summer harvest and vitamin K

[pink.gingham]

This is only my second summer with the mechanical valve and I'm worrying about food. I like to eat with the seasons, and right about now all the vegetables look so fresh and delicious! But I don't want to mess up my INR, which has been a constant problem.

 

[Guest]

Eat what you like. If you greatly increase the amount of green leafy vegetables, get your INR checked about once a week and have the warfarin dose adjusted accordingly. You will have to repeat the same thing after the first frost.

If you want to talk to someone who knows a lot about warfarin, call Diane Hindman at the Ontario Ministry of Health in Toronto. She was one of my students and can give you good advice. Tell her "Captain Coumadin" referred you. She will get a laugh out of that.

 

[pink.gingham]

I'm actually at my wit's end because I've been getting my INR checked pretty much every week for 2 years and have never stayed in the target range for more than a few weeks. I've just started keeping a food and medication diary.

Thank you for the contact info for your student, is she a public health worker?

 

[pink.gingham]

Well I cabn't find that woman. If anyone has a reference to very precise info about vitmamin K content of food, could you please let me know? I have several lists of what's high or low, but I'd like a chart that somehow helps me know how much is a serving so I can carefully eat about the same amount per day. Distressed by the INR dance. Thanks.

 

[Cris N]

Excellent Vitamin K list

Excellent Vitamin K list

Well I cabn't find that woman. If anyone has a reference to very precise info about vitmamin K content of food, could you please let me know? I have several lists of what's high or low, but I'd like a chart that somehow helps me know how much is a serving so I can carefully eat about the same amount per day. Distressed by the INR dance. Thanks.

I found this on the USDA website... you can download it either by alpha or by Vitamin K amount. It shows the amount in a common serving... like a cup of broccoli, instead of by weight. Huge list of food! Here's the link.
http://www.nal.usda.gov/fnic/foodcomp/Data/SR17/wtrank/wt_rank.html

Cris

 

[pink.gingham]

Thanks, Cris! That's exactly the kind of counter I've been looking for, thank you, I think that will be a great help. I'm so fed up with the INR dance.

 

[Ross]

I'm telling you right now, throw that Vit K counter out the window. It is going to do you absolutely no good. Doing it this way has never worked for anyone yet. Your only going to further drive yourself nuts. You need to eat what you want and adjust the dose to accomodate that diet. Dose the diet, do not diet the dose.

Help us out here. Give us as much information as you possibly can concerning your current dose management. Exactly how much Coumadin per week are you taking? What does your diet consist of? Any other medications? What was your last INR reading? Was the dose changed at that test?

I have a huge feeling that whomever is managing your dosing, is not doing properly and it's causing you all sorts of problems.

 

[MyAorticValveisKaPut]

This is only my second summer with the mechanical valve and I'm worrying about food. I like to eat with the seasons, and right about now all the vegetables look so fresh and delicious! But I don't want to mess up my INR, which has been a constant problem.

Wow that must be frustrating!I love to eat food! gonna go piggy valve.

This is why I'm really weary about going mechanical. my lifestyle would not tolerate checking levels and such. Some say its no big deal and all, but I could imagine thats a constant pain in the arse.

 

[Ross]

Wow that must be frustrating!I love to eat food! gonna go piggy valve.

This is why I'm really weary about going mechanical. my lifestyle would not tolerate checking levels and such. Some say its no big deal and all, but I could imagine thats a constant pain in the arse.

Really it's not, so long as whomever doing the dosing knows what their doing. I've been on it for almost 4 years now and it hasn't affected my lifestyle one bit. I truly believe that the person taking the drug is the one that limits themselves, not the drug itself. There are far too many bull crap stories being told to people about Coumadin. The worst part of all is that most of the BS comes right from the health care provider!

 

[pink.gingham]

Well actually, I *have* been eating what I want and getting my INR checked
every week for 2 years. And that's not working! I've just started keeping
a food diary and my other meds haven't changed in awhile. Are you a
thrombosis specialist? My doc says there's a handful of people like me who are difficult to keep steady. I'm vegan so my diet is primarily plants and carbs, and as you know it's the plants that are up and down with the K.

 

[Nancy]

My husband has been on Coumadin for 28 years. I guarantee you that your INR will fluctuate, that is the nature of the medication. You will be making adjustments frequently. There is nothing wrong with you, it's just the way it is. If you try to keep it exactly on target all the time, you will drive yourself crazy. It is not only food that makes it fluctuate, but your activity level, your medications, your time of the month, if that applies, how you feel that day and if the moon is in the seventh house, and Jupiter aligns with Mars, in otherwords, you cannot adequately predict what will happen. That is why testing when on Coumadin has to be done.

As others have said, eat what you like, don't overdose on anything, everything in moderation.

Al Lodwick is an EXPERT on Coumadin. Visit his site warfarinfo.com He is the "go to" man for Coumadin information, and he gives of his time freely here. We are blessed to have his expertise.

What he has said is the way it works. He runs a Coumadin clinic.

 

[Ross]

I'd still be very interested in knowing exactly how much Coumadin your taking over one week and exactly what dose on what days and what your last INR reading was and what changes if any they made. Please fill in the blanks for us so we can see what's going on.

 

[Guest]

Vegans are the easiest to manage. They take in very large quantities of vitamin K on a regular basis. This means that their vitamin K intake will change by only a small percentage each week. It is the person who usually eats few vegetables and then pigs out on a salad bar and gets the INR tested two days later that are difficult.

What I thing is happening to pink is that the large amount of vitamin K intake is slowing the response to warfarin. Instead of the full effect of a dosage change being apparent after 3 or so days, it is taking much longer to see it. My first move, if I were the warfarin manager, would be to lengthen the interval between tests to 4 weeks and see if that stabilizes the INR.

I think that vitamin K lists are useless, too. After more than 30,000 patient visits, I don't recall anyone who ever stabilized their INR by using one. They cause more anxiety than they relieve. They are like training wheels on a bicycle - OK for beginners but you aren't going to be good at it until you can be liberated from them.

If I had a young woman patient whose INR couldn't be controlled after two years, I'd ask the doctor to start investigating the possibility of Antiphospholipid Antibody Syndrome. This makes the INR test inaccurate.

http://warfarinfo.com/antiphospholipid.htm

The last person that I requested these tests be run on turned out to be negative but the tests came back positive for Lyme Disease. She is now undergoing treatment for that. I don't know for sure the relationship between Lyme and INR but we will see what happens when it is treated.

 

[pink.gingham]

Hi and thanks for the feedback. I will ask about Antiphospholipid
Antibody Syndrome next week at the Thrombosis Clinic. The other thing is my
medications have changed quite a bit, I have kidney disease and the
fluctuations in those meds might be part of the problem.

You're right, I should just oink out on all the delicious veg I want to! And accept that for now I have to go to the hospital every week. I don't
have a lot of energy to spare though so I'm not thrilled about having to
make the trip so often. My insurance won't cover a Coaguchek but I may get
one someday.

Is 4 weeks between testing not too long? You obviously have reasons to
thing that's safe, but I thought a clot can form within a few days? A
previous dr was having my INR checked every 3 or 4 days, and that probably
wasn't long enough to see a reaction from a changed dose. Just call me pin
cushion, I get a lot of blood drawn. (We don't have the finger pricking
kind of INR tests in my hospital.)

I like the food list because I can see what's really high, some of the veg
like asparagus are way higher than the others like zuchinni.

 

[Guest]

Today, at my clinic we are scheduling people who have been in range for the past 3 or 4 visits for follow-up on August 9.