During the initial stage of treatment, INR is checked daily; intervals between tests can be lengthened if the patient manages stable therapeutic INR levels on an unchanged warfarin dose. Newer point-of-care testing is available and has increased the ease of INR testing in the outpatient setting. Instead of a blood draw, the point-of-care test involves a simple finger prick. Maintenance dose
Recommendations by many national bodies, including the American College of Chest Physicians, have been distilled to help manage dose adjustments.The maintenance dose of warfarin can fluctuate significantly depending on the amount of vitamin K1 in the diet. Keeping vitamin K1 intake at a stable level can prevent these fluctuations. Leafy green vegetables tend to contain higher amounts of vitamin K1. Green parts of members of the family Apiaceae, such as parsley, cilantro, and dill are extremely rich sources of vitamin K; cruciferous vegetables such as cabbage and broccoli, as well as the darker varieties of lettuces and other leafy greens, are also relatively high in vitamin K1. Green vegetables such as peas and green beans do not have such high amounts of vitamin K1 as leafy greens. Certain vegetable oils have high amounts of vitamin K1. Foods low in vitamin K1 include roots, bulbs, tubers, and most fruits and fruit juices. Cereals, grains, and other milled products are also low in vitamin K1. Self-testing
Anticoagulation with warfarin can also be monitored by patients at home. International guidelines on home testing were published in 2005.
Oculopharyngodistal myopathy is a rare genetic disorder characterized by progressive muscle weakness affecting various parts of the body. Signs and symptoms
People with this condition exhibit symptoms susch as progressive muscle weakness affecting the eyes, face, and pharynx which consequently results in blepharoptosis, ophthalmoparesis, atrophy of the facial muscles, dysphagia, dysarthria, and muscle weakness and atrophy of the upper and lower distal limbs. These symptoms usually start during adulthood.On rare cases, hearing loss, severe proximal weakness and/or unilateral muscle weakness. Complications
Complications vary depending on the symptoms and their severity, for example, muscle weakness might leave people unable to work on manual labor jobs. Diagnosis
This condition can be diagnosed through physical examination and sequencing of the genes associated with the condition. Genetics
There are four known genetic causes of this disorder:
1. Trinucleotide repeat expansion located in the 5-prime untranslated region of the LRP12 gene. (CGG)2. Trinucleotide repeat expansion located in the 5-prime untranslated region of the G1PC gene. (GGC)3. Trinucleotide repeat expansion located in the non-coding region of the NOTCH2NLC gene. (CGG)4. Trinucleotide repeat expansion located in the 5-prime untranslated region of the RILPL1 gene.All of these mutations are inherited/expressed in an autosomal dominant manner, meaning that for a person to exhibit the symptoms of this condition, they must inherit a copy of the mutated allele from at least one parent, although in other cases, the mutation might not have been inherited, but rather the result of a spontaneous error.