

 

[Ross]

Olive oil- Oils, Olive/Safflower 7 Tbsp. 28 ug/100mg Vitamin K
Butter-Butter, regular (salted) 7 Tbsp. 7.0 ug/100mg Vitamin K

Your blood pressure is great! Why would you worry about lowering it? Yes I take meds to lower my BP. If I didn't, I'd be in the 145/90 to 150/100 area. Now that's a little high!

 

[terry40]

Hi christina

Hi christina

It took me 6 months to regulate my coumadin, for 10 months now I've been in range (knock wood), but I remember the frustration.

Olive oil has vitamin K in it, herbal teas, and your multi vitamin can have some too, in those long six months unregulated, I monitored everything, there is hiden vitamin K in many foods.

I take 10 mg a day and know of someone else who takes 15mg a day, we both like our salads and green veggies, and aren't willing to give them up, but I make sure I have a least one serving per day.

I don't think your B/P is high enough to start on meds yet, but it should be monitored, to me it sounds like your doing great!!!
Keep up that rehab, and best of luck going back to work.

Don't give up on coumadin, you,ll face the risk of stroke, valve failure, and a host of other problems.

Terry40

 

[tommy]

Check for Vit K in the herbal teas. If you can't find the "K" content, skip them for a while - reduce the variables.

 

[Christina L]

Thanks everyone.

I am thinking that what you are saying Ross is that fats and oils are high in vitamin K (?) - that could be a main component of my INR not rising. In fact, we just had grilled cheese sandwiches with butter slathered on the bread. We use that Smart Balance brand, but....

Also as for the herbal teas, I will stop those. Is regular decaf tea and decaf coffee okay?? Is organic half and half okay in my coffee??

Cheese okay?? Dairy? I guess I thought the worst thing was the green vegetables and the cruciferous veggies (which are my favorites) such as brussels sprouts, cabbage, broccoli, etc., so I have been staying away from them as much as possible.

Thanks for all your help. I just hate to have to up my dose of the Coumadin. I am wondering if I could be stopped on the Coumadin because of having a repair, but I am still having quite a lot of PACs and maybe that irregular rhythm might cause a clot (?). I just wish the doc would say, "oh well, we tried with the Coumadin, you can go off it." But believe me, I am amazed that the INR hasn't gone up as I have been compliant with the dosage of Coumadin and trying to eat correctly.

As for my blood pressure, it is just high for me and the nurse said something about it should be going down after exercise. She did tell me not to worry, but Ross, you know ME don't you?!

Have a great night's sleep everyone - peaceful and restful.

Christina L.

 

[Ross]

http://www.coumacarenews.com/consumer/INT_VitaminK1.asp

Here's a linky you might find useful.

I think your doing something or eating something that has VK hidden, but without being around you all the time, I couldn't say for sure. If your not making a steady diet of these wonderful sandwiches, I don't know. It could just be the way you metabolize the drug.

I really don't think you'll be on it much longer, but until they take you off, lets see what we can do.

 

[JimChicago]

How many things can affect coumadin and INR?

Personally I seem to notice exercise level - doing more exercise tends to lower INR. The Coumadin Cookbook says to 'treat' olive oil by exposing it to sunlight for 48 hours to reduce a lot of the vit K in it. What about absorption - some say taking coumadin with magnesium (in some multi-vitamins?) cuts down on absorption. Some herbal teas are supposed to raise INR but like others have said some teas may have vitamin K in them - and for some reson packages almost always never show vitamin K amouints in the little nutritional info section - we should petition to get vitamin K info labeled on packages - just like they do for vit. C and Iron, cholesterol etc

 

[Christina L]

Thanks Ross and Jim,

I scanned the list, Ross, on that web site of foods that are or are not high in vitamin K. I made a big pot of chili last week and I see that beans are high in vitamin K (we had chili as leftovers off and on during the week). Also, Wayne got some spicy mixed nuts for a Christmas gift that he will not eat, but I have been eating a handful of those every day. VERY high in vitamin K I see. The oils and fats are probably a big culprit and I hate to admit but probably the vitamins. I wonder what would happen if I suddenly quit all vitamins, but I don't want to do that, as there could be side effects from that!

The cardiologist's nurse told me right off the bat, DO NOT change your eating habits and don't pay attention to what is high in vitamin K or low in vitamin K - WE will adjust your Coumadin around you. However, I don't want to keep upping my dose of the Coumadin.

The Coumadin Clinic should call me tomorrow with the latest doctor orders. I'll keep you informed.

Thanks again for your help!

Christina L.

 

[Ross]

In all honesty, that nurse is 100% right. If we throw you off, you'll be bouncing forever. It's better to just leave things the way they are and live with an increase in dosage. Who knows Chris, it may just be your a fast metabolizer.

 

[Christina L]

A "fast metabolizer" - you flatterer you!! Hee!

Will do as you say, sir!! Thanks!!

Now get on to bed and get some rest!! You guys are two hours later than us here in the West - it is past your bedtime in Ohio!!

Christina L.

 

[Christina]

Christina, I think the nurse was correct by telling you to regulate your dose of Coumadin around your diet, otherwise it's going to drive you absolutely nuts. Remember, the things you are eating are GOOD for you, and your body needs foods like that to stay healthy and for you to FEEL good, so I would advise you NOT to stop them because you are on Coumadin. Consistency is the key here.
And for not drinking tea. That is rediculous! I would be concerned if you were eating the tea leaves.
It takes a while for some of us to get into range with the Coumadin, and being more active will lower your INR, so you need to up the dose avoiding a stroke or clot. I did not like upping my dose either, but I had to get it in range. No one knows how you or I metabolize vitamin K or Coumadin, and we need to take what we need in order to stay within the 2.5 - 3.5 range. I personally am taking 20mg a day right now.
Your INR is way too low. I threw a clot at 1.4 and the surgery needed to be redone 11 days after my first surgery. Not fun, so remember that!
You need fats in your diet, because your organs (heart is an organ) depend on you taking in some fats.
I eat what I want, but very healthy stuff, and take more supplements than you. This winter I started taking Cod Liver Oil and Fish oil, and I knew that that would up my INR so I know to adjust my Coumadin accordingly. I was taking 24mg a day, then 22 and right now am down to 20 again.
I would not take any BP meds if I were you. Just wait, and it'll all work out.
I home test once a week or more (if necessary) with the Protime because I want to be safe.

Wishing you the best.

 

[Nancy]

Since this thread is discussing Vitamin K, I thought I would mention that there are many cosmetics that contain Vitamin K.

Many women use these creams to minimize spider veins on legs and face, and they are also used to minimize undereye circles.

menadione, phylloquinone, menaquinone are names associated with Vitamin K.

 

[Harpoon]

Yeah, ummm... Watch those herbal teas!!!


Depending on what meds you take, anything with ginko biloba should be avoided for all kinds of reasons, including the fact that it's a stimulant that can mess your heart rate up some.


Other than that diet seems to be ok, maybe it's just taking a while for your body to settle out with the new medications running around....

 

[Christina L]

Thanks everyone. Great suggestions. Okay, I won't stop my herbal tea. I drink maybe 2-3 cups a day - don't think that is so bad.

I do not take ginko biloba as I know that would stimulate my nervous system and could cause arrhythmias. I have gone off all caffeine (forever) and am even watching not eating too much chocolate in a day as there is caffeine in chocolate, and definitely trying to stay away from too much sugar because it can exacerbate depression.

My body has been craving lots of protein and fats and I believe your body tells you what it needs. I do want to get back into a more healthy balance, but that will come in time. My body will tell me when it is wanting to have some more vegetables. I have had a taste for some fruits, though.

As for my INR being so low and not therapeutic, I guess maybe the one thing going for me in that respect is that I do not have a replacement or mechanical valve. I had a mitral valve repair. I know after ANY surgery, stroke is a real possibility, so I will just listen to my doctor. If he raises my Coumadin to 20 mg a day for now, so be it.

And Mark, you have me pegged - just as Ross has - I am a "bit" (understatement of the year) of a worrier. Hee.

Have a great day everyone. I need to get working at my job!!

Christina L.

 

[Harpoon]

The ginko biloba might be IN the herbal tea....

Check the ingredients carefully.

 

[JimChicago]

I wonder too if taking probiotics may stimulate the intestinal flora to produce more vitamin K2 (menaquinone) after reading so much about how antibiotics can decrease intestinal flora so as to decrease vitamin K. So it implies that (possibly) increasing intestinal flora (by probiotics) may possibly increase vitamin K?

I guess like everybody says taking the same amount of everything all the time and being adjusted for that level is OK - changineg one of the elements in diet/medication amounts may required further adjustment. Sometimes I wish I got tissue valves.

From:
http://home.caregroup.org/clinical/altmed/interactions/Nutrients/Vitamin_K.htm
>>>>
mechanism: When antibiotics destroy all or most of the beneficial bacterial flora in the gut they eliminate the organisms that synthesize a high proportion of the body's vitamin K. Therefore, many antibiotics can indirectly cause a depletion of vitamin K.
>>>>>

From:
http://home.caregroup.org/clinical/altmed/interactions/Nutrients/Vitamin_K.htm
>>>>>
? Probiotic flora in intestines with a healthy ecology normally manufacture vitamin K.
......
Vitamin K2 (menaquinone) is synthesized by probiotic bacterial flora in the large intestine.
......
? mechanism: When antibiotics destroy all or most of the beneficial bacterial flora in the gut they eliminate the organisms that synthesize a high proportion of the body's vitamin K. Therefore, many antibiotics can indirectly cause a depletion of vitamin K.
>>>>>

 

[Christina L]

Update

Update

Everyone,

I got a call from the Coumadin Clinic today. I guess my cardiologist usually keeps people who have had a repair on Coumadin for about 4-6 months, depending on episodes of atrial fibrillation. I did have an episode of a-fib at two weeks out from surgery, but none since (just a lot of PACs).

SO, we do have to get this Coumadin at a therapeutic level - above 2 for me since I don't have a mechanical valve.

The nurse and I talked about things I have been eating, supplements I take, and tea I drink, etc. She said you would have to eat mega greens to affect your INR, but she did say definitely go off the Co-Q10 which is a major interactant with Coumadin, and also to stop the herbal teas, and to be checked next week. She seems to think the Co-Q10 is the culprit as I started taking my vitamins again about three weeks ago and have been on the Coumadin for six weeks. The INR had started to rise and then came to a standstill - about the time I started on the vitamins and drinking the herbal teas - things like "Sleepytime" with valerian, Calm Ease tea, etc. Decaf coffee and decaf tea are okay, the nurse told me.

Oh, also she said to stop the probiotics as she says they are a big culprit also. So thanks for all your answers everyone - you were pretty much right on the money when it came to your suggestions for me!

Hope this helps others who are having trouble with regulating their INRs.

Christina L.