Tracking INR

I track a lot of things about my blood, diet, weight, sleep activity. One of the things that has been more exciting for people like me who have difficult medical issues is the advance of miniaturization in devices that allow me to be involved directly with some of the tracking and data acquisitions.

In 2011, I found myself with this situation where I had to have my aorta cart valve replaced. And I chose a mechanical prosthetic valve and if you stand next to me you can hear me clicking, and as a result I have to be on a lifelong anticoagulation therapy to keep my blood thin – not really the right term, but to prevent blood clots from forming.

INR is what doctors use to keep track of this, and the risk for me is that if the time to clot is to short I can risk dangerous blood clots from forming on the valve that I have in my heart. If it takes too long I can risk internal bleeding.

So the therapy that I’m on is I’m taking a drug called warfarin, other people know as Coumadin. It’s a daily dose, and it can be a little tricky because I have to take different doses on different days of the week and that often changes from week to week.

I have to have frequent blood tests, usually every month and get it evaluated by a doctor at the clinic who might make changes to the dose of the medication that I have to take. The half-life of the drug varies widely.

So this requires me to be monitored because a lot of things can affect my INR, which is the level of the blood coagulation; how long it takes for my blood to clot. So diet and exercise and other medications, supplements, how much alcohol I might drink those are all things that can vary on top of fundamentals sensitivities from warfarin that is possible to have as well.

When I learned that I had to have this valve replacement, the surgeon mentioned to me that it was possible to do self-testing. So I thought tell me more about this, this is really interesting. He goes, well instead of going to a lab, you would use a meter like this, take a drop of your blood, do the test yourself report in and be a part of the tracking. I think it might be good for you. So of course I thought this was interesting.

This is actually the meter, the drop of blood takes about a minute and a half to do the test. The results are fairly reliable. I cross check them about every six months with the lab.

One of the things that I learned about that really affects the metabolism of the drug and the effects of the blood clotting are the amount of vitamin K in my body. I didn’t know anything about vitamin K before I became a heart patient. Now I know that green leafy vegetables have a lot of vitamin K and this nutrient effect the effectiveness of the drug.

Lots of things that I like to eat, blueberries to have vitamin K in them, and so that was kind of a bummer for the first couple of months after I had heart surgery, I was completely afraid to eat a salad. Now I’m a little bit better. I eat a largely plant-based diet already, and I also learned things like this that vitamin K is produced in your body by some of your gut bacteria.

The tracking that I have done since February 2011 is here, and it shows that about half of the values that I obtained from the self-tracking are at the prescribed range of 2.5 to 3.5 that keeps me safe.

The thing that’s important to notice with this data is the trend that every time that there’s an out of range result, it heads back into a normal range because my doctor has made an adjustment to my drug and have me test frequently.

So I have some questions. If I test more frequently, then the typical once a month testing where everything is good and I helped keep myself in this therapeutic range more consistently, and if I make changes to my diet, which I’m interested in doing what’s the consequence of that. Because they tell you eat stably, eat a consistent amount of vitamin K and know what you are eating and drinking.

So those are the questions I had and I wanted to do an experiment, since it was easy for me to test and to track this over time. I thought about the things that I could control, like the greens that I eat and the change that I was interested in making like adding probiotics to my diet, the amount of alcohol I might consume, how much exercise. And the things that I don’t really have control over like any new medication I might get, or things that might happen like a stomach issue.

So I developed a planned for what I would do. I would test myself for two months on a weekly basis, and I would make some small diet changes incorporating some probiotic food and supplements into my diet, and I would try to be consistent with this change. I would track my INR and check-in with my doctor.

I nearly at the end of my experiment, and the interesting thing this entire time of this experiment might INR has actually been in the safe range. So I haven’t had any issues thankfully that required an adjustment, so all of the values that I got with weekly testing have been consistently in range.

What did I learn? I actually don’t know if weekly testing for the changes that are made was helpful for me to keep me in this range. So it’s wonderful that I’ve been in this range during this test period, but I don’t actually know.

One thing I did learn was that testing myself weekly made me more aware of how much vitamin K rich foods I was adding to my diet, and other factors I knew that would affect my INR. So it did make me think about it a lot more.

I have some next steps. I’m going to continue to learn more about probiotics foods, because a lot of these like some of the foods that I was looking at are also high vitamin K foods so that was why I was concerned about that. And then I asked my doctor that if I was to test more frequently when I have a near outer range value that would be helpful.

The best thing that I have learned really about this is by self-testing and self-tracking this particular thing, it’s allowed me to feel more active and positive about my health care and my partnership with my doctor.