I am exhausted of the run around. I call cardio's nurse and they say they will only send paperwork to their service which is a rental. I asked about testing more than once a week and they said I can't, which I am sure is BS if I buy my own test strips. I am searching for a new cardiologist that really will work with me instead of just telling me what they want without listening. As it is the cardio seems pissy that I got a mechanical valve and went to Cleveland, constantly asking if I i was sure I understood what I got and what was involved. He did not seem to understand why I went mechanical. Then when I asked questions about my meds he was like I don’t want to change anything Cleveland did it was their surgery! I'm like dude I am your patient now. Damn god complex egomaniacs here in Atlanta.
Anybody using Coag Sense for INR testing?
- Thread starter vivekd
- Start date
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If I remember correctly, you just had your valve replaced. I had to wait 6 weeks after hospital release before my insurance company would let me home test. This was policy. Maybe you need to talk to your insurance company.
My cardio has nothing to do with my INR test provider, other than to write the prescription when requested by the provider. My insurance company, provider and cardio worked together w/o my intervention to get me my first meter and supplies. My provider was chosen by my insurance company...this is "normal" so it's not too surprising the cardio and nurse are not savvy about where to get your meter and strips. Mine isn't. This is different from other medical devices which are often supplied by the doctor or they give you a choice concerning which company to use based upon their relationship and your insurance.
Actually, you don't need to test once a week. The clinical standard is every 2-weeks unless your INR is unstable. This is the maximum test rate allowed by insurance unless there is a medical need and additional insurance approval. My cardio nurse and my provider told me this. My provider gives enough strips for that scenario. If you get 12 strips, they won't reship for 24 weeks. If I have problems and have to test weekly, they send me extra strips for free, but won't do a full refill until the time period is up.
The cardio is probably not "pissy" over your hospital choice, they didn't lose any money on that deal. However, lots of questions w/o office visits means you are costing them more money plus you challenge the "system". Doctors are just as serious about maximizing their revenue stream as Disney. In general, doctors like compliant patients.
Because Medicare now allows for a $30 charge for all INR consultations, if you report your results to the cardio, they can charge you. The other insurers follow Medicare's lead. This just happened within the last year or two. So be nice to your cardio, you might not want a $30 charge every time you call in your INR, but your cardio can drop you as a patient if you don't comply to their INR reporting requirements. My cardio allows me to only call in when out of range, but his practice's coumadin clinic nurses do not like it at all. They want me to call in at least every 4 weeks. That's an extra $360/year for the cardio practice.
My insurance says they don't care where I go which is good. They are also a bit confused as to what is covered, I need to call them back and speak to another person. The one thing they did say was no waiting period to get a machine and the caridio's nurse ordered a service for me for now this way I don;t have to keep hauling to the office.
The carido is maybe not pissy, but was not interested in answering my questions, he was did not want to step on what Cleveland had done even though I am his patient now. I had legit concerns about low BP (99/60) that he blew off and said see you in a year. He is a good carido, but bedside manner needs work. I am looking for a carido and nurse combo that will be more collaborative
I know I am a bit of a pain, but it is my life and health, I have a more vested interested in it than they do. Even the coumadin clinic nurse was giving em a hard time and wanted cut back my dose when I told her my Vit. K intake the next 3 days would be high and to look at last week, I was 3.5 on Monday and 2.3 on Thursday. I told her we need to lower my dose as we enter the weekend when my Vit. K is low and ramp it back up for Monday. She finally started to understand what I was saying. They look at the reading and react, no conversation about what my diet looks like or what I forecast it to look like.
She also gave me contradictory info saying the dose change has impact the same day when everything I have read says coumadin dose changes take 24-72 hours to have impact to your INR.
They also only test Mon, Wed and Fri which makes it rough because it looks like my INR peaks on Monday then bottoms on Thursday, so I want to self test to get the dose to level that out more.
I am not the typical patient and over the years have worked to find doctors that appreciate and work with a patient vs. just look at results and spew out orders.
I admit I am new to all this, but just want providers that give a damn vs. going through the motions of their habits.
The carido is maybe not pissy, but was not interested in answering my questions, he was did not want to step on what Cleveland had done even though I am his patient now. I had legit concerns about low BP (99/60) that he blew off and said see you in a year. He is a good carido, but bedside manner needs work. I am looking for a carido and nurse combo that will be more collaborative
I know I am a bit of a pain, but it is my life and health, I have a more vested interested in it than they do. Even the coumadin clinic nurse was giving em a hard time and wanted cut back my dose when I told her my Vit. K intake the next 3 days would be high and to look at last week, I was 3.5 on Monday and 2.3 on Thursday. I told her we need to lower my dose as we enter the weekend when my Vit. K is low and ramp it back up for Monday. She finally started to understand what I was saying. They look at the reading and react, no conversation about what my diet looks like or what I forecast it to look like.
She also gave me contradictory info saying the dose change has impact the same day when everything I have read says coumadin dose changes take 24-72 hours to have impact to your INR.
They also only test Mon, Wed and Fri which makes it rough because it looks like my INR peaks on Monday then bottoms on Thursday, so I want to self test to get the dose to level that out more.
I am not the typical patient and over the years have worked to find doctors that appreciate and work with a patient vs. just look at results and spew out orders.
I admit I am new to all this, but just want providers that give a damn vs. going through the motions of their habits.
Asystole
Member
- Joined
- May 16, 2019
- Messages
- 11
I've used the Roche CoaguChek XS for a couple of years now and I've been pleased with it's performance. I enter my INR reading on the app on my phone and it's forwarded to my cardiologist and I order new strips and lancets through the app.
I'm fortunate that I have very good insurance and it's all covered.
I'm fortunate that I have very good insurance and it's all covered.
I've been using Coag-Sense for years. It may take a few tries to get a good drop collected and deposited.
A few months ago, they came out with a new transfer 'tube.' This is a small tube with a glass tip. It uses an even smaller plunger to push the blood onto the strip.
After lancing your finger, put the tip of the tube horizontally against the blood droplet. Capillary action will draw in enough blood (if you were able to get a good droplet from your finger) into the tube - just the right amount. Touch the tip of the tube to the strip, and slowly press the plunger.
After doing this once or twice, you'll probably never have the air bubble problem again.
I haven't.
I've been using the Coag-Sense for a few years. A few years ago, I did some personal testing of multiple meters - CoaguChek S (before it was discontinued), CoaguChek XS, InRatio 1 and 2 (before they were discontinued), ProTime classic and ProTime 3. I compared the results to each other, and to blood draws taken at a hospital or at the UCLA clinic.
In some cases, the CoaguChek XS was a fair amount higher than the lab results, and was usually slightly higher than lab results. The Coag-Sense was either exactly the same as the lab (which can be somewhat surprising) or slightly lower than the lab.
In most cases, CoaguChek XS and Coag-Sense were well within a safe margin of error compared the lab. In some cases, the prothrombin times reported by the lab and by the Coag-Sense were either identical or tenths of a second apart.
Testing with Coag-Sense, compared to CoaguChek XS doesn't involve much more than the CoaguChek. I agree, it's easier to touch the side of your finger with a drop of blood against the CoaguChek strip.
The Coag-Sense requires touching a transfer tube to the drop of blood on your incised finger, then putting the transfer tube onto the test strip and pressing a plunger. It's not that big a deal, once you've done it once or twice.
As far as I'm concerned -- and I've said this on other forums - I prefer to have a meter that gives me a slightly lower result than the lab result (if it doesn't match the lab result). Here's the reason - if your INR is below 2.0 or so, you're at risk of stroke if you have certain valves. If a meter gives you a reading of 2.1, and you're comfortable that it's equal to or lower than the lab result, you can be pretty confident that your INR is 2.1 or higher.
OTOH, if a meter that is frequently higher than the lab result tells you your INR is 2.1 - you have to wonder if a lab test will show your INR to be lower - possibly below 2.0.
One other thing: I now have the new model of the Coag-Sense (the PT2). It's nice looking, has many bells and whistles that the CoaguChek XS lacks, stores 2000 results, is rechargeable, and is almost fun to use.
Saying that a test every two weeks is safe isn't completely accurate. If your INR is below 2.0, you can develop a clot and have a stroke or TIA in one week. This has been fairly well documented. True, it may be uncommon for a person's INR to plunge - but changing diet (adding a lot of greens to a diet that rarely includes them), using medications that may accelerate clotting, or other factors CAN drop the INR.
Weekly testing can help to detect such drops. The Coag-Sense site also makes this recommendation.
As far as reporting to doctors (whose people probably don't know much about anticoagulation or anticoagulation management) is concerned, true, this is a boost to a practice's revenue. Unless your insurance requires this reporting, you may consider self-management. A lot on this forum manage their anticoagulation. (I do).
I used to have to go to an anticoagulation clinic for testing. They were comfortable with monthly testing. I continued to test and manage my dosing weekly, and used this monthly service primarily to validate the accuracy of my meter by comparing their lab or Protime meter's results to my own.
Many on this forum can help you determine the proper dosing to keep your INR in range. Although I can probably have Medicare supply me with another meter and strips, I've been happy with my Coag-Sense and get the strips and meter on my own.
Well I found a new cardio and chatted with her nurse and it looks promising. I explained I want collaboration on my treatment specifically INR and she said they are more than happy to work with me, I see the cardio in a few weeks and hope she will work with me wanting to test twice a week for a while until I can nail the fluctuations my weekday vs. weekend diet impose.
I may just get a machine on eBay as the insurance will only cover weekly testing at the 90 mark and then it runs about $117 a month which seems high compared to owning. Since I maxed my out of pocket this year I may take the service since it should wind up being free for this year.
I may just get a machine on eBay as the insurance will only cover weekly testing at the 90 mark and then it runs about $117 a month which seems high compared to owning. Since I maxed my out of pocket this year I may take the service since it should wind up being free for this year.
vivekd
Well-known member
i bought it on ebay few months ago.
Yeah, I have found what looks like a reputable seller on eBay that has new in the box unit with test strips that I will likely pull the trigger on this week. The issue short term is until I switch cardiologist in 3 weeks my current one and th Coumadin clinic have not been playing nice with me.
Sure Coag-Sense wants you to test weekly, but then they sell the strips
Monthly testing was the standard, now insurance will pay for biweekly testing...guess that's the standard set by lawyers so it should be "conservative"
The therapeutic goal as I understand it is to maintain an equilibrium that's in range, not to go up and down with weekly changes in dose. I "dose the diet and don't diet the dose." Comadin clinic nurses don't like that expression
Weekly testing isn't about selling more strips. I'm pretty sure that Roche also encourages - if not recommends - weekly dosing.
A few years ago I wrote about a study by a clinic at Duke University that indicated that it only takes a week - or a few days more than a week - for a person whose INR is too low for a clot to develop. I'm sure that other studies will confirm this.
If your INR is below range, it would be good to know -- weekly -- what your INR is, so that you can avoid this awful outcome.
No, it's not mandatory to test weekly. Years ago, when I didn't know much about anticoagulation and was stupid, I went for years without an INR test. I couldn't afford doctors, I couldn't afford blood draws, and I convinced myself that I was able to 'feel' when my INR was too low. I was lucky that the dose I was taking managed to keep my INR in range for all that time.
Ironically, I had a TIA when I WAS self testing. I use an InRatio meter, trusted my life to it, and found out that the 2.6 reported by that meter was actually a 1.7 when the hospital tested me after I had a stroke.
No longer did I want to trust a meter without verifying its accuracy. I did a series of tests of many meters (mentioned many times on this forum), and found the ones that I trust, and the one that I believe is the most accurate, in terms of comparisons to trusted blood draws. (I've had a test done at a clinic that I KNOW mismanaged my blood before it was picked up by a lab.)
I usually test weekly - although I have much confidence that my INR will be in range. If I change medications or diet, I may test more frequently. I'd rather know that my INR is in range - every week - than go two or more weeks out of range and not know it.
A few years ago I wrote about a study by a clinic at Duke University that indicated that it only takes a week - or a few days more than a week - for a person whose INR is too low for a clot to develop. I'm sure that other studies will confirm this.
If your INR is below range, it would be good to know -- weekly -- what your INR is, so that you can avoid this awful outcome.
No, it's not mandatory to test weekly. Years ago, when I didn't know much about anticoagulation and was stupid, I went for years without an INR test. I couldn't afford doctors, I couldn't afford blood draws, and I convinced myself that I was able to 'feel' when my INR was too low. I was lucky that the dose I was taking managed to keep my INR in range for all that time.
Ironically, I had a TIA when I WAS self testing. I use an InRatio meter, trusted my life to it, and found out that the 2.6 reported by that meter was actually a 1.7 when the hospital tested me after I had a stroke.
No longer did I want to trust a meter without verifying its accuracy. I did a series of tests of many meters (mentioned many times on this forum), and found the ones that I trust, and the one that I believe is the most accurate, in terms of comparisons to trusted blood draws. (I've had a test done at a clinic that I KNOW mismanaged my blood before it was picked up by a lab.)
I usually test weekly - although I have much confidence that my INR will be in range. If I change medications or diet, I may test more frequently. I'd rather know that my INR is in range - every week - than go two or more weeks out of range and not know it.
I bought one on EBay years ago. I no longer use it.
Keith:
$117 a month IS high, compared to self-testing. Once you own the tester (and I recommend Coag-Sense), the strips are around $5 each. Weekly testing should cost about $20 - and if you test less frequently, it'll cost even less.
If you're able to self manage, and if your insurance carrier allows you to do so, the cost will be lower. Your cardiologist or clinic may accept results that you call in.
In addition to strips, you'll need a lancing device. I started with lancets, but find that lancing devices designed for anticoagulation testing (at about a quarter or so each) are easier to use and do a better job. You can also dispose of them more safely than tossing away a used lancet. (I have hundreds, if anyone wants them).
To my mind, if you're able to self test and, preferably, self manage, you're way ahead of the game.
One more thing: Until I got my new Coag-Sense meter, the meters that I've used before - Protime Classic, Protime 3, InRatio, CoaguChek S, CoaguChek XS, were all bought used on eBay.
The price for each of them was pretty low (some as low as $30 or so, and one was a gift). I had (and still hold) a theory about why these expensive meters are priced so low. A few factors:
Some meters were provided by Medicare to people who died. Their heirs didn't think of returning them to Medicare (or wherever) and sold these things that they had no need for, on eBay. They were of no value to the heirs and often sold at very low prices.
Some meters were used by doctor's offices or clinics, and were replaced with newer models. In some cases, this 'capital equipment' had fully depreciated, and was of no value as a taxable asset. In one case, a vendor traded some equipment to a hospital in exchange for the 'retired' meters; in another case, a medical practice had closed, and the meters were sold for whatever the buyer wanted to pay.
The point is - you don't necessarily have to get a new meter. The 'used' meter may show only a handful of tests in its memory. Coag-Sense has calibration codes on the box of strips, and on the strip. CoaguChek XS uses a chip that sets the strips to a reagent value.
You probably won't have to worry about 'calibrating' a used meter.
SO - if you don't want to buy a new meter and strips, you may consider buying used, if you get some kind of return guarantee, or your seller has adequate positive feedback.
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I don't usually like to agree with the coagulation clinic. In this case, the person may have been partially right.
In my experience, although the half life for warfarin IS a few days, and the dose you take today won't have any effect for a couple days, it's different with Vitamin K. For me, eating a lot of greens or other sources of Vitamin K WILL drop my INR pretty rapidly.
If you're taking Vitamin K, your INR may change later in the day, or on the next day.
You shouldn't be at any risk of forming or throwing a clot in a day or two, but should test to determine the effects of K. (If you have your own meter, you could check any day and not have to wait until it's convenient for the clinic to test you).
I've read that Vitamin K2 doesn't effect INR. I will be brave one of these days and check this out.
One of the things about anticoagulation is consistency - if you consistently take the same amount of Vitamin K, you can adjust your warfarin dosage to accommodate to it. The same thing goes for diet.
Changes in medications (even over the counter stuff), diet, and in some cases, activity can result in changes in INR. It's good to be able to monitor for changes. (Again, this is another reason for self-testing).
pellicle
Professional Dingbat, Guru and Merkintologist
well gosh ... wow ... so has mine ... so?
as to dirty, wouldn't that appear in the eBay description?
also you have a "not as described option
oh ... sounds a different tune to:
https://www.valvereplacement.org/th...-need-help-deciding.887097/page-2#post-888310
"...making America Grate again ..."
First I want to thank everyone here and this forum in general. I have been INR testing twice a week to dial in my INR. I am switching cardiologists because mine is just not collaborating and seems not happy I chose a mechanical valve. I spoke to the new cardiologist's nurse who ironically is the nurse I see at the Coumadin occasionally at clinic for my testing. We chatted and she says I will like my new cardiologist and both of them will work with me on my INR.
My INR today (Friday) was 3.1 and Monday was 3.7 so it looks like 7.5 is a tad high for me and we are tuning it in. My goal is to land between 2.0 and 2.5 and stay there permanently even though at 90 day they say with the On-X I can go to 1.5-2.0. Just not worth the possible risk for me.
As for machine I think I will buy one in next few days out of pocket as over the long haul the money is minor, but will be cheaper than the service. I know I can buy used, but I don’t buy used anything, just my nature. I like the thought of the Coag-sense, but the extra step of the tube looks to be a pain in the ***. So I will likely do the CoaguCheck XS.
My INR today (Friday) was 3.1 and Monday was 3.7 so it looks like 7.5 is a tad high for me and we are tuning it in. My goal is to land between 2.0 and 2.5 and stay there permanently even though at 90 day they say with the On-X I can go to 1.5-2.0. Just not worth the possible risk for me.
As for machine I think I will buy one in next few days out of pocket as over the long haul the money is minor, but will be cheaper than the service. I know I can buy used, but I don’t buy used anything, just my nature. I like the thought of the Coag-sense, but the extra step of the tube looks to be a pain in the ***. So I will likely do the CoaguCheck XS.
Was doing some more reading and found this article that basically says Coag Sense and CoaguCheck XS are very accurate at INRs below 3 and above 3 the delta grows rapidly.
https://www.ncbi.nlm.nih.gov/pubmed/28379875
https://www.ncbi.nlm.nih.gov/pubmed/28379875
Noyolk
Active member
No matter your reasons for new, used, etc, get your meter and batch of strips tested against a known standard. I have a meter purchased new through my insurance and I buy 48 test strips in a batch from ebay. When a new package of test strips arrives, I have a lab draw done and before I leave the office I test with my meter. The lab results and meter have never exceeded a .1 differential. However the coumadin clinic meter and mine were often very different with .7 being the greatest. Love the Coagucheck XS.
That was my plan to periodically compare to a lab draw. I like that the CoagSense has individually wrapped strips.
