Tracking my Blood Anticoagulation Drug

Hi, I’m Rob Rothfarb, I’m going to talk a little about tracking my blood. I consider myself a proactive patient as a couple of different health conditions I require management and I’ve become very interested in some of this information in addition to activity tracking and tracking my weight. I track blood pressure, different aspects of my blood, things like migraines and my motivation is entirely my personal health to make myself and well-being better and to improve that.

I’ve been able to take advantage of medical devices that puts some control for data gathering into the hands of patients like me. as they become more miniaturized and more portable they allow people to participate in their care.

In 2011 I had a condition where I had to have my aortic heart valve replaced. So there’s a bionic part in here and one of the consequences is that it requires life-long anticoagulation which I’ll talk about more in a minute. This thing ticks all the time, it’s kind of intense. I get used to it sometimes but if you stand next to me you can hear me clicking.

The anticoagulation in other words it’s blood thinning. It’s common for people with HO fibrillation and other disorders and people who have mechanical heart valve have to have anticoagulation for life. The issue is the blood clotting time. If it’s the normal blood clotting time for somebody not on the therapy has it’s too dangerous and you can form a blood clot on the valve which could kill you. If it’s too long you can have a hemorrhage.

So the therapy that I’m on involves taking this drug called warfarin, otherwise known as Coumadin. And every day I take this drug, one of the complications of it. It’s a little hard to manage; you have to take different dosages different days of the week, and have frequent blood testing so that the doctor or the clinic can evaluate this level of anticoagulation of your blood, and adjust your medication accordingly.

There’s lots of things that affect the way this drug is processed by your body, and how it affects coagulation, most importantly diet, weight, and exercise. But other medications, supplements, alcohol, you can also have a genetic sensitivity to the drug.

So these are my I&R values since I started my tracking. You can see most of the range, most of the values are in my target range which I will mention a little bit more about in a moment. But basically the important thing to look at from this data is that every time there is an out of range value there is a trend back into my therapeutic range. This is because my doctor has made an adjustment to the medication that has put me back on the right track.

Some patients are eligible and appropriate to be doing the testing themselves rather than going to a lab, it’s definitely a pain in the butt to have to do that all the time. I’m able to use a portable device like this, with a test strip and a finger stick and two fairly quickly determine the I&R value, which is the level of anticoagulation.

One of the key things about diet that really effects the way the drug is processed by your body and in how well it anticoagulants you is the amount of vitamin K. In your diet, this is a nutrient that essential for blood clotting and to control bleeding. It’s really prominent in green vegetables, and it directly effects how your blood clots. It works against the drug that I take, so it has to be carefully balanced. When you have to take this drug you are told to eat vitamin K in a consistent way.

So as I started taking it, the first trip to a salad bar I was like being in a mental k hole here and really being scared of what I could eat and what I couldn’t eat. The vitamin K is in a a lot of things. Interestingly, it’s also produced in your body, not by your body, but by the gut bacteria. And I’m starting to learn a little bit about the research that’s happening right now that is looking how that affects coagulation.

So I had some tracking questions as I looked at these values more carefully. I wanted to know if weekly testing of my I&R values would help keep me in my therapeutic range more consistently, and if I made intentional changes to my diet that might include some vitamin K rich foods how often should I test.

Sometimes it’s hard to understand how much of the vitamin K is actually in the food that you eat. I thought about things I could control, what I’m eating, the amount of alcohol I might drink, exercise, things that the doctor drive the medications that I take or any changes to that. And then you know there is also the fact is that I can’t really control. Those are things like minor bleeding events or interactions between things that I didn’t necessarily expect.

I had an idea that I would test myself weekly, which is a more condensed interval for two months and make some small diet changes, and introduced some probiotics to my diet and see what would happen.

So here is the results of my recent two-month study, of testing myself on a weekly basis and the interesting thing is that I actually remained within my target range, which is 2.5 to 3.5 nearly the whole time and it’s just really at the end that I was at the bottom part of the range.

So what did I learn from that? I didn’t necessarily a learn or assume that testing weekly is keeping me in the range more consistently. I don’t know if that’s what’s happened. I want to repeat this test cycle, and maybe be a little more precise with tracking correlation factors. But one thing I did understand is that by tracking my I&R weekly, it definitely made me think on a daily basis of the non and vitamin K rich foods. I was eating as well as other factors that I knew would affect it.

Did I stick with my plan? I did pretty well, I think I can as I mentioned track a little bit more and try to correlate other things that relate to the I&R level changing. My next steps are to keep doing what I’m doing, to learn more about probiotic foods and how they might affect anticoagulation and to work with my doctor to repeat the test cycle. I think about when I’m near out of range recording that that might also be a trigger to test more frequently. But the main thing is that as I do my testing is that I realise it allows me to feel more active in my health care.

Thanks.