Other no-nos with coumadin?

[Marge]

I forgot to tell the Anti Coagulation clinic that I occasionally do take lasix, which is also a diuretic. Does lasix present problems with coumadin?

I haven't taken any recently (because haven't had fluid retention issues) -- if I do, do I need to advise them?

I did remember to ask about multi vitamins and calcium.

I was told OK for the multi vitamins as long as they don't have Vitamin K (mine don't) and that calcium is also OK as long as there is at least two hours between taking the coumadin & taking calcium.

Then I looked at the ingredients list in my calcium and -- it is "calcium with soy" -- and -- oops -- it has 40 mg. of Vitamin K in it. So I will get a different kind of calcium!

Any other odd-ball things I should be concerned about? (I don't take any other "dietary" or herbal supplements.)

 

[KMB]

I drink soy milk with 15% vitamin K - is that ok to drink?

 

[Nancy]

Joe takes huge amounts of Lasix every day (320mg). He takes his consistently. What does cause problems with the INR is the fluid retention, and then again when it is eliminated. So during the time when your fluid is unstable and is then being treated, you should check the INR more frequently.

Sources of vitamin K that most people forget to check out are things like health bars, Power Bars, and others like that, diet bars and drinks including those you mix with milk. Ovaltine is OK, so far. Health drinks in bottles which have additives like wheat grass, green algae and anything that sounds green. Read the labels and look for vitamin K, but don't assume that if it contains something that sounds green, and vitamin K isn't mentioned, that the product does not have vitamin K.

V-8 juice has it and doesn't show it on the can or bottle.

Ensure and Boost have large amounts.

I also wonder about products that women use to bleach out skin blemishes. Some of them do contain an ingredient related to vitamin K (hydroquinone), and could be absorbed by the skin. If you use something like that, just be careful. Products that are used on the skin to get rid of spider veins have vitamin K.

I would imagine you would have to use lots of the stuff to get a reaction, but who knows how much is a lot, and over how large an area some would use it?

 

[KMB]

When you leave the hospital do they let you know all this information, or is it something that you have to figure out on your own?

 

[Barry]

When you leave the hospital do they let you know all this information, or is it something that you have to figure out on your own?

I will spare you the rant on the dismal state of informed consent when it comes to prescribing drugs in general, not just Warfarin. You've gotta do your own research. An excellent source of info is that the next time you get refills, ask the pharmacist for the medication insert for each.

 

[Nancy]

For the best info. on Coumadin (warfarin), go to this site, run by an expert on Coumadin and its management, Al Lodwick, who is a member of VR.com too, and is so, so helpful to all of us. He's a good friend here.

http://warfarinfo.com/

 

[Barry]

I drink soy milk with 15% vitamin K - is that ok to drink?

My guess would be that, as with nearly everything else, so long as you take about the same amount every day it really doesn't matter because your warfarin dosage over time will be adjusted to keep you in therapeutic range. It's stuff you take once in a while that is a problem.

A few months ago I was talking with my doc about my fruitless search for an affordable sleeping pill that I could take just occasionally. While he exaggerates, he said that just about everything interacts with warfarin and not to worry about it if it's taken daily. Problem is I don't want to take sleeping pills daily because that's how you get strung out on them. [Ambien is what we settled on for occasional use, but it's so expensive that I haven't gotten my 'script filled for a long tme]

 

[Georgia]

Multi-vitamins without K

Multi-vitamins without K

Pam, look for One a Day (or generic or store brands) For Women - as far as I can tell, they're the only ones out there now without Vit. K.

 

[geebee]

One-A-Day Essentials does not have Vit. K either and that is the one I take. I also use the calcium chews that have Vit. K in them. I cannot take the large calcium pills and can't stand the chalky chewable tabs so I use the soft chews. As long as you take them regularly, your INR will be adjusted around them and it will not be an issue. Same with vitamins in general.

Just be aware if you alter your habits and test more often until you know the effect.

 

[Marge]

What's the name of your vitamins w/out Vit. K? I can't find any without it.

My multi vitamins are "Nature's Blend."

I get them from Long's, a big pharmacy chain out here on the west coast.

 

[bvdr]

Marge, this whole thing might seem very time consuming and intrusive right now but it most likely will settle down and be "just one of those things" before long. Don't try to micro-manage it. There are too many factors you just can't control. Pick your vitamins and then just don't change brands. Adjust your coumadin to your life rather than living your life around coumadin. It makes no difference if you need to take 2mg or 12mg or more as long as your INR is in range. If you can get a home unit and test yourself it could make everything much easier on you.

 

[Marge]

Marge, this whole thing might seem very time consuming and intrusive right now but it most likely will settle down and be "just one of those things" before long. Don't try to micro-manage it. There are too many factors you just can't control. Pick your vitamins and then just don't change brands. Adjust your coumadin to your life rather than living your life around coumadin. It makes no difference if you need to take 2mg or 12mg or more as long as your INR is in range. If you can get a home unit and test yourself it could make everything much easier on you.

Yes, I agree with EVERYTHING you're saying!

I really did not sweat it all that much when I was on coumadin before. (The main problem then was the frequent & difficult blood draws, but, I have to remember, I was already battered and bruised from all the poking with needles and IVs at the hospital.) I didn't worry much about diet or the other stuff -- but then I knew it was only for three months.

Now it is, I suppose, FOREVER, so I am probably getting too hung up on minor things.

I guess the main problem I have is with this "consistency" thing that everybody talks about.

Do you all live like that -- doing everything, as they say, "consistently"?

To do that would be a real life change for me.

The great thing about my surgery, I thought, was that there was so little I needed to change. Most of the things that were recommended (very little sodium in the diet, no smoking, moderate drinking, exercise, etc.) were things I already did. Basically, after 2-3 months of recovery, I went back to "life as before."

Now I find that I do have to make some changes -- and it is bothering me more than I should let it bother me.

For instance: I don't want to eat green vegetables "consistently." I want to eat them when I see some nice ones, when they're in season.

I don't want to drink a glass or two of wine "consistently". I don't have any desire to binge-drink, and I rarely drink anything alcoholic, other than wines. But I want to be able to do the sort of thing we're planning to do next month. We're supposed to go to a special "wine-tasting" dinner, with wines provided from one of the better Bay Area wine merchants. He provides a range of different wines to sample with each course & there are four or five courses.

I certainly don't want to take either pain killers or sleeping aids "consistently" -- that would indeed be crazy. I want to be able to take them when I need them.

I could list a whole bunch of areas where it will drive me batty if I have to be "consistent."

It would indeed be easier for me if I could self test.

 

[Nancy]

Re: Difficult blood draws--

After having had chemo. my veins are totaly fried. And others in the same position have similar complaints. Here is what the veterans say (those who have had chemo and have found a "work around" for the difficulty of draws.

They say to drink plenty of water the night before, and also the day of tests. They also say keeping the arm warm helps as well, even running some warm water on it at the docs office.

Maybe some of the nurses and docs here could impart some additional wisdom.

 

[geebee]

Marge,

I know this sounds all sounds like we plan everything but that is not really the case with consistency. Keep in mind that dosages are usually adjusted based on what you take in a week's time. If you eat green vegies at least once a week, that is consistency. If you drink a glass of wine (or 2) per week, again, consistency.

Also, even if you have something out of your normal schedule, just try not to get carried away. For example, don't eat a huge spinach salad with 2 or 3 cups of green tea. Those are the things that could cause problems.

That being said, if you find yourself in a situation where you want a huge spinach salad with lots of green tea, just try and test within a couple of days. That way you can adjust dosage if you need to.

I do not spend my time trying to decide when and how much of something I want to eat or drink. I am just aware of what I do so I can make allowances if need be.

 

[Granbonny]

Marge

Marge

Have you had an INR? since you began coumadin this last time? What was it? Have you had more than one? What was that one?........ Are you still going to have 2 draws a week..?If you don,t mind posting them..we will try to help you figure out what you need to do..without a huge doseage change.......It is harder to get an INR up..than lower it..... Lowing is easy..drink a V-8 juice..Have a little coleslaw...ect...If mine drops below 2.5 I tweak a few days..I bite a bit off of my regular 5 mg..Have a little private place I keep them. ..Go and enjoy that wine tasting dinner Then see what your next INR will be..I just hope that if you are testing 2 times a week..It's 3 days in between. ..Bonnie

 

[Guest]

The only time that Lasix makes much difference is if you are really swollen up (not just the ankles) and then take it. The reason is that when the fluid congests the liver, the blood does not flow through it as easily so that warfarin does not get metabolized very well. This makes the INR go up. When you take Lasix and remove the congestion, the warfarin gets metabolized faster and the INR goes down. It isn't something to worry about but if the INR is out of line it might be worth considering whether or not you are retaining fluid or just took Lasix in the past few days.

If you switch to a vitamin without Vitamin K and keep the warfarin dose the same, your INR will go up.

 

[Barry]

...
I guess the main problem I have is with this "consistency" thing that everybody talks about.

Do you all live like that -- doing everything, as they say, "consistently"?

To do that would be a real life change for me.

...I certainly don't want to take either pain killers or sleeping aids "consistently" -- that would indeed be crazy. I want to be able to take them when I need them.

I could list a whole bunch of areas where it will drive me batty if I have to be "consistent."

It would indeed be easier for me if I could self test.

Forget who said that consistency is the sign of a madman.

I don't want to take pain killers consistently, either - they're addicting. I've found I can take Hydrocodone (Vicodin) as needed without it messing up my INR. Probably any opiate would be OK, just remember that all opiates are addicting.

I don't want to take sleeping pills consistently, either - they're addicting, too. I've found that I can take Ambien as needed without messing up my INR. Haven't yet found a way to afford it, though.

Alcohol is only a bit less addicting than pain meds and sleeping pills - little known fact. So long as you can keep it to a couple of drinks, OK to drink consistently. But no need to drink consistently. I see no reason why you couldn't do a wine-tasting so long as you didn't get falling-down drunk.

Alas, episodic binges on huge spinach salads are probably risky.

 

[McCln]

Marge

Marge

There is something about soy that is bad for INR. And with your calicium, with the vitmain k at 40% is badddd. At least read all labels to make sure is has no vitmain k added. Such things as meal suppliments, vitmain k at 25%, too high for daily use. Just get educated on how to eat foods with vitamin k. good luck. Education is the key to knowledge.

 

[Marge]

Have you had an INR? since you began coumadin this last time? What was it? Have you had more than one? What was that one?........ Are you still going to have 2 draws a week..?If you don,t mind posting them..we will try to help you figure out what you need to do..without a huge doseage change.......It is harder to get an INR up..than lower it..... Lowing is easy..drink a V-8 juice..Have a little coleslaw...ect...If mine drops below 2.5 I tweak a few days..I bite a bit off of my regular 5 mg..Have a little private place I keep them. ..Go and enjoy that wine tasting dinner Then see what your next INR will be..I just hope that if you are testing 2 times a week..It's 3 days in between. ..Bonnie

No, it turns out they think I only need to test once a week. I suppose that could change depending on circumstances. I have only tested once since I've been on coumadin. I started taking it a week ago (Tuesday May 3).

I am taking 5 mg. a day except one day of the week when I'm taking 7.5 mg. This is the same dosage I was taking when I was on the stuff after the surgery. It got me in range fairly easily last time, so they are using the same dosage this time.

Yesterday (Monday May 9) was my first blood draw since starting. The INR per that test was only 1.8. They want me in the 2.0-3.0 range.but the anti coagulation specialist says it is going up predictably and it is OK, considering I've only been doing this for a week, so they want me to stick with the same dosage. Does that sound right to you?

 

[Marge]

Re: Difficult blood draws--

After having had chemo. my veins are totaly fried. And others in the same position have similar complaints. Here is what the veterans say (those who have had chemo and have found a "work around" for the difficulty of draws.

They say to drink plenty of water the night before, and also the day of tests. They also say keeping the arm warm helps as well, even running some warm water on it at the docs office.

Maybe some of the nurses and docs here could impart some additional wisdom.

WATER!! What a simple thing. But during my three months on the coumadin a year ago, with blood draws 2x a week for a good deal of the time, and all the drama at the lab when they tried to find a vein that would yield blood -- NOBODY said anything about drinking water.

Then finally, when I had the draw for the baseline test before going on coumadin this time around, and the same problems surfaced, the tech said: "Try drinking a lot of water before your next blood draw."

So I did. Yesterday, at my first blood draw since starting coumadin -- whether because of the water, or because I had a more experienced tech who didn't try to get blood out of the scarred area in the underside of my elbow, but further down my arm -- it went much MUCH better. I am now contemplating future blood draws with less dread.