At the end of each scene, you’ll get a chance to test your knowledge; Are their comments true or false?
Before reading this episode, you may like to catch up with the previous scenes
Scene 3 – a cafe
Clara Clearvessel raced from the lab to ‘Harper’s Kitchen’, it was the newest café in town and she’d read good reviews about it: It looked really busy, so she was glad she’d booked.
She was always very careful with her diet, avoiding anything that might interact with warfarin. She happily ordered pancakes and blueberries for a day-off treat, when she spotted the old man from the lab coming towards her. He said, “You’re the lady from the lab, aren’t you? This cafe’s so busy, do you mind if I share your table?”
Clara decided to be charming, after all he had let her push ahead of him in the queue for blood tests.
“Of course, I’m Clara and you’re …?”
“David. What do you recommend from the menu? I thought I’d have the eggs-benedict and spinach.”
The words popped out, before Clara had chance to remember to be gracious, “Surely you shouldn’t be eating spinach. It will affect your INR result.”
Immediately, she tried to redeem herself, “I’m so sorry about my attitude, I’ve got this unusual condition called anti-phospholipid syndrome and I’m worried I’ll never have a normal life. I’ve already had two pulmonary emboli, and I know it will be difficult if I want to have a baby.”
Her voice petered out, too much information to share with a stranger.
But he looked at her kindly, “You remind me of my son, he’s a pharmacist and always talking about my health and how I should look after myself. It’s hard to get the right balance between knowing so much you worry and not knowing enough.”
“I read so much” said Clara, “And I work in the library, so I’m used to looking things up for people. I try to keep up with all the information on anti-phospholipid syndrome.”
“I’m at the library each week” said David, “Maybe I’ll look for you next time I’m there and learn more about anti-phospholipid syndrome.”
What do you think of these statements? True or false?
both TRUE and FALSE
Questions about diet are some of the commonest questions I get relating to warfarin treatment. Most people are aware that vitamin K can alter the INR and that green vegetables contain a lot of this vitamin. However, the vitamin K in vegetables is poorly absorbed and you need to take a lot of vegetables to significantly change the INR. One study showed that people on warfarin needed to eat over half a kilogram of brocolli daily to have a significant impact. My advice is to keep to a normal diet and that normal portions of green vegetables are safe. Brocolli and spinach are the vegetables that contain most vitamin K so don’t binge on these!
You may never have heard of anti-phospholipid syndrome, which is one of the thrombophilias. If you have had more than one blood clot you should be tested for this condition especially if you are under 50 years old. There is a high risk of further clots so you may need to stay on an anticoagulant long-term. This condition can be very serious in young women as it causes an increased rate of miscarriages. With this condition the miscarriage can occur at any stage of pregnancy, obviously a miscarriage is always distressing but late pregnancy loss can be devastating. Women with a history of recurrent miscarriage should be tested for this condition even if they have not had a blood clot.