A stupid question

[dtread]

Blanche, thanks for the info. I still have over five years to go before I go on Medicare. At any rate I own the tester, and I can afford to buy my own lancets and strips as needed. So it looks like no need to report to anybody, even after I go on Medicare. Great!

By the time I'm eligible for Medicare perhaps the On-X Clinical Trial will be completed and I might have the option of going on Plavix instead of Warfarin. That would mean no more need to check INR. Or perhaps some other miracle drug may come along to replace Warfarin. However, I have some reservations about going on Plavix, or some other drug. Practically all drugs have some side effects. Although I do not like taking Warfarin, and would not take it if I did not have to, for me the side effects of Warfarin seem pretty negligible, or almost non-existent. I guess the biggest drawback with Warfarin is having to monitor for INR. Other than that, I was rather pleasantly surprised as it did not make me sleepy, or have dry mouth, or a lot of the other side effects that a lot of other medications have. I know its not a vitamin, but its not the monster that some folks may envision it to be, at least not for me.

I still think that folks that have to make a decision regarding biological vs mechanical valve should go on a trial with Warfarin for a couple of weeks before the surgery to see whether they like it or not, if they have the time that would be needed to conduct such an experiment. It might help them make their decision. They would need to stop taking the Warfarin at least a week, preferably longer, before the surgery. A prescription would be required for this but that should not be that difficult to obtain.

 

[Jkm7]

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.

I've been following this thread and think maybe I don't understand your post.

Do you never go to a coumadin clinic in order to occassionally verify your tester is still accurate? Isn't it necessary to check it from time to time?

 

[dtread]

My Cardiologist was concerned about the reliability of the home testers. The Kaiser Coumadin Clinic indicated that they did not believe that they were reliable. I finally got my Primary Physician to sign the Prescription for the tester, but I bought it on my own (from eBay) rather than go to battle with Kaiser. Although I know for fact that Kaiser has bought testers for at least one member in California, perhaps more, but not without a lot of hassle. I got this information from Archived posts on VR.com

My Cardiologist was also concerned about the calibration of the tester.

I called Hemosense and talked to Technical Support. I also went onto Hemosense website at www.hemosense.com. Basically the INRatio tester performs two quality control checks on the Test Strips each time a test is run, and if the Test Strips fail QC then the machine will not run the test. So, the "calibration" is more in the Test Strips than in the tester itself. Hemosense advised periodic comparison with laboratory results as a cross check.

My Primary Physician wrote it up that I can go to the Kaiser Lab quarterly to get a blood draw and then compare with my home tester. I've been a bad boy and have not been doing that, but I am pretty confident that the home tester is accurate. Also, I know that sooner or later I'll be going in for a blood draw at the lab. There is another member on VR.com, Marty, who works for Kaiser, and he compares his but once a year. I think quarterly is overkill. My last lab test was in March (6 months ago), so I don't feel overly concerned.

I seemingly have no contact with the Kaiser Coumadin Clinic unless I choose to call them.

After a blood draw at the Kaiser Lab, I can see the results on the Kaiser online system within 24 hours and compare with the home tester.

 

[ALCapshaw2]

My AntiCoagulation Clinic uses special FingerStick instruments that have Bar Code readers to identify patients and download the test results to their computer system.

Occasionally, they get False High Readings (as do other Labs using similar or OTHER Testers) and so have adopted a protocol to require a Veinous Draw for any INR reading over 4.5 (previously 5.0). Another office I know of requires a lab draw for a finger-stick instrument INR reading above 4.0

Bottom Line: The Higher the Number, the greater the 'variation'.
It appears that many Clinics /Labs feel confident in the numbers if they are below 4.0 (or are not overly concerned about variation in the range of 2.0 to 4.0. Presumably the variation under 2.0 is small.

Mathematically, INR = (Clotting Time / Test Sample Time) to the power of (ISI) which is a number dependent on the Reagent used.

 

[Blanche]

dtread:
Although our internist was initially against home testing and testing on a monitor, after his experiences with us he decided to open him own anticoagulation facility. They call it the anticoagulation club!!!!!Imagine that

We have the very same monitor that our doctor's office has so it is easy for us to do a check on our monitor. We have the INRatio. So far the comparisons have always been within the acceptable range. You do get subtle variations between monitors.

It seems to me that you have decided to take control of your own anticoagulation testing with back up from your doctors. To us, that's a good thing. If we can be helpful to you, please let us know.

Kind regards,
Blanche

 

[dtread]

Blanche, thank you for the offer of support. I?ve already gotten a lot of support from VR.com. I did not discover VR.com until a couple of weeks before my surgery. One of the biggest helps to me in getting through the surgery was viewing Stretch L?s photo journal of his surgery (listed in the Reference section): http://www.stretchphotography.com/avr/images/

I needed to understand what was going to happen to me, and the photo journal helped a lot. I also spoke to a coworker who had bypass surgery, and he clued me in to the breathing tube. But some things I was not aware of, such as the weight gain from the IV (20 lbs in my case).

The "Anticoagulation Club" sounds good. Definitely has some potential (for what, I'm not sure).

However, we?re getting off the original topic of this thread, which is Jackie?s question of whether it makes any difference what days she alternates her dosing (5 mg 4 times per week, and 4 mg 3 times per week, which results in a 32 mg weekly dosing). The answer is no, it doesn?t make any difference.

What I recommend is thinking about switching to just 5 mg tablets. You could take 5 mg 6 times per week and a half tablet (2.5 mg) once per week. That would result in 32.5 mg per week. If that results in too high an INR, just take the half tablet twice per week (that would be 30 mg for a week). Or, go with just the 4 mg tablets and get some 1 mg tablets to fine tune it.

 

[ALCapshaw2]

Blanche, thank you for the offer of support. I’ve already gotten a lot of support from VR.com. I did not discover VR.com until a couple of weeks before my surgery. One of the biggest helps to me in getting through the surgery was viewing Stretch L’s photo journal of his surgery (listed in the Reference section): http://www.stretchphotography.com/avr/images/

I needed to understand what was going to happen to me, and the photo journal helped a lot. I also spoke to a coworker who had bypass surgery, and he clued me in to the breathing tube. But some things I was not aware of, such as the weight gain from the IV (20 lbs in my case).

The "Anticoagulation Club" sounds good. Definitely has some potential (for what, I'm not sure).

However, we’re getting off the original topic of this thread, which is Jackie’s question of whether it makes any difference what days she alternates her dosing (5 mg 4 times per week, and 4 mg 3 times per week, which results in a 32 mg weekly dosing). The answer is no, it doesn’t make any difference.

What I recommend is thinking about switching to just 5 mg tablets. You could take 5 mg 6 times per week and a half tablet (2.5 mg) once per week. That would result in 32.5 mg per week. If that results in too high an INR, just take the half tablet twice per week (that would be 30 mg for a week). Or, go with just the 4 mg tablets and get some 1 mg tablets to fine tune it.

With both 4 mg and 5 mg doses available, Jackie can vary her weekly dose from 28 mg / week to 35 mg / week in 1 mg steps, taking only ONE Tablet per day simply by varying the allocation (preferably alternating doses symmetrically to minimize day to day variations). This has the added advantage of yielding the SAME COST as using a single dose tablet since only one tablet is consumed each day.

 

[dtread]

ALCapshaw, very good point on alternating doses so that only one pill is taken per day. The added advantage of that is a more "standard" dose each day versus taking a half tab, or a tab and a half on some days. Plus the ability to better adjust dosage.

Just have to remember what day to take what dose, but you'd have to do that if you were splitting tabs anyway. I'd guess the folks that take the same dose every day are the exception rather than the rule. Also have to get whoever writes the prescription to write two prescriptions, but that should not be a big deal.

With the health plan that I have the cost of Warfarin is pretty low, but it makes no sense to spend more than you have to in any case. So I agree that alternating tabs makes a lot of sense, both economically and dosage wise.

 

[KristyW]

Just have to remember what day to take what dose, but you'd have to do that if you were splitting tabs anyway.

Dan,

This is why most of us use a weekly pill box. I know, I know...it's like we're getting old, but it really is the easiest way to make sure you're taking the correct dose each day. Plus you have the advantage of knowing if you took your meds each day.

 

[dtread]

Kristy, excellent idea to use pill dispenser. That makes it practically foolproof and you don't have to try to remember whether you already took your dose or not (and possibly double dose). There are also medication dispensers that can be purchased. These might be a good idea particularly if you have to take multiple medications. Just do a search on the Internet for "medication dispenser" and you'll get lots of hits.