Pumping Marvellous

A blood clot that forms on the outside of the body over a wound is a good thing. It stops the bleeding if you cut yourself. But a blood clot that forms inside a blood vessel can cut off blood flow to vital organs like the brain or heart. This results in a stroke or heart attack. A clot can also block circulation in the legs or lungs.

If taken properly, blood thinners can help prevent dangerous clots but still allow normal clotting to take place and stop blood flow from an injury.

Examples of blood thinners are:

• Anticoagulants such as warfarin and heparin
• Antiplatelet drugs such as aspirin and clopidogrel

A newer drug called Pradaxa may also be an option to prevent stroke in some people with atrial fibrillation. Regular blood test monitoring is not required with Pradaxa as it is with warfarin.

To make sure your blood thinner medication is both safe and effective, follow these steps.

1. Timing is important

• Take your blood thinner at the same time each day.
• Never skip a dose or take more than your prescribed dose.
• If you miss a dose, take the medicine as soon as you remember.
• If you don’t remember until the next day, call your doctor or anti coag clinic for instructions before taking that day’s dose.

You may find it easier to take your medicine if you use a pill organizer with compartments for each day of the week.

2. Watch for signs of bleeding
A nose bleed or bleeding from a cut are obvious. But more serious bleeding can occur in the brain or digestive track hidden from view.

A head injury can result in bleeding within the brain. This can cause a severe headache or other signs of a stroke. If you hit your head hard then we would suggest you go to Accident and Emergency for a check up or call the Emergency Services.

Call the emergency services if you are on a blood thinner and you have:

• A severe headache
• A fall or injury to the head
• Confusion, numbness, weakness
• Cough up large amounts of bright red blood
• Vomited blood
• Passed a lot of blood in the stool

Bleeding from the digestive track can occur gradually over time and may not cause pain. Seek immediate medical help if you have any of the following:

• Bright red blood in the stool
• Very dark or black stool
• Blood in the urine
• Bleeding that does not stop
• Bleeding in the mouth after a dental procedure (make sure your dentist is aware you are taking blood thinners before any surgery)

3. Use caution
Be careful with:

• New prescription medicine. Any doctor you see should know that you are taking a blood thinner. Warfarin and other blood thinners can interact with many types of medicine.
• Over-the-counter products. Check with your doctor or pharmacist before taking any non-prescription product, including aspirin, herbal medicine, or vitamins.
• Alcohol. Alcohol increases the effect of blood thinners and raises the risk of bleeding.
• Foods containing vitamin K. Foods that contain vitamin K can interfere with blood thinners. They make warfarin less effective and raise the risk of a blood clot. Vitamin K is found in green and leafy vegetables such as broccoli, lettuce, and spinach. You don’t have to avoid these foods, but keep the amount of vitamin K you eat consistent from day to day.
• Dental visits. Tell your dentist that you are taking a blood-thinning medicine as well as about all your other medicines. He or she may modify certain dental procedures to limit bleeding. Avoid eating hard foods or foods with sharp surfaces for 2 days after a dental procedure.

4. Keep your lab appointments
Doctor and Anti Coagulant Clinic visits for blood tests or lab visits are important when you are on certain blood thinners such as warfarin. Frequent testing is often needed to make adjustments to this medicine.

While taking warfarin, a blood test is used to measure the time it takes blood to clot. It’s called the prothombin time, or “protime.” The result is reported as the INR, which stands for the International Normalized Ratio. The INR is what your doctor uses to monitor the effects of the drug. The goal is to take enough blood thinner to keep the INR in the therapeutic range, which is higher than normal so that clotting is delayed but not prevented.

• When the INR is too low, the risk of a dangerous blood clot is increased.
• When it is too high, the risk of bleeding is increased.

It often takes some time to get the INR into the therapeutic range. INR monitoring may be necessary twice a week or more at first, and then less frequently.

Understanding Atrial Fibrillation

At Pumping Marvellous we try to keep things simple as we are patients, however we do know a fair bit about our conditions so we do like to share our experiences with our readers. Sometimes it can become a little technical even for us with the conditions and we may need to use reference points to help us be factual but as stated we try to keep things simple.

Atrial fibrillation is a heart condition that causes episodes of irregular and often abnormally fast heart rate.

A normal heart rate should be between 60 and 100 beats a minute at rest. You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute.

There are three main types of atrial fibrillation:

* Paroxysmal atrial fibrillation. This comes and goes and usually stops within 48 hours without any treatment.
* Persistent atrial fibrillation. This lasts for longer than seven days (or less when it is treated).
* Longstanding persistent atrial fibrillation. This usually lasts for longer than a year.

What happens

When the heart beats normally, its muscular walls contract (tighten and squeeze) to force blood out and around the body. They then relax, so the heart can fill with blood again. This process is repeated every time the heart beats.

In atrial fibrillation, the upper chambers of the heart (atria) contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions.

This may lead to a number of problems, including dizziness and shortness of breath. You may also be aware of a fast and irregular heartbeat (palpitations) and feel very tired.

Some people with atrial fibrillation have no symptoms and are completely unaware that their heart rate is not regular.

So why does it happens

Atrial fibrillation occurs when abnormal electrical impulses suddenly start firing in the atria. These impulses override the heart’s natural pacemaker, which can no longer control the rhythm of the heart. This causes you to have a highly irregular pulse rate.

The cause is not fully understood, but it tends to occur in certain groups of people and may be triggered by certain situations, such as drinking excessive amounts of alcohol or smoking.

How common is it?

Atrial fibrillation is the most common heart rhythm disturbance and affects up to 500,000 people in the UK.

Who is affected?

Atrial fibrillation can affect adults of any age, but affects men more than women and becomes more common the older you get. It affects about 10% of people over 75.

Atrial fibrillation is more likely to occur in people with other conditions, such as high blood pressure or atherosclerosis.

It is not common in younger people unless they have a heart condition.

Outlook

Atrial fibrillation is generally not life threatening, but it can be uncomfortable and often needs treating.

Treatment may involve medication to control heart rate and/or rhythm, and medication to prevent stroke.

A healthy lifestyle, regular blood pressure checks and treatment for raised blood pressure can reduce the chances of developing the heart problems that cause atrial fibrillation.

Interesting little post about Coenzyme Q10 and its effects on Warfarin

Coenzyme Q10 can be used in the management of mitochondrial disease, heart failure, hypertension, angina and arrhythmias. It is thought to work by being a free-radical scavenger, antioxidant, and membrane stabilizer. Coenzyme Q10 is structurally related to Vitamin K (menaquinone); therefore, it possesses procoagulant properties which will effect your INR if you are taking Warfarin.

If you take Q10 without your clinician knowing and you are prescribed Warfarin talk to them.

Let’s hit the target

As I drove into the Royal Blackburn Hospital and parked up I thought that Pumping Marvellous needed Anti-Coagulation support as I know alot of you out there are on some form of Anti-Coagulation and would probably like to know more about it.

Anyway after hitting my INR of 2.8 which generated a yipeee down the corridor as I really put effort into being within range I have asked Sister Maggs who is actually become a good friend, to help support the patients and pumping marvellous. She has agreed to recieving emails of which she will answer questions on anti-coagulation and especially warfarin management. We will be adding a link to the site to help you communicate with Maggs.

We will also try and bring the Pharmacy into the fold so you can ask questions about your prescribed drugs.

As always we are trying to stay innovative and focussed on bringing targetted patient care to Heart Failure patients.

Cut your salt intake

Ok will all like a bit of salt but too much salt can raise your blood pressure, and this can lead to heart failure or a worsening of the condition.

Suggested recommended limit: 2,000 milligrams per day (less than one teaspoon per day).

Limiting sodium is one of the most important things that people with heart failure can do.

Sodium makes the body hold on to fluid. To pump the added fluid, the heart has to work harder. People with heart failure shouldn’t put this extra strain on their hearts.
Excess fluid can also cause weight gain. Your heart has to work harder when you put on extra weight.
Too much sodium in the diet can worsen symptoms like swelling and shortness of breath. If those symptoms become severe, the person may need to be admitted to the hospital.
Sodium increases blood pressure. High blood pressure constricts the arterioles, making them resistant to blood flow. This makes the heart work progressively harder to pump enough blood to the body’s tissues and organs.

Cut down on table salt now!

Take the salt shaker off the table.
Discuss using salt substitutes with your doctor.
Limit salt in cooking
Avoid any seasonings that taste salty, including:

stock cubes (make your own stock it’s vastly superior)
cooking sherry or cooking wine
chilli sauce
meat tenderizer
seasoning salts
soy sauce
steak sauce
worcestershire sauce

Try substituting salt-free seasonings with lemon juice, vinegar and herbs.

Drain and rinse canned foods before preparing them to remove some of the salt. Tuna can now be purchased in fresh water – avoid the brine.

If you can use fresh fruits and vegetables over canned or frozen versions with added salt.

Shop for canned or frozen foods with no salt added.

Avoid packaged foods such as soups or rice dishes that come with a packet of powdered seasoning.

Avoid all processed convenience foods

Most of us take in more sodium through packaged convenience foods and snacks than by using table salt.

Look for “low-salt” or “low-sodium” labels on cans and packages. This label means the food has 140 milligrams or less sodium per serving. “Very low sodium” means it has 35 mg or less per serving.

“Reduced-salt” or “reduced-sodium” simply means that the product has at least 25 percent less sodium than the original version of the same product.

These foods may still have more sodium than you’re allowed.

Canned soups and dry soup mixes
Canned meats and fish
Ham, bacon and sausage
Salted nuts and peanut butter
Instant cooked cereals
Salted butter and margarine
Processed meats, such as deli items and hot dogs
Prepared baking mixes (pancake, muffin, cornbread, etc.)
Prepackaged frozen dinners (look for options where one serving has less than 400 mg of sodium)
Preseasoned mixes
Snack foods (crisps, snacks, olives, pickles)
Cheese
Tomatoes
Salad dressings
Fast food
Pay attention to your serving sizes.
A 2.5-serving can of soup with 200 mg of sodium per serving actually gives you 500 mg of sodium if you eat the whole thing. That’s a real dent in your 2,000 mg-per-day allowance.

Watch for other forms of sodium.
Read the ingredients. Many foods contain more than one form of sodium, such as

sodium alginate
sodium sulfite
sodium caseinate
disodium phosphate
sodium benzoate
sodium hydroxide
monosodium glutamate or MSG
sodium citrate.
Know what’s in your medicines.

Some medicines are high in sodium, too – always read the sodium content and warnings before taking an over-the-counter medication. Don’t take headache or heartburn medicines that contain sodium carbonate or bicarbonate.

Also be very careful that if you use lo-salt products that are based on “potassium sulphate” this will effect your INR warfarin levels.

Yes it’s another drugs post but we think you should be aware of the drugs you should not be taking unless you are being directed by your Doctor or Heart Failure Nurse.

We believe this information is really important because you need to know what you can take and what you can’t and the reasons why.

Many types of drugs can aggravate heart failure by raising blood pressure and heart rate, creating irregular heartbeat or causing fluid buildup.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

These include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), which are given to relieve pain and inflammation. Even short-term use can increase blood pressure and interfere with blood-pressure-lowering drugs. Many over-the-counter cough and cold medicines contain NSAIDs. The same warning goes for COX-2 inhibitors such as celecoxib (Celebrex).

Thiazolidinediones

Rosiglitazone and pioglitazone are two examples of this class of diabetes drugs, which can result in dangerous levels of fluid retention in patients with moderate-to-severe heart failure.

Contraceptives

Both of these can raise blood pressure. Pregnancy, in and of itself, can also result in hypertension (high blood pressure).

Stimulants

Psychotropic drugs used to treat attention deficit hyperactivity disorder (ADHD) fall into the stimulant category, including Adderall (an amphetamine) and methylpenidate (Ritalin, Concerta). These medications often elevate blood pressure and increase heart rate. Many so-called diet pills are also stimulants.

Chemotherapy
Anthracyclines, including the commonly used doxorubicin (Adriamycin), are among the most effective chemotherapy medicines, but they can damage heart muscle. Giving these medications over a longer duration at a lower dosage can make them safer for many patients.

Antidepressants
Treating depression can be vitally important in patients with heart disease, but when you have heart failure this treatment must be undertaken carefully. Elevated blood pressure can result from taking noradrenaline reuptake inhibitors including venlafaxine (Effexor). Increased heart rate can be caused by tricyclics, which include amitriptyline (Elavil). Higher blood pressure and irregular heartbeat can be a consequence of mixing monoamine oxidase inhibitors, which include phenelzine (Nardil), with certain cheeses, wines and pickles.

Illegal Drugs
Cocaine and methamphetamine can cause a sudden rise in blood pressure and heart rate. Cocaine can also constrict the heart’s pumping chamber.

Quick Tip on Warfarin and the INR front

I currently have a target INR of 2.5 and I have regulary achieved this when I have my 4 weekly tests at the anti-coag clinic at the Royal Blackburn Hospital. I am 79% in range since I started taking Warfarin which I believe is the top result in the clininc!

There are lots of reason for your INR to fluctuate; diet / exercise etc but there are three very important ones which cause continued instable INR results therefore you need to control these

Alcohol intake – I don’t really drink Alcohol I never really have
Smoking – I use to Smoke but don’t now
Recreational drug use – hand on my heart I don’t do drugs

Reduce your consumption of Alcohol down to a minimum and don’t binge drink – this must be why you are struggling to keep your fluid retention levels under control

Therefore if you haven’t kicked the cigarettes do so – can’t believe you are still smoking with Heart Failure

Recreational drugs are so a complete no no – do I have to explain this?

Be sensible and use your judgement – your Anti-Coagulant Nurse is always there to answer questions.

New to Warfarin?

Just a little helpful tip which nearly caught me out.

After coming out of Hospital I thought that Warfarin Sulphate was the same as any drug in terms of:-

Get your prescription
Go to the pharmacy
Collect your Warfarin tablets

Assumption is an evil – I nearly ran out of Warfarin when I found that the GP had not authorised the prescription.

Remember that you need to show your INR record card to the GP and the Pharmacist to prove that you have been attending regular clinics for checking your INR level. In the UK you must produce your INR record card,
and lets face it Warfarin was used as Rat poison and if you take too much you will cause yourself untold problems; mainly your blood will not clot.