Health Demystified

WHY WE SUCCEED AT REPEATING FAILURES BUT FAIL AT REPEATING SUCCESSES (and the Art of Warfarin Dosing)

Hey there,

Doesn’t it bother you that certain people just don’t learn? They keep doing the same things over and over even though clearly their method doesn’t work!

Obviously this doesn’t apply to you. I’m talking about those other idiots in your life!

Maybe, you’ve found yourself in an equally upsetting situation where you’ve achieved success, but then you can’t recreate the success no matter how hard you try. WHY?

The answer is surprisingly obvious, and it dawned on me at a hematology clinic while watching pharmacists dose warfarin. Warfarin is a blood thinner that’s notoriously hard to dose. Most other drugs are dosed the same, day in and day out. Not warfarin. A “typical” dosing schedule may look like this:

5 mg daily on Sunday and Monday, 7.5 mg Tuesday, 5 mg Wednesday, 7.5 mg Thursday, 5 mg daily on Friday and Saturday, then 7.5 the next Sunday through Tuesday, then 5 mg daily for the next two days, etc. (Have I lost you yet?!)

It’s not just the confusing ever-changing dosing schedule that’s annoying. Once on warfarin, you need to get blood drawn regularly (up to 2-3 times a month) to monitor your INR, a measure of how likely you are to bleed. It’s a real hassle, but after a while, you get used to it, and it becomes part of your everyday routine.

The reason why warfarin dosing is so complicated is because warfarin must be dosed to achieve an INR of about 2-3 (just as with everyday life goals, each patient’s INR goals are different, but usually 2-3 is the goal we are shooting for most of the time).

Many factors may cause the INR to fluctuate: diet, amount of leafy vegetables you eat, liver function, etc. And, all these factors must be taken into account while dosing warfarin.

At the clinic, we see our patients about once a week, draw their blood, and get their INR. Then we reevaluate what we did with the patient’s warfarin dosing regimen the last time they came in: Did it work? Is it working well? What has worked in the past?

Then, after having taken the time to re-evaluate, we adjust each patient’s regimen as needed.

In your life, how well do your results match up with your goals?

Many factors may cause your results to fluctuate: The way you feel on a given day, what you ate, whether or not you exercised, or got into an argument, etc. All these factors must be taken into account while coming up with your daily plan of action.

At the end of the day, try this: take 5-10 minutes and re-evaluate everything you did that day. Did you meet you goals for the day? Are you doing something that doesn’t work (and repeating failures)? What did you do that led to success?

After taking the time to re-evaluate your day, adjust your action plan as needed. Get rid of the junk you do that doesn’t lead to the results you want. See what has worked for you in the past, and make sure you do more of that!

At first, the whole process of re-evaluating and adjusting feels like a real hassle, but after a while, you get used to it and it becomes part of your everyday routine.

Try it for a week, and let me know how it goes!

Best,

Eric

Eric Wang, Pharm.D. Candidate 2012

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