Gary’s article can be found immediately below.

“Coumadin^®, available generically as warfarin, has been widely used to reduce the risk of stroke for well over 50 years. Dwight Eisenhower, Richard Nixon and George Bush senior were all taking Coumadin during their active years of former Presidency. Despite millions of prescriptions written annually for this medication, practical, easy to use information remains a challenge.

One of the most common and historical needs of managing warfarin is diet, specifically, dietary vitamin K. Physicians use warfarin to increase the bleeding time in patients at risk for developing unwanted blood clots. The goal is to prolong the bleeding just time enough to prevent clot formation where it isn’t needed (the heart and lungs for example) but allow clotting to take place for normal blood vessel bleeding repair. While warfarin prolongs your bleeding time, dietary vitamin K increases the body’s natural ability to form clots.

The simple blood test called an INR test measures that active anti-clotting effect of warfarin. The higher the dose of warfarin, the more potent or longer the blood takes to clot. A diet high in vitamin K can reduce the effect of warfarin and lower the number of the blood test result. For this reason, it is important for patients to keep a consistent intake of dietary vitamin K to help maintain safe levels of protection warfarin provides without interfering too much.

It is difficult to monitor vitamin K intake when food and beverage labels do not provide this information and the FDA does not require it. While professionals teach vitamin K is abundant in leafy green vegetables – there are many hidden sources patients and their care givers need to know about. Salad dressings and some mayonnaise are good examples.

The vitamin K registry

An easy to use, extensive vitamin K database is available for patients and their family. The vitamin K diary allows you to simply type the first few letters of a food or beverage you’re interested in and a menu of products is displayed listing the serving size and the amount of vitamin K. The vitamin K registry can help you keep balance and choice in your diet. A printable version is also available to assist in creating grocery lists for the Coumadin patient.

The vitamin K diary

The vitamin K diary is an interactive resource for patients or caregivers to keep track of vitamin K intake. While using of the vitamin K registry as a source guide, the vitamin K diary allows the user to record the vitamin K (listed in micrograms) consumed for each meal. The diary, offered as a word document, calculates the total daily and weekly intake of vitamin K. The vitamin K diary is best used 7 days prior to the patient’s blood test to best evaluate the effect of diet and shared with the patient’s healthcare provider.

For other helpful resources on maintaining your quality of life, visit www.PTINR.com  ”

I also wanted to introduce you to the QAS website because they have some great teaching articles about vitamin K (a vitamin that should be limited when receiving Coumadin therapy) and also about some other medications that should be avoided during therapy.  He will discuss those more in later posts.

So without further adieu……

There is good news for patients taking Coumadin^® (warfarin)!

The good news for patients, family members and those who care for a loved-one taking Coumadin® (warfarin) came March 19, 2008 when Medicare announced coverage for patients to test their blood in the privacy of their home. The policy extends benefits to Medicare beneficiaries who have been taking warfarin for at least 90 days for any of the following reasons: atrial fibrillation, mechanical heart valve replacement, or venous thromboembolism (DVT/ PE).  

What is patient self-testing?

Patient self-testing allows patients taking warfarin to test their blood at home with a small finger-stick sample of blood – not too different for diabetic patients who check their blood for insulin levels.

Coumadin^® is a medication that requires a small sample of blood to measure the effect of prolonging the bleeding time designed to prevent dangerous blood clot development. Medicare and many private insurance company’s provide reimbursement for up to, but not more frequent, than weekly home testing to reduce bleeding risks.

Home INR testing however, requires a physician’s prescription for one of the FDA-approved, small, hand-held monitors and for testing supplies. The monitor and testing supplies are not available in retail pharmacies but can be obtained through specialty distributors such as Quality Assured Services, Inc. (QAS).  QAS is a Medicare and private insurance company that distributes, trains, and communicates patient’s home test results to the patient’s physicians.   

Who is a candidate for home INR testing?

Patients who are motivated, with a desire to improve their control of warfarin and reducing the risk of side effects are good candidates for home INR testing. The test is simple to perform by the patient or a caregiver.

How home INR testing works

Home INR testing enables patients to test more frequently than monthly, in the comfort of their home, resulting in better warfarin control and therefore improved safety. Home testing results may be phoned in through a secure 800# provided through the distributor of the monitor. Testing strips are shipped directly to the patient’s home at no additional charge.

Weekly testing is a testing frequency that has been proven superior in clinical studies. Testing weekly evaluates the effect of patients: diet, overall health, metabolism of Coumadin^® and interaction of other medications. Patients or care providers simply phone each home test result into their physician’s office or online service.

How to get started

Patients or caregivers can have many of their questions answered by visiting home INR testing. Specialty pharmacy providers such as QAS, Inc. provide full-service assistance including insurance, clinical and technical support at no charge to the patient.

Below, I have posted the article in its entirety; it is somewhat long but the information is great.

Incontinence – the Emotional and Physical Challenges People Caring for Aging Loved Ones Aren’t Talking About
 
New Survey from Caring.com and SCA, the Makers of TENA®, Reveals Adult Incontinence Adds Stress, Can Lead to Depression
 
SAN MATEO, CA and PHILADELPHIA, PA, November 5, 2009—Incontinence in a parent, grandparent or spouse has a significant emotional impact on a caregiver’s life, according to a survey released today by Caring.com and SCA, the makers of TENA® (www.tena.us). The survey reveals that while seventy percent report incontinence as an ongoing issue with their loved ones, caregivers are largely uncertain how to help make the situation better, or even talk about it. In fact, one in three prefer to avoid the conversation altogether. 
 
The research from Caring.com, a leading online destination for people caring for aging relatives, and TENA®, the worldwide leader in the management of bladder protection, found incontinence to be a widespread issue among adults caring for aging loved ones. More than 25 million adults are affected by incontinence in the United States today, a number that is projected to increase as the baby boomer population ages. 
 
“Sixty-five percent of Caring.com members are dealing with incontinence in a parent, grandparent or spouse. It’s a sensitive subject for both the caregiver and the person they’re caring for, ranking among the most difficult conversations people caring for aging parents are faced with, such as taking away the car keys and discussing finances,” said Andy Cohen, co-founder and CEO, Caring.com. “Caring.com can help make discussions about adult incontinence less stressful by knowing what not to say and providing supportive alternatives on how to talk to your loved one.”
 
Managing a Loved One’s Incontinence Takes an Emotional Toll
 
There is unexpected stress associated with incontinence issues and often the emotional aspect is just as hard as, or sometimes worse than, the physical aspects of caring for a loved one. The study found that incontinence can have a negative effect on a caregiver’s emotional wellbeing and influence home care and nursing home decisions:
42% report dealing with their loved one’s incontinence sometimes leads to depression;
32% find it emotionally difficult to change their loved one’s incontinence products;
27% report incontinence has a negative impact on the relationship they have with their loved one;
31% are unable to go on vacation because of their loved one’s incontinence issues; and
18% have considered moving, or have moved their parent to a care facility or nursing home because of incontinence.
 
Caregivers Try to Manage the Symptoms, but for Most It’s Not Working
 
People caring for aging relatives have tried a variety of techniques to try to manage the physical aspects of their loved one’s incontinence:
33% have made changes to their loved ones schedule;
24% have tried medications; and
23% have made dietary changes.
 
Despite trying different approaches to manage incontinence, three-quarters of survey respondents report their efforts aren’t working, reporting an increase in the amount of laundry they have to do each week, with an estimated extra two to three loads.
 
Starting the Conversation
 
“We know that understanding and discussing incontinence can be the first step to successfully managing it,” said Spencer Deane, vice president of marketing for SCA Personal Care in North America. “We applaud caregivers for trying different approaches to manage the symptoms, but over the years we’ve seen the best results when caregivers are able to talk openly about the condition and recommend the right solutions to manage it. Today there is a variety of care techniques and treatments, as well as absorbent and skin care products for all types of incontinence, which can dramatically improve the quality of life.”
 
Understanding how to discuss incontinence in a way that is supportive to both the person being cared for and the role of the caregiver is important.
 
“Incontinence often can be frustrating and overwhelming for a person caring for an aging parent or loved one, but there are steps caregivers can take to meet this challenge,” said Ann Cason, caregiving expert author and founder and director of Circles of Care. “These include considering all available treatment options, discussing incontinence in a straightforward and factual way, and asking for physical or emotional support if you need it.”
 
The Caring.com /TENA® Survey on Incontinence was conducted September 14 through September 28 by Caring.com. More than 560 respondents completed the online survey. Survey results and demographics are available upon request.

“As we enter into National Alzheimer’s Awareness Month, you may wonder whywe should bother promoting awareness.  Those who have been touched byAlzheimer’s are already aware and those who have not been touched can’t really help — so what’s the point?  After all, doesn’t it make more sense to skip the awareness effort and just focus all resources on a cure?

 As it turns out, lack of awareness and education are major contributors to the burgeoning Alzheimer’s problem.  And while the benefits of awareness may not be obvious, they are very real. 

 For example, do you know what you can do today to reduce your risk of getting Alzheimer’s later in life?  If not, your lack of awareness is fueling the ongoing problem.  Do you know how we can immediately improve the efficacy of those drugs currently approved for Alzheimer’s?  Sadly, most patients and many physicians do not. How clear is your grasp of the relationship between a healthy heart and a healthy brain?  For many of us, investing a few minutes to improve our understanding of that relationship could yield long-lasting health benefits.

 The answers to these questions along with four other important perspectives are summarized in a short article on the Brain Today blog (http://braintoday.blogspot.com)*.  The full article can be read in about five minutes and, with a couple of additional clicks, can be forwarded to your online networks. 

 In the spirit of National Alzheimer’s Awareness Month, please visit the Brain Today blog ( http://braintoday.blogspot.com) and read the article and then encourage your social networks to do the same.  In this way, you will become a part of the solution, doing your part to thwart Alzheimer’s through the simple act of awareness.

Dennis Fortier is President of Medical Care Corporation and Editor of the Brain Today blog (http://braintoday.blogspot.com).  Brain Today is a non-commercial publication devoted to interpreting the daily news about brain health and distilling the true value of that news.