A stupid question

[Jackie]

Can anyone tell me why the anticoagulation Pharmacist would change the days I take a certain dose. I have been taking 5mg on Sun, Tues, Thurs, and Sat. 4mg on Mon, Wed, and Friday. She now told me to take 4mg Mon, Thurs and Sat. I don't understand why this change was made, the only answer was from her mouth piece, " I don't know I am not a Pharmacist" It really doesn't matter, the only thing I could think of is that she wants to see if I follow her instructions, although I could tell her anything and she wouldn't know.

 

[Nancy]

Why not ask her?

 

[tobagotwo]

Why not take over this chore yourself? "Survey says" patients who manage their own Coumadin dosages do much better on average. This is at least in part due to the fact that not all Coumadin Clinicians are educated to the same level.

If that's not your cup of tea, then I would certainly ask her about her flights of whimsy, and point out you would much rather be on a schedule that has some rhyme and reason to the days.

The only logic I could imagine to it was that she may believe that you eat a lot of greens during the week, and not so many on the weekend. Considering the delay between dose and INR change, it seems like weekdays would be slightly more weighted with blood levels of Coumadin. Still, it shouldn't be much of a difference. Is she a perfectionist, perhaps wrapped just a little too tight? Or bit of a control freak?

Best wishes,

 

[Ross]

It makes no logical sense. It's going to yield the same INR regardless. Did this person graduate high school?

 

[dick0236]

I agree with the others. What difference would such a minor swith make ? I also agree with Nancy, why not ask her/him for the reasoning.

 

[ALCapshaw2]

That change makes NO SENSE to me so I would definitely as her directly for an explanation. Instructions relayed through a clueless intermediary are an invitation to ERROR.

Personally, I like the symmetry of your original dosing schedule which is easy to remember and follow, especially with a 7 day pill box.

 

[Jackie]

Thanks for all your responses. This is the same pharmacist that is trying to kick me of the anticoagulation clinic, because I have an INRatio and she thinks it is not accurate, and I question her about any changes.She does not speak to me now, since I filed a grievance against her. It just didn't make any since to me so I thought I would ask the experts.

If I wasn't on Medicare i would just take it upon myself to test and dose. Medicare requires that you test every week and call in to someone in charge, Doc, anticoagulation clinic, etc. At Kaiser the anticoagulation clinic handles it, not good mind you, but handles it.

tobagotwo: I think it could be a combination of all three.

Ross: I am not sure, do you think Kaiser would hire a Pharmacist who just graduated form High School? Maybe Sooooooo...................

 

[Duff Man]

Did this person graduate high school?

hehehe

I would've asked to speak with the Pharmacist in charge. I don't know if I've ever seen a pharmacy without a Pharmacist on duty.... they definitely owe you an explanation, instead of a pithy remark.

 

[Ross]

Thanks for all your responses. This is the same pharmacist that is trying to kick me of the anticoagulation clinic, because I have an INRatio and she thinks it is not accurate, and I question her about any changes.She does not speak to me now, since I filed a grievance against her. It just didn't make any since to me so I thought I would ask the experts.

If I wasn't on Medicare i would just take it upon myself to test and dose. Medicare requires that you test every week and call in to someone in charge, Doc, anticoagulation clinic, etc. At Kaiser the anticoagulation clinic handles it, not good mind you, but handles it.

tobagotwo: I think it could be a combination of all three.

Ross: I am not sure, do you think Kaiser would hire a Pharmacist who just graduated form High School? Maybe Sooooooo...................

So become Coumadin educated, prove to your Cardiologist that you are more then worthy to self dose and self test, then see if he'll be your call in contact.

 

[Nancy]

They always say the best defense is a good offense. This gal is putting out all kinds of signals that she is acting defensively.

I think she is threatened by the fact that you have an INR machine, and might learn more about it than she does, and that others will hear from you about the machine and want to also monitor their own INR, thus reducing her clientele.

I think she is dangerous, and trying to deliberately cause problems for you.

Does she have a superior? I think you should sit down with that person and bypass her entirely. And I also agree with Ross. Set things up with your card.

Something is absolutely not right here, and it isn't you, it's her.

Just my 2 cents.

 

[Jackie]

So become Coumadin educated, prove to your Cardiologist that you are more then worthy to self dose and self test, then see if he'll be your call in contact.

I feel that I am Coumadin educated (learned everything here) I think that is the problem. She doesn't want anyone to know more than she does. My Cardiologist would not write script for Home Testing because he said the monitors are not accurate and are dangerous. Do you get the feeling Kaiser is not in favor of Home Testing? They might have to look outside the box.

 

[Jackie]

They always say the best defense is a good offense. This gal is putting out all kinds of signals that she is acting defensively.

I think she is threatened by the fact that you have an INR machine, and might learn more about it than she does, and that others will hear from you about the machine and want to also monitor their own INR, thus reducing her clientele.

I think she is dangerous, and trying to deliberately cause problems for you.

Does she have a superior? I think you should sit down with that person and bypass her entirely. And I also agree with Ross. Set things up with your card.

Something is absolutely not right here, and it isn't you, it's her.

Just my 2 cents.

Nancy, I am trying to find out who her superior is, I have been talking to the grievance dept, and have written a letter and sent a copy to four different people in hopes to get more information. Thank you for you input.

 

[Duff Man]

Arrogance is dangerous in the field of medicine.

 

[Jackie]

hehehe

I would've asked to speak with the Pharmacist in charge. I don't know if I've ever seen a pharmacy without a Pharmacist on duty.... they definitely owe you an explanation, instead of a pithy remark.

The problem is that the Pharmacist in charge happens to be the same person.

 

[dtread]

I have Kaiser also. After being told that Kaiser would not fund any part of a tester, I ended up purchasing one on eBay, at a price that probably would have been comparable to what I would have had to pay even if Kaiser had bought one, since I believe Kaiser would have only paid for part of it.

At any rate, since I got my own tester I completely divorced myself from the Kaiser Coumadin Clinic. I am supposed to go in for a draw four times a year, but I haven't even been doing that. That would be to compare the readings on the home tester to the lab tester.

I'm wondering if I'm supposedly going to have to start calling in my INR readings every week after I become eligible for Medicare in a few more years? That would really suck. Since its my own tester and not funded by Medicare I would guess not. Not sure why you would have to call in readings every week anyway; I think that is too frequent. Before I got my tester (when I was still using the Coumadin Clinic), I was going in for blood draw every two weeks. And I think that could have been extended to an even longer period (3 weeks, or possibly even 4 weeks). I would ask them about extending your reporting, particularly if you've established a stable INR.

 

[Jackie]

I have Kaiser also. After being told that Kaiser would not fund any part of a tester, I ended up purchasing one on eBay, at a price that probably would have been comparable to what I would have had to pay even if Kaiser had bought one, since I believe Kaiser would have only paid for part of it.

At any rate, since I got my own tester I completely divorced myself from the Kaiser Coumadin Clinic. I am supposed to go in for a draw four times a year, but I haven't even been doing that. That would be to compare the readings on the home tester to the lab tester.

I'm wondering if I'm supposedly going to have to start calling in my INR readings every week after I become eligible for Medicare in a few more years? That would really suck. Since its my own tester and not funded by Medicare I would guess not. Not sure why you would have to call in readings every week anyway; I think that is too frequent. Before I got my tester (when I was still using the Coumadin Clinic), I was going in for blood draw every two weeks. And I think that could have been extended to an even longer period (3 weeks, or possibly even 4 weeks). I would ask them about extending your reporting, particularly if you've established a stable INR.

Dan, I was able to get my unit through Medicare, my Medicare is turned over to Kaiser, it took awhile but I won on an appeal. Medicare will approve Home Testing if you test every week, and call your results into a PPM service, which, in turn faxes the Anticoagulation Clinic. You also must have a mechanical valve for Medicare to cover the cost. Unfortunately, I can not afford the cost on my own.

If you paid for you unit and testing supplies than I don't think you will have to go thought the anticoagulation clinic. Does your Primary, write script to you coumadin?

 

[azpam]

I would ask her politely to write her instructions down so you won't forget it. Act nice like you appreciate her advice. Then you have it in writing on how stupid she is if it ever went to court,an advise board,etc.on her changing the days, (same dose) and she is just trying to screw with you!

 

[dtread]

My Cardiologist writes my prescription for Warfarin. I only see him once a year.

But I could probably get either my Cardiologist or my Primary to write the prescription for the Warfarin. The last time my Cardiologist wrote it he wrote it for three refills of 90 tablets each, so with the original it was good for a year.

If I need any refills or whatever I just send one of them an email on Kaiser's online system.

Works pretty good; minimal disruption to me. I don't miss the Coumadin Clinic; that's for sure!

 

[zipper2]

Jackie,this isnot a stupid question,this is good
When i went to a certified pharmacy here to
get my anticoagulant machine to self test
He's suppose to be a pharmasist??????
He didn't have any machines for sale,cus Roche
pulled him off cus,he was so full of defence regarding
he knew better than some machine that isnot accurate
told me he had some but wouldn't sell to me cus they
were old stock and told me the only way to do anticoagulation
was through instruction of him or my doc,Heavens he wasn't even
my pharmasist and later i found out he was fired.
Listen to nancy and azpam if you continue instruction from
this person Get it in writing for back-up....never know
what they are up too,can't be too careful in this day and age
I mean even what we think are good doc's are on the news
for trafficking narcotics illegally at least on news here and in
the paper here. I think your lady's up to no good giving you
improper direction.

zipper2 (DEB)

 

[Blanche]

Dtdread:
My husband and I are both on Coumadin and we are both on Medicare. We purchased our own monitor (it's the second one we bought) and we pay for our own strips. We also monitor our own doses. Both the cardiologist and the internist have no problems with this. Hubby has been on Coumadin since his valve was replaced in 1990 and I got a-fib in 2005.

If you are willing to pay for your own monitor and supplies, and you have a doctor to prescribe your anticogaluation meds, you can do whatever you like. No one can make you do anything just because you are on Medicare...that is, unless you want them to pay.

Blanche