Just as my brain-doctor (psychiatrist) predicted, almost six months to the day of my stroke, the feeling of euphoria started to subside. The feeling of “I can overcome anything that life throws at me”, is gradually replaced by doubt and anxiety. But I know the warning signs by now. After a visit to my psychiatrist, we decide to slightly increase the dose of the medication. But we have to be very careful not to increase the blood pressure levels at the same time.
Isn’t it amazing that exactly at the time where you need the highest spirits, your body gives it to you. Of course I would much prefer not to have any depression at all! Oh well, I’m happy with anything I can get at the moment.
It was so wonderful to feel like I’m 20 again, ready to face anything, armed and ready to change the world; less the anxiety of approval. Boy, was I glad to be back my old self again, albeit for six months. An experience I can draw energy from for many many years.
We continue the new slightly increased level of medicine until the summer.
Meanwhile, I discover something. The increased level of medication has a startling effect: My brain seems to respond better. I seem to speak better. Now, whether this is because of serotonin level increase in the brain that promotes neural connections, or because I have a higher quality of sleep now, I don’t know. I only know that there is a correlation. I don’t know the causality. It is a question for the science community to answer,
One thing remains certain though, however much you try to reach a patient, you cannot reach her unless her brain is open to help. Unless the chemical set-up in the brain allow her to be open to receive therapy. If you are depressed (and a lot of people are after a stroke), how can you be upbeat about doing any exercise? First you have to treat the mindset, then you can treat her.
Wednesday, October 7, 2009
Thursday, October 1, 2009
Mehmet’s dad helps me
Mehmet’s mom and dad are here. It is a new year, a new beginning as they say. What is my new year’s resolution?? Guess what??
By the time of the anniversary of my stroke I want to be more fluent in my speech. That’s all. I believe that goal is reachable. I mean, look at the progress I have made: from not being able to communicate at all, I am able gesture, mimic, speak at a conversational level… Surely I can speak more connectedly, more fluently in the next six months…
I must. There are so many things I want to do. First of all I want my son to be proud of me. As first generation immigrants, we already bring a different baggage to the table. I want to overcome that by integrating myself to my child’s life in an undisputable way: invite his friends over, get involved in the school, be friends with his friends’ parents…And do this in such a way so that my son wouldn’t be ashamed of introducing me around.
Everything on that front depends on effective communication skills.
Thank goodness I live in a community where people are so friendly. Every time I tell my story to someone they absolutely understand the hardship, congratulate the effort and genuinely go out of their way to accommodate.
In the new year (2007) Mehmet’s dad decides to help me on the Turkish language front. Every morning we sit down, I get my huge Turkish dictionary, starting from the letter “A”, we go down each page word by word, I pronounce each word. When I have difficulty pronouncing (which happens with every second or third word) he writes it down and works with me to hone it in.
We discover a method that works better than others: We call it “end to beginning method”. Especially with long words, you start with the last sounds and work your way to the first sounds. For example let’s say you want to say my name: “Banu Turhan”
You start with the last sound, when you have mastered it, move to the previous one :
An
Han
Urhan
Turhan
Uturhan
Nuturhan
Anuturhan
Banuturhan
I don’t know why, moving backwards works better for me. It just does. Maybe it is a quirk of the Turkish language, maybe not.
Mehmet’s dad works so diligently on this he even follows up with me. Only on the days I don’t feel well I get a break, otherwise I work on my mother tongue every day. If I get to publish my story in Turkish some day, I want to add a whole section with his work.
By the time of the anniversary of my stroke I want to be more fluent in my speech. That’s all. I believe that goal is reachable. I mean, look at the progress I have made: from not being able to communicate at all, I am able gesture, mimic, speak at a conversational level… Surely I can speak more connectedly, more fluently in the next six months…
I must. There are so many things I want to do. First of all I want my son to be proud of me. As first generation immigrants, we already bring a different baggage to the table. I want to overcome that by integrating myself to my child’s life in an undisputable way: invite his friends over, get involved in the school, be friends with his friends’ parents…And do this in such a way so that my son wouldn’t be ashamed of introducing me around.
Everything on that front depends on effective communication skills.
Thank goodness I live in a community where people are so friendly. Every time I tell my story to someone they absolutely understand the hardship, congratulate the effort and genuinely go out of their way to accommodate.
In the new year (2007) Mehmet’s dad decides to help me on the Turkish language front. Every morning we sit down, I get my huge Turkish dictionary, starting from the letter “A”, we go down each page word by word, I pronounce each word. When I have difficulty pronouncing (which happens with every second or third word) he writes it down and works with me to hone it in.
We discover a method that works better than others: We call it “end to beginning method”. Especially with long words, you start with the last sounds and work your way to the first sounds. For example let’s say you want to say my name: “Banu Turhan”
You start with the last sound, when you have mastered it, move to the previous one :
An
Han
Urhan
Turhan
Uturhan
Nuturhan
Anuturhan
Banuturhan
I don’t know why, moving backwards works better for me. It just does. Maybe it is a quirk of the Turkish language, maybe not.
Mehmet’s dad works so diligently on this he even follows up with me. Only on the days I don’t feel well I get a break, otherwise I work on my mother tongue every day. If I get to publish my story in Turkish some day, I want to add a whole section with his work.
Wednesday, September 30, 2009
The "re-do"
We start by reading word lists.
For example:
Advantage
Adventure
Advertise
……
Whenever there is a word I get stuck at, she says it, repeats with me, then lets me repeat it several times in extending intervals, all the while telling me to do it naturally, don’t get stuck at any sound, move your mouth like this…
In fact she doesn’t even need to say the last part. It is monkey see, monkey do. The moment my eyes get fixated upon her mouth, my own mouth follows suit. As we work through the word lists, my pronunciation becomes better, as is my stamina.
Sometimes, she lets me read a difficult article from Newsweek or something. Oh my oh my… If it wasn’t for the gentle soul sitting across me, I wouldn’t show my performance to anybody. It is one thing to read books to a 3 year old, it is quite another story to read this:
”The results may be big but the process shouldn’t be grandiose. From that perspective, he says, the democrats should have come forward and with relatively modest proposals that could be equally well received. The three plans put forth so far are striking more for their similarities then for their differences. “
Have you noticed how many words there are more than two syllables?
Jan doesn’t do this to torture me. But wherever I stumble, there she gets her clue to work with me.
She calls them strategies. “What is your strategy to say the word ’perspective’ “? She asks me. “What strategy?” I think. I didn’t know to pronounce a word you would need strategies?? Did you?
Slowly I learn. For example, let’s take the word “perspective”: It takes at least seven steps to pronounce the word “perspective”:
1) You start with the lips closed (for the sound ‘P’)
2) then you have to pull your tongue back (for ‘R”),
3) You have to bring your teeth together and smile (for ‘S’)
4) Lips closed again (for ’P’)
5) Back of tongue (for ‘K’)
6) Tip of tongue to the upper incisors (for ‘T’)
7) Lower lip to the upper teeth for (for ‘V’)
In other words; you have to remember to bring your lips together three times, while your tongue moves to the back of your throat and comes to the front to touch the teeth.
Every word has a, short hand, a strategy like that.
Let’s say you have mastered a word, but you have difficulty moving from word to word. Then the strategy is: think about the last sound of the first word and the first sound of the following word, think about how to combine these two sounds.
Under normal circumstances, one doesn’t think about all of the above, of course. Especially while trying to string meaningful sentences together. But if you are learning any new activity that requires muscle coordination, from scratch, you need that. Learning to play an instrument may be the best analogy there is. Before you learn how to play the violin, there is no section in your brain dedicated to “violin playing”. But you learn it, your fingers get more adept with every practice, your ears become keener, your arm muscles get more precise….
In the end, after lots of practice, you don’t think about your fingers and arms anymore, you just think about the music… It comes naturally… And now there is a set of dedicated neurons in your brain for playing the violin.
Like every muscle coordination activity practice is key!
Once I read a quote by a famous musician. He said something along the lines of; if I don’t practice for one day, nobody notices. If I don’t practice for a couple of days, I notice the difference. If I don’t practice for one week, the whole audience notices…
Think about that!
For example:
Advantage
Adventure
Advertise
……
Whenever there is a word I get stuck at, she says it, repeats with me, then lets me repeat it several times in extending intervals, all the while telling me to do it naturally, don’t get stuck at any sound, move your mouth like this…
In fact she doesn’t even need to say the last part. It is monkey see, monkey do. The moment my eyes get fixated upon her mouth, my own mouth follows suit. As we work through the word lists, my pronunciation becomes better, as is my stamina.
Sometimes, she lets me read a difficult article from Newsweek or something. Oh my oh my… If it wasn’t for the gentle soul sitting across me, I wouldn’t show my performance to anybody. It is one thing to read books to a 3 year old, it is quite another story to read this:
”The results may be big but the process shouldn’t be grandiose. From that perspective, he says, the democrats should have come forward and with relatively modest proposals that could be equally well received. The three plans put forth so far are striking more for their similarities then for their differences. “
Have you noticed how many words there are more than two syllables?
Jan doesn’t do this to torture me. But wherever I stumble, there she gets her clue to work with me.
She calls them strategies. “What is your strategy to say the word ’perspective’ “? She asks me. “What strategy?” I think. I didn’t know to pronounce a word you would need strategies?? Did you?
Slowly I learn. For example, let’s take the word “perspective”: It takes at least seven steps to pronounce the word “perspective”:
1) You start with the lips closed (for the sound ‘P’)
2) then you have to pull your tongue back (for ‘R”),
3) You have to bring your teeth together and smile (for ‘S’)
4) Lips closed again (for ’P’)
5) Back of tongue (for ‘K’)
6) Tip of tongue to the upper incisors (for ‘T’)
7) Lower lip to the upper teeth for (for ‘V’)
In other words; you have to remember to bring your lips together three times, while your tongue moves to the back of your throat and comes to the front to touch the teeth.
Every word has a, short hand, a strategy like that.
Let’s say you have mastered a word, but you have difficulty moving from word to word. Then the strategy is: think about the last sound of the first word and the first sound of the following word, think about how to combine these two sounds.
Under normal circumstances, one doesn’t think about all of the above, of course. Especially while trying to string meaningful sentences together. But if you are learning any new activity that requires muscle coordination, from scratch, you need that. Learning to play an instrument may be the best analogy there is. Before you learn how to play the violin, there is no section in your brain dedicated to “violin playing”. But you learn it, your fingers get more adept with every practice, your ears become keener, your arm muscles get more precise….
In the end, after lots of practice, you don’t think about your fingers and arms anymore, you just think about the music… It comes naturally… And now there is a set of dedicated neurons in your brain for playing the violin.
Like every muscle coordination activity practice is key!
Once I read a quote by a famous musician. He said something along the lines of; if I don’t practice for one day, nobody notices. If I don’t practice for a couple of days, I notice the difference. If I don’t practice for one week, the whole audience notices…
Think about that!
Tuesday, September 29, 2009
We start everything from scratch!
After my first session Jan thinks about me long and hard, then she decides that we need to go back to the drawing board and start everything from scratch!
What? How is that even possible? Do I need to forget everything I have learned so far?
She concludes that right after the stroke I had paralysis of the left side of my speech apparatus. Therefore I needed to exaggerate my movements, the tongue, the cheeks, the jaw, in order to produce the correct sounds. She believes that as I have been working on my muscles for almost six months now, they are ready to produce the correct sounds without having to overextend, like normal people do. Because she says, as of now, my main problem is not my muscles anymore, my main problem is apraxia of speech.
According to the American Speech-Language-Hearing Association (ASHA)
Apraxia of speech is: “a motor speech disorder. It is caused by damage to the parts of the brain related to speaking.
People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage.
People with apraxia of speech know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words. They may say something completely different, even made up words. For example, a person may try to say ‘kitchen,’ but it may come out ‘bipem’ or even ‘chicken.’ “ They may have “
· difficulty imitating speech sounds
· groping when trying to produce sounds
inconsistent errors
slow rate of speech
Apraxia can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage)”
Jan believes that because I exaggerate my movements my muscles get stuck at a sound and I cannot move fluently from sound to sound.
If I can re-learn to produce sound with minimal muscle movement, she believes that everything else will fall into place, my speed, rhythm, and fluency.
Wow! It is a tall order! Besides, should I believe that?
On a certain level it makes sense, if you think about it. For example: the way I produce the “L” sound. I curve my tongue upwards inside my mouth, touch my two front incisors at the back, right at the gum line. That way I can pronounce “LLLLLLLLLLLLLLL” as long as I want. My tongue is stretched, almost cramped in this position, and it hurts after a while. But when I want to say Elisabeth, I have great difficulty, because after producing “L” in such a cramped position, I cannot move to the next sound, which involves planning the lip movement of “iiiiiiiiiiiiiiiiiii” It is difficult to plan the muscle movement of different muscles in the brain and then execute it by telling the muscles “Now do it!”
On the other hand, if I don’t move my weak muscles as much as I used to, won’t I be losing the strength in them? I mean, if you are weak, in order to get stronger muscles you have to lift weight, right? The more weight you lift, the stronger the muscles become, and it is easier for you to move them, right? Well, yes and no. In medicine, as my husband always tells me, you cannot always make deductions from one field to another field, empirical evidence rules. He believes medicine is more art than science, especially the therapy part. The above principle may be true as far as the muscles go, as for the brain, it must be a different story. My problem lies in the brain. There is nothing wrong with the muscles, if the brain could give the right commend. Even when they tell you have muscle weakness, is a manner of speaking only.
So, what do I have to lose? It makes partially sense, although in my hearth of hearths it is hard to believe.
We start.
What? How is that even possible? Do I need to forget everything I have learned so far?
She concludes that right after the stroke I had paralysis of the left side of my speech apparatus. Therefore I needed to exaggerate my movements, the tongue, the cheeks, the jaw, in order to produce the correct sounds. She believes that as I have been working on my muscles for almost six months now, they are ready to produce the correct sounds without having to overextend, like normal people do. Because she says, as of now, my main problem is not my muscles anymore, my main problem is apraxia of speech.
According to the American Speech-Language-Hearing Association (ASHA)
Apraxia of speech is: “a motor speech disorder. It is caused by damage to the parts of the brain related to speaking.
People with apraxia of speech have trouble sequencing the sounds in syllables and words. The severity depends on the nature of the brain damage.
People with apraxia of speech know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words. They may say something completely different, even made up words. For example, a person may try to say ‘kitchen,’ but it may come out ‘bipem’ or even ‘chicken.’ “ They may have “
· difficulty imitating speech sounds
· groping when trying to produce sounds
inconsistent errors
slow rate of speech
Apraxia can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage)”
Jan believes that because I exaggerate my movements my muscles get stuck at a sound and I cannot move fluently from sound to sound.
If I can re-learn to produce sound with minimal muscle movement, she believes that everything else will fall into place, my speed, rhythm, and fluency.
Wow! It is a tall order! Besides, should I believe that?
On a certain level it makes sense, if you think about it. For example: the way I produce the “L” sound. I curve my tongue upwards inside my mouth, touch my two front incisors at the back, right at the gum line. That way I can pronounce “LLLLLLLLLLLLLLL” as long as I want. My tongue is stretched, almost cramped in this position, and it hurts after a while. But when I want to say Elisabeth, I have great difficulty, because after producing “L” in such a cramped position, I cannot move to the next sound, which involves planning the lip movement of “iiiiiiiiiiiiiiiiiii” It is difficult to plan the muscle movement of different muscles in the brain and then execute it by telling the muscles “Now do it!”
On the other hand, if I don’t move my weak muscles as much as I used to, won’t I be losing the strength in them? I mean, if you are weak, in order to get stronger muscles you have to lift weight, right? The more weight you lift, the stronger the muscles become, and it is easier for you to move them, right? Well, yes and no. In medicine, as my husband always tells me, you cannot always make deductions from one field to another field, empirical evidence rules. He believes medicine is more art than science, especially the therapy part. The above principle may be true as far as the muscles go, as for the brain, it must be a different story. My problem lies in the brain. There is nothing wrong with the muscles, if the brain could give the right commend. Even when they tell you have muscle weakness, is a manner of speaking only.
So, what do I have to lose? It makes partially sense, although in my hearth of hearths it is hard to believe.
We start.
My new therapist: Jan
I meet with my new speech therapist, Jan. Immediately I am drawn to her. Such a gentle soul you haven’t seen. She evaluates me again. After going through the basic motions, she wants to know, what I want to get out of this therapy. Well, my goals haven’t changed much:
1) Speed
2) Recovering my old rhythm, tonality, fluency, inflection of speech.
3) Being able to initiate speech easily.
4) And doing all that without exhausting myself, like normal people do
For the moment being, we decide to focus our efforts on “Recovering my old rhythm, tonality, fluency, inflection of speech.” She makes me read a few paragraphs. Whenever I stumble upon a word I cannot read well, she says the word, then she says it again, I repeat, she says, I repeat, then we say it together in tandem, then I say it alone by myself, repeat after ten seconds, and again after thirty seconds.
1) Speed
2) Recovering my old rhythm, tonality, fluency, inflection of speech.
3) Being able to initiate speech easily.
4) And doing all that without exhausting myself, like normal people do
For the moment being, we decide to focus our efforts on “Recovering my old rhythm, tonality, fluency, inflection of speech.” She makes me read a few paragraphs. Whenever I stumble upon a word I cannot read well, she says the word, then she says it again, I repeat, she says, I repeat, then we say it together in tandem, then I say it alone by myself, repeat after ten seconds, and again after thirty seconds.
The Change-over (Mehmet’s Parents)
My parents in-law are coming. Mehmet is going to drive to New York to pick them up, a six hour journey to the JFK airport, and back. Not an easy thing considering they will spend almost ten hours prior to that in the air plane. But they preferred this option. There is no direct flight from Istanbul to Washington DC. All the other flights connect somewhere in Europe and my in-laws are over 70 years of age, they don’t want to run from terminal to terminal. The last time they came, they were almost missing the connection in Frankfurt, making a sprint like nothing to make it to the gate. As a result they wowed not to come again, but alas… So here we are. In Professor Dumbledore’s words “Once again I must too much of you…”
My mom and Mehmet’s parents are going to overlap for a couple of days. So it is easy for Mehmet to leave me in mom’s very capable hands to go to NY. I have not been left alone since the time of the stroke. We don’t know how safe I am yet, besides on and off I am having these panic attacks, which render me totally useless.
When my in-laws come, they are very happy to be with us. You see, this not the first time they come for an extended visit. After Kaan’s birth when I came down with the post partum depression they came and helped us for six months. They are extremely helpful people, they have this old fashioned sense of duty. If you ask anything of them they want to give their 150% to it. We also get along very well, from the very beginning their attitude was very favorable to our marriage, with time this has deepened into a mutual respect and love for each other. Now they are ready to help me as much as they can, to teach me how to talk again. They are almost giddy about it as far as I can tell.
There is also a funny dynamic involved. Up until this stroke I have always called them by their name. My mother in-law’s name is “Nermin”, my father in-law is “Sureyya”. I address them as “Nermin Hanim” “Sureyya Bey”. I am pretty sure that they always wanted me to call them “Mom” and “Dad” because they love me like their daughter. But up until now I just couldn’t bring myself to it, thinking that my own mom and dad could be offended. Oh well, now I have much difficulty in pronouncing their names, so there is no other choice but to call them “mom” and “dad” now. (“anne” and “baba” in Turkish).
There is a reason why the first baby words are simple, don’t you think? Simple sounds, simple words.
A couple of days later my mom arrives home, dad missed him so much!
My mom and Mehmet’s parents are going to overlap for a couple of days. So it is easy for Mehmet to leave me in mom’s very capable hands to go to NY. I have not been left alone since the time of the stroke. We don’t know how safe I am yet, besides on and off I am having these panic attacks, which render me totally useless.
When my in-laws come, they are very happy to be with us. You see, this not the first time they come for an extended visit. After Kaan’s birth when I came down with the post partum depression they came and helped us for six months. They are extremely helpful people, they have this old fashioned sense of duty. If you ask anything of them they want to give their 150% to it. We also get along very well, from the very beginning their attitude was very favorable to our marriage, with time this has deepened into a mutual respect and love for each other. Now they are ready to help me as much as they can, to teach me how to talk again. They are almost giddy about it as far as I can tell.
There is also a funny dynamic involved. Up until this stroke I have always called them by their name. My mother in-law’s name is “Nermin”, my father in-law is “Sureyya”. I address them as “Nermin Hanim” “Sureyya Bey”. I am pretty sure that they always wanted me to call them “Mom” and “Dad” because they love me like their daughter. But up until now I just couldn’t bring myself to it, thinking that my own mom and dad could be offended. Oh well, now I have much difficulty in pronouncing their names, so there is no other choice but to call them “mom” and “dad” now. (“anne” and “baba” in Turkish).
There is a reason why the first baby words are simple, don’t you think? Simple sounds, simple words.
A couple of days later my mom arrives home, dad missed him so much!
Lost within: INR / PT levels, Vitamin K, Coumadin, Labs: solution we found
Ever since I came home from the hospital, I have been on a lot of medication:
1) Blood thinning drugs (Coumadin)
2) Blood pressure lowering drugs
3) Cholesterol lowering drugs
4) + My previous anti depressants
Of course all of the above medications have interactions with one another.
My anti depressant drugs raise my blood pressure, which I have to bring down with blood pressure drugs, the blood pressure drugs in return effect my mood. But worst of all is Coumadin, it interacts with everything I eat.
You see, Warfarin (brand name Coumadin) according to National Institutes of Health,” is a medicine prescribed for people at increased risk of forming blood clots. Sometimes medical conditions can make blood clot too easily and quickly.
This could cause serious health problems because clots can block the flow of blood to
the heart or brain. Warfarin (Coumadin) can prevent harmful blood clots from forming.”
But, while taking Coumadin, you have to go to the lab and give blood to monitor your blood clotting levels continously.
Again according to N.I.H. “International Normalized Ratio (INR) and Prothrombin Time (PT) are laboratory test values obtained from measurements of the time it takes for a clot to form. Individuals at risk for developing blood clots take Coumadin to prolong the usual time it takes for a clot to form, resulting in a prolonged INR/PT. Doctors usually measure the INR / PT every month in patients taking Coumadin to make sure it stays in the desired range.”
But here is the catch: The food you eat can affect your blood clotting levels. Because: ”Blood clots are formed through a series of chemical reactions in your body. Vitamin K is essential for those reactions. Coumadin works by decreasing the activity of vitamin K;
lengthening the time it takes for a clot to form. To help Coumadin work effectively, it is important to keep your vitamin K intake as consistent as possible. “
So, you have to be careful around food such as:
Kale, Spinach, Turnip greens, Collards, Swiss chard, Parsley, Mustard greens…. The list goes on and on. You can eat them of course, but you have to be consistent. If you eat them, eat them every day in the same amount.
In the beginning it was weird to say the least. Mehmet would take me to the lab in the morning, I would give blood, the next day I would find out the INR / PT ratio results, according to which I would decide how much Vitamin K to take. Every second day I would be on my way to the lab, trying to catch up on yesterday’s results, as well as reading the same People magazine for days in a row in the waiting room.
After a while Mehmet started to research whether there is a better way. And he found it!
A do-it-yourself in-home test kit:
“The INRatio monitor is a diagnostic Point Of Care system that provides Prothrombin Time (PT) and International Normalized Ratio (INR) results using fresh capillary whole blood from a fingerstick.
The INRatio system reduces the headache of oral anticoagulation management, is easy to use, and features on-board quality controls with every test.”
The test kit is not cheap. But all in all, it might be cheaper than the lab-co-pays. For us the deciding factor was the real time ability to monitor today’s results with today’s medicine intake, and the convenience of not having to spend 1.5 hours in the lab every two days.
After three months we get this device home, monitor it for accuracy for one week (meaning we do the lab testing and in-home testing side by side for one week), and the make the switch over for good.
1) Blood thinning drugs (Coumadin)
2) Blood pressure lowering drugs
3) Cholesterol lowering drugs
4) + My previous anti depressants
Of course all of the above medications have interactions with one another.
My anti depressant drugs raise my blood pressure, which I have to bring down with blood pressure drugs, the blood pressure drugs in return effect my mood. But worst of all is Coumadin, it interacts with everything I eat.
You see, Warfarin (brand name Coumadin) according to National Institutes of Health,” is a medicine prescribed for people at increased risk of forming blood clots. Sometimes medical conditions can make blood clot too easily and quickly.
This could cause serious health problems because clots can block the flow of blood to
the heart or brain. Warfarin (Coumadin) can prevent harmful blood clots from forming.”
But, while taking Coumadin, you have to go to the lab and give blood to monitor your blood clotting levels continously.
Again according to N.I.H. “International Normalized Ratio (INR) and Prothrombin Time (PT) are laboratory test values obtained from measurements of the time it takes for a clot to form. Individuals at risk for developing blood clots take Coumadin to prolong the usual time it takes for a clot to form, resulting in a prolonged INR/PT. Doctors usually measure the INR / PT every month in patients taking Coumadin to make sure it stays in the desired range.”
But here is the catch: The food you eat can affect your blood clotting levels. Because: ”Blood clots are formed through a series of chemical reactions in your body. Vitamin K is essential for those reactions. Coumadin works by decreasing the activity of vitamin K;
lengthening the time it takes for a clot to form. To help Coumadin work effectively, it is important to keep your vitamin K intake as consistent as possible. “
So, you have to be careful around food such as:
Kale, Spinach, Turnip greens, Collards, Swiss chard, Parsley, Mustard greens…. The list goes on and on. You can eat them of course, but you have to be consistent. If you eat them, eat them every day in the same amount.
In the beginning it was weird to say the least. Mehmet would take me to the lab in the morning, I would give blood, the next day I would find out the INR / PT ratio results, according to which I would decide how much Vitamin K to take. Every second day I would be on my way to the lab, trying to catch up on yesterday’s results, as well as reading the same People magazine for days in a row in the waiting room.
After a while Mehmet started to research whether there is a better way. And he found it!
A do-it-yourself in-home test kit:
“The INRatio monitor is a diagnostic Point Of Care system that provides Prothrombin Time (PT) and International Normalized Ratio (INR) results using fresh capillary whole blood from a fingerstick.
The INRatio system reduces the headache of oral anticoagulation management, is easy to use, and features on-board quality controls with every test.”
The test kit is not cheap. But all in all, it might be cheaper than the lab-co-pays. For us the deciding factor was the real time ability to monitor today’s results with today’s medicine intake, and the convenience of not having to spend 1.5 hours in the lab every two days.
After three months we get this device home, monitor it for accuracy for one week (meaning we do the lab testing and in-home testing side by side for one week), and the make the switch over for good.
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