Questions about diet and INR

[JiminMI]

After a full year of being "in the waiting room" for OHS, I'm finally going in for surgery next week for repair of an aortic root aneurysm and a possible AVR. My surgeon says that his first priority is to spare the valve if he can with a David procedure. If he determines that the valve needs to be replaced, then he will put in an ON-X valve, which I feel is my best choice in the mechanical valve department.

The "tissue or mechanical" decision was definitely not an easy one. I've read many opinions about valve choice on this forum, and though it never really made my decision easier, it was encouraging to see so many positive attitudes from people with both kinds of valves. Ultimately I chose mechanical because that's what 2 of 3 surgeons thought would be best for me (the 3rd surgeon had no preference, saying the decision was strictly mine). Though I'm still leery about how I'll handle ACT, I had more confidence in having a more durable valve in me. Seems from what I've read, a tissue valve could last a dozen years or maybe only a couple, and I don't want my chest cracked open any more than once if possible.

A few INR questions about food and other consumables: I've read about the need for maintaining a consistent diet while on warfarin. I assume this means that you should regulate your intake of vitamin K ; can other foods be consumed pretty much as you like? At 6'0" and 140 lbs., I'm certainly not an overeater, I'm just trying to get an idea of just what needs to be closely monitored. Consistency. . .so if I have a small salad at lunch and some steamed vegetables at the evening meal, does this mean I should try and eat this every day? I suppose INR is an individual thing, but again I'm wondering about how sensitive this INR balancing act is. Caffiene . . .I like 1-2 cups of coffee in the morning, and I'll have 1-2 caffed soft drinks in the afternoon. As for alcohol, while I've read it should be generally avoided, many have said that a drink or 2 a day shouldn't be a problem. At about 2-3 beers per week (12 oz/day), I think I'm a light drinker---but would this pose a problem for "consistency" in that it would throw my INR out of wack? Somehow I doubt that the rule is that if you're going to have a drink, then you better have one every day!

It's been these kinds of personal concerns that had me waffling back and forth about "tissue or mechanical". If I had to monitor everything I ate and drank that closely every day, along with doing the periodic blood tests, do I really want to have a mechanical valve for the rest of my life?!! However, depite these concerns, I still chose to "go mechanical" . . .hope I made the right choice. The personal experiences of others on this forum has me confident that I'll be able to adapt and manage it. Better learn to---right?!

 

[normofthenorth]

Jim, I'm hardly an expert, though I've been on Warfarin (with reasonable success, despite a small target range of 2.5-3.0) for ~5 weeks now. (After some initial roller-coastering, my last two or three weekly INR readings were both right in the middle of that tiny target range at 5mg/d of generic Warfarin -- and I've also noticed NO tendency to bruise OR bleed! -- so right now this ACT thing seems easy from here -- touch wood!)

First, if you're thinking of tweaking your diet, this might be a good time -- and not just because it's New Years! -- to consider tweaking it in directions that seem to be good for health and longevity. The two things you mention that line up with epidemiological studies I've seen recently are the "1-2 caffed soft drinks" /day and your "about 2-3 beers per week (12 oz/day)".

BTW, I don't know how you translated "about 2-3 beers per week" into "12 oz/day"! Either the beers are MUCH bigger in MI than they are here in ON (Canada), or something else is wonky. Most of our beers are pretty close to 12 oz. each, AFAIK, and 2-3/week is less than 1/day. . .

At first blush, I think you'd be imitating the long-term survivors better if you quit the soft drinks (esp. if they're sugar-sweetened, though I've recently seen one study that links artificially-sweetened soft drinks with bad health outcomes!) and increased and "regularized" your alcohol intake to around 1-2 wines or beers per day.

I haven't seen anything linking soft drinks (or sugar) to INR, and what I've seen about alcohol isn't very strong -- i.e., <=2 drinks/day doesn't seem to have much effect on it.

Most of the Warfarin/Coumadin guidelines and calculators now focus more on WEEKLY drug dosage rather than DAILY, and it may be helpful to take that "aerial view" of your diet, too. E.g., maybe there's not much practical difference between having TWO leafy-green dishes every OTHER day, and having ONE PER day.

I don't know -- and I don't know if our species knows, either -- how important our daily, or hourly, or instantaneous INR is, as opposed to our bi-daily or weekly average. Obviously our INR readings are "snapshots" that tell us exactly what we've got at the moment of the blood draw, and nothing else. But our risk of "thromboembolic events" from "funny" heart parts (like my MV ring and your mech AV), and our risk of "bleeding events" etc., may not follow the same schedule. E.g., I can imagine that the risk of a heart part "throwing a clot" is a cumulative risk that takes at least days if not weeks or months to reach the stage where you're in real danger of seeing something clinical happen. That certainly makes sense if clots regularly form and re-dissolve (e.g., on my MV ring or your mech AV hinges), as INR fluctuates, e.g., from day to day. E.g., I can imagine (note the verb choice!) that if your INR were 1 point too low for a week, a little clot would likely start forming at your mech AV hinge. But after a week, it still might not have reached the critical size when it might break off and cause a stroke or such. Then, if your INR went into range or a smidge above (say for another week), it might slowly dissolve, until it was completely GONE at the end of that second week. I'm just imagining here, but it might well correspond to the real-world mechanisms that lie behind one of the main things we're trying to avoid.

On the other hand, the risk of a "bleeding event" may be a function of real-time, "instantaneous" INR, relatively unimpressed by the fact that our INR is perfect on a weekly-average basis. (I was raised with a politically-incorrect joke that's relevant here: "I'm manic-depressive [now bipolar], but on the AVERAGE I'm fine!" ) IOW, if you're unlucky enough to "blow" a brain aneurysm, or to slash yourself in an industrial accident, at a moment when your INR is unusually high (say, you were just ON YOUR WAY to have your big salad of the week!), that "bleeding event" probably doesn't give a HOOT what your AVERAGE INR has been for the past week, or month, or even day.

Again, I'm just trying to "draw a picture" of the mechanisms that seem logical, given what (little) I know about INR, and about the risks on both sides of the range.

I THINK I remember that the studies (e.g., on survival of mech-valve recipients) show much higher survival risks from clots than from bleeding events, and I'd GUESS that the clot risk is more a function of time-averaged INR than (say) its cumulative variance from the middle of your target therapeutic range, while the (smaller) bleeding-event risk may be more a function of the latter.

I'd be shocked if modern science even had good solid guesses (much less stat-significant data) about the relationship between INR "shape" and INR risks that I'm discussing here, though they're obviously very important to both (almost all!) of us -- though me, I HOPE to lose interest after my 3 months of planned ACT is finished!

BWT, you don't mention if you've got a BAV or not, and I haven't re-read your old posts to find out. If you do, I'd think that the same personal values that make you strongly prefer a mech to a tissue AVR would also incline you to AVOID a "David" valve-sparing procedure. Am I the only person who sees the parallel here? You're working hard to avoid the uncertain-but-likely future risk of a re-op that comes with a tissue valve, so you're opting for a "forever" mech valve instead, even though it comes with other nuisances and risks. But you're delighted to accept the uncertain-but-likely future risk of the re-op that would come from the ultimate failure of a congenitally defective BAV?? Obviously it's not my decision in any way shape or form, but to me, the logic (and values) suggests that they should replace a "maybe forever" BAV with a "definitely forever" Mech AV at the same time, while they've got you cracked open and on the pump anyway. . . (If your AV is not a BAV, but is otherwise a bad risk for the long haul, I think I'd apply the same logic if I had chosen mech over tissue, in my situation, given my personal values.)

 

[dick0236]

I am sure that "strict consistency" is not the key to my INR management and for the past several years, I have had a very stable INR(2.5-3.5). A few recent problems(5 or 6 years ago) had been due to improper management by an X-PCP. I do not, and will not, maintain a repetitive diet. Stay with your normal eating/drinking/activity habits and adjust the warfarin dose accordingly. I prefer the phrase "do not binge" on either food, drink or lifestyle. I have had few problems so long as I maintain my normal diet and lifestyle. If you dramatically alter your eating, drinking or lifestyle habits you probably will have some difficulty maintaining your INR. FWIW...it was a decade+ after my surgery before doctors began to "warn":rolleyes2: me of vit K intake.....and yet I survived those early years in complete ignorance of vit K effect.

My only caution to anyone going on warfarin is to "take the warfarin as prescribed and test routinely" and you probably will have few problems....at least that is my experience.

 

[JiminMI]

I have tricuspid AV Norm; though I was told from the initial echocardiogram that I had a BAV, they later confirmed it was a normal tricuspid valve with a TEE . . .problem was the doc said there was still "some leakage", though he said it "wasn't that bad". I've obtained several copies of my records over the last months to send to other surgeons for their opinions. At one point, I had to have a look myself, so I popped the CD of my TEE in my computer's DVD drive and clearly saw 3 triangular leaflets of my AV flapping away. Looked like they were doing their job as far as I could tell, but what do I know? It was interesting at least!

I've had long to contemplate my situation and I definitely do know what you mean about a valve sparing procedure and using a mechanical valve. If they can spare my natural AV with a chance that it may eventually need to be replaced, essentially I'm choosing a tissue valve--my own tissue! But if they need to replace it, while they're in there I chose the mechanical valve! Of course it depends on the condition of the valve and if the doc thinks he can or should repair or replace it. I was given the option of making that decision for myself by one surgeon; he had recommended a MV with conduit. When I expressed my concerns about ACT, he said he could just repair the aneurysm and leave the valve if I wanted it that way, but he said there was a chance of a reoperation. I decided I really could not play doctor myself, and I said that he would have to decide during the procedure if the valve was saveable. But this is one of the things that caused much agonizing and indecision about what to do.

As for the beers, I should clarify that I drink about 2-3 12oz. beers in a week . . .say one Friday, one Saturday, and a third on another day when I feel I can use one.

 

[JiminMI]

I am sure that "strict consistency" is not the key to my INR management and for the past several years, I have had a very stable INR(2.5-3.5). A few recent problems(5 or 6 years ago) had been due to improper management by an X-PCP. I do not, and will not, maintain a repetitive diet. Stay with your normal eating/drinking/activity habits and adjust the warfarin dose accordingly. I prefer the phrase "do not binge" on either food, drink or lifestyle. I have had few problems so long as I maintain my normal diet and lifestyle. If you dramatically alter your eating, drinking or lifestyle habits you probably will have some difficulty maintaining your INR. FWIW...it was a decade+ after my surgery before doctors began to "warn":rolleyes2: me of vit K intake.....and yet I survived those early years in complete ignorance of vit K effect.

My only caution to anyone going on warfarin is to "take the warfarin as prescribed and test routinely" and you probably will have few problems....at least that is my experience.

Thanks Dick. I get a bit confused reading the many posts from people on ACT. While many say just eat a normal diet and be consistent, there's always an occasional story of someone's INR fluctuating out of range, for reasons not always clear. Since I have no experience to date with ACT, I have been wondering for some time just how delicate the INR maintenance thing really is.

 

[ALCapshaw2]

MY definition of 'being consistent' in vitamin K intake is to eat something green every day.
Maybe even 2 different green things (e.g. a small spinach salad and a green vegetable).
NO Measuring. NO counting. Works for me and my INR is fairly stable with some minor changes with the seasons.
It's NO BIG DEAL as far as I'm concerned.

You may want / need to limit your Caffeine (coffee, tea, colas, Chocolate, etc.) consumption,
especially post surgery, since Caffeine is a known trigger for heart arrhythmias.

'AL Capshaw'

 

[normofthenorth]

I have tricuspid AV Norm; though I was told from the initial echocardiogram that I had a BAV, they later confirmed it was a normal tricuspid valve with a TEE . . .problem was the doc said there was still "some leakage", though he said it "wasn't that bad". I've obtained several copies of my records over the last months to send to other surgeons for their opinions. At one point, I had to have a look myself, so I popped the CD of my TEE in my computer's DVD drive and clearly saw 3 triangular leaflets of my AV flapping away. Looked like they were doing their job as far as I could tell, but what do I know? It was interesting at least!

I've had long to contemplate my situation and I definitely do know what you mean about a valve sparing procedure and using a mechanical valve. If they can spare my natural AV with a chance that it may eventually need to be replaced, essentially I'm choosing a tissue valve--my own tissue! But if they need to replace it, while they're in there I chose the mechanical valve! Of course it depends on the condition of the valve and if the doc thinks he can or should repair or replace it. I was given the option of making that decision for myself by one surgeon; he had recommended a MV with conduit. When I expressed my concerns about ACT, he said he could just repair the aneurysm and leave the valve if I wanted it that way, but he said there was a chance of a reoperation. I decided I really could not play doctor myself, and I said that he would have to decide during the procedure if the valve was saveable. But this is one of the things that caused much agonizing and indecision about what to do.

As for the beers, I should clarify that I drink about 2-3 12oz. beers in a week . . .say one Friday, one Saturday, and a third on another day when I feel I can use one.

First, about the beers: I've got no trouble with your 2-3 12oz. beers in a week. My only confusion came when you said that was the same as 12oz. a DAY. I guess you meant you have 12oz. a day, and you do that 2-3 days per week. OK, but it still puts you a little closer to the "tee-total" edge of the population curve, than the longevity "sweet spot"!

Concerning the valve sparing, I think I'm still concerned that your values and your surgeon's may not align yet. It sounds perfectly sensible to let him decide "if the valve was saveable" or not -- until you realize that he may be recommending tissue valves to many patients, when you would choose mechanical in their places. A valve that's likely to last for (say) 15 years is probably "saveable" and "worth sparing" to y'r average surgeon -- but NOT to somebody who is really keen on not getting cracked open a second time, even if it means being on ACT forever.

Look, you don't need this "tissue-valver" to tell you what you value, but. . . if you're going to end up sharing my logic here, you might as well do it BEFORE the surgery, right? Basically, if your AV can be "saved" (either by being repaired or by just being left alone) to the point where it has a life expectancy comparable to a new tissue valve (like a CEP or a Hancock II), you presumably DON'T want to keep it ("spare" it), any more than you would want that new tissue valve, right?

If you think they're planning to leave your (T)AV as it is, you may want to look at the sequence of your last bunch of echo-cardiogram results, to see if its rates of stenosis or regurg are changing. If the numbers aren't changing and your cardio and your surgeon all think it's stable, and likely to last longer than you are, then you have my blessing to spare it(!).

 

[Protimenow]

Consistency is a good thing -- but being obsessive about it is not necessary. My diet DOES vary from day to day, but I'm not a big fan of dark green vegetables. (Research continues to show benefits of Vitamin K, so I'm learning to like more green stuff. The think with K is that it helps to reduce your INR -- but this is not a problem - you just adjust your warfarin to compensate).

Being on warfarin isn't a bad thing - you don't really change your lifestyle all that much.

Also - the fear of bleeding out may be a bit overrated, too. An INR of 2.0 means that it takes twice as long as 'normal' for you to clot. I've had some worrisome bruising events -- I dropped an 80 pound block of marble on my foot, and it DID blow up -- but aside from pain, bruising, a really remarkable looking bruise and some discomfort, I survived it -- although I don't know what my INR was at that time.

I suggest that if you're worried about managing the INR, see if your doctor can prescribe self testing -- either prescribe a meter and strips, or refer you to one of the services that acts as intermediary between you and doctor. This way, if you feel that you've fallen too far out of consistency (maybe three or four salads and a keg of beer, instead of a salad a day), you can always check a day or two later and confirm whether or not you have a problem.

I've been on warfarin since 1991, and we have one member who has been on it since 1967. I don't think it's something to be feared -- respected, yes -- but not feared.

My INR fluctuated - for whatever reasons (phase of the moon, activity/inactivity, diet, season, etc.) and, like the others here, I didn't overreact but responded appropriately (so far).

I wouldn't choose between tissue and mechanical just because of ACT - I'd look at my age and how many years I plan to be around - regardless of whether or not I'd have to take warfarin. (In other words, if I'm 90 years old, I'd go with tissue -- at 41 (which I was when I had my AVR), mechanical was the best choice for me.

It sounds like you've made the right choice -- IF the surgeon thinks you need a valve replacement, mechanical is probably the best choice.

 

[normofthenorth]

Protimenow, with all respect saying "I wouldn't choose between tissue and mechanical just because of ACT" is a lot like saying "I wouldn't choose mechanical over tissue just because of the risk of re-ops"!!

These ARE PRECISELY the two main disadvantages of the two types of valves! Some of the new data indicates that the risk of re-ops (at least when done at the best centers) is now surprisingly low. The risks of ACT may well also be coming down with INR and with self-testing, though the comparison between the two clearly depends on the patient's age. At your (then) 41 years, it seems almost certain that your choice of a mechanical valve was "going with the odds".

 

[normofthenorth]

Jim and all:
Above I speculated that ". . . if you're unlucky enough to "blow" a brain aneurysm, or to slash yourself in an industrial accident, at a moment when your INR is unusually high (say, you were just ON YOUR WAY to have your big salad of the week!), that "bleeding event" probably doesn't give a HOOT what your AVERAGE INR has been for the past week, or month, or even day."

I was just drawing a logical picture, but I've since found a study that seems to confirm that logical truth:

http://www.ncbi.nlm.nih.gov/pubmed/18073596
Retrospective study (2004-2006) of all elderly trauma patients (age >/=65 years) who were evaluated by the trauma service at a Level I trauma center and underwent computed tomography of the head for suspicion of an intracranial injury was performed. Three cohorts were grouped: (1) warfarin users with an admission International Normalized Ratio >/=2 (therapeutic group), (2) warfarin users with an admission International Normalized Ratio <2 (nontherapeutic group), and (3) warfarin nonusers. Main outcome variables were presenting with a Glasgow Coma Scale (GCS) score </=13 points, intracranial hemorrhage (ICH), overall mortality, and mortality after ICH.
RESULTS: A total of 225 trauma patients were studied, including 40 warfarin users (17.3%), of whom 22 (55.0%) were in the therapeutic group. Age, gender, and mechanism of injury were similar among groups. Likelihood of Glasgow Coma Scale score </=13 (odds ratio [OR] = 5.13, 95% confidence interval [CI] 1.97-13.39, p = 0.001), ICH (OR = 2.59, 95% CI 0.92-7.32, p = 0.07), overall mortality (OR = 4.48, 95% CI 1.60-12.50, p = 0.004), and mortality after ICH (OR = 3.42, 95% CI 1.09-10.76, p = 0.03) was increased in the therapeutic as compared with the nonuser group. There was no difference in any measured outcome between the nonuser and nontherapeutic groups.
CONCLUSIONS: Therapeutic anticoagulation with warfarin, rather than warfarin use itself, is associated with adverse outcomes after traumatic brain injury in elderly patients.

Note that the people who said they were on Warfarin, but whose INR measured <2, survived the brain-trauma injuries just as well as the poeple who said they were NOT on Warfarin. But those with INR >2 did much worse, in all outcomes including survival and intracranial hemorrhage (ICH), etc. In these cases ("trauma", =~ people who fell down), I think it's logical that their INR histories didn't affect their "bleeds" -- just their actual INR at the time of the trauma. As I said above, I THINK the mechanism of clotting events is quite different, and MAY WELL be affected by the long-term history of the patient's INR maintenance.

Also, my recent glancing over some studies suggests that bleeding events (made worse by high INR) may be slightly less FREQUENT than clotting events (made worse by low INR), but they are generally more serious, more often fatal, and less often (partly or completely) self-reversing or temporary.

Off to take my Warfarin now. . .

 

[Philip B]

Diet & INR?

Diet & INR?

Eat what you want and eat it when you want to. It's not that tough to adjust coumadin dosage to keep your INR where you need it to be.

-Philip

 

[dick0236]

NO Measuring. NO counting. Works for me and my INR is fairly stable with some minor changes with the seasons.
It's NO BIG DEAL as far as I'm concerned.

Amen:biggrin2::biggrin2:

 

[JiminMI]

NO Measuring. NO counting. Works for me and my INR is fairly stable with some minor changes with the seasons.
It's NO BIG DEAL as far as I'm concerned.

Eat what you want and eat it when you want to. It's not that tough to adjust coumadin dosage to keep your INR where you need it to be.

That's what I like to hear; thanks for the reassurance. With my surgery only days away, and having canceled two previous ones, I'm starting to get that uneasy 'fight or flight' feeling.

 

[dick0236]

That's what I like to hear; thanks for the reassurance. With my surgery only days away, and having canceled two previous ones, I'm starting to get that uneasy 'fight or flight' feeling.

Over time, it won't get easier:wink2:. Putting it off only allows the heart damage to continue. The track record for successful OHS is very, very high and the opportunity for a long, healthy life will follow the surgery....but it does require a "little leap of faith":smile2:

 

[Bina]

no measuring or counting for me either. I eat sensibly anyway, no fast food or caffeine.
But my point is that my coumadin dosage stays the same for years at a time. I eat broc and salads about 4 times
a week because that stuff I love, and it's nutritous too, double bonus.
Nit-picking over vitamin K will drive a person nuts and it just isn't worth it. Been there, done that. Bought the tester.

 

[Philip B]

Diet Concerns

Diet Concerns

As I've got older, I tend to be much more concerned about exercising some level of common sense about my diet because I want to eat healthier to avoid weight gain. This aspect of watching what I eat is much more important to me than my diet's affect on my INR.

-Philip

 

[Protimenow]

Protimenow, with all respect saying "I wouldn't choose between tissue and mechanical just because of ACT" is a lot like saying "I wouldn't choose mechanical over tissue just because of the risk of re-ops"!!

These ARE PRECISELY the two main disadvantages of the two types of valves! Some of the new data indicates that the risk of re-ops (at least when done at the best centers) is now surprisingly low. The risks of ACT may well also be coming down with INR and with self-testing, though the comparison between the two clearly depends on the patient's age. At your (then) 41 years, it seems almost certain that your choice of a mechanical valve was "going with the odds".

Norm -- I think you missed my point. I am saying that the choice between mechanical and tissue should NOT be made simply to avoid the possibility of having to take warfarin. The choice between tissue and mechanical because of the risk of reoperations is a much more SERIOUS choice. Even now, we're seeing people with tissue valves needing reoperations in as little as 7 or 8 years. Having a reoperation is a LOT MORE SERIOUS than simply having to take ACT for decades. I didn't have a lot of choices when I had my surgery - I was relatively young, and tissue valves would clearly have failed many times during my lifetime - a mechanical was the only logical choice.

The risk of reoperations that you mention may be low, in part, because the population getting the tissue valves is much older than the population choosing the mechanicals, and these older people may die of other causes before their valves fail. I'd look at the POPULATION for whom these 'surprisingly low' results are being made -- and at something about how long the valves have lasted before making any statements about reduced risks or applicability to a younger population. Although there are procedures that are less invasive than OHS, and perhaps in the next few decades, there won't be much need for mechanical, I still see mechanical as the valve type of choice for anyone planning on living more than a decade or two. (Also -- along with the improvements in valve surgery, we may be seeing new ACT drugs that make the whole issue of INR management much less of an issue for people with mechanical valves).

 

[normofthenorth]

Sorry, guy, but I think you're trivializing the most serious, most important, and most PERSONAL choice most of us VR folks have to make. To you it's clearly a "no-brainer", despite the fact that you're apparently in the minority of people currently making this important decision! Hello!! I bet you've met a LOT of people who are on one fringe or another, and believe that the REST of the world is crazy! I know I have, and I think there's one sitting at about every bar in the world. (SOME of them may be RIGHT, too!! )

Your response also confuses two different ways to avoid dying from a re-op: (1) You're right (but it's NOT what I was talking about), that a remarkable number of tissue valves are currently demonstrating remarkable longevity -- e.g., see the new (2010) study from TGH that refers to the Medtronics Hancock II valve as the "Gold Standard" of tissue valves, with quite high 20-year durability stats in the two more senior age categories (70+ and 60-70). No guarantees, of course, but you didn't get any, either.
(2) But the people I was referring to in my comment about 'surprisingly low' mortality rates were NOT the people who skipped the re-op entirely because their tissue valve lasted so long. Rather, they were the people who GOT the re-op and survived it, because a number of recent studies are showing re-op mortality numbers that are . . . well, 'surprisingly low'! Some studies have shown re-op survival rates that are actually equivalent to current first-op survival rates(!), and many have shown re-op survival rates that are better than first-op survival rates USED to be, a decade or two ago. See, for example, one recent study with the title "Repeat Sternotomy in Congenital Heart Surgery: No Longer a Risk Factor"!! (Those authors suggest that people facing heart surgery should actually IGNORE the possibility of needing a re-do, because the risks are so low that it's not "a Risk Factor"! I think they're NUTS, because there are lots of sound reasons to dread, or to avoid, a re-op, even if the mortality stats are ZERO, which they aren't.)

Meanwhile, you currently have an elevated risk of experiencing a problem (possibly serious or fatal) from a clot (despite your ACT) AND of experiencing a problem (possibly serious or fatal) from a "bleeding event" like head trauma and an inter-cranial hemorrhage (because of your ACT). Maybe you don't consider those possibilities SERIOUS, but please forgive me if I do. (And I am currently at risk for both of those myself, because of my MV repair and the ACT it's got me on, for three months, so I'm not claiming that you're at a risk I'm immune from!)

You are welcome to ignore the risks you've chosen for yourself; in fact, if it helps you stay sane and functional, I recommend it! But please don't insist that the rest of us make that same decision, or ridicule us if we don't.

 

[Bina]

Reminder: Jim has asked a very sane and common question as he prepares for surgery; diet effects on INR.
Let's NOT have this thread turn into a debate and argument over his choices.
Many tissue valvers and many non-valvers end up taking Coumadin for A-Fib or clot risk factors, so either way
his question is a very important and valid one.

 

[Philip B]

Flight?

Flight?

Hi Jim,

It's easy to let our well-meant comments kinda freak you out. Some of the commentary here even confuses me.

If it's any consolation, I was trying to talk my way out of the surgery that was going to save my life right up until they finally knocked me out.

Move forward with confidence. You'll be okay.

-Philip