Regulating Vit K and coumadin question

[jenebug]

I am approaching 4 weeks post AVR, and this coumadin thing and vit K has me somewhat concerned. To begin with I was very thin (INR) at 5.4, so they changed my dosage. The next week I was fine at 3.2. They said we would come back in a week to recheck, then try for the 2 week periods. When I returned last week, it was down to 2.3. I had only had a high K food twice, unless something crept in that I didn't catch. So now it's back to once a week again.
Question is this, why can't the coumadin be adjusted to what I eat instead of vice versa? I do recall them saying that it was pretty critical during the first 30 days (mechanical valve). Will this ease up after a while? I am having to check every food I eat against the list they provided, for fear I'm gona mess up something, and aparently it didn't do me much good last week.
Please tell me this is going to get easier. Eating the 1/2 c. of broccoli for supper was really hard, as I could have eaten much more ! LOL
Thanks in advance for any help.

 

[dick0236]

Question is this, why can't the coumadin be adjusted to what I eat instead of vice versa? .

That is your eventual goal....."dose the diet, do not diet the dose". In the beginning, this INR stuff may seem a little frustrating and the "INR swings" might be a little unnerving. It WILL level out after a little while and you won't have have to worry about 1/2c of broccoli. After only 4 wks. you should expect some swings and going from 3.2 to 2.3 ain't a big deal. My last three INRs were 3.4, 3.5, 2.6. I do not have any concerns so long as I stay within, or close to, my range of 2.5-3.5......and I have never really figured out the swings in my INR. Only when I show a trend up or down do I normally make a change in dosage.....and then only a little. That said, the 5.4 would concern me since I have been on this stuff a long time. With you, a 5.4 probably has a lot to do with your recent introduction to the drug. Take a deep breath.....it ain't "rocket science" and you will get a handle on it shortly.

 

[Jkm7]

Most current, well educated coumadin management professionals profess your suggestion of dose the diet and NOT diet the dose. To diet the dose puts the responsibility on the patient to prove the coumadin manager right that they prescribed the proper dose. That is no way to live.

I only had a short course of coumadin after getting my tissue valve but all my doctors and nurses at Mass General were firm in their advice to me to eat a reasonable diet including Vitamin K foods and it was far more important to be consistent than to avoid certain foods. They told me if I like brocolli, which I do, to eat it consistently, or salad, or asparagus or whatever. You can eat your favorite foods in reasonable quantity but should pay attention to be consistent. Consistency is the key

Discuss this idea with your coumadin managers. Their instructions to you really are out of date. They are most assuredly not alone. Much of the medical community is woefully undereducated when it comes to managing and dosing ACT.

It is rather common for people newly starting ACT to need a period of time to get solidly in their proper range. Post op, as you become more active, you may find your dosage needs to be adjusted. You are not alone in having a bit of adjustment in these early weeks. It Does get better sooner or later. Some start off easily in range and others take a bit longer.

You may wish to read the Anti-coagulation section of this forum if you have not done so. Read back many pages and you will be very versed more practical management of this life saving drug.

Happy you found us and really hope we can help.

 

[jenebug]

Thanks to both of you - encouraging words. They've got me feeling like if I eat something with moderate vit K daily, I will be really harming myself. My so called "critical" 30 days will be up this week, and I am to see the cardiologist for the first time since surgery, on Thursday. He and I are gona have a good sit down talk about this.
I will read the anti coagulation section. Thanks for pointing it out to me. This is a great site, and has helped me already.

 

[Luana]

Question is this, why can't the coumadin be adjusted to what I eat instead of vice versa? I do recall them saying that it was pretty critical during the first 30 days (mechanical valve).

That is exactly how it should be: the dose is tailored to the diet, not the other way around. Most people who manage ACT still believe and tell patients to avoid or severely limit salad greens and green vegetables. I freely eat what I like of both and maintain INR just fine. I threw out the silly pamphlets I was given in the hospital and never even think about what I eat when it comes to vitamin K.

It's not unusual to be a bit rocky initially as you may be on meds that could be interfering with INR, too.

 

[tom in MO]

Your advice to "check every food I eat against the list they provided, for fear I'm gona mess up something" is exactly what the young pharmacist in the hospital told me NOT TO DO. He said don't avoid foods, but make sure I eat a balanced diet, and don't binge on any food. That's the modern approach.

I got my mechanical valve in February and it took awhile to get my INR stable and then after about 4 months it changed and settled down again. Don't worry.

If it's possible, get on the train for home testing. For me, insurance let me do it after 90 days. It makes the whole process a lot easier.

 

[drivetopless]

Yep-- good advice here.
Quit checking that food list. Eat what you would normally eat. If you can, try to eat about the same amount of greens every day.
The key is consistency. Take a daily multi-vitamin with a small amount of Vita K will help the swings by leveling the amount of K in your system.

It took me a good 6 months post-op to get really stable, so be patient. I think post op our bodies are still recovering from the shock of the surgery and some unexplained swings happen.

If i tested at 5.4, I'd eat some spinach immediatey. Ha ha!

 

[AgilityDog]

Good advice up there.

One thing I do, since I'm also on a very low salt diet, and watching my weight, is to make up my own frozen lunches to take to work, in single serve portions. So I'll make up a huge (12-16 servings) batch of soup, with meat (turkey, chicken, ground beef), a whole grain like barley or brown rice, or whole wheat pasta, lots of veggies, including either a head of cabbage, or a single bunch of kale, or a bag of spinach, with onions, carrots, celery, and lots of spices. Then I'll also make up a big spinach lasagna, and a big casserole of saute'd veggies (including leafy greens), meat, and ww couscous or brown rice, or other whole grain. I put each into single serving tupperware and freeze them.

Then I have a month or two of lunches in the freezer, each of which has a reasonable dose of Vit K in it. I then spend one day every 2nd or third weekend and make a batch of whatever I'm running low on: pasta dish, casserole, soup, whatever, to keep the freezer stocked.

Then for dinner it's lean meat, a potato, and either a salad or a serving of brussels sprouts, or spinach, asparagus, or sometimes even saute' kale.
This keeps my diet and vit k intake reasonably consistent, and also helps with my sodium control and weight control.

 

[jenebug]

Thank you all ; you are helping to take the fear out of this situation. I live in the country and we have a garden with lots of fresh greens most of the year. I cannot see myself not enjoying them, in moderation of course. I do agree with what someone said- it is not my job to make the coumadin clinicians look good! LOL. We normally eat something green 3-5 times a week, so hopefully in time this will adjust. Thanks again.

 

[Jkm7]

So happy you asked and we could start to put your mind more at ease.
When you see your cardio, have that conversation you mentioned.
Let us know how you are doing.

 

[jenebug]

I certainly will, and you can expect me to report back in about Thursday nite! lol

 

[tom in MO]

I live in the city but have access to a very good City Market. In season I eat something fresh and green virtually every day, lettuce, kale, spinach, green beans, brocolli, kohlrabi, bok choy, okra, etc. In cardiac rehab they tell you to eat something of every color (including green) every day. My Cardio and coumadin clinic are fine with it.