My current doctor asked me if I wanted her to refer me to a hematologist. I said no. She said she had lots of Warfarin patients but I don't think that she had one like me who was so sensitive to Warfarin.
I am avoiding spinach, kale and brussels sprouts but I never ate that much of them anyway.
No, there are no clinics nearby. The closest is in Boston which is a big of a hike from where I live.

Considering the fact that it seems to be so diffcult to regulate your INR and the nearest INR clinic is so far away I would recommend to switch to another anticoagulant, like xarelto, which does not require any INR testing, and I think the diet has actually no effect on effectiveness of xarelto. Warfarin affects the whole K-vitamin processes in the clotting cycle but xarelto only a small and specific portion of the biochemical cycles.

Another possibility is to continue on warfarin and get a INR home testing kit, and then regulate the doses yourself. it is possible to download some simple softwares for free to calculate the appropriate dose. Also, you can measure your INR more often (than in INR clinic that is located so far away) and thus you can adjust your dose more accurately.

I have to respectfully disagree with @stefan014. I think it might be a little premature to switch meds. You don't need a coumadin clinic to manage your warfarin... many doctors are completely capable of doing this. (Although, whether you feel like your doctor is one of them is another question entirely.) And, honestly, I feel like many of the stories we've heard on here about coumadin clinics make them sound a little old school about managing INR--they often seem to advise drastic changes in diet, which I don't feel like is realistic for a warfarin lifer. I mean, I became a lifer at the age of 35 ... it seems like a bad idea to avoid green veggies for the rest of my life.

If you are going to be a lifer on warfarin, it might be worth checking with your doctor and insurance company about a home tester. I think you'd already talked about doing that in another thread? That won't happen overnight, of course.

Honestly, it sounds like your doc is slowly dialing in the correct dose of the meds for you. You are sensitive to the meds, but that doesn't change the procedure for getting to the correct dose. You adjust, check the INR 4+ days later, adjust again. Doing small tweaks is better than big adjustments that could send you wildly fluctuating.

Once you get the correct dose figured out, I don't think you'll fall into the "difficult" category at all and I would think your INR will stabilize nicely after that. Every person is different, of course, and considering that doctors can dose you anywhere between .5 mg a day and 20 mg a day, it can take a while to figure out what is right for you.

And, I agree with the others... don't change your diet. If you regress back into your old eating habits at some point (and you probably will), then your numbers will get weird again and you'll be causing more problems than you solve. It's better to adjust the dose to your actual life, since it has less of an impact on your mental well-being at that point.

Brooklin developed the clot on the August 11, i.e nearly 2 months ago. How long time does need to elapse before changing meds if stable INR cannot be achieved? 3 months? 6 months? just wondering when does "premature" becomes "non-premature".

I'm going to agree with Toss 100%.

Do you guys hear that?? It's the sound my head banging against the wall, over and over again.

I've been on the PE board and the DVT board for several years. It's not unusual AT ALL for it to take a few months if not more to dial into the right INR. I believe what is an acceptable amount of time would be something determined by a medical doctor.

@Stephan014. It can often take several months to dial in the right dose of warfarin, as we've seen on here many times. It can be especially challenging if you're at one end or the other of the spectrum (i.e., need a very low or very high dose) as it'll take a while to get there. If she's been stable in the past on warfarin, there's no reason to assume that she won't be again.

In Brookin's case, especially, since she's had problems with bleeding in the past (even at INRs that aren't that far out of range), I would not be in a hurry to switch her to a newer anticoagulant that has no reversal mechanism. In her case, I think taking the time to dial in the correct dose with a medication that has a reversal agent would be preferable to using one that can't be reversed easily (if at all).

Of course, ultimately, it depends on what she's comfortable with.

Im not saying what is best to do, just raising the options. There are pros and cons with warfarin and xarelto: see
http://www.newsmax.com/Health/Health-Wire/warfarin-Xarelto-differences-blood/2015/05/27/id/646980/

In case of serious bleeding, the antidode for warfarin is by giving the patient K-vitamin while for Xarelto it is giving fresh plasma (which is less effective). However, the effects of xarelto are much quicker to disappear, thus if the bleeding is not serious, then the clotting potential of the blood is back to "normal" after about 24 hrs. In case of warfarin, this can take days...

I was on warfarin for nearly a year (after 2 months on heparin). I got the dosage within the right range reasonably quick, or few weeks. If I would have problems for three months or more to get it right, either going under or over the theurapeutic range, thus spending countless hours of my time going to some type of INR clinic at short intervals to strive to get the INR right, it would have driven me mad and I would have probably rather switched to heaprin even though I would have to inject myself rather than spend all this endless time in INR clinics, although paying for such INR testing device would be come an option.

Anyway, this is my opnion, and I hope this forum is open to all views and ideas, (even though it means member of this forum banging the head to the wall in response to my views) as I believe there is no single universal truth with respect to treatment of DVT

This is the last thing I will say in this thread..

Hope you have a lovely day (those from US) and bye from me (from a cold evening in Iceland)

Until they come up with a reversal agent for Xarelto, I will stick with Warfarin. We are retired and the lab is very close by so I don't mind having to go once a week until my INR is stable.
Medicare pays for the blood work too.

I was banging my head against the wall over the fact that it felt to me as if all the conversation about food and diet seemed to be going in circles.

Don't bang your head against a wall. We need your input.
Anyway, I posted yesterday that my INR was finally at 2.7 and then the nurse calls and tells me to up my dosage by 2 mgs per week meaning 14mgs to 16 mgs. I questioned the nurse and told her that it took months to get my INR in the right range and that upping the dosage didn't seem right to me. She said she'd ask the doc and she called me back and told me that I was right and to keep it at 14mgs and not 16mgs.
She made light of it and I kept my cool but I was very disturbed by the fact that she gave the doc the wrong info which would have resulted in my INR going up, yet again. Thank goodness I have a brain and questioned them but I have lost faith in both the doctor and the nurse.

Many, if not most physicians are fully capable of managing Warfarin, but I LOVE my pharmacist at my ATU clinic! Is that dorky?? Haha! They are the opposite of old school, very attentive, and really teach the same things that Toss and rmb have been discussing. They have told me directly "do and eat what you normally do, be somewhat consistent, and we will adjust your dosing accordingly." I only asked because if you were feeling frustrated, maybe that is an option? Maybe I am just lucky at my hospital, Idk!!!

I checked and there are no clinics nearby at all.
I have faith that the doctor would finally get the dosage right and she did the previous week but then the nurse calls me with my INR at 2.7 (yay) and then tells me to go from 14 mgs for the week to 16. I questioned her on it and she went back to the doctor and I was right.
It's that kind of stuff that drives me crazy. Had I listened to the nurse (who was reading the wrong numbers from the chart) I'd have gone about an INR of 3 yet again.
The moral to this story is that if we feel that the doctor or nurse got it wrong, we need to question them on it.
Taking another blood test tomorrow and hopefully it will still be in range.