A-flutter: Coumadin or not?

[Guest]

What is most likely to put a stop to your travels?

Getting your blood tested.

Being in a wheelchair and maybe not being able to swallow.

 

[Karlynn]

Oh Al, I got something for you to command Karlyn to do.

What took you so long. You must be off your game.

 

[Marge]

I test every 3 weeks..unless, I think, I may have done something that would throw my INR off. like I was really concerned when I took so much cough med a few weeks back... Would you believe..a perfect 3.0 ..I tested yesterday..because I am going to a Derm doctor tomorrow. I knew he would snip a few things...Was on the high side.So, I tweaked last night. Back in range today.( I'm really wondering if it's true now that it takes 2-3 days for INR to show a change)Mine showed up in one day But, this is the beauty of home-testing.... If he finds something that he thinks may have to be removed..at a later date...I can check it before then. And try to have my INR at a lower INR (Not off coumadin)....If you don't want to change your Insurance. Just purchase one on your own....Expensive yes..but, worth the worry. Bonnie

I would be perfectly willing to pay for my own unit. (I paid for my own cardiac rehab too because I thought I needed it)

But I'd still have to find some way to work with Kaiser while using it wouldn't I? Those of you who have them: isn't there some training period during which you learn to use them properly? And don't you correlate with testing at the clinic/doctor's office for a while to make sure it is working and you are doing it right? And who would I report my readings to if Kaiser is not cooperating.

I will probably go ahead and go back to the blood draws and work on the home health unit thing later. But eventually I do want to do the home testing. I do not know why Kaiser should mind if I pay for the damn thing myself.

 

[Marge]

Thanks for the list of articles. I am making a copy of the list & will try to get hold of copies for my "campaign" to get Kaiser to work with me on home testing!

Even if I am not eventually successful I really do want to feel that I am still trying & doing more than just going along meekly with the lab blood draws.

 

[ALCapshaw2]

Marge,

Rather than just submitting to the 'system', how about getting data sheets on the different types of finger test instruments, giving them to your Doctors (PCP, Cardiologist, Surgeon etc), and ask them why they continue to PUNISH their patients with Vein Draws for INR? Then, start to campaign for Home Testing for patients who believe they could do their own testing and maybe even their own dosing with proper information and instruction.

You might be surprised how much you can accomplish. I was responsible for getting BCBS of Alabama to cover Home Test Instruments and Test Strips. Don't forget the old saying, "The squeaky wheel gets the grease".

'AL Capshaw'

 

[Marge]

Ross, I have to differ with you on this point. Kaiser does NOT collect any money for lab visits.

They don't use the fingerstick units themselves because you can go to any Kaiser clinic lab and have the protime drawn, but the anti-coagulation unit is centrally located. They do NOT want the lab people managing the coumadin & to control costs there isn't an anti-coagulation "person" at every clinic. Kaiser lab techs do expect anyone on anti-coagulation therapy to be older...I get so many surprised looks when I walk in there at age 42.

As far as home testing...well, that's something that we're all trying to deal with whether or not our Insurance and/or Doctors believe in it.

I agree with the premise that every coumadin patient should be called back the same day, but in reality...it doesn't happen more than it does. I know with Kaiser in the Denver area, if you get your test done before 10am, you'll be called back that day, otherwise they'll call you the next day. I make sure that I get in there prior to 10am because I know that little tidbit. I know that because I asked.

One of the great things about this site is that it teaches us all to be very proactive about our health. Unfortunately, it's mostly the proactive types that will seek out a site like ValveReplacement.com. I wish there was a way to reach the rest of the poplulation that just "does what the Dr. tells me."

Kristy is right about the way Kaiser works -- it works exactly the same way here in the Bay Area. There is a central anti coagulation clinic but you can go to any lab near you to have the blood drawn.

There is no co-pay (at least not on my plan) for a blood test for coumadin or anything else.

I was told when I was on coumadin therapy for the three months after the operation last year to come in before 11 a.m. so the INR could be reported that same day -- it was in my printed instructions, I did not have to ask. I was also told, during the initial period when I was testing 2x a week, to please come in Monday and Wednesday, or Tuesday & Thursday, but not on Friday, because that made it difficult for them to report back the same day.

 

[Marge]

I test every 3 weeks..unless, I think, I may have done something that would throw my INR off. like I was really concerned when I took so much cough med a few weeks back... Would you believe..a perfect 3.0 ..I tested yesterday..because I am going to a Derm doctor tomorrow. I knew he would snip a few things...Was on the high side.So, I tweaked last night. Back in range today.( I'm really wondering if it's true now that it takes 2-3 days for INR to show a change)Mine showed up in one day But, this is the beauty of home-testing.... If he finds something that he thinks may have to be removed..at a later date...I can check it before then. And try to have my INR at a lower INR (Not off coumadin)....If you don't want to change your Insurance. Just purchase one on your own....Expensive yes..but, worth the worry. Bonnie

Golly, it has been how many years and you still test every three weeks?

I hope I would not have to test that often. When I was doing the three months coumadin therapy that I was on after the surgery my INR got in range and stayed in range pretty quickly. They were starting me on once a month testing -- just before my cardio took me off it.

 

[Nancy]

Joe's been on it for 28 years, and he is tested every week for the most part. He can go out of range easily.

 

[Granbonny]

Marge

Marge

Why I test every 3 weeks at home...FOR PEACE OF MIND. Yes, I am most always in range. 2.5-3.5.I have a mech. valve....I may soon be age 65 But, still very active..We travel a lot, too.Don't eat like when I'm home... ..... Like in my above post...Had the cruddy cough for 3 weeks a few months back..Wanted to know if the cough med..had increase it or decreased it..(INR)...When I took my INR...I could have tweaked it up or down.. But, was in range. LUCKY..A lot of OTC meds affect your INR.....Most active members posting often on VR.Com..report that when they come home from a vacation..Their INR is higher...having those exotic drinks, ect. but, most hometest and can get it (INR) back down in a few days. Eating more greens, drinking V-8 Juice, ect. or tweaking...Tweaking is lowing your doseage for a few days..........Will repeat to you a story I have told before on this site...I had 2 friends..who hubby's only testing every 3 months. Shortly, after I had my surgery..I tried to tell them. they should test more often. Was laughed at and told I was obsessed. Well, a few months later, one hubby had such a severe nosebleed, that he fell and hit his head. 911 called..He was lucky..the other friends Hubby died a few months ago wintering in Az...When I saw him in Nov. he looked great. She will return to our community in May..I will try to find out what happened to him..Could have been nothing to do with coumadin..but, I will be interested in knowing.... ..He was very active..in fact, I saw him outside weed-eating a few days before they left. Outside of my friends on VR.Com who take Coumadin..they were the only outside people I knew on coumadin. That is why I love the support here..when members have to have an invasive type surgery...on coumadin. Then, when and I hope never. I will be more educated to know what I will face.....Bonnie

 

[Guest]

What is most likely to put a stop to your travels?

Getting your blood tested.

Being in a wheelchair and maybe not being able to swallow.

*raises eyebrow*

Trick question?



I vote for the wheelchair predicament....

Not that that would stop me... .


Cort, "Mr MC" / "Mr Road Trip", 31swm/pig valve/pacemaker
'72,6,9/'81,7.hobbies.chdQB = http://www.chevyasylum.com/cort/
MC Guide = http://www.chevyasylum.com/mcspotter/main.html
"You better not try to stand in my way" ... J Paycheck ... 'Take This Job & Shove It'

 

[Guest]

Some people do not report their INR or dosage changes to anyone except when they need a new prescription.

Diabetics test their own and change insulin doses. The effect of an overdose of insulin is much more rapid and dramatic than a nosebleed that a warfarin overdose might cause.

 

[johnM]

What is the usual daily aspirin dose as a possible alternative to anticoagulation?

Does anticoagulation send up ones cholesterol?

 

[tobagotwo]

There is some controversy over how much and what type of aspirin. Most studies conclude that an 81mg (baby) aspirin is sufficient. However, many doctors still want their patients to take a 325mg (regular adult) aspirin daily.

Studies from the British Isles have concluded that enteric coated aspirin, which isn't absorbed in the stomach, but later on by the colon, is often not as effective as non-coated aspirin that is absorbed by the stomach. The conclusion is that less of it is absorbed by some people.

I take two enteric coated baby aspirins, which is 162mg - less than a 325mg, which may cause bleeding in some, but twice as much as one baby aspirin, to make up for what might not be absorbed because of the coating.

It's just aspirin. You have to wonder how complicated they can make it...

Best wishes,

 

[warrenr]

Afib

Afib

Marge,

Keep in mind that for afib you won't have to take as much coumadin as a person with a mechanical heart valve and once you are consistantly in range your INR checks would be less frequent. Your chances of having bleeding problems especially if kept at lower end of range would be very rare. Believe me when I say you don't want to go through what my father is going through because of a stroke.

 

[Marge]

I have another question about coumadin.

I am curious what pain medication you can take when you are on coumadin. For headaches, etc.

When I was on coumadin before they told me not to take aspirin, to take tylenol if I needed a pain medication. I get severe headaches (always have had). Tylenol has never done me much good. Aspirin usually relieves them. During the three months that I was on coumadin after the surgery, I had headaches pretty consistently. What, besides tylenol, can a person on coumadin take? I didn't bother the anti coagulation people about this when I was on coumadin before, I just put up with it, and took the tylenol, because I knew it was only a three month deal. (When the headaches got really bad I took some of the percocet they gave me at the hospital.) But it becomes much more important if I'm going to be on the stuff for the rest of my life.

 

[geebee]

Marge,

Keep in mind that for afib you won't have to take as much coumadin as a person with a mechanical heart valve .......

Warren,

Are you sure about this? Why then would cardios increase the INR range for patients who have valves & A-fib? My INR range was 2.5-3.5 until I went into constant A-fib. Now my range is 3.0-4.0. Is the comibination more dangerous than A-fib alone?

Just curious.

 

[catwoman]

Warren,
Are you sure about this? Why then would cardios increase the INR range for patients who have valves & A-fib? My INR range was 2.5-3.5 until I went into constant A-fib. Now my range is 3.0-4.0. Is the comibination more dangerous than A-fib alone?
Just curious.

Gina:

I understood what Warren said, but it was a little misleading.
INRs for patients taking Coumadin for A-fib or A-flutter match those for mechanical aortic valvers -- 2.0-3.0. Granted, the INR would be lower than for a mechanical mitral valver (2.5-3.5). This is per prescribing info for Coumadin.

 

[Guest]

The whole question of pain medications is up in the air right now whether you take warfarin or not. The FDA Advisory Committee made the water more muddy than clear.

I have never been able to find a report in any medical journal showing that naproxen (non-prescription Alleve) has caused anyone on warfarin any harm.

 

[warrenr]

afib + mechanical valve

afib + mechanical valve

Warren,

Are you sure about this? Why then would cardios increase the INR range for patients who have valves & A-fib? My INR range was 2.5-3.5 until I went into constant A-fib. Now my range is 3.0-4.0. Is the comibination more dangerous than A-fib alone?

Just curious.

If a person has afib + mechanical valve they are at higher risk for stroke than afib alone.

 

[Guest]

There is no study, that I have ever come across, to show that an INR of 3.5 is not sufficient in these cases. That doesn't mean that 4.0 is necessarily dangerous. I look at the 3.5 to 5.0 range as a safety net. Few people have major bleeding with INRs in that range. However, if you keep the INR at 4.0, you have a smaller safety net.

There is probably a slightly less risk of clotting at 4.0 and a slightly smaller safety net. Is this justifiable? It just depends on what the individual feels comfortable with. There is no answer.

I have people with antiphospholipid antibody syndrome that I keep up around the 5.0 range. The doctors argue with me but I point out that my doing this has never resulted in a major bleed and that every time some of them get below 2.5 or so they wind up in the hospital with a clot. Not just in the leg. They are at risk for clotting any artery or vein in the body - loss of an eye, heart attacks, strokes (teens and early 20s) etc. I discuss my theory with the patients - some agree some don't but it seems to work.