A Protime/Coagucheck question

[EVELYN]

Hello Al

As usual, A BIG THANK YOU FOR YOUR WONDERFUL ADVICE. I, too, believe our machine is malfunctioning...I DON'T believe it is the replacement cuvettes. I also think it has been malfunctioning since last year when we had difficulties with its readings. I am going to check it with the loaner they're sending us. Thank you for suggesting that we do NOT change our ISI to 2. I have a call in to ITC to request that they do not change it prior to shipping the loaner. Hopefully, we can have this resolved satisfactorily. I will definitely keep you posted!!!

I, too, wasn't that crazy about Tyce's INR of 5. He's been WAAAY higher....of course we didn't hold the coumadin for two days, we just reduced his dosage by 15%.....well, between 10 and 15% and will test with our two machines on Wednesday and with our cardio's lab machines and our machines on Friday. I also have to call Lance and keep him apprised of this situation. I do hope if the machine has to be replaced that they will stand by their products, but I guess we'll see what happens.

Again, my sincere thanks for all your advice. You definitely keep things in perspective....I hope someone from my cardio's office is going to Geneva in December----you know I'll find out on Friday---I will definitely have them touch base with you so they can learn about proper coumadin procedures!!!

Be well, and thanks again.

Evelyn

 

[catwoman]

Evelyn:

How long have you had your machine? What kind of warranty came with it? Was Tyce's visit to the cardiologist a regular one, or does the doctor require/ask that you go in every so often for a "professional" PT/INR? Just wondering, since I'm wanting to do home-testing.
Thanks!

 

[Guest]

The ISI can vary from batch to batch. That is why the CoaguChek has a code chip. The ISI is programmed into the chip and the strip has the code number programmed into it too. If you try to mismatch them, the machine will not acceot the strip.

Problems can also arise with hospital lab testing. Some of these machines do not have fail-safe chips like the CoaguChek does. The lab techs at one hospital in Philadelphia (about 5 years ago) did not set the correct ISI when they changed batches. As a result they did about a thousand INRs with incorrect results and killed (2 people, I think). There can also be other mix-ups in the lab. When you see your own blood go onto the test strip and read the results, you are 100000000% sure whose blood got tested.

Evelyn, It looks like you guys know better than the doctor's staff about what to do.

The meeting in Geneva is about the use of the internet in medicine, not about anticoagulation. That just happens to be my topic.

 

[Granbonny]

Catwoman

Catwoman

I have had my Protime for 17 months....Script approved by my Cardiologist..He has never asked me to bring mine in.. But, mine is always in the 2.5-3.5 range... Have never had any bleeding or brusing..so I trust my Protime. I am relaxed enough now..that I only check every 4 weeks and call it in to My clinical Nurse. She calls back within a few hours and says to stay on same doseage..which I have also been on for 17 months. Bonnie

 

[EVELYN]

Hi Catwoman

We have had our Protime for about 15 months. When we originally got it we brought it into our cardio to check against their Coaguchek....always in range....or at least .6 difference which ITC says is normal. (Protime being lower than their Coaguchek) It comes with a year's warranty, but you can buy an additional year for about $150....but don't quote me on that amount. I do know that we received our Protime in July or August, but did not received the warranty card until March of this year. I do believe that when you spend the amount we spent on this unit that it should be a lifetime warranty. The way I see it is, it has only been used about 87 or so times and should still be accurate and warrantied.

We had "trouble" with the unit....I would say in November of last year,(3 months) at which time I thought it was the charger.....the battery wouldn't hold a charge and is still leaking. ITC sent us a loaner unit to attempt to determine what was wrong. I erroneously believed it was the charger, so we exchanged chargers and that was the end of that story.

We have brought it into our cardio's office once or twice. and I also have checked my inr on the unit, in the hopes of me being 1.0. Of course, now I know that the higher the number, the more out of range it can be with the Coaguchek. We always faxed Tyce's results in to our cardio, and if there was any question, he had to go there for a test. He has been WAY high a few times....8.0 once to the best of my ability without looking at my records. The 8.0 on ours was a 5.0 on the dr.'s. We went to the cardio for a checkup for Tyce and it was his office assistant who said....let's check your INR while you're here.....the beginning of the saga. When we checked this past Friday on our Protime, it read 2.9....cardio's office 5.0 on each of their two Coaguchek machines, resulting in a lab draw directly from the cardio of 4.9....

Recently we were called by ITC and were told that our cuvettes were defective and we had to return them. They sent us new cuvettes and we have been testing with those since, I believe, September/October. Now no one seems to know what is wrong. I guess that is what we will attempt to find out this week with the second loaner unitl we are receiving.

I do hope that we can resolve this issue and that ITC/QAS will stand by their machine.

Bonnie, I'm really glad that you love your unit so much. I wish I could echo your sentiments, but right now I cannot.

Evelyn

 

[Blanche]

Evelyn:

We had multiple variations in INR results when we first got the ProTime monitor in early 2001. ALso, we've had our machine twice as long as you have had yours. If they find that the problem is in your machine, and not something that affects all ProTime monitors, can you find out how one can determine that their machine has problems? I understood that if there was a problem, the ProTime would shut down.

This a concern for anybody with a monitor. I agree that it is good idea to check any home monitor against the lab frequently. Saddly, we have not done that in long, long time. Al has an appointment with the Cardiologist, who now has a Coumadin Lab. We will be checking with him about this.

I am so sorry that this is happening to you again. I really hope that the problem is something simple and can be solved soon. Worry and wait, two of the hardest things in the world. I'll keep you in my thoughts.


Regards,
Blanche

 

[EVELYN]

Hi Blanche

Sorry I didn't get to posting yesterday, but "Gone at 8 and back very late doesn't make for a good post."

We received the monitor and cuvettes Tuesday....will hopefully check today and let you know the difference. Unfortunately we have to go to a wake tonight for a friend of ours who was killed when his tractor flipped over on him Monday.....tragic and so very sad......You never know, do you!!!

Thanks for echoing your concerns. I never heard that "If there was a problem, the Protime would shut down." as you said....maybe I missed that in the operator's manual or maybe it's just for other types of problems. I'm glad you will be checking your monitor against the cardio's lab. I'm not sure I'll ever trust any machine completely again!!

I hope everything works out, and I'll definitely keep you posted. Thanks for caring.

Evelyn

 

[Guest]

Please accept my condolences.

 

[sylviayasgur]

hi evelyn!
sorry to hear about your friend..
i'm also sorry to hear that you and tyce had to go through this... must have been scary!
my dad lurks from time to time and i've emailed him some posts. i've been trying to get him to get a coagucheck or protime so that he can take them with him when he travels and goes to fla. for weeks at a time.
he has been so hesitant precisely because he is worried that this sort of thing will happen.
he prefers getting his blood drawn regularly_ can you imagine??
i'm glad things are starting to get under control. hope this new machine works well.
all the best, sylvia

 

[Blanche]

Evelyn:
I'm sorry for the saddness in your life with the passing of your neighbor.

In my last post, I wrote " If there is a problem, the ProTime will shut down." Thank you for questioning this. The statement is WRONG. What I should have said is, "If there is a problem, the ProTime will not complete the test and an error message will appear on the screen." I apologize for any confusion that I might have caused. The ProTime does not shut down, it sends an error message. I understand this to mean that if there is a problem of any kind, you won't get test results of INR and PT. Hope this
helps.

Blanche

 

[EVELYN]

Hi All
Many thanks for your condolences on my neighbor's passing. Between funerals, work, dr.s appointments and vets, it has been a busy, busy week.

I thought I'd fill you all in on the continuing mystery of our Protime/Coaguchek difference last week. It's still a mystery, and any advice will be welcome as to why our machine performed as it did.

As you may have read, we tested on our Protime last Friday and Tyce was a 2.9. However, the cardio's coaguchecks read 5.0 and 5.0 and the hospital lab was 4.9. I called ITC and they promptly sent me a second Protime unit and additional cuvettes to test with. They said to test with both our cuvettes and theirs on Wednesday and the same with ours/theirs on Friday and compare it with the Dr's coagucheks....Here are our results:

Wed: Our Protime and our cuvettes 2.0 26.1
Our Protime and ITC's new cuvettes 1.7 22.2


ITC's Protime and our cuvettes1.7 22.2
ITC's Protime and their cuvettes1.8 23.5

On Friday we repeated the tests and then went to the Cardio's lab where she checked Tyce's blood on the Coaguchek and Coaguchek S....The results:

Friday:Our Protime, our cuvettes 2.0 26.1
Our Protime, ITC's cuvettes 1.5 19.6

ITC's Protime, our cuvettes: 2.2 28.7
ITC's Protime, ITC's cuvettes: 1.7 22.2

Cardio's Coaguchek 2.3
Cardio's Coaguchek S 2.4

Now I know the Coaguchek can be up to .6 higher than the Protime machine and it's still in the normal range, but these results would indicate to me that our machine and ITC's machine are quite comparable, as is the Coaguchek..........So why the huge difference last week?

I'd really be very grateful for any advice you guys out there is cyberspace can give, especially you, Mr. Al.

At our visit, last week, the Dr. told Tyce to withhold warfarin for 2 days....of course we did not,just halved it one day to 2.5 and then went on as normal.....notice how Tyce's level went from 2.9 or 5.0 (whichever machine you believe) to 1.7 or 8......Of course I told them that we refused to withhold for 2 days last week....don't think they were happy, but can you imagine what the results would have been if we had!!!!

Anyway, Monday morning I will chat with QAS and ITC and see where we go from here.......

The mystery continues.

Evelyn






As you all may have

 

[JimChicago]

Thanks for the update Evelyn.

I guess one thing is that all the macines are lower now after you cut back the 2.5 mg one day. With 5 per day or 35 per week cutting back 2.5 in one week is apparently 7% less. I'm new to this but from what I've seen so far I would be surprised it went from 5.0 down to around 2 by just a 7% reduction. Did Tyce eat more salads too? Good thing you didn't hold for those 2 days.

It was also interesting the new ITC cuvettes were almost always lower INR scores than your cuvettes. I wonder if fresher ones tend to give lower scores?

One thing I would wonder is what effect all those finger sticks would have on an INR score? If they took longer to get enough blood out of one finger stick to do two tests could that extra time mean that the INR would be lower? For a while the place I was going to was using 2 Coagucheks and taking the blood for both in one capillary tube but it took extra time to get the blood out of my finger.

 

[EVELYN]

Hi Jim

Nope, we did multiple finger sticks.....wanted to get it right on each time......poor Tyce looks like an addict....he says he's got tracks on each of his fingertips!!! Tyce didn't eat or drink anything different from the norm. What I did find interesting is that the cuvettes that ITC sent us were the ones that required about 6 drops of blood, rather than our 3 channel.....which requires about 3 drops....wonder if that could make it lower? Actually, while I'm writing this I'm sitting here reading notes I made from a conversation with Dr. Zucker from ITC, and my notes do say that 5 channel can test lower than 3 channel.

I guess my big problem is that I don't understand the huge difference between the original 2.9 and 5.0......it still puzzles me! Was it a malfunction in our machine? If so, why did it happen for a second time and what can be done about it!!! I guess I'll find out on Monday when I contact QAS and ITC.

Evelyn

 

[Guest]

I don't know what caused the difference.

I can't figure out what difference the cuvettes make. It should make no difference whether you stick yourself with a needle, cuvette or even a bullet, the blood is all the same.

We have repeatedly taken blood from the same stick when we missed the target or wanted to test different machines and it has made no difference. Sometimes the third drop of blood will give the highest INR.

The main thing is that nothing happened to Tyce. This is the biggest factor in self testing. You are able to make small adjustments and check in another week. This prevents bad events from happening. It is not just waht your INR is but how long you have been at that number that figures into bad things happening. Put in this perspective, there is not much difference between a 2.9 and a 5.0.

 

[JimChicago]

Evelyn - I am curious what you plan to do now with the 2.2 to 1.7 results from Friday. Are you going to go back to your prior dosage to get the INR between 2.5 and 3.5? Sometimes I get the feeling coumadin regulation is like playing Roulette.

 

[Guest]

It is like playing Roulette but the rewards and punishments come more slowly.

 

[catwoman]

< Now I know the Coaguchek can be up to .6 higher than the Protime machine and it's still in the normal range ... >

Can someone please explain why CoaguChek can be up to 0.6 higher?? Is this because of the difference in the ISI??

 

[Guest]

I haven't any idea either. When ITC gave me a ProTime to test, I checked about 15 to 20 people with both. Neither one was consistently high or low. As I recall, they were always within about 0.3 units of each other.

 

[EVELYN]

Hi All

Well, we're presently in a "wait and hold" mode. ITC has no idea why our machine did what it did. Our service tech there said to test the machines and cuvettes for two more weeks, and then check again against the cardio's coaguchek. She has been wonderful, so I guess we will and will see what happens. Of course this is the second go round for this bizarre behavior....so.........who knows!!

Jim--our cardio put Tyce back on a bit different dosage. He had been on 5mg. 6 daysweekly, 7.5 once weekly.....he is now on 5 mg. 5 days weekly, 2.5 twice weekly.....we'll see what happens from here. Anyway, we'll retest Wednesday and I'll let you know if he's come up a bit....sure hope so!

Catwoman, I can't explain why the difference, but when I spoke with Dr. Zucker of ITC, she said that up to .6 was perfectly within the normal range variation between the two.

I must say that ITC has been wonderful with this situation. Lakeesha, our service tech, and I have become great comrades...I just hope we're able to solve the problem or replace/repair the machine.

Evelyn

 

[Granbonny]

Ev

Ev

I am and have been for last 17 months on same dosage.. 5 mg. 6 days a week ..2 1/2 on Sunday's.I stopped my Sat. and Sun. dosage last weekend to have my dental work at 10 a.m. Monday morning..Tested that afternoon at 1.6..Called my clinical nurse and she said for me to start back on regular dosage. Took one Monday night (Had been on mornings)..and tested today at 2.5...Took a week to climb surely but slowly.. Will test again next Monday.. Don't think my trip to Alabama tomorrow for Thanksgiving should do anything to change it. I asked my clinical nurse last Monday if I should tweek it and she said no.. She didn't want it to go too high... I don't want to start the rollar-coaster ride..so happy with what she said to do. Thankfully, my teeth should be in good shape now.. Bonnie