WellLife: A guide for living on warfarin is brought to you by Alere Home Monitoring, Inc., the leader in anticoagulation monitoring and services. Alere also sponsors PTINR.com, America’s #1 online anticoagulation resource for doctors and patients.

The content presented in this publication is not intended to be a substitute for professional medical advice. No effort is made at diagnosis or treatment of any condition. Only your doctor can help you with diagnosis and treatment of medical problems. Always discuss your concerns with your physician. Do not change your diet or medication without first checking with your physician.

1. Libby P. The vascular biology of atherosclerosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 43.

2. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119:e21-e181.

3. Hypertension: Management in Adults in Primary Care: Pharmacological Update. NICE Clinical Guidelines, No. 34.National Collaborating Centre for Chronic Conditions (UK).London: Royal College of Physicians (UK); 2006.

4. Living with Hypertension. American Family Physician. 1998 Mar 1;57(5):1019-1020.

© 2012 Alere. All rights reserved. The Alere Logo, Alere, Café PTINR, and PTINR.com are trademarks of the Alere group of companies. PN: 700325-01 2/12

In this Issue

Signs & Symptoms of Stroke

Health Tip: Medication

Q&A: How does fat affect Vitamin K?

Uncontrolled High Blood Pressure

Café PTINR® BREAKFAST: Smoothie & Frittata

A guide for living on warfarinWellLife

Preventing Stroke – Treatable Risk FactorsIf you’re like most Americans, you plan your future; when you buy a home, you consider factors so your investment is safe. Today, more and more Americans are protecting their most important asset—their brain. Some of the most important treatable risk factors for stroke are:

High blood pressure, or hypertension. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.

Cigarette smoking. It has been linked to the buildup of fatty substances in the main neck artery supplying blood to the brain. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.

Heart disease. Your doctor will treat your heart disease and may also prescribe medication, such as an anticoagulant, to help prevent the formation of clots.

Warning signs or history of stroke. If you’ve previously had a stroke, your risk of having a stroke is many times greater than someone who has never had one.

Diabetes. According to the National Institute of Neurological Disorders and Stroke, having diabetes is the equivalent of aging 15 years. Treating diabetes can delay the start of complications that increase the risk of stroke.

Cholesterol imbalance. Cholesterol can build up in blood vessels, leading to atherosclerosis. Atherosclerosis is the major cause of blood vessel narrowing, leading to both heart attack and stroke.1

Physical inactivity and obesity. Obesity and inactivity put a strain on the entire circulatory system. Discuss your diet and exercise habits with your doctor.

Serves: 1 Serving size: about 1 1/2 cups 1/4 cup non-fat yogurt 1 cup fresh strawberries 1/2 cup mango juice 1/2 banana

Place the yogurt, strawberries, mango juice and banana in a blender and blend on high until smooth.

Serves: 2 Serving size: 1/2 pie

This recipe can be multiplied by 2 or 3 but requires large skillet. Wrap tightly after cooled and refrigerate.

1 tsp unsalted butter 1/4 cup onion 5 asparagus spears 2 large eggs 2 large egg whites 2 Tbsp water 4 Tbsp Parmigiano- Reggiano cheese

Preheat the oven to 400°F. Heat ½ teaspoon butter in a small non-stick pan over low-medium heat and add chopped onion. Cook until translucent. Set aside.

Slice the base of asparagus crosswise into small rounds.

Leave about 2 inches of the tops intact. Set the tops aside to decorate the frittata.

Whisk the eggs, egg whites and water in a bowl until frothy.

Heat the remaining butter in a small non-stick skillet over medium-high heat. When hot, add the egg mixture. Reduce heat to medium and simmer for about 2 minutes. Add the onion and chopped asparagus.

Arrange the asparagus tops in a pattern on top of the cooking egg mixture. Scatter the parmesan cheese over the top and then fresh ground black pepper to taste.

Place in the oven. Reduce the heat to 350°F degrees and bake for 10 - 15 minutes until it puffs and is firm to the touch.

This recipe brought to you with permission by Dr. Gourmet.For more information visit www.drgourmet.com

Café PTINR® Breakfast

WellLife: A guide for living on warfarin is brought to you by Alere™ Home Monitoring

VOLUME 8

STRAWBERRY BANANA SMOOTHIE

ASPARAGUS FRITTATA

Alere Home Monitoring, Inc. 6465 National Drive, Livermore, CA 94550 1.877.262.4669

Nutrition FactsAmount Per ServingCalories 234 Calories from Fat 0 % Daily ValueTotal Fat 1g 1% Saturated Fat 0g 1%Cholesterol 32mg 1%Sodium 103mg 4%Total Carbohydrates 51g 17% Dietary Fiber 5g 20% Sugars 40g Protein 9g Vitamin A 19% Vitamin C 191%Calcium 29% Iron 7%Vitamin K 5mcg Potassium 786mgMagnesium 63mg

Nutrition FactsAmount Per ServingCalories 166 Calories from Fat 87 % Daily ValueTotal Fat 10g 15% Saturated Fat 5g 22%Cholesterol 225mg 75%Sodium 280mg 12%Total Carbohydrates 5g 1% Dietary Fiber 1g 5% Sugars 2g Protein 15g Vitamin A 13% Vitamin C 6%Calcium 15% Iron 11%Vitamin K 17mcg Potassium 244mgMagnesium 21mg

Stroke Signs & Symptoms

How does fat affect Vitamin K?

Low-fat choices not only mean reduced calories, it often means a significant reduction in vitamin K. If you are looking to replace your regular salad dressing and sauces with low-fat options, you may, unknowingly, be influencing your next INR test result. The rise or fall in INR is dependent on the quantity of vitamin K and the time that has gone by since the dietary change.

The golden rule on vitamin K is to maintain a consistent intake rather than trying to eliminate, or avoid vitamin K altogether. Work closely with your doctor to determine the range of vitamin K that works well with your warfarin dose. For more information regarding the vitamin K content in foods, go to PTINR.com and click on the Vitamin K Finder.

Uncontrolled High Blood PressureBlood pressure goes up and down, even in people who do not have hypertension. A painful injury or an illness with fever can cause blood pressure to go up for awhile. True hypertension occurs when blood pressure is continually elevated, such as a high (systolic) number of 140 or more and/or the low (diastolic) number is 90 or more. The symptoms of uncontrolled hypertension can often be very vague, like a dull headache.

In most cases, a significant number of patients require two or more blood pressure medications to achieve control of their blood pressure3; though, more than 90 percent of patients can get good results from antihypertensive medicines and following their doctor’s instructions.4 It is very important to keep your doctor’s appointments, even if your blood pressure is currently under control.

Q&AIf you have symptoms of a stroke, call 911 or other emergency services right away. General symptoms of a stroke include2:

• Suddennumbness,tingling,weakness,orlossofmovementinyourface,arm,orleg, especially on only one side of your body.

• Suddenvisionchanges.

• Suddentroublespeakingorgarbledspeech.

• Suddenconfusionortroubleunderstandingsimplestatements.

• Suddenproblemswithwalkingorbalance.

• Asudden,severeheadachethatisdifferentfrompastheadaches.

Symptoms can vary depending on whether the stroke is caused by a blood clot or bleeding, where the stroke occurs in the brain, and how bad it is.

A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.

If several smaller strokes occur over time, you may have a more gradual change in walking, balance, thinking, or behavior.

It is not always easy for people to recognize symptoms of a small stroke. They may mistakenly think the symptoms can be attributed to aging, or the symptoms may be confused with those of other health conditions.

Speak to your doctor about the signs of stroke and your risk.

Everyday Health - MedicationDid I take my pill today? How many times have you asked yourself this question? To avoid forgetting, create a daily routine to take your medication.

Use a pillbox: these are available at most pharmacies and can help you remember when to take your medication with compartments labeled with the days of the week (some include AM/PM) and various dosage frequencies.

Keep written or computerized schedule: this list should show each medicine you take on a regular basis, its purpose, how much to take, and when to take it. Both the Food & Drug Administration (FDA) and the Agency for Healthcare Research and Quality (AHRQ) have guidelines on how to make a medication list.

Remind yourself: for high tech solutions, you can use medication reminder pagers and wristwatches, automatic pill dispensers, and even voice-command medication managers. For a low tech solution, use a printed calendar or sticky notes to remind you.

Keep medications in same place where you will notice them: for medication to be taken with food, keep your pillbox near the kitchen.

Travel, including flying: ensure you have enough refills on hand for the duration of your trip. If you are flying, be readily able to identify each medication by bringing your medication record with you. For additional information call your airline or go to the Transportation Security Administration (TSA.gov) website.

It is important to discuss all medication with your doctor and to take all your medication as prescribed.

HOME INR MONITORING decreases the likelihood of stroke with more frequent testing.

Go to PTINR.com or talk to your doctor for more information.

Stroke Signs & Symptoms

How does fat affect Vitamin K?

Low-fat choices not only mean reduced calories, it often means a significant reduction in vitamin K. If you are looking to replace your regular salad dressing and sauces with low-fat options, you may, unknowingly, be influencing your next INR test result. The rise or fall in INR is dependent on the quantity of vitamin K and the time that has gone by since the dietary change.

The golden rule on vitamin K is to maintain a consistent intake rather than trying to eliminate, or avoid vitamin K altogether. Work closely with your doctor to determine the range of vitamin K that works well with your warfarin dose. For more information regarding the vitamin K content in foods, go to PTINR.com and click on the Vitamin K Finder.

Uncontrolled High Blood PressureBlood pressure goes up and down, even in people who do not have hypertension. A painful injury or an illness with fever can cause blood pressure to go up for awhile. True hypertension occurs when blood pressure is continually elevated, such as a high (systolic) number of 140 or more and/or the low (diastolic) number is 90 or more. The symptoms of uncontrolled hypertension can often be very vague, like a dull headache.

In most cases, a significant number of patients require two or more blood pressure medications to achieve control of their blood pressure3; though, more than 90 percent of patients can get good results from antihypertensive medicines and following their doctor’s instructions.4 It is very important to keep your doctor’s appointments, even if your blood pressure is currently under control.

Q&AIf you have symptoms of a stroke, call 911 or other emergency services right away. General symptoms of a stroke include2:

• Suddennumbness,tingling,weakness,orlossofmovementinyourface,arm,orleg, especially on only one side of your body.

• Suddenvisionchanges.

• Suddentroublespeakingorgarbledspeech.

• Suddenconfusionortroubleunderstandingsimplestatements.

• Suddenproblemswithwalkingorbalance.

• Asudden,severeheadachethatisdifferentfrompastheadaches.

Symptoms can vary depending on whether the stroke is caused by a blood clot or bleeding, where the stroke occurs in the brain, and how bad it is.

A stroke usually happens suddenly but may occur over hours. For example, you may have mild weakness at first. Over time, you may not be able to move the arm and leg on one side of your body.

If several smaller strokes occur over time, you may have a more gradual change in walking, balance, thinking, or behavior.

It is not always easy for people to recognize symptoms of a small stroke. They may mistakenly think the symptoms can be attributed to aging, or the symptoms may be confused with those of other health conditions.

Speak to your doctor about the signs of stroke and your risk.

Everyday Health - MedicationDid I take my pill today? How many times have you asked yourself this question? To avoid forgetting, create a daily routine to take your medication.

Use a pillbox: these are available at most pharmacies and can help you remember when to take your medication with compartments labeled with the days of the week (some include AM/PM) and various dosage frequencies.

Keep written or computerized schedule: this list should show each medicine you take on a regular basis, its purpose, how much to take, and when to take it. Both the Food & Drug Administration (FDA) and the Agency for Healthcare Research and Quality (AHRQ) have guidelines on how to make a medication list.

Remind yourself: for high tech solutions, you can use medication reminder pagers and wristwatches, automatic pill dispensers, and even voice-command medication managers. For a low tech solution, use a printed calendar or sticky notes to remind you.

Keep medications in same place where you will notice them: for medication to be taken with food, keep your pillbox near the kitchen.

Travel, including flying: ensure you have enough refills on hand for the duration of your trip. If you are flying, be readily able to identify each medication by bringing your medication record with you. For additional information call your airline or go to the Transportation Security Administration (TSA.gov) website.

It is important to discuss all medication with your doctor and to take all your medication as prescribed.

HOME INR MONITORING decreases the likelihood of stroke with more frequent testing.

Go to PTINR.com or talk to your doctor for more information.

WellLife: A guide for living on warfarin is brought to you by Alere Home Monitoring, Inc., the leader in anticoagulation monitoring and services. Alere also sponsors PTINR.com, America’s #1 online anticoagulation resource for doctors and patients.

The content presented in this publication is not intended to be a substitute for professional medical advice. No effort is made at diagnosis or treatment of any condition. Only your doctor can help you with diagnosis and treatment of medical problems. Always discuss your concerns with your physician. Do not change your diet or medication without first checking with your physician.

1. Libby P. The vascular biology of atherosclerosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 43.

2. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics—2009 update. A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009;119:e21-e181.

3. Hypertension: Management in Adults in Primary Care: Pharmacological Update. NICE Clinical Guidelines, No. 34.National Collaborating Centre for Chronic Conditions (UK).London: Royal College of Physicians (UK); 2006.

4. Living with Hypertension. American Family Physician. 1998 Mar 1;57(5):1019-1020.

© 2012 Alere. All rights reserved. The Alere Logo, Alere, Café PTINR, and PTINR.com are trademarks of the Alere group of companies. PN: 700325-01 2/12

In this Issue

Signs & Symptoms of Stroke

Health Tip: Medication

Q&A: How does fat affect Vitamin K?

Uncontrolled High Blood Pressure

Café PTINR® BREAKFAST: Smoothie & Frittata

A guide for living on warfarinWellLife

Preventing Stroke – Treatable Risk FactorsIf you’re like most Americans, you plan your future; when you buy a home, you consider factors so your investment is safe. Today, more and more Americans are protecting their most important asset—their brain. Some of the most important treatable risk factors for stroke are:

High blood pressure, or hypertension. Controlling blood pressure will also help you avoid heart disease, diabetes, and kidney failure.

Cigarette smoking. It has been linked to the buildup of fatty substances in the main neck artery supplying blood to the brain. By quitting, at any age, you also reduce your risk of lung disease, heart disease, and a number of cancers including lung cancer.

Heart disease. Your doctor will treat your heart disease and may also prescribe medication, such as an anticoagulant, to help prevent the formation of clots.

Warning signs or history of stroke. If you’ve previously had a stroke, your risk of having a stroke is many times greater than someone who has never had one.

Diabetes. According to the National Institute of Neurological Disorders and Stroke, having diabetes is the equivalent of aging 15 years. Treating diabetes can delay the start of complications that increase the risk of stroke.

Cholesterol imbalance. Cholesterol can build up in blood vessels, leading to atherosclerosis. Atherosclerosis is the major cause of blood vessel narrowing, leading to both heart attack and stroke.1

Physical inactivity and obesity. Obesity and inactivity put a strain on the entire circulatory system. Discuss your diet and exercise habits with your doctor.

Serves: 1 Serving size: about 1 1/2 cups 1/4 cup non-fat yogurt 1 cup fresh strawberries 1/2 cup mango juice 1/2 banana

Place the yogurt, strawberries, mango juice and banana in a blender and blend on high until smooth.

Serves: 2 Serving size: 1/2 pie

This recipe can be multiplied by 2 or 3 but requires large skillet. Wrap tightly after cooled and refrigerate.

1 tsp unsalted butter 1/4 cup onion 5 asparagus spears 2 large eggs 2 large egg whites 2 Tbsp water 4 Tbsp Parmigiano- Reggiano cheese

Preheat the oven to 400°F. Heat ½ teaspoon butter in a small non-stick pan over low-medium heat and add chopped onion. Cook until translucent. Set aside.

Slice the base of asparagus crosswise into small rounds.

Leave about 2 inches of the tops intact. Set the tops aside to decorate the frittata.

Whisk the eggs, egg whites and water in a bowl until frothy.

Heat the remaining butter in a small non-stick skillet over medium-high heat. When hot, add the egg mixture. Reduce heat to medium and simmer for about 2 minutes. Add the onion and chopped asparagus.

Arrange the asparagus tops in a pattern on top of the cooking egg mixture. Scatter the parmesan cheese over the top and then fresh ground black pepper to taste.

Place in the oven. Reduce the heat to 350°F degrees and bake for 10 - 15 minutes until it puffs and is firm to the touch.

This recipe brought to you with permission by Dr. Gourmet.For more information visit www.drgourmet.com

Café PTINR® Breakfast

WellLife: A guide for living on warfarin is brought to you by Alere™ Home Monitoring

VOLUME 8

STRAWBERRY BANANA SMOOTHIE

ASPARAGUS FRITTATA

Alere Home Monitoring, Inc. 6465 National Drive, Livermore, CA 94550 1.877.262.4669

Nutrition FactsAmount Per ServingCalories 234 Calories from Fat 0 % Daily ValueTotal Fat 1g 1% Saturated Fat 0g 1%Cholesterol 32mg 1%Sodium 103mg 4%Total Carbohydrates 51g 17% Dietary Fiber 5g 20% Sugars 40g Protein 9g Vitamin A 19% Vitamin C 191%Calcium 29% Iron 7%Vitamin K 5mcg Potassium 786mgMagnesium 63mg

Nutrition FactsAmount Per ServingCalories 166 Calories from Fat 87 % Daily ValueTotal Fat 10g 15% Saturated Fat 5g 22%Cholesterol 225mg 75%Sodium 280mg 12%Total Carbohydrates 5g 1% Dietary Fiber 1g 5% Sugars 2g Protein 15g Vitamin A 13% Vitamin C 6%Calcium 15% Iron 11%Vitamin K 17mcg Potassium 244mgMagnesium 21mg