what is wrong

[atydev]

Okay went back to the doctor again today. This is the second visit since I left the hospital and both times I was accused of not taking my coumidin. I started out on 3mg when I left the hospital. Last friday I was increased to 5mg. I was increased to 7.5mg today. I don't know what my numbers were but it was low enough that I was accused of not even taking my coumidin. What can cause your levels to drop so low? I think I read somewhere on here that an active life cause's your body to process it to fast. Any ideas. Oh, My incesion is also badly infected. Has been for about 2 weeks. So now my scare is going to be big and ugly. It has 2 big gaps and is draining really badly. I was surprised that all the doctor did was clean it out some by bleeding it. WOW was that painful. I shook all over for over an hour after that one. I have to clean it with peroxide and put gauze on it. That was a shock I would have thought I would have gotten an antibotic.

 

[Nancy]

As you have mentioned, your INR can vary depending on your activities, also what you eat and drink. Too many things with Vitamin K can throw everything off. You need some green veggies to be healthy, but people on Coumadin have to be moderate in what they eat and try to keep things even in the amount. Food products like Boost, Ensure, Luna Bars, other nutritional supplements and power bars contain a large amount of Vitamin K and can cause INR problems. Read each and every food ingredient label.

V-8 juice contains Vitamin K, and doesn't mention it on the label.

Also, after surgery, when your body is regulating and adjusting, it is expected that your INR will fluctuate and that there will be frequent adjustments until things smooth out.

I am also very surprised that you didn't get an antibiotic for your incisional infection.

 

[JimL]

I have a little booklet furnished by DuPont in which I record every day's dosage, along with every INR test; that way I have a record so that I can tell what's been going on and so I can adjust my coumadin dosage accordingly.
I used to use the four-month booklets, but now I have the full year booklets. Ask your coumadin clinic nurse for one. If you can't get one, there are various charts available. But the important thing, in my opinion, is that you keep a record for yourself.

 

[Ross]

April make sure they tell you those numbers and tell them to you the same day your tested! You NEED TO KNOW the numbers.

 

[Karlynn]

It could be anything (see Nancy's list). Mine has been lower lately, but I'm exercising more. Just increased my dose to 9 a day from 9 - 4 days and 8 - 3 days.

When I joined this forum is was because I was trying to find out why my INR was so low. The culprit was a protein bar with 33% DR of Vit. K. I had been eating protein bars a while, got a new kind and didn't check the nutrition facts.

So look everywhere. If you aren't sure about something you are eating or drinking, check here, or with the company.

 

[Shine_on_Syd]

April,
I can't speak to coumadin but I am sorry to hear that they accused you of not taking it. You shouldn't have to take that b.s.
I'm a pretty laid back guy and have a very high boiling point and avoid conflict. But as I have gone through this valve replacement process I don't take any crap from any doctor or anyone else when it involves my heart. If someone accused me of not taking my medicine when I did indeed take the medicine I would have become very assertive. In fact I would have gone wild, don't let them accuse you of something that you have done properly.
I'm sorry to hear about the infection. I had a really good nurse in my step down unit who was adamant about me taking a bar of soap and rubbing it up and down my scar emphasizing that is the best way to prevent infection. I was afraid that I would irritate the scar by scrubbing it.

 

[atydev]

So

So

I thought that if you ate foods high in vitiman K it would make your INR numbers to high? I did have a mixed greens salad 2x's, fish and coleslaw this week. I am starting to get my appetite back and I love my salads and fish. I am trying to not over do them. I would eat a salad at least 3 or more times a week, and fish about 2-4 times a week. I eat lots of greens it is a southern thing turnip, collard or mustard greens with cornbread. I eat lots of green onions some may call them scallons. in salads as a garnish on things in our mexican cooking and sometimes raw at the table with our dinner. Help....I can now eat salt again just none added at the table but looking on warifininfo.com I just need to find some food to put it on......hehehehehehe

 

[Nancy]

April-

I was looking through your older posts and found that you had absolutely no instruction regarding Coumadin and how to handle it. That is really shameful on your doctor's part, especially in the light of him and his staff accusing you of not taking your Coumadin.

Here is what you posted:

"No instructions

I was not givin any instructions about my coumidin. I dont know what to eat what not to eat or anything. Any one got any answers?"

They should have gone over everything with you and given you some literature.

I am appalled at the lack of professionalism on their part.

Just read all you can on Al Lodwick's site. It will give you the information you need.

 

[ALCapshaw2]

April,

You've got it backwards. Vitamin K causes the blood to clot and REDUCES INR, fairly rapidly. That may be what is happening to cause your low numbers.

Please take the time to read over the Coumadin (generic Warfarin) information on www.Warfarinfo.com

'AL'

 

[Ross]

You silly girl, I'm coming to your house when my INR goes out of range. I need you around here to help keep me greened!

 

[Mary]

Ross,
Looking at your avatar picture, it looks to me like you're consuming plenty of greens.
Mary

 

[Shine_on_Syd]

Mary .
How do you know Ross isn't b.s.ing us with that avatar picture....I think she is a tricky one

 

[Harpoon]

For what it's worth, eat what you want but try to keep things balanced and regular.

It's best not to eat salads every day then suddenly stop. Your INR may jump or drop if you change habits suddnely.

In addition, and I'm REALLY suprised they didn't think of this when they scolded you, an infection like the one you described can also knock off your INR as well as some medications they might give you to treat it.


EVERYTHING will affect your INR, that's really how we should probably think of it.

The idea though is to avoid making drastic changes in your daily routines. Don't suddenly start eating spinch salads then stop again. If you have a V-8 every morning with breakfast that's cool, go for the low sodium stuff. But don't go off and on it.

MODERATION

MODERATION

MODERATION


You should also have the numbers when they check your INR/protime. Ask for it and ask where your cardiologist or surgeon wants you to be at.

My cardiologist prefers me at 3.5. When I go in for my protime, I get to watch the machine with the nurse that does the fingerstick (my primary physician's office does a coumadin therapy clinic and they have coaguchek which is really nice) We both see the results at the same time and she writes it down for me on a sheet of paper to take home which I note in a little logbook where I keep track of my diet and activity levels and such.

Ask about getting set up with a clinic of some kind that focuses on checking protimes or at the VERY least make sure there's one doctor, preferably your cardiologist, who is getting the results and monitoring them for you.


For the record, I've been at 7mg for about two months now, that's down a touch from the 8mg I was taking over several months before. I left the hospital at 9mg. I'm about a year and a half post-op now.


ANYTHING (almost) can mess with your INR results. Try to take your coumadin as regularly as possible, at the same time during the day, every day.

 

[atydev]

Thanks

Thanks

I am looking for someone local that will check my levels. I don't like driving 80 miles one way every week. (right now having someone drive me). I will as for my numbers and were I should be at. I never new that an infection would cause your numbers to go up. Cause I have a really bad infection. I think I am in almost as much pain now as I was after surgery. I will check on this friday when I go back.

 

[JimChicago]

From the coumadin cookbook:
mustard greens 47.6 mcg vitamin k per ounce
green scallion onion 57.9 mcg vitamin k per ounce

Once you get your coumadin adjusted for that level of vit k intake it will be OK but changing eating habits of foods moderately high in vitamin K can require closer monitoring. For me it was Ensure that was throwing off my vitamin K when I first started coumadin last year.

 

[ALCapshaw2]

Do you have a Primary Care Physician closer to home?

If so, are you seeing him / her?

Your PCP may be able to help orchestrate better care for you. The lack of consistency and appropriate care you describe is appalling. I hope you can find a better solution for your followup care.

'AL'

 

[atydev]

Al

Al

I do have one a little closer about 30 miles one way. I am thinking though about changing to one here in my town, but my concern was should I get just a general doctor or a cardioligist here in town? I do get really frustrated with not getting any answers. I lost my job last year after getting endo. and spending 6 weeks in the hospital so I have no insurance . I started going to LSU because it is called a charity hospital which means you pay based on your income. Well, believe me for the care I seem to be getting it should be free. I have over 20 grand in hospital bills and I have not gotten them all yet. I went friday to get my levels checked saw my surgeon and showed her my incision which is badly infected and she did not give me any antibiotics. It has gotten more sore everyday (going on 5 days now) it drains really bad (I guess this is a good thing getting the yucky out) but does not smell very pleasant. I am going to see my general doctor in the morning and will see what he says. I am hoping he can give me something to clear this infection up.

 

[tommy]

April,

A smelly drainage sounds dangerous to me. That needs to be treated right away. It has gone on way to long. Do not take "no" for an answer.

Regarding your INR, the mantra is "eat what you want and adjust the dose". But be as consistent as possible with your vitamin K intake. You may still have some temporary variance due to infection and antibiotics, but don't let that discourage you.

Read as much as you can about your situation. Knowledge gives you power and confidence. In addition to www.warfarinfo.com site, look on the front page of VR.com and click on "links". There are a bunch of sites listed there.

Wishing you well.

 

[Mary]

April,
I completely agree with Tom. You should have no odor with the drainage. Insist someone treat it, or start documenting for when you take them to court.
Mary

 

[ALCapshaw2]

When it comes to Primary Care Physicians for Heart Patients, a doctor specializing in Internal Medicine is a good choice, if you can find one close to you.

Otherwise, ask your friends / family if they know of a good family doctor in the area. A 30 mile commute is not out of the question, but closer to home is nice IF you can find a good doctor there.

Given your current ongoing difficulties, I would stick with your current PCP since he knows you and hopefully can get you the care you need if he can't do it himself. If he is unable or unwilling to treat your infection, ask for a referral to someone who can help. It sounds like you need IMMEDIATE and PROPER Treatment. Good Luck!

'AL'