My dis­claimer: I am nei­ther a doc­tor nor a nurse, nor have I ever played one on TV!

As I con­tem­plate on life’s lessons I recall that day in mid-August 1999 when my sons and I brought my hus­band, M, home from the nurs­ing home to which he’d been con­signed for reha­bil­i­ta­tion fol­low­ing a long hos­pi­tal stay.

M’s pan­ic at being forced to leave the hos­pi­tal before he was psy­cho­log­i­cal­ly or phys­i­cal­ly ready (he had no idea what had hap­pened to him dur­ing his 70 day hos­pi­tal stay — for 50 days of that he was in an induced coma. He had no con­cept of how seri­ous his con­di­tion was); our pan­ic when we real­ized what sort of facil­i­ty the nurs­ing home was; our thoughts that he would die if left in that place and all the tears that ensued that rainy first night.

The deci­sion was made. We would beg the facility’s physi­cian to release him to our care; we would clear our liv­ing room of fur­ni­ture and have a hos­pi­tal bed installed.

That done he came home in an ambu­lance with­in two days, glad to be in his own home. Now what?

He had numer­ous meds to take, none of which I knew any­thing about. I called his car­di­ol­o­gist to ask about man­ag­ing Coumadin and said “What do I do next?”.

The man­age­ment of Coumadin (the gener­ic is War­farin) intake dif­fers case by case. As a blood thin­ner there are intake require­ments based on your PT/INR (Pro­thom­bin Time/International Nor­mal­ized Ratio). If you have an arti­fi­cial heart valve the intake is dif­fer­ent from intake for oth­er conditions.

We start­ed with dai­ly blood tests. Some­how I nev­er seemed able to get his PT/INR bal­anced with­in the required para­me­ters for his condition.

I found a good web­site and bought the Coumadin Cook­book
which explains which foods have the nat­ur­al blood thin­ner Vit­a­min K and pro­vides recipes and guid­ance. Of course I had his car­di­ol­o­gist as my loy­al advi­sor – I could nev­er have made it through the whole expe­ri­ence with­out him.

By this time my hus­band was receiv­ing phys­i­cal and occu­pa­tion­al ther­a­py 3 times a week from ther­a­pists and from us on the oth­er days. 

My ques­tion was: Do both diet and exer­cise have a bear­ing on the bal­ance of Coumadin?

My the­o­ry was (I’ve found no research to back my the­o­ry): Since I had a patient whose exer­cise regime was chang­ing (increas­ing — he was becom­ing more and more mobile by the day) no mat­ter how sta­ble his diet (and I real­ly worked on that) it was obvi­ous that his body was not in a sta­ble state.

After 7 1/2 years I now believe that sta­bil­i­ty in diet and exer­cise affects one’s Coumadin balance. 

I learned over time and by using log­ic and reasoning. 

Now that he is phys­i­cal­ly sta­ble and ambu­la­to­ry M rec­og­nizes that when he appre­cia­bly changes his fit­ness rou­tine and/or diet his every 6 week PT/INR test results will not be stable. 

There’s no way my moth­er could have taught me that!!